Glaucoma and Macular Degeneration: Practical Home Support

Glaucoma in brief

Glaucoma is a group of conditions in which the optic nerve, which carries images from the eye to the brain, is gradually damaged, usually, though not always, because the pressure inside the eye is too high for that eye. Types include:

• Primary open-angle glaucoma: the most common, painless, slow, with no early symptoms. The side (peripheral) vision fades first, so central vision stays sharp until late.
• Angle-closure glaucoma: the drainage angle in the eye is narrowed or blocked. It can be chronic and silent, or acute and sudden.
• Other types: normal-tension, secondary glaucoma related to injury, inflammation, steroid use or diabetes, and others.

Risk is higher with increasing age, family history, diabetes, short-sightedness or long-sightedness (depending on type), high eye pressure, thin corneas, long-term steroid use, previous eye injury and some ethnic backgrounds. Because damage is not reversible, early detection through regular eye examinations is vital. See do you know about the silent thief of sight, glaucoma and glaucoma treatment and surgery.

### Acute angle-closure: an emergency

A sudden attack can cause severe eye pain, redness, a hazy cornea, blurred vision, halos around lights, headache, nausea and vomiting. This is a medical emergency. Go to an eye hospital or emergency department at once, or call 112; delay risks permanent sight loss.

### Treatment

Treatment aims to lower eye pressure and slow or halt further damage, not to restore lost vision. Options include:

• Eye drops, usually the first treatment, used regularly for life.
• Laser treatment to improve drainage or to create a drainage opening.
• Surgery to create a new drainage path or to place a drainage device.
• Tablets in some situations.

Never stop or change glaucoma drops without the eye doctor's advice, even if the eyes feel fine. Missing doses lets the pressure rise and damage accumulate, silently.

Macular degeneration in brief

AMD affects the macula, the small central area of the retina that gives sharp detail. It is a leading cause of severe vision loss in older adults. Types:

• Dry (atrophic) AMD: the common, slower form, with gradual thinning of the macula and slow loss of central vision. No medicine reverses it, though some people at higher risk may be advised specific nutritional supplements; ask the eye doctor, and do not start supplements without advice.
• Wet (neovascular) AMD: less common but more rapid, when abnormal blood vessels grow under the retina and leak. It can cause sudden distortion or loss of central vision. Treatments such as injections into the eye can slow or stop leakage and preserve vision if started promptly.

Symptoms: blurred or dim central vision, distortion (straight lines look wavy or bent), a dark or empty spot in the centre, difficulty reading and recognising faces, colours appearing faded. Side vision usually remains. Risk factors include age, smoking, family history, high blood pressure and cardiovascular disease, and sun exposure. See eyecare: common eye diseases and can your eyes tell you about your health.

### Wet AMD: an urgent situation

New distortion, a sudden blur or a dark spot in the centre of vision needs urgent assessment, ideally within days, because wet AMD treatment works best when started early. Go to an eye specialist at once; do not wait for the next routine visit. People with AMD can check each eye separately at home using a simple grid (an Amsler grid) as instructed by the eye doctor, covering one eye and looking at a central dot while noting any wavy, missing or blurred lines. Any change should be reported at once.

Check-ups and monitoring

• Regular, lifelong follow-up with an ophthalmologist, at the intervals advised, which may be every few months to a year depending on the condition. Tests may include eye pressure, optic nerve imaging, visual field tests and retinal scans.
• Do not skip visits because vision "feels the same". Damage occurs without symptoms.
• Bring the list of drops and any other medicines, and the previous reports.
• Take someone along to appointments, as dilating drops blur vision for hours and bright sun is uncomfortable. Sunglasses help.
• Keep a diary of drop use, symptoms and appointments.
• See a hearing and vision check-up schedule after 60.

