Your mother has stopped doing the crossword. She leaves the lights on in every room, has trouble reading her pill bottles and says faces look blurry across the table. She shrugs it off as getting old. But some of what's happening may be treatable, and much of the rest can be worked around.
This guide uses the National Eye Institute (NEI) and Medicare. It's general information. Your parent's eye doctor is the right person to diagnose and treat eye disease.
What low vision means
The NEI defines low vision as a vision problem that makes everyday activities hard and can't be fixed with glasses, contact lenses or standard treatments like medicine or surgery1. A person may have low vision if they can't see well enough to read, drive, recognize faces, tell colors apart or see a TV or computer screen clearly1.
The most common types are loss of central vision, loss of side (peripheral) vision, night blindness, and blurry or hazy vision1. Low vision is more common in older adults because many of the diseases that cause it are more common with age, but aging doesn't cause low vision by itself1. For surgery and recovery, see cataract surgery for elderly parents.
The most common causes
According to the NEI, the most common causes of low vision are age-related macular degeneration, cataracts, diabetic retinopathy and glaucoma1.
- Age-related macular degeneration (AMD). Damage to the macula, the part of the eye for sharp, straight-ahead vision. It blurs central vision and is a leading cause of vision loss in older adults, but it doesn't cause complete blindness2.
- Cataracts. Clouding of the eye's lens, which makes vision blurry, hazy or less colorful. Surgery can usually fix it3.
- Glaucoma. A group of diseases that damage the optic nerve. It often starts with loss of side vision and may have no early symptoms4.
- Diabetic retinopathy. Damage to blood vessels in the retina from diabetes1. See diabetes in the elderly.
Stroke and brain injury can also cause vision loss1, sometimes on one side of the visual field. For glaucoma care, see glaucoma in the elderly.
More on macular degeneration
There are two types of AMD. Most people have dry AMD, in which the macula gets thinner with age; it develops in early, intermediate and late stages and usually progresses slowly over years2. Wet AMD is a less common late form in which abnormal blood vessels grow and damage the macula, and it usually causes faster vision loss2. Treatment options are available for wet AMD2, including injections.
Early AMD usually has no symptoms, so a person may not notice vision loss for a long time2. Later symptoms include blurry or wavy areas in central vision2. Medicare Part B may cover certain tests and treatments, including some injectable drugs, for AMD5. For treatment and low vision help, see macular degeneration.
Signs a parent's vision is changing
- Squinting, holding things very close, or asking for more light.
- Missing food on one side of the plate, or spills when pouring.
- Bumping into things or tripping on steps and curbs.
- Trouble reading mail, bills and labels.
- Giving up hobbies such as reading, sewing or cards.
- Not recognizing people until they're close1.
- Changes in driving, such as new dents, trouble at night or with signs.
Vision loss can look like confusion or memory problems. A parent who can't read the clock or recognize faces may seem disoriented. Have vision checked whenever thinking seems to change. See early signs of dementia.
Sudden vision loss is an emergency
Even if vision comes back, a brief episode of vision loss should be checked promptly, because it can be a warning sign of stroke.
Eye exams and what Medicare covers
Regular eye exams are the best way to catch AMD, glaucoma and diabetic eye disease early2. A dilated eye exam, where drops widen the pupils so the doctor can see the back of the eye, is simple and painless1.
Original Medicare's coverage is narrower than many families expect:
- Routine eye exams for glasses are generally not covered6.
- Diabetic eye exams. Part B covers an exam for diabetic retinopathy once a year for people with diabetes7.
- Glaucoma screening. Covered once every 12 months for people at high risk, including people with diabetes, a family history of glaucoma, African Americans 50 and older and Hispanic Americans 65 and older8.
- AMD tests and treatment. Certain tests and treatments may be covered5.
- Glasses after cataract surgery. One pair of standard glasses or one set of contacts after each cataract surgery that implants a lens9. Otherwise, glasses usually aren't covered9.
Some Medicare Advantage plans offer extra vision benefits9. Part B cost sharing applies to covered services. During Medicare open enrollment, compare vision benefits if eye care is a priority.
Deciding about cataract surgery
Cataracts are one of the most fixable causes of poor vision. The NEI says cataract surgery is safe, corrects vision problems caused by cataracts and is one of the most common operations in the United States; by age 80, most people have cataracts or have had the surgery3. Families often wonder whether a very old or frail parent should have it. Questions worth asking: How much is the cataract affecting daily life, such as reading, cooking or walking safely? Are there other eye problems, like AMD, that would limit how much vision improves? Can your parent manage eye drops and follow-up visits, or will someone help? For a parent with dementia, ask how the team handles anesthesia and aftercare, and plan for someone to stay with them for the first days.
Vision rehabilitation and making the most of sight
Low vision is usually permanent, but treatment can sometimes improve vision, make daily tasks easier or keep vision from getting worse, depending on the cause1. For minor loss, the NEI suggests brighter lights, anti-glare sunglasses, a magnifying lens for close-up tasks, and phone and computer settings that increase contrast, enlarge text or read aloud1.
If vision loss is getting in the way of everyday activities, ask the eye doctor about vision rehabilitation1. A specialist can train your parent to use magnifiers, help set up the home so it's easier to move around, adjust phone and computer settings and share resources for coping1.
Changes at home that help
- More light, less glare. Bright, even lighting in hallways, stairs and the kitchen; night-lights to the bathroom.
- Contrast. Colored tape on step edges, a dark cutting board for light foods, a light plate on a dark placemat.
- Big and bold. Large-print calendars, phones with big buttons, labels in thick marker.
- Medicines. Ask the pharmacy for large-print labels, and use a pill organizer with big letters. See medication management.
- Keep things in the same place. Moving furniture or objects can cause falls.
- Clear paths. Remove clutter and loose rugs. See home modifications.
Vision loss is a major fall risk. Our guide to fall prevention has a room-by-room checklist.
Vision and driving
Many people give up driving gradually as vision changes, starting with night driving. If your parent is still driving with worsening vision, ask the eye doctor whether their vision meets the state standard. See when should elderly parents stop driving and transportation for seniors for other ways to get around.
The emotional side
Losing sight can bring grief, frustration and isolation, especially when it means giving up driving or a favorite hobby. Watch for withdrawal and low mood. Audiobooks, large-print books, phone settings that read aloud and support groups for people with low vision can help your parent stay engaged. See loneliness in the elderly and depression in older adults.
Vision loss and care settings
If your parent lives in assisted living or a nursing home, tell staff exactly what your parent can and can't see. Ask how they help residents with low vision find the dining room, read menus and activity calendars, and take medicines. Good lighting, contrasting colors and a consistent room layout matter even more in a new place. When you tour, notice whether hallways are well lit and signs are large. In a nursing home, ask that vision needs be part of the care plan; see care plan meetings.
An example
Harold, 80, kept missing his pills and stopped reading the paper. His son took him for a dilated eye exam. Harold had cataracts in both eyes and early dry AMD. Cataract surgery sharpened his vision a lot, and Medicare covered his new standard glasses after surgery. For the AMD, his eye doctor set a schedule of checkups and showed him how to watch for changes at home. His son added brighter bulbs and a large-print pill organizer. This is an illustration; treatment depends on each person's eyes.
Next steps
Book a dilated eye exam if your parent hasn't had one recently, and bring a list of the changes you've noticed. Ask about vision rehabilitation if daily tasks are getting hard. If vision loss is part of a bigger need for help at home, our home care guide and the care quiz can help you plan.
