As the global population ages, ophthalmologists are increasingly presented with patients whose vision is shaped as much by the biology of aging as by discrete pathology. And yet, as a biological process in its own right, it has seldom been the central subject of clinical inquiry—until now. Aging in Ophthalmology, co-edited by Jorge L. Alió, MD, PhD, FEBOphth, FWCRS; Andrzej Grzybowski, MD, PhD; and Anat Loewenstein, MD, MHA, is what Professor Alió describes as the first comprehensive work dedicated to ocular aging, drawing on contributions from 60 international experts across 21 chapters.¹

In this Q&A conversation with the Eye Care Network, Professor Alió reflects on the core concepts behind the work, the role of aging as a disease driver, structure-specific changes across the eye, the translational impact on clinical practice, the evidence base for prevention and modifiable factors and what the future holds for the field. He is professor and chairman of ophthalmology and scientific emeritus at Miguel Hernández University in Alicante, Spain.

Note: Transcript edited for clarity and length.

Professor Alió, what motivated you and your co-editors to develop a comprehensive volume focused specifically on aging in ophthalmology?

Jorge L. Alió, MD, PhD, FEBOphth, FWCRS: Aging is a process [that is] now dominant in our Western societies. Aging is the main reason for disease in patients over 60, and the generation of baby boomers—many [of whom] are reaching the level of [centenarians]—makes everything even more important. The aging process should be better known, [as should] the measures to prevent it [and] its consequences, in order to be preventable in part. The treatment alternatives for the aging process of the different structures of the eye [have] experienced very extensive development over recent years. All these issues together deserve to be comprehensively addressed in the book.

How would you characterize the role of aging as a central risk factor across ocular diseases such as cataract, glaucoma and age-related macular degeneration (AMD)?

Professor Alió: Aging is the main driver of these diseases. AMD especially is becoming prevalent in up to 30% of patients over the age of 70 in Western Europe. Glaucoma increases over time, and cataract is universal above the age of 70. With this, and the parallel decay that happens in the lacrimal system, ocular surface and eyelid system, it is clear that aging makes a global impact on the visual performance and quality of life of patients—[a population] in which aging is a process that affects the whole body.

The volume examines aging across multiple ocular structures. Which age-related changes in the lens, cornea or retina do you feel remain most under-recognized in clinical practice?

Professor Alió: What is under-recognized in clinical practice [is an awareness of] the expectations [of] ocular disease related to aging and how to detect [these changes] properly to avoid their consequences and in some cases to prevent them adequately. The role of diet, vitamin therapy, dietary supplements [and] lifestyle [are] addressed in this book, as this multi-author structure allows [for] different perspectives on the topic from the diagnostic, therapeutic and pathophysiology perspective.

How do you see current knowledge on ocular aging influencing day-to-day clinical decision-making or surgical planning for ophthalmologists?

Professor Alió: Patients need to know what is happening to the eye and the related ocular structures [in] parallel [with] aging. The reason for that is that they should seek preventive [measures] based on early diagnosis [and] using therapies that are adequate to implement—for instance, [addressing] the ocular surface, especially in women after menopause; early detection of glaucoma; and the treatment of universal problems like presbyopia that [make] some activities difficult to perform, as the need for glasses happens universally at a certain age. The different options to study the lens and the consequences [for] quality of vision are described, such as the dysfunctional lens syndrome [as described by our group] years ago, [which] is dominant…now, with the current alternatives [including] different types of intraocular lenses—including the newly appeared accommodative ones—[making] lens substitution [a reality] in the restoration of vision beyond a certain age. Ophthalmologists, properly analyzing these issues, can guide patients towards adequate modifications in quality of life, the use of preventive therapies, dietary supplements and, [eventually], surgeries, depending on the type of problem [being] addressed.

The work includes evidence-based perspectives on prevention and dietary supplementation. What do you consider the strongest evidence-supported strategies for influencing ocular aging trajectories?

Professor Alió: Today medicine is evidence based. It is not [solely] the art of being a doctor. This art is much more focused on how we inform and educate our patients about the impact of aging [on] their eyes. Evidence-based medicine is dominant throughout the book and all the statements have been made with special consideration [for] their fundamental [grounding in] evidence published in the ophthalmic literature. This evidence-based methodology is dominant throughout the whole book and all the chapters have been the subject of internal peer review…to [ensure] that this is accomplished in every one of the chapters.

Looking ahead, how do you expect the field of ophthalmology to evolve as we deepen our understanding of the biology and mechanisms of ocular aging?

Professor Alió: [As] we understand better the biology and mechanism[s] of ocular aging, we shall be able to prevent them in part. It is not only about early diagnosis of disease and its adequate therapy. It is not only about lens substitution [when] the dysfunction of the crystalline lens [reaches] levels that deserve to be the subject of surgery. It is about knowledge. The knowledge about the mechanism[s] of aging will [enable] much more preventive measures and therapies that aim to decrease the negative effects of aging on the eye and its structures in a medically appropriate management of ocular aging.

Jorge L. Alió, MD, PhD, FEBOphth, FWCRS

E: [email protected]

Jorge L. Alió, MD, PhD, FEBOphth, FWCRS, is professor and chairman of ophthalmology and scientific emeritus at Miguel Hernández University in Alicante, Spain. He is also Chair LXIII of the Academia Ophthalmologica Internationalis, Chair XLIX of the European Academy of Ophthalmology, and founder of Vissum Miranza and the Fundación Jorge Alió. Financial disclosures: none reported

REFERENCE

1. Alió JL, Grzybowski A, Loewenstein A, eds. Aging in Ophthalmology. Elsevier Academic Press; 2024.