Photo courtesy of Southern California College of Optometry at Marshall B. Ketchum University
Encourage routine testing and timely treatment with calm conversations about common age-related eye conditions
By Emily Stephey, OD, FAAO
April 7, 2026
Over years in practice, I’ve learned that the best conversations are honest, concise and calm. When I talk with older patients—or with middle-aged patients worried about aging parents—I try to provide clear, useful information.
Here’s how I explain the three most common age-related eye diseases, what to watch for and ways to make the conversation meaningful without sounding alarmist.
Each condition behaves differently, and our messaging needs to match. I find that patients are often familiar with the names of these diseases, even though they may not know what exactly they mean.
CATARACTS
I tell people plainly: A cataract is the natural clouding of the lens inside the eye. It’s something that happens to most of us if we live long enough, like gray hair.
I highlight these symptoms:
- blurred vision that doesn’t improve with new glasses
- trouble with glare or halos (especially at night)
- colors that look faded
- trouble with contrast
I reassure them that cataracts are treatable; surgery to replace the cloudy lens is the most common surgical procedure performed in the United States. It’s only necessary when vision interferes with activities of daily living such as driving at night, reading or watching TV.
My staff is prepared to talk with patients who may be concerned about cataracts while waiting to see the doctor. They can share that cataracts are common and usually progress slowly. “We’ll monitor closely and talk about surgery if and when your vision starts to affect your daily life.”
GLAUCOMA
Glaucoma is trickier to explain. It’s not a single simple number the way blood pressure can be high or low.
I tell patients: Glaucoma affects the optic nerve, which sends images from the eye to the brain. Glaucoma risk is determined by eye pressure, family history, age and structural features of the optic nerve.
The toughest part to explain compassionately is that early glaucoma often has no symptoms. Peripheral vision can be lost first, and patients typically don’t notice until glaucoma is quite advanced. That’s why I emphasize the importance of routine annual exams and specific tests including visual fields and OCT scans if a patient is at higher risk.
For many people, glaucoma can be controlled with eye drops or laser treatment; for others who maintain risk but appear normal on ancillary testing, we monitor closely.
Staff can be reassuring in the conversation, as well. “We found some changes that we should keep a closer eye on things and do more testing. Catching it early will result in the best prognosis.”
AGE-RELATED MACULAR DEGENERATION (AMD)
AMD affects central vision—reading, recognizing faces and seeing fine detail. Patients sometimes know the phrase “macular degeneration” or have seen TV ads for eye vitamins. I explain there are two broad types: dry (more common, slower progression) and wet (less common, can progress quickly).
I highlight these risk factors:
- age
- family history
- smoking
- lighter skin/eye color
For early dry AMD, we discuss lifestyle changes such as changes in diet and/or smoking cessation. When I talk about the AREDS2 supplement formula, which some have seen advertised, I’m candid that supplements aren’t a cure but can reduce the risk of progression in people who meet the criteria.
PROMOTE FOLLOW UP AND ROUTINE CARE
You want to convey the importance of the follow-up care and additional testing and treatment if needed without scaring them from coming back. In my experience, older patients tend to be a bit more compliant with follow-ups but it’s not always the case.
Staff plays a great role in continuing the conversation. Whenever possible, it’s ideal for them to schedule the next visit before the patient leaves. “We want to see you back in four (or six) months. We can reevaluate, repeat the scans if needed and see if anything has changed.”
Consider implementing a routine for the front desk or your phone team to follow up with patients who don’t schedule right away or those who do not show their appointment. Their compliance is important. Don’t let these patients slip through the cracks.
We also emphasize the importance of routine visits aside from specialty visits. I make the analogy to the dentist, where patients often visit up to twice a year even when they don’t have a toothache. “Even if everything seems fine, there are many factors beyond visual acuity and prescription. It matters when you catch it—even without symptoms. When these conditions are caught early, they are usually more manageable.”
Read more about senior patient care here.
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Emily Stephey, OD, FAAO, is an assistant professor at the Southern California College of Optometry at Marshall B. Ketchum University. She serves as the chief of the Ophthalmology Consultation and Special Testing service, where she manages the clinic department. She also provides patient care in the Primary Care and Ocular Disease clinic department with third-year and fourth-year interns. To contact her: estephey@ketchum.edu |
