VISUAL LOSS

IN ELDERLY

Presented by : roll no 31-35

 CONTENTS OF THE SEMINAR:

• Introduction to visual impairment

• Presbyopia
• ARMD
• Cataract
• Glaucoma
• Retinopathy
• Visual impairment is important health problem in
elderly
• With advancing age normal visual function decreases
and there is increase in ocular pathology.
• Untreated visual disturbance lead to increased
incidence of falls, depression, social isolation and
dependency.
• Elderly should have visual assessment 1-2 yearly for
early detection and prevention of permanent visual
impairment.
 VISUAL IMPAIRMENT
ACC TO WHO:
MILD VISUAL IMPAIRMENT : visual acuity worse
than 6/12 to 6/18
MODERATE VISUAL IMPAIRMENT : visual acuity
worse than 6/18 to 6/60
SEVERE VISUAL IMPAIRMENT : visual acuity worse
than 6/60 to 3/60
BLINDNESS : visual acuity worse than 3/60
According to national blindness and visual impairment survey:

• Prevalence of blindness in overall population is 0.36

• Prevalence of visual impairment in overall population is 2.55
• Prevalence of blindness in population >= 50yrs is 1.99
• Prevalence of visual impairment is 13.76
• MAJOR CAUSE OF BLINDNESS IS CATARACT 66.2
• AND GLAUCOMA 5.5
• MAJOR CAUSES OF VISUAL IMPAIRMENT – CATRACT -71.2
REFRACTIVE ERROR-13.4
 The most common causes are(BLINDING):
 AGE RELATED CATARACT GLAUCOMA
 DIABETIC RETINOPATHY ARMD

Non blinding causes are:

 Lid problems like meibobinitis; chalazion;Entropion;
ectropion; ptosis.
 Dry eye syndrome like itching ; grittiness ; watering ;
eye strain.
 NORMAL AGE RELATED EXTERNAL
CHANGES OF EYE:
• Graying and thinning of eyebrows and eyelashes.

• Subcutaneous tissue atrophy leading to wrinkling and thinning of

skin around eyes.

• Decreased orbital fat leading to sunken eye appearance and

sagging of eyelids.

• Atrophy of lacrimal glands leading to der eye

NORMAL AGE RELATED INTERNAL CHANGES OF EYE

• Reduced elasticity of lens decreases the ability of lens to

accommodate.
• Decreased pupil size, decreased retinal illumination:
 decreased visual acuity (sharpness of vision)
Decreased light sensitivity (difficulty seeing in dim)
Dark and light adaptation takes longer.
Distortion in depth perception
• Lens becomes cloudy(opacification)
• Lipid deposits around peripheral cornea -> ARCUS SENILIS
 PRESBYOPIA
It is not an error of refraction but a condition of physiological
insufficiency of accommodation leading to progressive
Fall in near vision.
As the age increases , near point of accommodation recedes
beyond the normal reading range.

This condition of failing near vision due to age related

decrease in the amplitude of accommodation is called
PRESBYOPIA.
 CAUSES
Decrease in accommodative power of crystalline lens with increasing age,
occurs due to :

1)AGE RELATED CHANGES IN LENS

• Decrease in the elasticity of lens capsule
• Progressive increase in size and hardness/sclerosis of lens substance
which is less easily molded.

2)AGE RELATED DECLINE IN CILIARY MUSCLE POWER

 SYMPTOMS
1) DIFFICULTY IN NEAR VISION: pt
complaints of difficulty in reading small
prints and difficulty in threading needles
etc.

2) ASTHENOPIC SYMPTOMS : due to fatigue

of ciliary muscle.

3) INTERMITTENT DIPLOPIA : due to

disturbed relationship between
accommodation and convergence ,
experienced by few patients.
 TREATMENT
1)OPTICAL TREATMENT : Prescription of appropriate convex glasses for near work.
ROUGH GUIDE FOR PROVIDING PRESBYOPIC GLASSES IN AN EMMETROPE:
40-44 YEARS : +0.5 TO + 0.75
45-49 YEARS: +1 TO +1.25D
50-54 YEARS : +1.5 T0 + 1.75D
55-59 YEARS : +2 TO + 2.25D
60 AND ABOVE YEARS : +2.5 TO +3D
Exact presbyopic addition should however be estimated individually.
2)SURGICAL TREATMENT OF PRESBYOPIA:
• Monovision keratoplasty
Monovision LASIK
• Corneal inlays for presbyopia
• Trifocal IOL implantation
• Anterior scleral sclerotomy