2. Masoud R. Manaviat, M.D. June 2011
Aging and the eye
Masoud R. Manaviat, M.D.
June 2011

3. The Challenges of Aging – How older patients are different from all other patients
As people age, some physiologic changes are inevitable
Other changes, while not universal, are far more common than among younger people
Older people also face unique psycho-social challenges
These changes and challenges can lead to a variety of geriatric syndromes and issues
These in turn can lead to poor health outcomes, functional decline, frailty, disability and dependence

4. Physiologic Changes Associated with Aging
Examples of universal changes
Decreased night vision
Decreased muscle mass
Loss of hair pigment
Decreased lung vital capacity
Decreased height
Decreased gait speed

5. Physiologic Changes Associated with Aging
Examples of changes (including diseases) that are increasingly common, though not inevitable, as people age
Hearing loss
Macular degeneration
Hypertension
Heart disease
Cancer
Parkinson’s disease
Dementia

6. Social Problems More Common with Aging
Loss of income
Loss of close family
Loss of community
Social isolation

7. Geriatric Syndromes Sensory Impairment (Visual and Hearing)
Gait Impairment
Falls
Incontinence
Dementia
Depression
Delirium
Polypharmacy
Sleep Problems
Pressure Ulcers

8. The Challenges of an Aging Population – Why it matters
In the 2000 US Census, 12.5% of the US population was >64
By 2030, it is predicted that 20% of the US population will be >64
As the elderly population increases the care needs and expenditures for that care will increase
The geriatric workforce is not predicted to increase to meet this demand

9. Sensory Impairment - Vision
Visual impairment affects 20-30% of people over the age of 75.
Visual impairments that occur with greater frequency as people age include
Refractive error
Cataracts
Glaucoma
Macular degeneration
Diabetic retinopathy
Blindness

10. Age-Dependent Changes:
Physiological and Performance

11. Aging Eye

12. General Aging Changes Mostly affect appearance
Seldom affect performance
Some need monitoring with age
Lens
Aqueous Humor
Retina
Macula

13. General Aging Changes Sclera- thinner, pigment change
Aqueous Humor- intraocular pressure 
Vitreous Humor- thins, opacity 
Cornea- arcus senilis (Ca and cholesterol), sensitivity 
Iris- muscles weaken, smaller pupil
Lens size and thickness , elasticity 
Conjunctiva- dry eye 

14. More General Aging Changes!
Retina- dulls, blood vessel changes
Optic Nerve- boundaries less defined, fewer capillaries
Macula- little or no foveal reflex, drusen and lipofuscin deposits, pigmentation 
Lids- orbicularis oculi muscle weakens
Lacrimal Glands/Tears- production , 
Orbit- fat loss, enophthalmos

15. Age Changes in Performance
Refraction- lens and ciliary muscles
Results in Presbyopia
Age 40+
Acuity and Contrast
Decreases after age 50
Due to Brain
Glare 
Due to lens and vitreous humor
Dark
Pupil and Lens

16. More Performance Changes!
Fun stuff- Vitreous Humor?
Haziness
Flashing Lights
Moving Spots
Color
Discrimination  as cones 
Dark
Pupil and Lens
Visual Field
Size  1 to 3 degrees per decade

17. Diseases and Syndromes
Age-Related Changes:
Diseases and Syndromes

18. Normal 
Dry AMD 
 Wet AMD

20. Cataracts Symptoms: increase in lens opacity Causes/Risk Factors:
Peripheral to nuclear
Causes/Risk Factors:
UV light/free radicals
Glycation
Corticosteroids
Diabetes

21. Cataracts

22. Cataract
What is it?
Clouding of the eye’s lens that causes loss of vision.

23. Who is at higher risk? Most cataract are related to aging
(continued from previous slide)
Who is at higher risk?
Most cataract are related to aging
Other risk factors
Diabetes
Smoking
Exposure to sunlight

24. Cataract
Normal vision
Same scene as viewed by a person with cataract

25. Cataract Symptoms Cloudy or blurred vision.
Colors that may not appear as bright as they once did.
Glare.
Poor night vision.

26. Treatment options Glasses Better lighting Surgery
(continued from previous slide)
Treatment options
Glasses
Better lighting
Surgery

27. Cataract What can you do? Eat a healthy diet.
Wear sunglasses and a brimmed hat when outdoors.
Don’t smoke.

28. Glaucoma

29. Glaucoma
What is it?
A group of eye diseases that can damage the optic nerve in the eye.
Glaucoma can develop in one or both eyes.
Primary open-angle glaucoma is the most common form.

