Eyes and Vision

How can I tell if my complaints are a consequence of aging or an actual problem?

DEAR DOCTOR K: Every time I complain about a new medical issue, my husband says, "You're 84. What do you expect?" How do I know if my complaints are just a consequence of aging or if there's an actual problem?

DEAR READER: I'm not 84, but I ask myself that question regularly. You don't have to be a doctor to understand that new symptoms develop as we age. But some changes aren't a normal part of the aging process. I'll discuss some common age-related health changes, as well as changes that suggest there might be a problem.

Any reason not to get inexpensive drugstore reading glasses instead of pricier versions?

DEAR DOCTOR K: My vision has been getting worse, and I definitely need reading glasses. Is there any reason not to get the inexpensive ones sold at the drugstore?

DEAR READER: If you're over 40, reading glasses can be a necessity. Many people end up buying several pairs at the drugstore. They are inexpensive and available in a wide variety of styles. (Not to mention that reading glasses tend to be easily misplaced.)

How does diabetes affect vision?

DEAR DOCTOR K: I was recently diagnosed with Type 2 diabetes. Can you explain how diabetes affects vision?

DEAR READER: Both of the common types of diabetes, Type 1 (which usually begins in childhood) and Type 2 (which usually begins in adulthood), can affect vision in several ways. After 20 years of having Type 2 diabetes, most people have eye problems. But the risk can be reduced, as I'll explain.

Can I do anything to reduce the risk of glaucoma?

DEAR DOCTOR K: My mother has open-angle glaucoma. This increases my risk for glaucoma. Can I do anything to reduce that risk?

DEAR READER: You're right to think that your risk is increased. Because your mother has the condition, your chance of getting it is at least double that of most people you know. That doesn't mean you definitely will get glaucoma; it just means you inherit a risk, and therefore need to be particularly careful.

How can we protect our eyes from the sun?

DEAR DOCTOR K: Does spending time in the sun pose a threat to our eyes? What can we do to protect ourselves?

DEAR READER: Yes, it does. And to a large extent, the damage may already be done. I spoke to Dr. Louis Pasquale, an ophthalmologist at Harvard-affiliated Massachusetts Eye and Ear Infirmary. He noted that spending a lot of time in the sun without sunglasses when you're young may put you at risk for developing eye problems when you're older. The damage would probably be done in your 20s and 30s.

Can you describe the complications of cataract surgery?

DEAR DOCTOR K: I am having cataract surgery in a few weeks. Can you describe the possible complications?

DEAR READER: A cataract is a clouding of the normally clear lens of the eye. As the condition worsens, you may experience blurred or dim vision, increased glare, double vision, nearsightedness and worsening night vision. Surgery is the only effective cure. During cataract surgery, the doctor removes the clouded lens and replaces it with a clear artificial lens. (I've put an illustration of the procedure at the end of this post.)

Are dark circles and under eye bags caused by lack of sleep?

DEAR DOCTOR K: I have dark circles and bags under my eyes. Does this mean I'm not getting enough sleep?

DEAR READER: Lack of sleep probably has nothing to do with the dark circles and bags under your eyes. In fact, getting too much sleep is more likely than too little to cause this appearance. That's because when you're sitting or standing up, gravity tends to pull excess fluid in your body downward toward and into your belly and legs.

What can I do to continue driving safely at night?

DEAR DOCTOR K: I am in my 60s. Over the last few years, my night vision has gotten worse, and I'm finding it increasingly difficult to drive at night. What can I do to continue driving safely after dark?

DEAR READER: Night vision does start to decline as we get older, usually after age 50. Perhaps you've noticed more difficulty seeing in dim light, or maybe you're more bothered by the glare from headlights. Problems with night vision are the result of several changes to the eye that occur with aging. The first change involves the iris and pupil. As we age, the iris muscle weakens and becomes less responsive.

How do you put in eye drops?

DEAR DOCTOR K: I have dry eye syndrome. My doctor prescribed artificial tears, but I can't manage to get the drops into my eyes. Any advice?

DEAR READER: Dry eye syndrome occurs when your body doesn't produce enough tears. Tears moisten, protect and cleanse our eyes. Without enough tears, your eyes may burn, itch, or feel like there is something gritty in them. Dry eye syndrome can also increase your sensitivity to light and cause excessive tears. Dry eye syndrome is often effectively treated with artificial tears. Available over the counter, they mimic the composition of natural tears. Of course, they work only if you can get them into your eyes. Like you, many people need to learn how to do it.

Can you tell me more about blepharitis?

DEAR DOCTOR K: I had some itching and burning in my eye. My ophthalmologist said I have blepharitis. Can you tell me more about this condition?

DEAR READER: Blepharitis is an inflammation of the edges of the eyelids and eyelash hair follicles. It is a common and sometimes long-lasting condition. The good news is that it will not permanently damage your eyesight. Blepharitis can be triggered by bacterial infections, though it is not contagious. You can also develop blepharitis if your eyelid glands make too much oil. People with skin conditions such as rosacea, seborrhea, oily skin, dandruff or dry eyes are more likely to get this condition.