Helping with glaucoma drops

Adherence is a major problem: people forget, find drops hard to instil or dislike the side effects. Ways to help (see also eye drops made easy: tips for older hands):

• Link drops to routines, such as brushing teeth or tea, and use phone alarms.
• Use a chart or a pill organiser-style reminder; see pill organiser guide and medicine reminders for forgetful parents.
• Label bottles clearly, with large print or colour codes, and keep them together.
• Show and check technique, with a nurse or pharmacist.
• Use drop aids to guide the bottle if hands shake.
• Wait five minutes between different drops, or as advised.
• Report side effects: burning, redness, tiredness, a slow pulse, breathing difficulty (certain drops can affect the heart and lungs, so tell the doctor about asthma, COPD or heart conditions), dry mouth or changes in eyelashes. Do not stop; call the doctor.
• Keep spare bottles and reorder early; do not run out.
• Carry the drops when travelling.

Adapting the home

Good lighting, contrast and organisation help most people with glaucoma or AMD, though the needs differ.

For glaucoma (peripheral vision loss):

• Scan the environment by turning the head, since side vision is reduced. Keep walkways clear and use mirrors where useful.
• Be careful in crowds, doorways and kerbs, where objects appear from the side.
• Take care when driving, and follow medical advice on fitness to drive; see safe driving tips for the elderly.
• Keep furniture in fixed positions and doors fully open or fully closed.
• Light up dim areas and reduce glare.

For AMD (central vision loss):

• Strong, directed light beside the reader; see lighting for older eyes: brightness, colour and glare.
• Magnification: a magnifier lamp, handheld magnifiers, large-print books and video magnifiers; see magnifier lamps: reading and hobbies with low vision.
• High contrast: black on white or white on black, bold pens and marker pens, contrasting plates.
• Look slightly off-centre to use the healthier part of the retina, a technique a low vision therapist can teach.
• Audio and talking aids: talking clocks, audio books, phone voice features; see talking clock guide and phone accessibility features for hearing and vision loss.
• Faces: ask people to say who they are, and use voices to recognise.

For both:

• Follow the principles in low vision home safety: contrast, labels and layout.
• Keep a fixed place for glasses, keys, phone and medicines.
• Label switches, medicine boxes and appliances with large, bold or tactile marks.
• Use night lights and clear paths; see motion night lights for seniors.
• Prevent falls: see falls risk assessment at home.
• Check the kitchen: use contrast, tactile markers on the stove, and safer tools; see kitchen setup for seniors.

Health factors that matter

• Smoking: a major risk factor for AMD and other eye disease. Stopping helps.
• Blood pressure, cholesterol and diabetes: good control protects the eyes; see diabetic eye care for older adults and high blood pressure after 60: a home care guide.
• Diet: a diet with plenty of vegetables, especially leafy greens, fruit and fish is generally good for health; see foods to improve eyesight in old age and vitamins for eyes. Supplements for AMD are advised only for particular stages and should come from the eye doctor.
• UV protection: sunglasses and a hat; see best sunglasses for seniors.
• Medicines: tell the eye doctor about steroids and others; do not stop any without advice.
• Exercise is good for general and eye health, within safe limits.

Emotional and social support

Losing sight is a grief. Many people with glaucoma or AMD become anxious, withdrawn or depressed, and some experience visual hallucinations (Charles Bonnet syndrome), seeing patterns, faces or objects that are not there, while knowing they are not real. This is common and not a sign of mental illness, but tell the doctor. See depression in older adults, anxiety in older adults and loneliness and isolation in older adults. Low vision services, rehabilitation workers and peer groups can help with training, aids and company; ask the eye hospital.

When to ask a professional

See an ophthalmologist regularly, and urgently for sudden changes. Ask for a low vision assessment for aids and training. Ask an optometrist for appropriate glasses. Ask the pharmacist or nurse about drop technique. Ask the family doctor about blood pressure, diabetes and mood. Go at once for severe eye pain with redness, halos, nausea and vomiting; new distortion or a dark spot in the centre of vision; sudden loss of vision, flashes or a curtain. Call 112 for weakness, facial droop, speech difficulty or confusion.