Glaucoma is the leading cause of irreversible vision loss in the United States. Nearly 2% of adults in the United States older than 40 suffer from glaucoma and it is the leading cause of blindness for those 60 and older.
While glaucoma is linked to chronically elevated pressure in the eyes (intraocular pressure), it’s more accurately described as an optic neuropathy – gradual damage to the optic nerve resulting in progressive loss of vision. The progressive loss of peripheral vision in glaucoma often leads to difficulty with driving, particularly at night, and can increase the risk of falls and subsequent fractures.
All forms of the disease result from increased intraocular pressure, but how that pressure builds-up is what differentiates each form and its potential treatment.
Open-angle glaucoma is the most common form of the disease. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork within the eye is partially blocked which causes pressure that damages the optic nerve. The pressure increase is gradual, and patients may lose vision before they’re even aware of a problem.
Closed-angle glaucoma occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can't circulate through the eye and pressure increases. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma. Closed-angle glaucoma may occur suddenly or gradually. Acute angle-closure glaucoma is a medical emergency that is often signaled by the following symptoms:
- Severe headache
- Eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
Patients with normal-tension glaucoma experience optic nerve damage even with eye pressure that is within the normal range. Causes for this form of glaucoma are difficult to diagnose, but there may be links to reduced blood flow to the optic nerve as the result of atherosclerosis — the buildup of fatty deposits (plaque) in the arteries — or other conditions that impair circulation.
While a diagnosis of glaucoma may be made in a person's 40s, 50s, or 60s, even with careful management of the condition, vision loss may be a reality as they age.
Because vision loss associated with long-term glaucoma is a very gradual process, seniors may not be aware of how compromised their eyesight has become. Caregivers should be aware of several telltale signs of impaired vision including:
- Squinting or head tilting when trying to focus.
- Bumping into things or knocking objects over.
- Losing interest in activities that rely on vision like reading or writing.
- Trouble with depth perception and missing objects when reaching for them.
- Falling or walking hesitantly.
If a loved one is still driving, an increase in accidents and risky maneuvers may also indicate visual changes.
Individuals with declining vision may have different needs, but the following tips may help seniors adjust to vision loss:
Improve lighting conditions in the home – taking careful note of contrasts, not just brightness. Glare can be a significant problem, so the right lighting and minimizing reflective surfaces is important. Avoid significant lighting differences, like a bright lamp shining into a dark room. As task lighting is increased, the surrounding room lighting should also be increased. Keeping lights on during daytime hours helps to equalize lighting from both indoor and outdoor sources.
Strategically using light and dark colors can make daily activities much easier for a person with limited vision. Like colors can make it difficult for those with visual impairments to detect doorways, stairs and furniture and especially smaller objects that blend into their surroundings.
Bathrooms, which often have little contrast, can pose a challenge. Choose towels, washcloths and bathmats that contrast sharply with the color of the tub/shower, counters and flooring.
Painting door jambs throughout the home with a contrasting color and using brightly colored tape to highlight the edges of steps are other modifications that can be used to improve safety in the home.
Designate spots for commonly used items and be sure to return objects to the same place every time so that your loved one always knows where things are. Sometimes using a basket to store like objects can make it easier to find things like keys, remotes to electronics and other items.
Consider Overall Safety
Even with household modifications, home may not be the safest place for a senior with deteriorating vision, or even complete vision loss. Assisted living communities and adult homes are well prepared to provide the assistance these seniors need, while promoting as much independence as possible. “Our senior care communities were designed to account for the loss of vision often associated with aging and chronic conditions like glaucoma,” said Kristina Dott, Community Relations Coordinator for Elderwood Village at Colonie, an adult home community in the greater Albany, NY area. “Our residents enjoy a wide range of activities and when necessary, modifications are made so that they can be enjoyed by residents with vision impairments.” Medication management, essential for those with glaucoma is also provided to residents by Elderwood.
January is glaucoma awareness month, and the staff at Elderwood want to remind everyone to take great care of their eyes, understand the warning signs for glaucoma – including family history – and if you are 40 or older, get your eyes examined annually.