Age-Related Vision Loss
By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech
January 04, 2024, marks the World Braille Day – birth of Louis Braille (1809-1852), inventor of the reading and writing system used by millions of blind and partially sighted people.
Age is a leading risk factor for many eye diseases, including diabetic retinopathy, glaucoma, and age-related macular degeneration. In 2022, there were approximately 34 million adults aged 50 years and older who were blind and 210 million with moderate to severe vision impairment. As our populations continue to age rapidly, eye health will become increasingly relevant.
Although people of all ages with vision impairment and blindness face challenges, older people are more likely to have difficulties with mobility, to be disabled, and to have higher risk of falls and fractures. These limitations not only impede access to health services but also impair wellbeing, quality of life, and autonomy. Driving exemplifies the link between vision impairment and wellbeing because the ability to drive not only permits access to basic needs, health-care services, and support networks, but also provides an important sense of independence that older people are often denied.
Being stripped of the right to drive is especially burdensome for older people living in rural areas because it exacerbates existing access barriers and takes a toll on mental health, with the report showing that 54% of older people in these areas say that they would feel lonelier if no longer able to drive. Vision impairment has also shown to decrease employment rates and productivity across ages. For older workers, who already face impediments employment due to health issues, caring responsibilities, and structural ageism, the inability to participate in the workforce is detrimental.
Compounding these challenges, treatment and rehabilitative services for eye care are plagued with access barriers due to poor integration within primary health-care services and inefficient referral pathways. In many low-income communities, eye-care services are restricted to secondary or tertiary hospitals and, as these are disproportionately located in urban settings, many older people living in rural areas receive delayed diagnoses and treatment. Moreover, eye-care diagnosis and treatment, such as cataract surgery or refractive error assessment, are largely not covered by health insurance in these communities.
However, low uptake of eye-health services is not entirely attributable to these access barriers. Eye-health literacy remains low, leading to low adherence to interventions and overall poor health outcomes. The 2021 World Health Organization (WHO) report on vision shows that older people are often unaware that vision problems are treatable and therefore do not report impairments, driven in part by assumptions that these are a normal part of aging. Given that 50% of sight loss is preventable, early detection is crucial to ensure timely interventions. To care for our aging populations, eye care must be moved to the forefront of health-care and policy planning. The growing burden of vision impairment must be addressed by integrating eye care and by facilitating access to interventions for older people (e.g., voice assistant technology).
On a broader level, the future of eye health, and the care of older people more generally, requires perceptions of aging to be reframed. The under-reporting of eye conditions in older populations reflects the widespread confounding of age as a risk factor for various conditions and the inevitability of these conditions with age. The dismissal of functional decline as an unavoidable by-product of aging is rooted in societal ageism, which equates aging with impairment. This dangerous notion leads older people to accept declining health in silence. We must shed these misperceptions and recognize that, although aging is inevitable, age-related impairment, including loss of vision, is not.