30. Who is at higher risk? African Americans over age 40.
(continued from previous slide)
Who is at higher risk?
African Americans over age 40.
Everyone over the age of 60, especially Mexican Americans.
People with a family history of glaucoma.

31. Glaucoma
Normal vision
Same scene as viewed by a person with glaucoma

32. Glaucoma Symptoms Treatment options No early warning signs or symptoms
No pain
Loss of side vision
Treatment options
Medications, usually eye drops
Laser or conventional surgery

33. Glaucoma What can you do?
People at higher risk should get a comprehensive dilated eye exam every one to two years or as instructed by your eye care professional.

34. Macular Degeneration

35. Age-Related Macular Degeneration (AMD)
What is it?
Common among people aged 60 or older.
Can damage the macula, which is needed for sharp, detailed central vision.

36. Who is at higher risk? The greatest risk factor is age.
(continued from previous slide)
Who is at higher risk?
The greatest risk factor is age.
Other risk factors
Smoking.
Family history.
Obesity.
Race. Caucasians are more likely to lose vision from AMD.

37. Age-Related Macular Degeneration (AMD)
Normal vision
Same scene as viewed by a person with AMD

38. AMD Symptoms No pain. Blurred vision.
Drusen (can only be seen by an eye care professional).

39. (continued from previous slide)
Treatment options
Age-Related Eye Disease Study (AREDS) special vitamins/minerals supplement formulation.
Laser surgery.
Eye injections.
Photodynamic therapy.

40. AMD What can you do? Eat a healthy diet Don’t smoke, or stop smoking
Maintain normal blood pressure
Maintain a healthy weight
Exercise

41. Diabetic Retinopthy

42. Diabetic Eye Disease What is it?
A group of eye problems associated with diabetes.
Diabetic retinopathy is a leading cause of vision loss and blindness.

43. Who is at higher risk? People with diabetes.
(continued from previous slide)
Who is at higher risk?
People with diabetes.
The longer someone has diabetes, the more likely it is he or she will get diabetic retinopathy.

44. Diabetic Retinopathy Normal vision
Same scene as viewed by a person with diabetic retinopathy

45. Diabetic Eye Disease Symptoms
No early warning signs or symptoms
Early detection and timely treatment can reduce the risk of vision loss.
Treatment options
Laser treatment
Surgery

46. Diabetic Eye Disease What can you do?
Control your ABCs - A1C, blood pressure, and cholesterol.
Take your medications as directed.
Maintain a healthy weight.
Exercise.
Don’t smoke.
Have a dilated eye exam at least once a year.

47. Dry Eye What is it? The eye does not produce tears properly.
Tears evaporate too quickly.
Inflammation of the surface of the eye may occur along with dry eye.

48. Who is at higher risk? Women often experience dry eye more than men.
(continued from previous slide)
Who is at higher risk?
Women often experience dry eye more than men.
Dry eye can occur at any age.
Older adults frequently experience dryness of the eyes.

49. Dry Eye Symptoms Stinging or burning of the eye.
Feeling as if sand or grit is in the eye.
Episodes of excess tears following dry eye periods.
A stringy discharge from the eye.
Pain and redness of the eye.
Episodes of blurred vision.

50. Symptoms Heavy eyelids.
(continued from previous slide)
Symptoms
Heavy eyelids.
Decreased tearing or inability to shed tears when crying.
Uncomfortable contact lenses.
Decreased tolerance to any activity that requires prolonged visual attention.
Eye fatigue.

51. (continued from previous slide)
Treatment options
Using artificial tears, prescription eye drops, gels, gel inserts, and ointments.
Wearing glasses or sunglasses.
Getting punctal plugs.

52. Dry Eye What can you do? Use an air cleaner to filter dust
Avoid dry conditions
Use lubricating eye drops
Visit an eye care professional

53. Low Vision Aids

54. Low Vision Aids

55. Low Vision
What is it?
A visual impairment that is not corrected by standard eyeglasses, contact lenses, medication, or surgery.
It interferes with the ability to perform everyday activities.

56. Who is at higher risk? People with eye disease.
(continued from previous slide)
Who is at higher risk?
People with eye disease.
Some people develop vision loss after eye injuries or from birth defects.

57. Low Vision Treatment options What can you do? Vision rehabilitation.
See a specialist in low vision.
Talk to your eye care professional about vision rehabilitation.
Use low vision devices.