Why is my vision worsening?

Posted on 28 February 2018

As you age, it’s natural for your vision to deteriorate. Thanks to modern medicine, there is usually a treatment option for your condition. An eye specialist at Mediclinic Pietermaritzburg explains more.

‘Every situation will be different and will depend on your medical history, what medical conditions you have (such as diabetes, hypertension or arthritis) whether you are taking certain chronic medications, your genetics and your lifestyle – like whether or not you smoke,’ says Dr Nicholas Davey, an ophthalmologist at Mediclinic Pietermaritzburg with subspecialty cornea and refractive surgery training in Europe and Canada.

‘If you have reached the age of 40 to 50 years and are struggling with your reading vision, you need to have your eyes tested at an optometrist or your glasses replaced. This could be a natural age-related process of the eye known as presbyopia. However, if it’s a sudden deterioration of vision, at any age, you need to go to your optometrist or ophthalmologist more urgently.’

Danger signs for eye problems other than a sudden change of vision or the visual field could be a red eye, painful eye and sensitivity to light.

Danger signs in children include red eyes, tearing eyes, squinting eyes and a white coloured pupil.

According to Dr Davey, the most common reasons for worsening vision or irritated eyes in adults are age-related and include:

Presbyopia: A natural process caused by a gradual thickening and loss of flexibility of the natural lens inside your eye.

Solution: See your optometrist to discuss your options for glasses and bifocals or speak to an ophthalmologist about laser surgery.

Posterior vitreous detachment (PVD): In people over 50, there is a normal process where the vitreous gel from your retina, inside your eye, starts detaching. This is called posterior vitreous detachment (PVD). In a very small percentage of people, the detachment of the gel from the retina can produce a small tear that can cause a retinal detachment.

Solution: Seeing flashing lights can be a normal part of PVD, however, if you see these flashing lights on a regular basis or persistently over a few days, or if the symptoms are very bothersome, it is advisable to see an ophthalmologist to check the retina and ensure there are no holes or tears. Other warning signs of retinal detachment include seeing dark spots showering up or down your vision or flashing lights accompanied by a ‘curtain’ crossing your visual field. If caught early enough, retinal detachment can be prevented with laser therapy.

Cataracts: A thickening and opacifying of the lens of your eye as you age which interferes with the quality and clarity of your vision. It can also be induced at a younger age by medication such as cortisol or chemotherapy as well as by smoking and diabetes.

Solution: See your ophthalmologist for possible surgical intervention and ensure you have your eyes tested regularly.

Age-related macular degeneration (AMD): While rare forms of macular degeneration can strike younger people, especially those with a genetic predisposition, this condition mostly occurs in people older than 60. The older you are, the higher the risk.

Solution: See your ophthalmologist to discuss medications that may help to ease the symptoms and preserve your vision. In some instances, you may require injections of medication into your eye.

Glaucoma: Glaucoma is an eye condition where the pressure inside the eye is too high. Over time, the sustained high pressure damages the optic nerve fibres.

Solution: Have your intraocular [eye] pressure checked by your optometrist or ophthalmologist especially if you have a family history of the disease or you are over 60. Early intervention in the form of chronic medication or microinvasive surgery is essential to prevent blindness.

Your lifestyle can also cause a number of eye conditions, especially if you smoke or live with diabetes.

Diabetes: Diabetes affects your small blood vessels so it usually affects your eyes, your kidneys, your feet and your heart. Diabetes can affect your lens (cataracts), your retina (diabetic retinopathy) and can also cause fluid build-up in your macular or retina, which affects your vision.

Solution: Diabetic eye problems are all treatable and managed better if diagnosed early. Type one diabetics should have regular eye check-ups from childhood.

Smoking: This habit is linked to a number of eye diseases because of the harmful chemicals contained in cigarettes as well as how it disrupts the blood flow to the eye.

Solution: See your GP for support to quit smoking and work with your ophthalmologist on treating the secondary conditions.

Dry Eyes: This usually results in irritated, gritty and watery eyes. Dry eyes can also affect the clarity of your vision. This can be an age-related process or due to certain conditions such as diabetes, eye allergies and auto-immune conditions.

Solution: Consult your eye specialist for an assessment and for the correct eye drops to use for your specific type of dry eye.

Uveitis: Uveitis is an inflammatory reaction within your eye resulting in a red, painful eye with blurry vision. This condition can have many causes, including eye injury, infective and inflammatory diseases. Many cases of uveitis are chronic, and they can produce numerous possible complications, including clouding of the cornea, cataracts, elevated eye pressure (IOP) or glaucoma, swelling of the retina or retinal detachment. These complications can result in permanent vision loss. Uveitis occurs most frequently in people aged 20 to 50.

Solution: Your eye specialist will treat you according to the cause of your inflammation. You might need cortisol or steroid eye drops to control the inflammation.

How often to go for eye tests

The optometrist and ophthalmologists will make a call on the frequency of testing on an individual basis based on your medical background and condition of your eyes. As a rough guideline for an otherwise healthy individual with stable vision, they recommend:

• After the age of 30: At least every five years.
• After the age of 40: Every two to three years.
• After the age of 50: Every one to two years.

‘The first step is to report to your optometrist who can refer you to an ophthalmologist if need be. Some ophthalmologists, including Dr Davey, offer safe modern laser surgery technology to correct refractive errors and astigmatism in healthy candidates over the age of 18.