Cataract and Glaucoma: Home Care for Older Adults

Cataract: what to look for

Common signs include: cloudy, misty or blurred vision; colours looking faded or yellowed; glare from headlights, sunlight or bulbs; halos around lights; poor vision at night; needing brighter light to read; frequent changes in spectacle numbers; double vision in one eye; difficulty recognising faces. Cataract develops over months or years. The person may blame age and not seek help, or may reduce driving, reading, going out or cooking without saying why. See cataract and daily life and get familiar with eye cataract.

Risk factors include age, diabetes, smoking, long sunlight exposure, eye injury, long-term steroid use (which the doctor manages) and family history.

Treatment: cataract does not clear with drops, exercise or home remedies. The treatment is surgery to replace the clouded lens with a clear artificial lens, usually as a short day-care procedure under local anaesthesia. The eye doctor advises when surgery is worthwhile, which is usually when the cataract interferes with daily life, not just when it is "ripe". Delay can lead to harder surgery and, rarely, to other eye problems. See cataract surgery: when you need it.

Glaucoma: what to look for

The most common type, open-angle glaucoma, causes no pain and no obvious change at first. Side vision narrows slowly, and the brain fills in the gaps, so people often notice only when much has been lost. Warning clues include bumping into things, missing objects at the side, difficulty with stairs and steps and needing to turn the head more. A less common type, angle-closure glaucoma, can cause a sudden attack: severe eye pain, headache, nausea or vomiting, blurred vision, halos around lights and a red eye. This is an emergency; seek eye care at once or call 112.

Risk factors: age over 40 to 60, family history, diabetes, high blood pressure, short-sightedness or long-sightedness, previous eye injury, long-term steroid use and certain eye shapes. Glaucoma damage that has already happened cannot be reversed, but treatment can slow or stop further loss, so early detection by regular eye tests is vital. See do you know about the silent thief of sight, glaucoma, glaucoma treatment and surgery and glaucoma and macular degeneration at home.

Eye checks: the best protection

• Everyone over 60 benefits from a full dilated eye examination at least once a year, and sooner if there is diabetes, a family history of glaucoma or any change in vision. Glaucoma checks include eye pressure, the optic nerve and a visual field test.
• Spectacles alone cannot detect glaucoma; a shop test is not enough.
• People with diabetes need a yearly retinal check; see diabetic eye care.
• Bring the medicine list and previous reports to each visit; see hearing and vision checkup schedule.
• Sudden changes such as a curtain over the vision, flashes, many new floaters, sudden loss of sight or double vision need same-day care.

Eye drops: making the routine work

Glaucoma drops usually have to be used every day for life. Cataract surgery requires a course of drops for several weeks. Missing doses is the commonest cause of treatment failure. Tips:

• Follow the schedule exactly, as written on the prescription, and do not stop because the eyes feel fine. Never change drops or timing without the eye doctor.
• Build a routine linked to meals or brushing teeth, and use alarms, a chart or a pill organiser-style reminder; see pill organiser guide and medicine reminders for forgetful parents.
• Wash hands before every use. Do not touch the dropper tip to the eye, eyelid or fingers.
• Technique: tilt the head back or lie down, pull the lower lid gently to form a pocket, squeeze one drop in, close the eye gently for a minute and press lightly on the inner corner by the nose. This reduces absorption into the body and keeps the drop in the eye. Wait about five minutes between different drops, unless the doctor says otherwise.
• Use a helper or an aid if hands shake or arthritis makes squeezing hard; see eye drops made easy and arthritis daily living gadgets.
• Store as the label says; note the date opened, and discard after the time stated.
• Tell the doctor about stinging, redness, headaches, breathing or heartbeat changes or any other new symptom. Some glaucoma drops can affect breathing or heart rate in people with asthma, COPD or heart conditions; the eye doctor needs a full medicine and illness list.
• Keep a refill reminder so the supply never runs out, including during travel and festivals.

Preparing for and recovering from cataract surgery

Surgery is common and generally safe, but older adults need planning. The eye doctor will give written instructions; follow them. In general:

• Before: arrange a companion, transport and a quiet recovery area; manage diabetes and blood pressure; tell the team about all medicines, including blood thinners (never stop them on your own; the doctors will advise); bring a medicine list.
• After: use the drops exactly as prescribed; wear the protective shield at night as advised; avoid rubbing or pressing the eye; avoid dirty water, dust and smoke; avoid heavy lifting and bending as instructed; wash the face carefully, keeping water and soap out of the eye; keep sleeping on the back or the unoperated side as advised.
• Watch for increasing pain, redness, worsening vision, discharge, light flashes or a curtain: contact the eye doctor at once.
• Fall safety matters: vision may be unbalanced between the two eyes for a while; take extra care on stairs and floors.
• Second eye: if surgery on the other eye is planned, keep the dates.

See after cataract surgery home care.

Making the home safe and bright

Low vision increases the risk of falls and accidents. See low vision home safety, falls risk assessment at home and monthly home safety check.

• Light: use bright, even, glare-free lighting, including in corridors, stairs and bathrooms; bright task lights for reading and cooking; night lights on the route to the toilet; see bathroom night lights.
• Contrast: mark stair edges and steps with contrasting tape; use a dark plate on a light cloth; place a contrasting toilet seat; paint door frames in a contrasting colour.
• Reduce glare: curtains or sheer blinds, matt floors rather than polished marble, and a hat or tinted spectacles outdoors if the doctor agrees.
• Declutter: keep walkways clear, tuck away cables and avoid rugs and loose mats; see flooring, rugs and trip hazards.
• Keep things in the same place so that the person can find them by memory.
• Large-print and magnifiers: large clocks, big-button phones, large-print books and a magnifier lamp; see magnifier lamp guide and reading lamp buying guide.
• Medicine safety: use clear large labels, a pill organiser with big compartments and avoid confusing similar bottles; see monitoring with poor eyesight or tremor.
• Kitchen and stove safety; see kitchen safety for older adults.
• Stairs and steps: handrails on both sides; see handrails and stair lifts.
• Going out: offer an arm, plan routes with fewer hazards, avoid driving if vision does not meet legal standards; the eye doctor advises on this.

Emotional side

Vision loss can bring frustration, fear of dependence, embarrassment and low mood. Depression is more common in people with vision loss; see depression in older adults. Encourage questions, keep social activities, use audio books and talking devices, and ask the eye doctor about low vision services.

Emergency and urgent signs

Call 112 or get to an eye emergency service at once for: sudden severe eye pain with headache, nausea or vomiting; sudden loss or marked drop of vision; a curtain or shadow across the sight; new flashing lights with many floaters; eye injury or chemical splash (rinse with clean running water for at least 15 minutes while getting help); or an eye that is red, painful and light-sensitive after surgery. See an eye doctor the same day for new double vision, sudden blur, or discharge and swelling after surgery.

When to ask a professional

An ophthalmologist (eye doctor) diagnoses and treats cataract and glaucoma. An optometrist checks spectacles and low vision aids. A diabetologist helps with eye risk in diabetes. A pharmacist can demonstrate drop technique. A low vision rehabilitation service teaches skills and devices. For senior services, call Elderline 14567. In an emergency, call 112.