Peripheral Vision Loss: Why It Happens and What You Can Do About It

How is peripheral vision loss diagnosed? 

Ophthalmologists and optometrists usually test your peripheral vision as part of a routine eye exam. Abnormalities will trigger further testing. 

An ophthamologist may perform a peripheral vision test during an exam.

Getty Images

For instance, you might take an automated static perimetry test. To ensure the results are as accurate as possible, you’ll wear a patch over the unaffected eye and a prescription lens over the affected eye. Then, you’ll stare at a target inside the center of a bowl-shaped instrument called a perimeter. Each time you see a light flash around the target, you’ll press a button; the machine tracks which lights you don’t see, giving your provider a sense of how well your peripheral vision works. 

What are some of the most common causes of peripheral vision loss in older adults? 

Glaucoma

What it is: Glaucoma can be caused by elevated pressure and fluid in the eye that damages the optic nerve over time, or in cases when the eye pressure is normal it may be caused by lack of proper blood supply resulting in vision problems, unusual headaches and eye pain.

According to the Glaucoma Research Foundation, the disease affects around 3 million Americans — and half of them don’t even know they have it. Having a family history of the disease and being a member of certain ethnic groups increase your risk. “Glaucoma is the number one cause of blindness in the African American community,” says Dr. Ruben Sanchez, an ophthalmologist at Kaiser Permanente in Southern California. “So, there is a higher risk of both developing glaucoma and losing vision from glaucoma if you’re of that ethnicity. And if glaucoma runs in your family, it’s really important that you’re routinely screened for it at regular intervals.” 

As it progresses, glaucoma makes older adults vulnerable to serious falls and fractures, and the fear of progressively going blind can lead to anxiety and depression. 

How to prevent it: It’s essential to manage diabetes and high blood pressure, two major risk factors.

Sabel’s recommendation: “The other thing you can do that we recommend to our patients is to drink more water. Hydrating can also enhance blood flow to the eyes. I recommend a half a gallon per day.”

How to treat it: “If glaucoma is caught in the early stages, then the first-line treatment is using eye drops, many of which do not have systemic side effects. Some of them do, but overall, eye drops have a very low-risk profile,” Sanchez says. If glaucoma isn’t well controlled with eye drops, surgery is the next option. 

Read more on treatments for glaucoma.

Proliferative Diabetic Retinopathy (PDR) 

What it is: The most advanced stage of diabetic eye disease where the retina grows new blood vessels (neovascularization). These fragile blood vessels break and release blood that causes floaters, blurriness, fluctuating vision, peripheral vision loss and central vision loss. It can even trigger tractional retinal detachment, Sanchez explains, which can lead to profound vision loss. 

How to prevent it: In five years or less, roughly two percent of type 2 diabetes patients will develop PDR. And the risk increases with time. Even if you take metformin, insulin or weight loss drugs commonly prescribed to diabetics such as Ozempic, making healthy changes to stabilize your blood sugar and lose weight is essential for preventing PDR from occurring or progressing. Be mindful of how much sugar you eat, get enough sleep, keep your stress levels under control, get moving every day and avoid drugs and alcohol. 

How to treat it: Your doctor may prescribe medications like Avastin and Eylea, which may slow or even improve PDR-induced vision loss. If you have advanced PDR, your doctor may use laser surgery to seal the tiny, leaking blood vessels. 

Another surgical option is to replace the clear, viscous gel behind the lens and in front of the retina with another solution, but it comes with risks such as retinal detachment, developing cataracts, lens damage, problems with eye movement and infection. 

Stroke

What it is: Reduced blood flow to the brain (ischemic) or uncontrolled bleeding in the brain (hemorrhage) that leads to a life-threatening emergency. More than 795,000 U.S. Americans suffer from stroke each year, according to the Centers for Disease Control (CDC). And peripheral vision loss is a common complication: A study published in PloS One that examined more than 1,000 stroke patients found that 73 percent of survivors experienced impaired vision. How to prevent it: Kick your vices – and prioritize your mental health. For one, research shows that any form of smoking can increase the chances of ischemic stroke, and so does ongoing mental stress. 

How to treat it: In the event of a stroke, it’s important to act quickly and call 911. If an ischemic stroke patient is seen within three hours of onset, doctors can use tissue plasminogen activator (tPA) to break down the blood clot to enhance blood flow or other medical procedures to open a blockage and restore blood flow. Hemorrhagic stroke may require aneurysm clipping or coil embolization to stop the bleeding, plus high blood pressure medications to help lower your blood pressure that may be contributing to or causing the bleeding. 

Retinal detachment

What it is: The thin layer of tissue at the back of the eye that helps us convert light into images (the retina) detaches or pulls away from its normal position and disconnects from blood vessels that nourish the eyes. This can be a gradual process (with ageing) or more sudden, due to trauma. Many patients report a sudden increase in floaters, flashes of light and abrupt or gradual peripheral vision loss. If left untreated, retinal detachment will result in partial or total blindness. 

How to prevent it: Age-related changes to the vitreous gel increase the likelihood of retinal detachment, as does severe nearsightedness and head and eye injury. You can lower your risk by managing all forms of diabetic retinopathy and other eye diseases, such as retinal thinning. It’s also important to take preventative measures and address comorbidities, such as diabetes.

How to treat it: If this is caught early, your surgeon will use a laser or freezing (cryopexy) technique to reattach your retina to the back of the eye again. In the case of a larger retinal detachment, you may need surgery. 

Can you improve your peripheral vision? 

Getting regular eye care and engaging in a healthy lifestyle of exercise and healthy eating can help improve general eye health and peripheral vision, particularly by keeping your blood pressure in a healthy range and staying on top of diabetes if you have the condition. 

There’s research showing that in combination with a healthy lifestyle, supplements may help improve your peripheral vision. Sabel suggests speaking with your doctor about supplementing your diet with  AREDS2, a multivitamin that received its name from Age-Related Eye Disease Studies supported by the National Eye Institute. AREDS2 contains vitamin C, vitamin E, copper, zinc and other powerful nutrients that may help your vision. 

You should also get a comprehensive blood test to see if you have a B12 deficiency, or other vitamin deficiencies that trigger inflammation in the eye and the rest of the body. 

But the best way older adults can boost their vision is by catching problems before they start. 

“Every person after the age of 60 should get regular vision screenings,” Sanchez says. “So, whether that’s with an optometrist or an ophthalmologist, we need to check the health and the function of the optic nerve.” It’s the most effective way to spot the warning signs of glaucoma before they progress and cause noticeable vision loss, he explains. The same goes for other diseases of the eye.