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If you haven’t had a lot of issues with your eyes or vision throughout your life, you might assume things will stay that way. Sure, you may need reading glasses at some point—but that’s it, right?
Not so fast: You can develop other eye conditions as you age, even if you don’t have a history of vision problems. “Unfortunately, after age 40 is when you get the litany of things that can go wrong with your eyes,” says Ryan Parker, M.D., an optometric physician in Denton, Texas. “But the more you know about what can possibly go wrong, the better armed you’ll be at your next eye exam to talk to your optometrist or ophthalmologist about any symptoms you’re experiencing, and make sure they’re screening you for common eye diseases.”
Here, the four big eye issues that tend to surface after you hit age 40, and what you need to know about each.
1. Presbyopia
Even if you’ve had 20/20 vision all your life, it’s important to understand that this condition—a natural process of aging that makes it difficult to see objects up close—happens to everyone at some point after age 40. Hello, reading glasses. “Sadly, none of us escape it, and there’s a good chance it’ll likely get progressively worse as you get even older,” says Dr. Parker. (If you are nearsighted and wear glasses or contacts for distance, presbyopia may happen a little later for you, Dr. Parker adds.)
Why it happens
In each of your eyes, there’s a lens that helps you focus on objects so you can see them. When you’re looking at something at a distance, that lens is one size, explains Dr. Parker. When you want to read or focus on something close to you, that lens needs to get bigger. Your eyes’ lenses are easily able to do this when you’re younger—they’re elastic, and you’ve got eye muscles to help them grow and accommodate focusing on objects and words that are close to your face. But over time, two things happen: First, your lens loses elasticity and becomes more rigid, meaning it can’t change shape as easily; and second, the eye muscles start to wear out, making it extra tough for your lens to change so you can see clearly up close.
What to do about it
If you have to hold your phone, book, or a restaurant menu farther away from your face in order to focus, it’s time to get your vision checked. (Another sign: You notice a dull ache in the back of your eyes.) If you’re diagnosed with presbyopia, you’ll likely walk out with a prescription for reading glasses. Already wear glasses for distance? Switching to progressive lenses, like the ones from Varilux, is a game-changer, says Dr. Parker. In case you’re not familiar, progressive lenses help you see clearly at all distances with just one pair of glasses. You look through the top of the lens to see things far away, the middle to focus on intermediate objects, and the bottom to see what’s nearby.
“Progressive lens technology has come a long way in recent years, and they are a lot easier to get used to than you might imagine,” he says. “In fact, research shows they work for more than 95 percent of the population when the right technology is fitted appropriately.”
2. Cataracts
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While you may think this eye condition only happens to the senior set, Dr. Parker says it can occur any time after age 40. That’s why it’s especially important to know the signs, so you can make an appointment with your eye doctor ASAP if you notice changes.
Why it happens
A cataract happens when the normally clear lens of your eye starts to get cloudy. And while you may not be able to see this clouding when you look at yourself in the mirror, a cataract will likely start to change your vision at some point. People often complain that it feels like looking through a fogged-up window. You may also start to notice dim vision, a fading or yellowing of colors, sensitivity to light, and increasing difficulty with vision at night.
“If you live long enough, you’re going to get cataracts,” says Dr. Parker. That’s because the lenses in our eyes absorb tons of ultraviolet radiation over the course of our lives. In fact, very little ultraviolet light gets to the back of the eye because the cornea (your eye’s clear, protective layer) and lens filter out that radiation. “Yet as the lens does this, it slowly yellows over time,” explains Dr. Parker. “When enough of that yellowing happens, you’ve got a cataract.” In addition to age, genetics may play a role in how soon you develop cataracts. There’s also evidence that injury to the eyes as a child—even something like a head injury—can cause changes in the lens that may result in early-onset cataracts, adds Dr. Parker.
What to do about it
The good news is that most cataracts develop slowly and won’t impact your eyesight early on. In fact, Dr. Parker says he’s seen patients at age 75 who don’t have an issue. But if your vision becomes impaired, your doctor will likely talk to you about cataract surgery—a safe, effective procedure where the lens of your eye is removed and replaced with an artificial one.
3. Glaucoma
This is actually a group of eye conditions that damage the nerve connecting the eye to the brain—a.k.a. the optic nerve, which is essential for good vision. And while glaucoma isn’t tied to aging, your risk does increase after age 40, says Dr. Parker.
Why it happens
The damage to your optic nerve is caused by a buildup of fluid inside your eye. (This happens for a few different reasons which you can read about here.) While this fluid normally drains out of your eye, an overproduction means that the drainage system can’t keep up. This results in an increase in eye pressure. “This buildup of pressure causes the optic nerve to slowly die over time,” says Dr. Parker. The result: A painless, and often symptomless, loss of vision.
What to do about it
The good news is that glaucoma is treatable, says Dr. Parker. “We can prescribe medicated eye drops that lower your eye pressure and can also use oral medications, laser treatment, surgery, or a combination of these treatments,” he says. However, it’s important to realize that when damage caused by glaucoma has happened, it can’t be reversed. Which makes regular eye exams crucial.
“I can’t tell you how many patients come in when they’re 47 because they’ve lost the ability to read and we say, ‘Yep, here’s your progressive lens prescription and also, you have glaucoma,’” says Dr. Parker. “They don’t believe it because they have no symptoms.” He points out that if you skip regular eye appointments over the years, glaucoma can progress without anyone detecting it.
4. Macular degeneration
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Your macula is the part of the retina at the back of your eye that’s responsible for central (as opposed to peripheral) vision, deciphering color, and picking up the fine details. As we age, the macula thins, causing blurred or reduced vision.
Why it happens
Genetics may be partly to blame for a macular degeneration diagnosis, but lifestyle habits are also at play: people who smoke, are obese, or eat poor diets are often at greater risk of developing the condition. Exposure to high energy blue light from the sun has also been linked to increased death of the cells in the macular, explains Dr. Parker, “and in many of us, this causes the macular to break down.”
What to do about it
As with most eye conditions, the earlier macular degeneration is detected, the better. If you wait until your vision changes are noticeable, there are fewer things that doctors can do. “Eye doctors are able to pick up the early stages of this condition sooner than ever before during a dilated eye exam, and we can help stave off the progression,” says Dr. Parker. While there’s currently no treatment for macular degeneration, eating healthy diet high in antioxidants (like vitamin C) and quitting smoking both help to support the cells of the macula, according to the American Macular Degeneration Foundation. “It’s more proof of how important it is to get your eyes checked often,” says Dr. Parker.
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