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    Treating the aging eye

    Certain conditions affect your older patients more

    Advances in medicine have extended the average life span of American men to 76.4 years and American women to 82.1 years,1 but greater life spans have brought one or more chronic illnesses to 80 percent of those over the age of 60.2 Along with their general medical problems, older patients must deal with declining vision and its physiological and psychological effects. Loss of vision can restrict one’s ability to carry out daily activities and lead to depression, social isolation, falls, fractures, and the inability to live independently.

    In the aging eye, accommodation decreases; the crystalline lens yellows, hardens, and eventually opacifies; and systemic diseases such as arthritis, thyroid disease, cancer, diabetes, atherosclerosis, and high blood pressure take their toll on the eye. In addition, cognitive and functional limitations affect the aged. They may not have support from their families or be unaware of available community services. Often changes in vision are undiagnosed and untreated. Patients may be living with unoperated cataracts, undiagnosed primary open-angle glaucoma, age-related macular degeneration, or diabetic retinopathy.

    Keep in mind that one-third of new cases of blindness could have been prevented by early intervention.

    Let’s look at some of the common visual conditions that affect our senior population.


    Cataracts represent another common cause of visual loss in the elderly. Although we all will develop cataracts if we live long enough, the decrease in vision from cataracts is gradual, and not everyone who lives a normal life span will require surgery (see Figure 2). In addition to age, causes of cataract include ultraviolet radiation from sunlight or other sources, corticosteroids, diabetes, family history, smoking, and previous eye injuries, inflammation, or surgery.6

    As cataracts develop, the crystalline lens becomes yellow or cloudy. Initially, vision may be improved with a simple prescription change in eyeglasses. As cataracts progress, they cause reduced visual acuity, increased glare, starbursts around headlights and streetlights at night, reduced color vision, and the need for more light when reading. These changes in vision are related to the size and location of the cataract and are generally slow and painless.

    More from iTech: The pros and cons of clear lens exchange

    Surgery becomes necessary when cataracts interfere with normal daily activities, such as driving, watching television, or reading the newspaper. Cataract surgery is the most frequently performed surgical procedure in the United States and has an excellent prognosis, with 90 percent of patients achieving vision of 20/40 or better.7 The surgery, a procedure called phacoemulsification, is done under local or topical anesthesia with IV sedation. A tiny incision is made, and the contents of the crystalline lens are emulsified, suctioned out, and replaced with an intraocular lens (IOL). The IOL power is determined by presurgical measurements. We are now able to correct astigmatism with toric IOL designs and presbyopia with bifocal and multifocal IOL implants.

    Next: Macular degeneration

    Phyllis L. Rakow, COMT, NCLM, FCLSA(H)
    Phyllis Rakow, COMT, NCLM, FCLSA(H) is a JCAHPO-certified ophthalmic medical technologist, at a large three-location group practice in ...


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    Optometry Times A/V