Vision loss in older age: common causes, eye tests and support in the UK

The eye is a delicate system: the cornea and lens focus light, the retina at the back senses it, the macula gives sharp central detail and the optic nerve carries the signals to the brain. Age brings changes to several of these parts, and some conditions become more common after 50 or 60. The NHS says cataracts usually affect older adults, glaucoma is most common in adults aged 50 and over, and age-related macular degeneration usually first affects people in their 50s.

Not all vision change is a disease. Needing reading glasses for close work and needing a new prescription from time to time are common. But gradual changes can hide conditions that are treatable, and some, such as glaucoma, cause no symptoms early on. That is why regular eye tests matter even when you feel your sight is fine.

This page is a guide to the main groups of causes. For each, there is a more detailed page for the condition.

The table below summarises what the NHS and RNIB say about the common causes of age-related vision loss.

The NHS says cataracts develop slowly and symptoms include blurred vision, difficulty seeing at night, difficulty reading or watching television, sensitivity to light and glare, double vision, halos around lights and faded colours. Surgery is done under local anaesthetic, replacing the cloudy lens with an artificial one, and you should be able to go home the same day.

Glaucoma is a condition in which the main nerve connecting the eye to the brain becomes damaged. The NHS says it is usually caused by a build-up of pressure when fluid cannot drain as it should, that it usually affects both eyes but may be worse in one, and that risk is higher if you are over 50, have a parent, brother or sister with glaucoma, are from a Black African, Caribbean or Asian background, or have short-sightedness, long-sightedness or diabetes. Sometimes glaucoma develops suddenly with intense eye pain, a red eye, rainbow-coloured circles around lights, blurred vision, sickness and headache, which the NHS says is a medical emergency needing 999 or A&E.

RNIB explains that the first thing people with age-related macular degeneration usually notice is that it is harder to see detail such as small print, with a small blurred area in the centre of vision, straight lines that look wavy or distorted, and sensitivity to bright light. It describes early AMD, often found at a routine eye examination, and late AMD, which is either dry (very slow, with a dark or missing area in the centre) or wet (new blood vessels growing and leaking, which can develop within days or weeks).

RNIB says wet AMD can be treated on the NHS with anti-VEGF injections, usually starting with three injections a month apart, that treatment usually needs to be given quickly and that suspected wet AMD should be seen by an eye clinic within two weeks. It says early and dry AMD has no treatment, and advises checking vision at home with door frames or tiles and telling your optometrist straight away about a change.

The NHS says diabetic retinopathy usually has no symptoms at first and is found at diabetic eye screening, which is offered every 1 or 2 years to people with diabetes aged 12 or over. Later symptoms include worsening eyesight, blurred vision, floaters and difficulty seeing in the dark. It says to ask for an urgent GP appointment or contact NHS 111 if you have diabetes and your eyesight suddenly gets worse or becomes blurred.

Several UK pages draw a line between slow change, which needs an eye test, and sudden change, which needs help the same day. The NHS says to see a GP or optician if you have any concerns about your vision, and to call 999 or go to A&E for sudden symptoms of acute glaucoma. Its cataract surgery page says to get NHS 111 help if floaters suddenly appear or increase, you see flashes of light, a dark curtain or shadow moves across your vision or your vision suddenly blurs, which could be signs of a detached retina.

RNIB says that changes in vision from wet AMD can happen quickly and that if you notice changes you should see your optometrist straight away. Do not wait for your next routine appointment if something changes.

The NHS says everyone should have regular eye tests at least every 2 years, with more frequent tests if you are at higher risk, for example with a close relative with glaucoma. An eye test is carried out by an optometrist at a local optician, and some people can receive free tests on the NHS.

NICE guidance says that an adult with a cataract should be encouraged to have an eye examination by an optometrist to assess visual acuity accurately and exclude other causes of impaired vision. Glaucoma is usually found during routine tests and then referred to a specialist eye doctor for further tests. People with diabetes are invited for retinal photography at diabetic eye screening.

Even when sight cannot be restored there is a lot of practical help. RNIB says most people with AMD have some vision and there are many ways to make the most of it, including making things bigger, using brighter lighting and using colour. It says a low vision assessment from your eye clinic or optometrist can explore magnifiers, aids and vision strategies such as eccentric viewing, and that an eye clinic may have an Eye Care Liaison Officer or sight loss adviser.

The NHS says that if you have some sight loss it can be difficult to come to terms with, and support groups and national charities can help. On driving, the NHS says you must let the DVLA know if your eyesight does not meet the minimum standards for driving, and RNIB says you are required by law to tell the DVLA about an eye condition that affects both eyes, or one eye if you only have sight in one.

The NHS also describes Charles Bonnet syndrome, where people who have lost a lot of their sight see things that are not real. It is not caused by a mental health problem or dementia, most people know the images are not real and it usually becomes less frequent over time. A GP can refer for talking therapy if it is upsetting.

Most eye care in older age starts at a high street optician, who refers you on to NHS hospital eye services, which provide cataract surgery, glaucoma care and injections for wet AMD. Some people choose private consultations or cataract surgery to reduce waiting time or to choose a lens type. The tests and treatments for the conditions above are the same, so ask any provider about the follow-up arrangements for conditions that need long-term monitoring, such as glaucoma and AMD.