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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.
•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.
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).
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.
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.
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.
REFERENCESJager, R. D., W. F. Mieler, et al. (2008). "Age-related macular degeneration." N Engl J Med 358(24): 2606-17Solomon 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): 1113-24Rosenberg, E. A. and L. C. Sperazza (2008). "The visually impaired patient." Am Fam Physician 77(10): 1431-6
.Funded by The Donald W. Reynolds Foundation
Figure 4: Diabetic Retinopathy (DR)Figure 3: Cataracts
Figure 2: Primary Open Angle Glaucoma
Figure 1: Age Related Macular Degeneration
Vision Loss and Aging
Insert age-related macular
degeneration picture
Insert cataracts picture
Insert primary open angle glaucoma
picture
Insert diabetic retinopathy picture