Download Aging Q3 Vision Loss Detailing Sheet - 66 KB

Vision and Aging
Blindness or low vision affects 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.
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Vision problems are common with aging and the goal is to maintain
functional vision, independence, and prevent injury such as 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 annually.
Age-related macular degeneration (AMD)
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 s 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).
{Insert Age-related macular degeneration picture}
Cataracts. 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 intraocular lens using phakoemulsification, and visual function is restored in the
majority of patients.
{Insert Cataracts picture}
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Vision and Aging
Glaucoma. 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.
{Insert Glaucoma picture here}
Diabetic retinopathy (DR). 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 nonoptical interventions include special filters and enhanced lighting.
{Insert Diabetic retinopathy picture}
REFERENCES
Jager RD, Mieler WF, Miller JW. Age-related Macular Degeneration. New Engl J Med; 358 (24):2606-2617.
Solomon R, Donnenfeld ED. Recent Advances and Future Frontiers in Treating Age-related Cataracts.
JAMA;290 (2):248-251.
Kwon YH, Fingert JH, Kuehn MH, Alward WLM. Primary Open-angle Glaucoma. New Engl J Med; 360
(11):1113-1124.
Rosenberg EA, Sperazza LC. The visually impaired patient. Am Fam Physician. 2008 May 15;77(10):14316.
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