Aging and the eye

2. 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. Age-Related Changes: Diseases and Syndromes

18. Normal  Dry AMD   Wet AMD

20. Cataracts • Symptoms: increase in lens opacity • 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. (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. (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. (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 • 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. (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. (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. (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. (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.