Vision Health and Diagnosis
Presbyopia is an age-associated progressive loss of the focusing power of the lens, and increases with age. Age related macular degeneration (AMD) is the leading cause of severe vision loss in older Americans. It is characterized by atrophy of cells in the central macular region of the retinal pigment epithelium resulting in the loss of central vision.
Glaucoma is the second leading cause of blindness in the United states . Although glaucoma is most often associated with elevated Intraocular pressure (IOP), it is the optic neuropathy that defines the disease. Patients with acute angle-closure glaucoma typically present with unilateral intense pain and blurred vision. Any opacification of the lens is termed a cataract.
Cataract disease is the most common cause of blindness worldwide and the most common eye abnormality in the elderly. Because the cataracts tend to develop slowly, the patient may not be fully aware of the degree of vision impairment.
Diabetic Retinopathy is the leading cause of blindness in adults in the United states . The disorder has four stages: 1) mild, 2) moderate, 3) severe nonproliferative retinopathy, and 4) proliferative retinopathy.
Vision Health Interventions
Because presbyopia is due to normal age-related changes of the eye, there is no proven prevention. All patients should be educated to anticipate a decline in near vision with aging. When left uncorrected, problems may occur with reading, driving, or other activities. Treatment for this disorder is as simple as purchasing reading glasses.
AMD – Current treatment options include laser photocoagulation, photodynamic therapy, and antiangiogenesis medications.
Glaucoma – The primary treatment of open-angular glaucoma consists of pharmacologic and surgical interventions aimed at decreasing the IOP.
Cataracts – The treatment of cataracts is predominately surgical. Although small cataracts may be treated by an updated eyeglass prescription, but most benefit surgical removal of the cataract and replacement of the lens.
Diabetic Retinopathy – In addition to maximizing glucose and blood pressure control, laser photocoagulation surgery (focal and scatter) or vitrectomy is the mainstay of acute and chronic treatment and may preserve vision in certain patients. Vision rehabilitation should be sought when vision is lost. Social Issues & Barriers To Care
Sensory impairment affects up to two thirds of the geriatric population. Identification, evaluation, and treatment of these conditions may improve patient’s quality and quantity of life. The impact of sensory impairments is significant. The same objective level of sensory function can result in different levels of disability depending on the needs and expectations of patients. Vision and hearing impairments have been linked with the wish to die in elderly patients. Poor hearing and vision is associated with depression as well as decreased quality of life, mental health, and physical, social, and cognitive functioning. Vision impairment increases the risk of death and is associated with an elevated risk of falling and hip fracture. Patients should be counseled about available treatments when abnormalities are identified, and referred to vision health resources promptly.
Goldzweig, CL, et al, Preventing and managing visual disability in primary care. Clinical applications. JAMA 2004; 291:1497. [PMID: 15039417].
Rowe, S. et al: Preventing Visual loss from chronic eye disease in primary care: Scientific review. JAMA 2004;29:1487. [PMID: 15039416]
Vision Health Resources
Lighthouse International (health information on vision disorders, treatment, and rehabilitation services)
National Institute on Aging (patient education handout on the aging eye and hearing loss)
Division of Blind Services (local office): 352-955-2075
Center for Independent Living: 352-378-7474
Alachua County Elder Care Services: 352-265-9040
Gainesville Community Ministry: 352-372-8162
Vision Health Facts
According to one estimate, approximately 10 million people in the United States are blind or visually impaired. American Foundation for the Blind (AFB).
Recent figures also indicate that only 46% of working-age adults with vision impairments and 32% of legally blind working-age adults are employed. Job Accommodation Network, Work-Site Accommodation Ideas for Individuals with Vision Impairments, citing AFB statistics from 2000.
Vision impairment can occur at any time in life, but as a person’s age increases, so does the likelihood that he or she will have some form of vision impairment. National Center for Health Statistics, U.S. Dept. of Health and Human Services, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2002, Vital and Health Statistics, Series 10, No. 22 (DHHS Publication No. 2004-1550) (July 2004).