Jayendra JhaOptometrist

C L Gupta Eye InstituteMoradabad (U.P)

AGE RELATED VISUAL CHANGES AND PROBLEMS.

Presenter

AGEING

• The gradual, irreversible biological changes that occur over the course of time, that do not result from diseases or other accidents and eventually lead to the increased risk of death in near future.

• As a person ages, anatomy and physiology undergo many changes, that become more apparent with increasing age

Contd…• Ageing is a progressive physiological

process, characterized by degeneration of tissues and organ systems with consequent loss of functional reserves of these systems.

• Similarly ageing results anatomical and physiological changes in eye

• These changes result in alteration of visual functions.

LIDS• With age, the orbicular oculi muscles

(which squeeze the lids shut) decrease in strength.

• Senile Ectropion.• Spasm of orbicular oculi muscles may

cause the lid margin to turn in (Entropion)

• Trichiasis resulting in chronic irritation.• The lids contain many glands that

secrete sebum or sweat.• These glands drain externally to the

skin surface of the lid. They can become blocked and swollen.

LACRIMAL GLAND AND TEAR DRAINAGE

• Tear production by the lacrimal gland may decrease with age .

• Abnormalities of the lacrimal system may result in decrease or increase tear production.

• Normal tear production is measured with schirmer test

SCLERA

• The sclera forms the posterior five sixth of the eyeball.

• In children's the sclera is opaque, with a slight blue cast where it is thin and underlying pigment of the choroid shows through.

• In adults the sclera is white in elderly persons It may have a yellow tinge resulting from dehydration and lipid deposits. Which should not be confused with jaundice.

• Other age related changes include

yellowing or browning due to exposure to ultraviolet light, wind and dust more random splotches of pigment.

• A bluish cast due to thinning of the sclera that may occur with some diseases.

CONJUNCTIVA

• Its goblet cells produce mucin, which lubricates eyelid movements and provides a protective layer to slow evaporation of the tear film.

• With age the number of mucous cell decreases, as a result of KCS for no specific reason.

• This change contributes to dry eye condition. Which is manifested by a scratchy sensation and chronic irritation.

Contd…• Conjunctiva appears congested due to

often increased redness from dilatation of blood vessels in the conjunctiva.

• The increased redness commonly occurs because the conjunctiva is heavily vascularized.

• Capillaries in the conjunctiva are fragile and tend to burst easily. Resulting in a pooling of blood in the space between the sclera and the overlying conjunctiva.

LIMBUS

• The limbus marks the junctions between the sclera and the cornea .

• Although it is only 1.5 to 2 mm wide, the limbus contains the trabecular meshwork and schlemm’s canal.

• Which are important in maintaining correct intra ocular pressure.

AQUEOUS HUMOR

• The aqueous humor must be continuously formed from blood plasma that is filtered through the ciliary body.

• The aqueous is constantly reabsorbed back into the blood after it flows out through the canal of schlemm in the limbus.

• With age, the value of the resting level of IOP can rise over time by as much as 25% without damaging vision.

CORNEA

• The most important refractive part of the eye.

• Arcus senilis is common in persons above 60 and has no clinical significance.

• Arcus senilis, which should not be mistaken for a cataract, is on the surface of the eye, not within it

Contd..

• Corneal sensitivity decreases with age.

• The threshold to touch decreases double after 40 years age.

• Age related changes like degenerations and dystrophies may seen like spheroidal degenerations, crystalline dystrophy.

IRIS

• The iris contains two sets of muscles that work together to regulate pupillary size and reaction to light.

• With age , these muscles weaken, and the pupil becomes smaller, reacts more sluggishly to light , and dilates more slowly in dark.

• Persons above 60 may complaint that objects are not as bright at outdoors.

Contd…

• They also experience difficulty when going from a brightly lit environment to a darker one.(delay dark adaptation)

• If VA is normal . Patients need only reassurance that these changes are normal.

• None of these changes results in decrease VA.

• Hyper pigmentation also seen in older age

CRYSTALLINE LENS

• Lens thickness and surface curvatures are changed by the actions of the ciliary muscle and suspensory ligaments (zonules).

• The lens continuously grows during life and increase in density and weight.

