How vision changes as you age

Why does eyesight get worse with age?

It’s common to experience certain eye problems with age, such as difficulty focusing close up or needing more light to see clearly. These issues typically result from age-related changes in your eyes. However, aging also increases the risk of conditions that can affect your eyesight in other ways. 

While some common age-related eye problems are a natural part of aging, others may signal more serious eye issues. Knowing what to expect as you age can help you navigate these changes and take steps to preserve your vision.

Common age-related vision changes

The likelihood of experiencing various eyesight changes and vision conditions increases with age, particularly once you’re 40 and over. Here are some of the most common age-related eye issues in adults:

Presbyopia

Presbyopia is a refractive error that typically occurs after age 40. It develops when the eye’s natural crystalline lens becomes less flexible, making it harder for your eyes to focus at close distances. This condition is also referred to as age-related hyperopia or age-related farsightedness. Signs and symptoms

It’s common to develop this type of farsightedness in middle age. When it occurs, you may experience signs and symptoms that include:

• Blurry near vision (such as when reading small print)

• Squinting to see clearly up close 

• Holding items at arm’s length to see them clearly

• Difficulty seeing in dim lighting

• Headaches when performing close-up tasks

• Eye strain, fatigue or discomfort

• Double vision

Treatment

Presbyopia may be addressed with one or more of the following options:

• Reading glasses – Standard reading glasses have a single optical power (magnification) throughout the lens to help improve near vision.

• Multifocal glasses – Multifocal lenses (such as bifocals, trifocals and progressives) have multiple powers within the lenses to improve vision at two or more distances. 

• Monovision contact lenses – One lens corrects near vision while the other corrects distance vision. The lenses work together to improve vision at all distances.

• Multifocal contact lenses – Like multifocal glasses, multifocal contacts contain multiple optical powers within each lens to sharpen vision at two or more distances.

• Medication – Miotic eye drops temporarily decrease pupil size, allowing the eye’s lens to focus better at different distances.

• Eye surgery – Refractive eye surgery, corneal inlays or surgically implanted intraocular lenses (IOLs) can help improve presbyopia symptoms.

SEE RELATED: Corrective surgery options for presbyopia

Cataracts

A cataract is the clouding of the eye’s natural crystalline lens. As a cataract grows, it can affect your eyesight in several ways and could lead to vision loss without treatment. There are several types of cataract, but most are due to age-related changes in the eye.

Symptoms

Age-related cataracts can cause various symptoms and vision changes, which generally occur around age 60 or older. Some of these symptoms include:

• Blurry or cloudy vision

• Poor night vision

• Difficulty seeing in dim lighting

• Color vision changes (colors appear faded)

• Sensitivity to bright light

• Double vision

• Seeing glare or halos around lights

• Change in focus of the eye (such as worsening nearsightedness)

Treatment

Cataracts are treated with cataract surgery. This process removes a clouded lens from the eye and replaces it with an artificial intraocular lens. IOLs can also correct refractive errors and reduce the need to wear glasses or contacts — meaning your uncorrected vision can get better after cataract surgery.

Age-related macular degeneration

Age-related macular degeneration (AMD) is a condition involving the macula, which is part of the retina. It affects central vision (what you see directly in front of you) and is one of the top reasons adults aged 50 and over experience permanent vision loss. 

There are two primary forms of AMD:

• Dry AMD – This is the most common type. It occurs when the macula thins and begins to break down.

• Wet AMD – As the more severe form, wet AMD occurs when new, abnormal blood vessels develop in the macula. They may leak blood and fluid into the back of the eye, causing macular damage.

Symptoms

The early stages of AMD may not present any noticeable symptoms. But as the disease progresses, symptoms may develop gradually or suddenly and can include:

• Blurry vision

• Difficulty seeing in dim lighting

• Wavy or distorted vision

• Blank spots in your field of vision (scotomas)

• Color vision changes (colors appear muted)

Treatment

Treatment varies according to AMD type:

• Dry AMD – Only one form of dry AMD can currently be treated (geographic atrophy). Treatment involves eye injections of medications designed to help prevent the disease from advancing. In some cases, specific formulations of vitamin and mineral supplements may help slow the progression of dry AMD.

