presbyopia
farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age.
Inability to focus on near objects begins after 40
Caused by gradual hardening of the lens decrease musculature effectiveness of the ciliary bodies
What is Arcus Senilus?
Arcus Senilus (corneal arcus) is an opaque grayish to white ring at the periphery of the cornea caused by deposits of cholesterol or fats.
What does Arcus Senilus indicate in patients under 45?
Arcus Senilus can indicate lipid disorders.
Is intervention required for Arcus Senilus in the elderly?
NO
it should just be monitored as it will not cause visual acuity issues.
ARMD (age related macular degeneration)
And how’s it diagnosed
slow, progressive loss of central and near vision. most common cause of irreversible vision loss in > 60 world wide
Dx: funduscopic exam: prescence of drusen lesions
what does macular degeneration look like?
What’s the tx
presence of drusen (dry form: yellow deposits under retina) or choroidal neovascularization (CNV) (wet form: new blood vessels in choroid layer).
-patient complain: dark spot in central vision
Tx: dry: vitamins (C, E, zinc, lutein, zeaxanthin) Dec risk of CNV
Wet : intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors ocular injections tx CNV
What is the most common cause of irreversible blindness in the world?
macular degeneration
Risk: age/genetic/smoking/htn/fair skin
what is the treatment for cataracts?
Surgical (extraction) replacement of the lens of the eye
Local or topical anesthesia , small incision, aspiration of old lens, insertion of artificial lens
90% achieve 20/40 vision or better
Symptoms of cataracts in older adults
Increased glare (especially at night)
Dec ability to recognize contrast
Dec visual acuity
Change in color perception
Definition of glaucoma
optic nerve head damage & visual field loss
Affects >2.2 million Americans >40
Most common in black American
Inc IOP major risk factor but may w/glaucoma have normal pressure
open angle glaucoma (primary)
most common
drainage angle formed by iris and cornea stay open. other parts of drainage system don’t drain properly = slow, gradual increase in eye pressure.
Slow aqueous fluid buildup, leads to chronically inc IOP
asymptomatic can suffer peripheral vision field loss before consulting ophtho
Multi factorial and polygenic
what is closed angle glaucoma (acute angle closure)
enlarged iris blocks fluid (drainage angle btwn Iris and cornea is blocked) from draining properly in your eye (aqueous humor cannot drain) This causes your intraocular pressure to rise then have sx
Acute (sudden-complete block): rapid pressure, buildup causes eye pain, headache, redness with acute vision loss, N/V. (Ophthalmologic emergency referral)
Signs and symptoms of closed angle glaucoma?
eye pain
headache
ocular hyperemia
hazy cornea
dilated pupil
decreased vision
N/V
Closed angle glaucoma treatment
Glaucoma management
acetazolamide (PO or IV)
-surgery
Mgmt: laser trabeculoplasty, drainage devices (stents), ciliary body destructive procedures, filtering surgery with or w/o antimetabolite, drops
And IOP lowering meds (local/systemic)—aqueous suppressant/aqueous outflow facilitators
How often for routine ophthalmology follow up?
Comprehensive eye exam every 1-2 years for adults 65+, monitor IOP, visual fields, early detection of cataracts, glaucoma, and macular degeneration
-make sure patients are seeing eye doctor
S/S that require immediate referral to ophthalmology
retinal detachment
acute angle closure glaucoma
ischemic optic neuropathy
central artery occlusion or giant cell arteritis
bacterial keratitis
scleritis
posterior uveitis
corneal ulcers
uveitis
herpes zoster opthalmicus
S/s of retinal detachment
flashes, floaters, decreased vision
s/s of ischemic optic neuropathy
sudden loss of vision (complete or partial) in one eye, swollen optic nerve
s/s of central artery occlusion or giant cell arteritis
sudden painless loss of vision in one eye, if from giant cell arteritis then review of symptoms may revel jaw claudication, headache and transient diplopia
S/S of Bacterial Keratitis
Decreased vision, eye redness, pain, discharge
S/S of Scleritis
Eye redness, pain, decreased vision
S/S of Posterior Uveitis
Floaters, decreased vision
What are common refractive errors seen in older adults?
And Tx
Leading cause of visual impairment worldwide (along with cataract)
Ametropia (inability to focus)
- Astigmatism: visual distortion
- Myopia: nearsightedness
- Hyperopia: farsightedness
Tx: eyeglasses, contacts, laser surgery
Prevalence of cataracts and adults > 75
And risk factors for cataracts
~50% or more have cataracts
RF: age, dec vitamin intake, UV light exposure, smoking, alcohol, long-term steroid use, diabetes
