Trouble Seeing at Night?

It’s normal for your vision to worsen from the light of day to nighttime’s dark environments. A dimly lit movie theater or driving after sunset can become more challenging as you age. But, for some, night blindness is a chronic condition that significantly reduces visibility in low-light conditions.

“People with night blindness (nyctalopia) are not completely blind in low-light or dark environments,” says Claudia Arroyave, M.D., a comprehensive ophthalmologist at Bascom Palmer Eye Institute, part of the University of Miami Health System. “They can still see to some extent in low light, but they may experience symptoms such as difficulty seeing stars on a clear night, trouble navigating indoors in dimly lit spaces, poor night vision while driving and prolonged adjustment periods when moving from brightly lit areas to darker ones.”

The degree of this visual impairment varies. Some have mild difficulties, while others struggle significantly to see in low-light situations.

What causes night blindness?

Nyctalopia is caused by a dysfunction or degeneration of the retina’s rod cells, which are crucial for vision in low-light conditions. These ocular cells can be affected by eye conditions, including myopia (nearsightedness), glaucoma(and glaucoma medications that close the pupil), cataracts, retinitis pigmentosa and keratoconus. Other causes of night blindness include certain medications, diabetes and vitamin A deficiency.

Is night blindness curable?

“Some causes of nyctalopia can be effectively treated, leading to improved night vision. Successful treatment can restore some degree of night vision, making night driving safer,” Dr. Arroyave says. “Other causes, especially genetic conditions, may have limited treatment options. Early diagnosis and treatment are crucial to managing nyctalopia and maintaining the best possible vision.”

The treatment for night blindness depends on the underlying cause.

For nyctalopia caused by genetic disorders involving degeneration of rod cells (such as retinitis pigmentosa), there is no cure. Dr. Arroyave says ongoing research and clinical trials are exploring gene therapy, retinal implants and other treatments that may help preserve or improve vision for people with these genetic disorders. Some may benefit from low-vision aids and adaptive devices recommended by an ophthalmologist.

When night blindness is caused by cataracts, surgery to remove them can allow more light to reach the retina, which can improve night vision.

Myopia (nearsightedness) is very common. Some individuals experience a condition called night myopia, which makes distant objects appear blurrier at night than during the day. Corrective glasses or contact lenses may improve this.

Other common refractive errors, like astigmatism, can reduce contrast sensitivity, particularly in low-light conditions, even with corrective glasses or contact lenses.

In cases when diabetes is the underlying cause of vision loss, including nyctalopia, managing blood sugar levels and addressing diabetic retinopathy with laser treatments, injections or surgery can help prevent further retinal damage and improve vision.

Sometimes, night blindness is a side effect of particular medications, such as antihistamines, antidepressants and blood pressure medications. Switching medications or adjusting the dosage or time of administration can sometimes restore normal vision.

Night blindness caused by vitamin A deficiency can often be improved with vitamin A supplements.

Can people with nyctalopia drive at night?

“I advise that individuals with nyctalopia (night blindness) take special precautions when considering driving at night due to their reduced ability to see in low-light conditions,” says Dr. Arroyave.

If you’re diagnosed with mild nyctalopia, you may retain enough night vision to drive safely in certain conditions if you take additional precautions. However, those with severe nyctalopia should avoid driving at night. Consider using public transport or ridesharing services.

Dr. Arroyave also recommends checking with your local motor vehicle authority regarding specific licensing requirements or restrictions for individuals with impaired night vision. Compliance with these regulations is crucial for road safety and legal purposes.

Nighttime driving is challenging for many people without nyctalopia, especially older adults.

Several factors can contribute to difficulty in seeing clearly while driving at night, even for individuals who wear corrective glasses or contacts. These factors can affect visual acuity, contrast sensitivity and overall night vision.
Dr. Claudia Arroyave

Wearing contacts and glasses at night:

In darkness, pupils dilate to allow more light in, and at night, tear production decreases. This reduces depth of field and can blur vision, especially when vision problems aren’t fully corrected by glasses or contact lenses. Even with corrective lenses, common conditions like astigmatism can reduce contrast sensitivity, particularly in low-light conditions. Wearing contacts, in particular, can lead to dry eyes, which can cause discomfort and blurred vision. In addition, imperfections in glasses or contact lenses can worsen glare and lens flare, making it harder to see at night. Wearing glasses or contacts with an outdated prescription can reduce visual acuity, and poorly fitted glasses or contacts can cause discomfort and reduce visual effectiveness.

Environmental factors:

Bright lights from oncoming vehicles can cause temporary blindness or discomfort, particularly for those with light sensitivity (called photophobia).

Car air conditioning or heating can dry out eyes, worsening issues with clarity.

Aging eyes:

As we age, several physiological changes occur in the eyes, often worsening night vision and the ability to see in low-light conditions. “Seniors often find it more challenging to drive at night because of decreased pupil size, lens opacity, reduced rod function, slower dark adaptation, increased glare sensitivity and other age-related factors,” Dr. Arroyave says. As a result, our ability to perceive contrast diminishes as we age, making it harder to distinguish objects against dark backgrounds.

Age-related macular degeneration affects the central part of the retina, which is crucial for sharp vision. This condition can make night driving particularly challenging.

Cataracts are a common age-related condition that clouds the lens of the eye and scatters light within the eye, which causes glare and halos around lights. This significantly impairs night vision. Cataracts can also lead to or worsen nyctalopia.

In addition, people with diabetes can develop diabetic retinopathy, which damages blood vessels in the retina and affects night vision.

Safety tips for those living with night blindness

Living with nyctalopia requires some adjustments and precautions to ensure safety and ease in low-light and dark environments. “By incorporating these safety and lifestyle strategies, individuals with nyctalopia can navigate low-light environments more safely and comfortably,” Dr. Arroyave says.

• Get regular eye exams.
• Wear optimized corrective glasses or contacts.
• Consume sufficient vitamin A, which is crucial for eye health.
• Ensure well-lit living and working spaces.
• Use antiglare screens on electronic devices.
• Some night-vision apps can enhance low-light vision using your phone’s camera.
• Wear sunglasses with antiglare coating to reduce daytime eyestrain.
• Use high-powered flashlights and headlamps to illuminate dark areas.

When you are at home:

• Place nightlights in residential hallways, bathrooms and other frequently used areas.
• Install motion-sensor lights in areas like staircases and hallways.
• Use reflective tape on stairs, door frames and other potential hazards.
• Familiarize yourself with your home’s layout to move around more confidently.

When you are in other environments:

Arrive early to movie theaters, before the lights dim. Choose seats near the aisles for easier access and additional lighting. Bring a small flashlight or use your phone’s flashlight to navigate.

Plan outdoor activities during daylight hours and finish before dusk. If hiking or walking in natural areas, stick to well-marked and maintained trails or familiar paths.

When alone, avoid unknown or poorly lit areas. When going out at night, have someone accompany you to help you navigate.

Optimize your eye care.

In addition to regular eye exams with an eye care professional, people with night blindness should have the severity of their condition assessed by an optometrist or ophthalmologist.

If you live in South Florida and need to see an eye doctor, Bascom Palmer Eye Institute, part of the University of Miami Health System, is the nation’s leading medical institution devoted to the eye.

To schedule a consultation, call 305-326-6000 or visit www.bascompalmer.org.

Dana Kantrowitz is a regular contributor to UHealth’s news service.

Tags: Bascom Palmer Eye Institute, Dr. Claudia Arroyave, eye care in Miami, trouble seeing, Vision problems