• Wet AMD – Wet AMD treatment helps control the growth and leakage of abnormal blood vessels in the macula. While it’s commonly treated with anti-VEGF eye injections, laser eye procedures may also be performed.

LEARN MORE: Age-related macular degeneration treatment

Diabetic retinopathy

Diabetic retinopathy can occur in people who have diabetes, a condition that develops when the pancreas doesn’t produce enough insulin or when the body becomes insulin-resistant. Insulin helps regulate blood sugar levels in the body. Without enough insulin or its proper regulation, blood sugar levels remain high. 

Diabetic retinopathy develops when high blood sugar levels damage retinal blood vessels or cause new, abnormal vessels to develop. These blood vessels may leak blood or fluid into the retina or even become blocked, affecting the retina in ways that can harm your eyesight.

Symptoms

Symptoms of diabetic retinopathy may not be noticeable in the early stages. But as the disease progresses, the following symptoms may develop:

• Blurry vision

• Double vision

• Fluctuating vision

• Eye floaters or flashes

• Dark or blank spots in your vision

• Eye pain or pressure

• Color vision changes (colors appear muted)

• Difficulty seeing at night

• Vision loss

Treatment

Diabetic retinopathy treatment may involve one or more of the following:

• Eye injections – These can include anti-VEGF medications or steroids to help control swelling and slow disease progression. 

• Laser surgery – Laser procedures target abnormal vessels and help control fluid leakage.

• Vitrectomy – This surgery removes the vitreous (a gel-like substance in the middle of the eye) and blood leaked from retinal vessels to help improve vision. 

Managing blood sugar levels and blood pressure is also vital to preventing the progression of diabetic retinopathy. 

Glaucoma

Glaucoma is a group of eye diseases that affect the optic nerve. While it can arise from various causes, it often develops when fluid in the front of the eye (called aqueous humor) doesn’t drain properly through a structure called the trabecular meshwork. This causes the fluid to build up in the anterior chamber and increase pressure within the eye, damaging the optic nerve. 

Without treatment, glaucoma can lead to vision loss and blindness. Symptoms

Glaucoma typically develops in people aged 40 and over, though it can affect a person at any age. Symptoms of glaucoma may not appear until the condition has progressed to more advanced stages. When symptoms do arise, they can include:

• Peripheral (side) vision loss

• Eye pain

• Nausea

• Vomiting

• Headaches

• Eye redness

• Blurry vision

• Double vision

• Multicolored halos around lights

• Dark or blind spots in your vision

Some forms of glaucoma can cause a sudden onset of symptoms; these require emergency medical treatment. Seek prompt care if you experience any glaucoma symptoms.

Treatments

While treatment depends on the type of glaucoma present, options typically include:

• Prescription eye drops – These medications help lower and maintain intraocular pressure (IOP).

• Laser eye procedures – Laser treatments may be used to help drain eye fluid.

• Surgery – Surgical procedures may also be performed to help drain eye fluid.

Retinal detachment

Retinal detachment occurs when part or all of the retina separates from the back of the eye. This is a medical emergency that requires prompt care to help prevent irreversible vision loss or blindness.

Symptoms

A detached retina can develop in people of all ages, but it typically happens in those over 40. It can cause symptoms such as:

• A sudden onset of floaters

• A sudden increase in the number of floaters

• A sudden onset of light flashes

• A dark veil or gray shadow covering part of your vision

Treatment

If you think you may have a detached retina, seek medical care immediately. Your doctor may recommend emergency treatment to reattach the retina to the back of your eye. Treatment options may include:

• Laser photocoagulation or cryopexy procedures – These involve using laser or freeze treatment to reconnect the retina to the eye wall.

• Pneumatic retinopexy – A gas bubble is injected into the eye to hold the retina in place as it heals.

• Scleral buckling – A band is placed around the eye’s outer wall to keep the retina in place as it heals and reattaches to the back of the eye.

