Transcript Vision Loss and Aging

Vision Loss and Aging
Blindness or low vision effects more than 3 million Americans 40 years and older, and this number is
projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and co-morbid medical
issues, physicians must be aware of the physical limitations and social issues associated with vision loss to
optimize health and independent living for the visually impaired patient.
Insert age-related
macular
degeneration
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Figure 1: Age Related Macular Degeneration
Insert cataracts
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Age-related macular degeneration (AMD).
(Fig. 1) AMD is the most common cause of
blindness in Americans over 50, and risk
factors include older age, smoking, and
hypertension. Vision is lost in central visual
fields, and diagnosis is made by exam,
which shows macular exudates (drusen) in
dry AMD, and macula hemorrhage in wet
AMD. There is a range of treatments,
including vitamin, antioxidant and zinc
supplementation, intra-ocular injection of
monoclonal antibodies, and laser therapy.
AMD may be preventable with risk factor
reduction (smoking cessation) and a diet
rich in anti-oxidants (green leafy
vegetables).
Cataracts. (Fig. 3) Cataract is the most
common cause of blindness worldwide.
Cataracts are central (nuclear) or
peripheral clouding of the ocular lens,
leading to decreased visual acuity,
decreased color perception, decreased
contrast sensitivity, and glare disability.
Risk factors include age, smoking, UV
radiation exposure, and corticosteroid
use. Treatment is lens replacement with
an intra-ocular lens using
phakoemulsification, and visual function
is restored in
the majority of patients.
Figure 3: Cataracts
REFERENCES
Jager, R. D., W. F. Mieler, et al. (2008). "Age-related macular degeneration." N Engl J Med 358(24): 2606-17
Solomon R, Donnenfeld ED. (2003). “Recent Advances and Future Frontiers in Treating Age-related Cataracts.” JAMA; 290(2): 248-251
Kwon, Y. H., J. H. Fingert, et al. (2009). "Primary open-angle glaucoma." N Engl J Med 360(11): 1113-24
Rosenberg, E. A. and L. C. Sperazza (2008). "The visually impaired patient." Am Fam Physician 77(10): 1431-6
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Funded by The Donald W. Reynolds Foundation
•Vision problems are common with
aging and the goal is to maintain
functional vision, independence, and
prevent injuries, MVAs and falls.
•Common vision problems include
cataracts, glaucoma, aging-related
macular degeneration, and diabetic
retinopathy and many are treatable.
•Eye medications should be recorded
and continued during hospitalization
•New visual symptoms should be
evaluated promptly, including a
funduscopic exam and referral to an
ophthalmologist.
•Older patients should be examined
for aging related vision-threatening
disease every year.
Primary Open Angle Glaucoma. (Fig. 2)
Primary open angle glaucoma occurs
more in African Americans, and may cause
peripheral vision loss (tunnel vision).
Funduscopic exam shows increased
diameter and cupping of the optic disc,
with vision loss due to loss of central
retinal ganglia. Intraocular pressure is
usually elevated and thought to be caused
by reduced aqueous humor drainage
through the trabecular meshwork and
Canal of Schlem. Treatment reduces
intraocular pressure, and is primarily
topical ocular medications or surgical
iridectomy. Narrow angle glaucoma, an
ocular emergency, occurs more commonly
in Asians and presents with eye pain,
nausea, acute vision loss and rapid
increase in intraocular pressure.
Diabetic retinopathy (DR). (Fig. 4)
Among US adults 40 years and older
known to have DM, the estimated
crude prevalence rates for
retinopathy and vision-threatening
retinopathy were 40.3% and 8.2%,
respectively. Early DR is characterized
by background changes, exudates,
and progresses to proliferative stage
and finally retinal hemorrhage, which
produces traction on the retina and
blindness. There is no convincing
evidence that diabetic retinopathy
responds to very tight glucose control,
and severe DR marked by macular
edema is treated with laser
photocoagulation. Vision-enhancing
devices can help magnify objects, and
non-optical interventions include
special filters and enhanced lighting.
Insert primary open
angle glaucoma
picture
Figure 2: Primary Open Angle Glaucoma
Insert diabetic
retinopathy picture
Figure 4: Diabetic Retinopathy (DR)