Vision & Hearing Problems of Older Adults

Fall 2006 CSANews Issue 61  |  Posted date : Jun 01, 2007.Back to list

Although various eye and ear disorders affect persons of all ages, there are certain conditions that are of particular prevalence as we age. As infants and children, common ear problems include middle ear infections and swimmer’s ear; eye problems such as conjunctivitis (pink eye) and acuity disorders. Other than most of us requiring glasses by our 40s, younger adults with no other serious conditions experience few disorders of the eyes and ears. But when we become seniors, the incidence of difficulty with vision and hearing increases, almost all caused by a relatively few common medical conditions.

The important information for us is what, if anything, we can do to reduce the risk of suffering such sensory loss and what remedies are available to improve our sight or hearing. Although there are numerous other diseases which may affect vision and hearing, these are the most common.

Vision Loss
The most common eye conditions include cataract, macular degeneration and glaucoma.

Persons with diabetes are vulnerable to a number of other conditions as well, including retinal hemorrhages, retinal detachment and small, balloon-like enlargements of the retinal blood vessels (venous aneurysms).

Cataract
This condition involves a clouding of the normally transparent lens of the eye. The lens is normally a clear material within the eye which redirects light images to the retina, where they are converted into electrical messages to the brain. When the transmission of the light is impaired, the image becomes blurred. The more opacity that develops, the more one’s vision in either one or both eyes becomes impaired. This condition is so common that by the age of 80, about half of us will have some impairment from cataract.

Although the exact reason for the lens deteriorating is not clear, the mechanism is known. Cataracts that develop with aging do so because the protein within the lens begins to clump, rather than being evenly distributed, and the lens becomes yellowish-brown.

Vision becomes blurred and images may take on a brownish tint. Symptoms may also include poor night vision, a tendency for lights to appear glaring and, in some cases, a halo may appear around lights. Double images may occur.

Most cataracts develop without a clear history as to causative factors. Diabetes is one risk factor and excessive exposure to ultraviolet light is known to increase the chances of cataract development. Clearly, the use of anti-glare sunglasses, especially for snowbirds, is advised. Smoking and excessive alcohol use increase the risk as well. Although your diet should include plenty of green leafy vegetables containing lutein, the possible benefit of this antioxidant in preventing eye diseases remains unproven.

Once the diagnosis has been established by your optometrist or ophthalmologist, you will probably be followed for a period of time, until the cataract becomes“mature.” During that time, you may get some relief with new glasses, better lighting for reading and use of a magnifying glass. You should avoid night driving. In due course, you will be offered the only effective treatment – surgical removal of the offending lens and insertion of an artificial lens. Although risks associated with this operation are minimal, infection and a future retinal detachment occasionally occur. This outpatient short surgical procedure, usually performed under local anesthesia, is highly successful for improving vision in those with no other eye disease. For Canadians, the wait time can be aggravating but our health insurance covers the cost. As with any elective procedure, snowbirds should make the necessary arrangements well in advance of the 90-day stability requirement of travel health insurance policies.

Age-related Macular Degeneration (AMD)
AMD is another very common disease of the eye which affects vision in many Canadians primarily over the age of 60, the risk increasing with age. This condition involves deterioration in the macula, that part of the retina which sends signals to the brain for fine detail such as reading and sewing. The vision loss is usually gradual and involves the central field of vision.

There are two types of AMD – dry AMD and wet AMD– the latter being more serious. In dry AMD, there is a breakdown in the light-sensitive cells of the macula which, as it advances, begins to cause blurred central vision. Driving, reading and recognizing faces begin to be affected and can become worse as the disease progresses. Initially, the diagnosis is made in the early stage by the development of yellow deposits under the retina but, with later stages, there is breakdown of the cells and supporting tissue of the macula. The disease may initially affect only one eye, but vision can become seriously impaired with more advanced cases in both eyes.

In wet AMD (which is always preceded by dry AMD), the mechanism involves the development of new tiny blood vessels in the macula which can bleed and ooze fluid, thereby lifting the macula. Initially straight lines can appear wavy, but this may more aggressively cause blurring of one’s central vision. Wet AMD, as well as advanced cases of dry AMD, result in various degrees of vision loss.

The cause of AMD is not clear, but there are a number of risk factors known including heredity, obesity and smoking. The incidence is higher in women and Caucasians.

Early stages of dry AMD require thorough and repeated examinations and testing by an ophthalmologist, but specific treatment may not be indicated unless more advanced, or if wet AMD develops. At that time, more sophisticated tests can assist the eye doctor in determining if there are leaking blood vessels that should be treated. This is usually done with laser treatment to the affected vessels in the doctor’s office. Another treatment is photodynamic therapy whereby light is shined into the eye following the injection of a drug that reaches and destroys the affected macular vessels. A third form of treatment is the injection of specific drugs directly into the eye. Results of all of these treatments are often temporary and only slow the progression of the vision loss. Recent research has found that a dietary supplement of antioxidants and zinc may significantly reduce vision loss when prescribed for certain cases of intermediate or advanced AMD.