• Vitrectomy – This procedure removes the area of the vitreous where the retina has detached. An air, oil or gas bubble can then be placed in this area to keep the retina in position as it heals.

Other age-related eye changes

Other eye and vision changes may also occur with age, some of which might be more subtle than others. Some of these include:

Reduced pupil size

The pupil (the dark area in the center of your eye) helps control how much light enters your eye. Over time, age-related changes in your eyes can affect the size of your pupils. 

For instance, the muscles that regulate your pupil size become weaker, causing the pupil to shrink. This allows less light to enter your eye, making it more difficult to see — especially in dim lighting. Reduced pupil size is one of the main reasons why aging eyes need more light. 

A smaller pupil size can also affect your peripheral vision, which could decrease the size of your visual field.

Glare sensitivity

As you get older, your eyes can become more sensitive to glare from reflective surfaces like smooth water, pavement or your car’s windshield. You may also be less tolerant of glare from oncoming headlights when driving at night.

This increased sensitivity to glare in older adults is due to age-related changes in the eye’s natural lens. These changes affect how light moves through the eye, causing it to scatter instead of landing directly on the retina — intensifying the amount of glare you see. 

Dry eyes

With age, your tear production and quality of tears may decrease, leading to eye dryness. This is particularly true for women after menopause. Dry eyes can cause symptoms such as eye redness, burning and light sensitivity. It can also cause blurry and fluctuating vision, and may lead to eye damage or other vision concerns in the advanced stages. 

Treatment options for dry eyes often include:

• Over-the-counter, preservative-free artificial tears

• Prescription eye drops or ointments

• Warm compresses

• Eyelid massage

• Procedures to temporarily or permanently block the tear ducts

READ MORE: Tips about vision, aging and driving safely

Decreased color vision

As you age, you may notice changes in how well you perceive colors. The eye’s natural crystalline lens may become thicker and discolored, taking on a yellow tint. This affects the amount of light that reaches the retina, the part of the eye responsible for color vision. These changes can impair your ability to distinguish between certain colors, such as blue and green or blue and black. 

Changes in your color vision can make it harder to do everyday tasks, especially activities that require fine color discrimination. 

Vitreous detachment

Posterior vitreous detachment occurs when the gel-like vitreous humor in the center of the eye becomes more water-like, begins to shrink and separates from the retina. This common age-related change can cause symptoms such as:

• Eye floaters 

• Eye flashes (flashes of light, typically in your peripheral vision)

Since floaters and flashes can also be associated with more serious eye conditions, such as retinal tears or retinal detachment, you should visit your eye doctor for an eye exam if you notice these symptoms.

LEARN MORE: Symptoms and causes of retinal tears

Warning signs of eye health problems common with age

Some eye and vision changes occur naturally with age. So, it’s important to maintain regular eye exams to identify any issues early and protect your eye health and vision. Certain signs and symptoms could indicate a more serious concern. Some warning signs of age-related eye issues in adults include:

Fluctuating vision

Fluctuating vision, or changes in the clarity of your eyesight, can be a symptom of age-related eye problems. While it can be caused by conditions like dry eyes, it may also indicate more serious issues like diabetic retinopathy. Fluctuating vision can also be caused by high blood pressure or diabetes, both of which can impact your eyesight.

Schedule an appointment with your eye doctor if your eyesight changes or you notice other symptoms.

Loss of side vision

Your side (peripheral) vision helps you see out of the corners of your eyes and navigate your surroundings. If your peripheral vision becomes impaired, it can feel like you’re looking through a tube or tunnel. This is often referred to as “tunnel vision.”

Peripheral vision loss can result from certain eye conditions, including:

• Retinal tears

• Retinal detachment

• Retinitis pigmentosa

• Glaucoma

• Other diseases affecting the optic nerve

If your side vision becomes blurry or dark or you develop tunnel vision, contact your eye care provider right away.

Seeing floaters and flashes

Eye floaters and flashes are often associated with typical age-related eye and vision changes such as posterior vitreous detachment. Even so, if you notice them, it’s important to consult your eye doctor to rule out other issues. Floaters and flashes can also indicate more serious conditions, like a retinal tear or detachment, which often require urgent treatment.

