Hearing and vision: the modifiable risks nobody talks about

This page is short and its content is out of proportion to its importance, because hearing and vision problems are common, under-treated, and connected to outcomes people do not expect.

Hearing loss is one of the strongest modifiable risk factors for dementia. The association is consistent across studies, the mechanism is plausible (reduced stimulation, social isolation, increased cognitive load), and hearing aids may reduce the risk — which makes getting assessed one of the highest-value preventive actions available to an older adult. It is also associated with depression, falls and social withdrawal. The intervention is a hearing test and, if indicated, hearing aids.

Age-related macular degeneration is the commonest cause of severe visual loss in older people, and nutrition has a real role. The AREDS2 formulation — specific doses of lutein, zeaxanthin, zinc, vitamin C and vitamin E — reduces progression to advanced AMD in people with intermediate AMD, and it is the standard recommendation for that group. Note the population: it reduces progression in people who already have intermediate AMD, not in everyone as a preventive. Lutein and zeaxanthin are dietary components (leafy greens, egg yolk, corn) and the macular pigment responds to intake.

Smoking is the strongest modifiable risk factor for AMD, and stopping helps. Blood pressure control matters. Sun protection for the eyes matters.

Dry eye is common, and the evidence-based measures are lubricating drops (preservative-free if used more than four times daily), warm compresses and lid hygiene for meibomian gland dysfunction, treating blepharitis, reducing screen time and ensuring blinking, and adequate hydration. Omega-3 supplements have been tested in large trials and did not outperform placebo for dry eye — a good example of a plausible mechanism failing in a trial. Cyclosporine drops and other treatments are prescribed.

Bacterial conjunctivitis is usually self-limiting and resolves in 5-7 days without antibiotics in most cases; antibiotic drops shorten it modestly. A red eye with severe pain, reduced vision, a fixed pupil, or contact lens use is an emergency — it could be keratitis or acute glaucoma.

Cataract is treated surgically and there is no supplement that reverses it. Vitamin C and dietary antioxidants are associated with lower risk in observational studies; the trials have not shown supplementation to prevent cataract.

The honest framing. For hearing and vision, the interventions that matter are assessment, correcting the problem (hearing aids, glasses, cataract surgery, AMD treatment), and stopping smoking. Supplements play a role in one specific situation (AREDS2 in intermediate AMD) and essentially nowhere else.