Glaucoma
This condition is characterized by the development of increased pressure of the fluid within the eye, causing damage to the optic nerve. The initial symptom is usually a loss of peripheral vision. Patients describe their vision as“looking through a tunnel.” As with cataract and AMD, this condition most commonly affects seniors and increases in frequency with age. Persons at higher risk are those with a family history and persons of Mexican or African descent. The precise cause is unknown.

There are several types of glaucoma, the most common being open-angle glaucoma in which the fluid in the anterior chamber of the eye does not drain effectively, giving rise to the increased pressure. Initially, there are usually no symptoms. Because early treatment can help to save loss of vision, it is very important that we all have a thorough eye examination every two years, including dilation of your pupils and pressure testing. Those at higher risk need more frequent monitoring.

Although vision already lost as a result of glaucoma cannot be restored, treatment with drugs or surgery will usually help to control further vision loss. Drugs in the form of drops or pills are used to assist drainage or reduce the production of fluid, thereby reducing the pressure. Surgical treatment using laser light focused on the drainage site may improve drainage and reduce pressure. Treatments may not always be effective and newer drugs or techniques may be indicated. Research continues to determine effective prevention and treatment guidelines.

Diabetes and Sight
Diabetes causes problems with the flow of blood throughout your body – including your eyes. Approximately one in four people with diabetes has some form of blurred or changed vision due to a change in the blood vessels that feed the retina. Commonly known as “diabetic retinopathy,” this condition can cause severe vision loss or blindness unless diagnosed early. Controlling your blood sugar levels can help delay or slow the progression of retinopathy in most people, and surgical treatments are available for severe cases. If you’re a Type 1 or Type 2 diabetic, be sure to see your ophthalmologist yearly, and make sure that they know of your condition so that they can perform the appropriate monitoring of your eyes.

Hearing Loss
Hearing loss in older adults is very common. It is estimated that the incidence is more than 30% in persons over the age of 65 and about 50% in those over 75. There are many possible causes and these are divided into two basic types – conductive and sensorineural hearing loss. Conductive hearing loss causes include any condition of the outer ear canal that limits the transmission of sound from the outer to the inner ear. Conditions which can cause this include fluid or infection in the middle ear, wax impaction, damage to the ear drum and otosclerosis, a disease of the inner ear bones. Sensorineural hearing loss is due to damage to the pathway for sound transmissions from the inner ear to the auditory nerve and brain. Excessive noise causing damage to the internal ear, viral infections, Meniere’s disease, tumour and certain drugs are such causes, but the most common by far is a condition called presbycusis, which accounts for the vast majority of cases of hearing loss in seniors.

Presbycusis
This condition comes on gradually as a person ages and is usually caused by changes to the inner ear. These can also be changes involving the middle ear or the nerve pathways leading to the brain. The changes usually affect both ears and are progressive. Early signs are often detected by the spouse when the TV is too loud. Eventually, higher-pitched sounds are difficult to hear and the hearing loss becomes distressful to the affected person, as well as to family and friends. There are many factors which increase the risk of developing this condition including hypertension, diabetes, certain conditions of the outer and middle ears and, especially, excessive exposure to noise. Loud noise (from machinery, listening to music, snow blowers, gardening equipment and traffic) over the years is a major factor in hearing loss. While it is not too late for us to protect ourselves from further risk, the message is of particular importance to the young and even baby boomers, as their exposure is most often greater than ours was at that age. Statistics reveal an alarming increase in this condition among the middleaged.

Although there is no cure for this aging process, technological advances have become increasingly helpful in improving hearing ability. Telephones with microphone adjustments, FM tuners for hearinghandicapped persons, and earphones for radio and television have all helped to ease the condition.

As well, great advances have been made in the quality of personal hearing aid technology. Although expensive, a hearing aid, if properly measured and chosen with the help of a professional audiologist, is the single most effective assistive device. Many individuals do not acquire them early enough or wear them when purchased. This can make life miserable for both the person and the family. Persistence and repeated professional advice may be necessary to ensure satisfaction. Partial costs in many provinces are provided by government health plans.

Hearing aids come in a variety of types, including aids that are not visible to others, as well as newer digital aids which transmit sounds more effectively and clearly. Some advanced analogue aids can be computer programmed for individual needs; digital aids use a computer chip to process sounds for adjusting to different environments. Be sure to seek the services of a recognized professional audiologist for this advice and supply.

Our vision and hearing are extremely important senses that allow us to enjoy life. While many of us will experience these problems, there are preventive steps which we can still take and newer treatments and devices that will make life more enjoyable for many.

Turn Down the Noise!
While short-term effects of loud noise (ringing in your ears or a “stuffed-up” feeling) may go away in a few hours, repeated exposure to loud noise can cause permanent damage. Protect your hearing by wearing ear plugs to concerts or other loud places, and help your friends and family by recommending that they do the same – especially if they work in a noisy environment!

Additional Sources:

  • Canadian National Institute for the Blind (CNIB)
  • The Canadian Hearing Society, National Institute for Occupational Safety and Health (NIOSH)
  • League for the Hard of Hearing




Related links
Canadian National Institute for the Blind (CNIB)
The Canadian Hearing Society