Seek immediate medical care if you experience:

• New floaters or flashes

• A sudden appearance of floaters or flashes

• A sudden increase in the number of floaters or flashes 

• A dark shadow in any part of your vision

• Floaters or flashes along with eye pain

• Floaters or flashes along with blurry vision

Seeing distorted images

Visual distortion happens when objects in your visual field appear wavy, bent or otherwise abnormal. You may even see blind spots or a blank or dark area in your central vision. 

Seeing distorted images can be an indication of age-related macular degeneration. However, this can also be caused by a wide variety of other eye concerns. Contact your eye doctor if you experience any type of visual distortion.

What you can do about age-related vision changes

You can’t control the aging process or certain risk factors for developing some eye conditions. However, you can take the following steps to promote optimal eye health as you age:

• Attend regular eye exams – Getting a comprehensive eye exam at least once a year allows for the early detection of eye conditions.

• Control your blood pressure – Keeping your blood pressure within a healthy range reduces the risk of developing certain eye issues.

• Manage blood sugar levels – Managing your blood sugar levels also lowers your risk of developing certain eye problems.

• Eat a balanced, healthy diet – Consuming nutritious foods may help support your eye and vision health.

• Avoid smoking and tobacco use – Using tobacco products increases your chances of developing a variety of health problems, including certain eye conditions.

• Protect your eyes from ultraviolet (UV) rays – Wearing sunglasses with 100% UV lens protection and a wide-brimmed hat when outdoors reduces your risk of eye damage associated with harmful UV rays.

• Understand your genetic risk – Being aware of any genetic eye conditions in your family can help you better assess your risks and take proactive steps to protect your eye and vision health.

Speak with your eye doctor to learn other ways to help protect your eyesight as you age.

Vision And Aging		All About Vision
Age	Eye Problems	What To Do
40s	You can't escape presbyopia (difficulty with near vision focus).	Have routine eye exams at least once a year, and explore vision correction options.
	Be aware of increased risk of dry eye & computer vision syndrome.	Eat a healthy diet high in omega-3 fatty acids and antioxidants.
50s	Risks increase for cataracts, glaucoma & macular degeneration (AMD).	Have routine eye exams.
	Presbyopia becomes more advanced.	Multiple eyewear solutions might be needed for presbyopia at this age.
	Risk of dry eye increases for women after menopause.	Tell your eye doctor about medications (some can cause visual side effects, including dry eye).
60s	Risks increase for common age-related eye diseases (see 50s above).	Besides regular eye exams, have annual physicals to identify underlying conditions such as diabetes that might cause eye problems.
	Ability to see in low lighting decreases.	Use brighter lights for reading. Allow more time to adjust to changing light conditions.
	Age-related eye changes cause visual disturbances such as spots & floaters.	If eye floaters appear suddenly, see your eye doctor immediately (this might be a retinal detachment).
70s & 80s	Most people in this age group already have or will develop cataracts.	Cataract surgery is the only option for correcting cataracts.
	Color vision declines, and visual fields begin to narrow.	Ask your eye doctor about eyewear or lenses for increasing contrast vision. Use extra caution while driving.

Eye problems with age? Contact your eye doctor

It’s common to experience certain eye and vision changes as you get older. Knowing what’s normal and recognizing when to seek treatment can help you protect your eyesight as you navigate these changes. 

Regular eye exams are essential for managing eye problems with age. During these visits, your eye doctor will perform tests to detect a variety of conditions. If needed, they can recommend treatment or other strategies to help maintain your eye health and vision.

If your eyesight changes or you have other symptoms between visits, contact your eye doctor immediately — especially if these changes occur suddenly. Early intervention is critical in protecting and preserving your eyesight.

READ NEXT: 8 ways to protect your eyesight

Page published on Thursday, March 14, 2019

Page updated on Tuesday, December 17, 2024

Medically reviewed on Friday, December 6, 2024