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Losing focus
Blindness or low vision affects 3.3 million Americans age 40 or older, according to a 2004 study by the National Eye Institute. That number is expected to jump to 5.5 million by 2020.

“As people age, there will certainly and naturally be a loss of clarity of the lens in the middle of the eye,” Hollas said. When the lens loses claritym, it becomes hazy. “That’s a cataract.”

When the haziness begins to impact people’s lives, when they can no longer read the newspaper or books or street signs or recognize friends’ faces, the cataract can be removed and a new, acrylic or silicone fixed lens implanted, restoring sight.

Cataracts vary from person to person and are dictated by family genes, environment, and a person’s health.

“Many people who are well into their 70s have minimal cataract formation, and maybe they’re seeing pretty much 20/20. But for others, that’s not the case,” Hollas said.

“We experience so much with our vision,” he said. “Without vision, we have difficulty communicating with the outside world. We have difficulty being part of society and being independent.”

According to The Administration on Aging, 1.8 million noninstitutionalized elderly Americans report difficulty with basic activities such as bathing, dressing and walking around the house in part because of visual impairment. Visual impairment increases the risk of falls.

The eyes have it
Retinal detachments and extensive vitreous hemorrhages could require a vitrectomy – extracting the contents of the eye and refilling it with saline.

Affecting about 25 percent of people 70 and older, age-related macular degeneration is the leading cause of irreversible visual impairment in the elderly, the Centers for Disease Control and Prevention reports.

With macular degeneration, a person’s retinal nerve fibers wither and die before they should. Like cataracts, it steals vision slowly in the early stages, meaning there could be extensive damage before it’s detected.

“Once nerve damage has occurred, it has occurred. Once vision is lost, it’s gone,” Hollas said.

Macular degeneration affects a fraction of the retina called the macula. But because that fraction holds the keenest vision, macular degeneration leaves people with strong peripheral vision but a grayish blob in the central vision.

Smoking, age, high cholesterol, ultraviolet rays, and especially genetics cause it.

“There are people who are never going to get macular degeneration, no matter what they do,” Hollas said. “Other people can do all the right things and they will have fairly advanced macular degeneration because it’s in their genes.”

Fortunately, taking nutritional supplements can slow macular degeneration. Vitamins A, C, and E, as well as zinc and lutein help.
Glaucoma, irreversible damage to the optic nerve caused by increased pressure in the eye, is twice as common among older blacks as older whites, the CDC reports.

It occurs when the normal flow of the watery fluid between the cornea and the lens of the eye is blocked. It is less commonly caused by other factors, such as an injury or severe eye infection.

Medicines, lasers and surgery can slow the effects, said Dr. Brent McQueen, a Berkeley Eye Center optometrist who operates on glaucoma patients.

“The whole idea is to treat it before it becomes a problem in day-to-day life,” he said. “We can’t stop it. We just try to control it.”

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