Understanding Age-Related Vision Changes

As we age, many of us come to expect a decline in our eyesight. The reliance on reading glasses or various devices seems to reinforce this belief. A multitude of eye conditions can arise as we grow older, including glaucoma, cataracts, and age-related macular degeneration (AMD). These issues often stem from nerve damage or unusual deposits forming on the lenses of our eyes.

AMD, as the name implies, is connected to aging. The National Eye Institute (NEI) explains that age-related macular degeneration is a condition that can obscure the sharp, central vision essential for tasks such as reading and driving. The term "age-related" indicates that this condition primarily affects older individuals, while "macular" refers to its impact on a specific area of the eye known as the macula.

According to the NEI, AMD is a prevalent condition and a leading cause of vision impairment for those aged 50 and above. Although AMD does not result in complete blindness, the loss of central vision can significantly hinder one's ability to recognize faces, operate a vehicle, or engage in close-up activities like cooking or repairing household items.

In some individuals, AMD progresses slowly, and even those with early signs may not notice immediate vision loss. Conversely, others may experience a rapid decline, affecting one or both eyes.

The primary issue with AMD is its commonality and its status as a significant contributor to vision loss in older adults. But what exactly does AMD do to our eyesight?

According to the NEI, AMD involves the degeneration of the macula. The VMR Institute elaborates that the macula is the central area of the retina, which is the light-sensitive tissue lining the eye. This region is crucial for achieving "20/20" vision and for optimal color perception. Thus, any degeneration in the macula can lead to decreased sensitivity to light, making it challenging to recognize faces, drive, or perform close work.

The accumulation of drusen, which are small yellow deposits of fatty proteins under the retina, is a problem associated with AMD. These drusen obstruct light from reaching the retina, resulting in impaired vision — leading to a situation where we cannot see as clearly as we should.

Unfortunately, these deposits are linked to both metabolic and inflammatory issues. A recent article noted that AMD is classified as a vascular-metabolic-inflammatory disease. It is characterized by two types of extracellular deposits, soft drusen/basal linear deposit (BLinD) and subretinal drusenoid deposit (SDD), which contribute to severe stages of atrophy and neovascularization.

This indicates that the fatty drusen deposits are related to problems in cholesterol metabolism.

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Additionally, research has shown that Advanced Glycation End-products (AGEs) are present in these drusen deposits. AGEs accumulate with age and are associated with various age-related conditions, including Alzheimer’s disease, atherosclerosis, and AMD. Studies suggest that AGEs contribute to oxidative stress, cell death, and the buildup of lipofuscin within the eye.

These AGEs can be detrimental, particularly in the context of high sugar consumption, which has implications for our overall health and well-being.

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Another significant factor is that diabetes increases the risk of developing AMD, although diabetics may first experience diabetic retinopathy.

It is crucial to take steps to safeguard our eyesight. If proteins and lipids can clump together and form solid deposits on our eye lenses, could similar processes occur elsewhere in the body? Indeed, we observe analogous situations with amyloid beta plaques in the brain, leading to inflammation, neuronal death, and potentially Alzheimer’s disease.

The possibility of protein misfolding triggering pathways to both Alzheimer's and AMD is a troubling reality, as many elderly individuals globally confront these challenges.

Joel Yong, Ph.D., is a biochemical engineer and educator dedicated to elucidating the biochemical mechanisms that influence health and well-being, often misunderstood by the general public. He aims to make this information accessible to everyone through his writings and educational efforts.