Visual impairment in later life: regular check-ups are important

To a certain extent, it is part of the normal aging process to experience increasing difficulty seeing things up-close and to need to start wearing reading glasses. If the ability of the eye to focus deteriorates despite wearing glasses with the correct prescription, or if the ability to perceive color and glare and contrast sensitivity decline, this may indicate that a cataract is beginning to develop.

Other eye diseases also become more common in advanced age, and can lead to serious problems with vision and even visual impairment or blindness. Regular check-ups with an eye specialist and early detection measures help ensure that these eye diseases are detected and treated at an early stage.

Despite having to deal with increasing limitations, it is still possible for older people with vision problems to continue living as independently as possible. Prescription vision aids, medical treatment, aids to help with everyday life (such as household appliances with audio response or audio readers, for example) and adaptations of the living space can help in this regard. Advice and support are available from a large network of advice centers and support groups.

If vision deteriorates with advancing age, this is often due to presbyopia (age-related farsightedness). This normal deterioration of the eyesight affects everyone from the age of 50 at latest, and can be corrected with glasses or contact lenses. It is important to have these adjusted regularly because, over time, the lenses in the eyes become increasingly less flexible at adapting to seeing things at close hand.

Other changes that are usually age-related, such as cataracts, can be treated effectively with surgery. In addition, regular check-ups are important to allow doctors to rule out other eye diseases. If left untreated, these could result in visual impairment or blindness.

In Germany, the following three diseases most frequently lead to sight loss when untreated:

• age-related macular degeneration (AMD)
• glaucoma
• damage to the retina caused by diabetes mellitus (diabetic retinopathy)

If these diseases are detected at an early stage, they can largely be prevented from progressing and more significant visual impairment or blindness may be prevented.

Visual disorders and visual impairment can place significant restrictions on older people’s quality of life. Not only is good vision important for leading an independent life, remaining physically active, and absorbing information and gaining impressions – it is also part of interacting with other people.

Sight loss can lead to isolation and depression. Poor vision is also part of the reason why older people have more frequent falls and make mistakes when taking medication. That’s why it’s important to seek advice and avail of the vision aids that are available and can be customized to suit individual needs. Ophthalmologists (eye specialists), opticians, and advice centers can all be contacted for this purpose.

In addition to medical treatment by an eye specialist, adaptations and accommodations can be made to an individual’s living space, while optical and electronic aids for everyday use can help those affected to continue living as independently as possible in older age – even if their vision is significantly impaired. 

In a few simple steps, the home of an older person with a visual impairment can be easily adapted to suit their needs. For example, it’s important to ensure good lighting that provides lots of indirect light and doesn’t cause glare. Bright colors and strong contrasts improve visibility and help prevent accidents.

If prescription glasses or vision aids such as magnifiers or magnifying spectacles no longer help, screen-reading devices and other practical aids can be valuable tools for everyday tasks. These aids include phones with large buttons and audio output, speaking clocks and weighing scales, and many other tools for assistance around the house, with hobbies, and in the medical and healthcare area.

Deteriorating vision presents a major challenge to older people in particular. They often have other health issues to deal with too, and may struggle to retain their independence. For this reason, it’s important that they receive not only treatment for their eyes from an eye specialist, but also advice and support on how to better adjust to living with their condition. 

Many people put off asking for help out of fear of appearing weak or being a burden to others. However, being able to admit – after many years of independence – that one needs help can be seen as a sign of great strength. If those close to the person affected are unable to provide all of the assistance required, there are many other places to turn to for help. 

Advice centers and support groups exist throughout Germany to provide support and advice on financial assistance, benefits and allowances, and other resources. They also provide practical tips for everyday life and information about how to adapt the home, mobility and leisure-time options, as well as psychological support if needed. They can also advise friends and relatives. Support groups meet to share their experiences with others and help one another deal with their new life situation.

There are various signs that indicate that an older person’s sight is deteriorating. Experience indicates that people of very advanced age may occasionally display irritating and changeable behavior – for example, because eye diseases affect the sufferer in different ways depending on the current light conditions and because the person’s mood on any given day also seems to have a role to play. Some examples are provided below:

Movement

The person may move hesitantly, stumble more frequently, and be startled if they are suddenly spoken to. They may avoid going on walks in the sunshine or at twilight.

Orientation

The person may be shaky and unsteady in their movement, even in a familiar environment. They may confuse times and dates and often have “butterfingers”, i.e. miss their target when reaching for things or trying to pick things up. They may show uncertainty when moving from darkness into light or from light into darkness.

Unusual appearance

The person may sometimes wear stained or mismatched clothing, or have an untidy or unkempt appearance. Their home may no longer be as clean and tidy as it once was.

Noticeable eye or head movements

The person may often hold objects or written text close to their eyes. They may be unable to focus properly on objects or on the person talking to them and may look past them. They may lean their head to one side and narrow one or both eyes. Their eyes may water or hurt or appear red or sticky. 

Changes in behavior

The person may drop things or knock them over more frequently and often misplace their belongings. They may show a lack of interest in their usual activities and become more withdrawn in general. In some cases, they may be unresponsive to, suspicious of, or react differently to familiar people and situations.

Sighted people are usually ready and willing to help but may be unsure whether their help is always welcome. On the other hand, they may forget that blind and visually impaired people cannot always understand them when they speak and gesticulate normally.

The German Federation of the Blind and Partially Sighted (Deutsche Blinden- und Sehbehindertenverband e.V.) provides practical tips on dealing with blind and visually impaired senior citizens.

An overview of advice centers in Germany is provided on the blickpunkt-auge.de website of the German Federation of the Blind and Partially Sighted (Deutsche Blinden- und Sehbehindertenverband e.V.).