• These changes decrease the elasticity of the lens.

Contd…

• Between the age of 40 and 50, the lens usually becomes so inelastic that close objects can no longer be brought into focus (presbyopia) without the assistance of corrective lenses.

• Opacification of lens i.e. CATARACT

VITREOUS HUMOR

• The vitreous humor is normally clear, but with age. Discrete opacities or structural changes leading to a general haziness may develop.

• The vitreous undergoes liquefaction with age as a result, normal eye movement produce intermittent tension at the attachment points on the retina.

• This tugging stimulates the peripheral retina mechanically, causing vertically oriented flashing, almost always in the far temporal visual field.

RETINA

• The retina is difficult to examine in elderly patients because of their small pupils, increased random eye movements and lens opacities.

• The retina, which glistens in younger persons, becomes duller with age.

• The optic nerve tend to have less distinct margins and may appear slightly pale than in younger persons because of a loss of capillaries.

Contd…

• The macula, which in younger persons usually has a bright central foveal light reflex. May show no foveal reflex in elderly persons .

• Yellowish white spots (drusen) often appear in the macular area.

• The retina layers may become disrupted resulting in pigmentation and obscuring the view of underlying blood vessels.

ORBIT

• With age , there is loss of periorbital fat, which surrounds and cushions the eye ball.

• This loss of fat often causes enophthalmos. Also known as Deep seated eye.

• An asymptomatic condition that often poses a cosmetic problem and may be corrected with surgery.

AGE-RELATED CHANGES IN OCULAR FUNCTION.

May be divided into two groups.•THOSE RELATED TO VISION .•Like refractive changes, visual acuity, contrast sensitivity, glare haziness, flashing lights, moving spots, and visual fields.•RELATED TO EYE COMFORT.•Foreign-body sensation and headache.

VISUAL ACUITY

• Uncorrected V/A begins to decrease in a normal healthy persons around the age of 50.

• The eye becomes more hyperopic and astigmatic with age.• Small changes in visual acuity as a result of normal age-

related brain changes.• In the absence of disease, V/A should be at or correctable to

20/20, even in very old persons.

CONTRAST SENSITIVITY

• It decrease with age at middle-spatial and high-spatial frequencies.

• This change was originally thought to be due to the fact that elderly persons have smaller pupils and more lens opacities.

• The loss of contrast sensitivity is due to a loss of neurons in the visual pathway in the brain rather than to any retinal changes.

• This loss of contrast sensitivity has very little effect on the elderly persons life.

• Currently this loss cannot be prevented or reversed.

COLOR VISION

• Color discrimination declines with age .• With age all three classes decline in sensitivity, resulting in a

reduction of brightness discrimination.• Colors appear to be less bright, and contrast between colors

are less noticeable to the elderly persons than to a younger.• In persons >60, this age related changes results in a reduction

in discrimination of blue objects, which often appear grey.

VISUAL FIELDS

• The size of a normal visual field decrease by about 1 to 3 degree per decade.

• For persons in their 70s or 80s, a visual field loss of 20 to 30 degree may result.

• The peripheral retina has fewer neurons than the central retina, equal losses in the two areas have a greater effect on reducing V/A in the periphery.

KEY NOTES

40sBe aware of increased risk of dry eye, computer vision syndrome and presbyopia

Eat a healthy diet high in omega-3 fatty acids and antioxidants . Explore different modes of presbyopia correction.

50sRisks increase for cataracts, glaucoma & age related macular degeneration (ARMD).

Have routine eye exams.

Risk of dry eye increases for women after menopause.

Use lubricating eye drops and regular ocular examination

60s Ability to see in low lighting decreases. Increased risk of age related changes

Use brighter lights for reading. Allow more time to adjust to changing light conditions.

Age-related eye changes cause visual disturbances such as spots & floaters.

Eye floaters appear suddenly,(this might be a retinal detachment).

70s & 80s

Most people in this age group already have or will develop cataracts. Color vision declines, visual fieldBecomes narrow.

Cataract surgery

REFRENCES

THANK YOU

• Internet

• Visual perception, 2nd edition

- Stephen J Schwartz • Primary Care Optometry - Theodore Grosvenor

• Geriatric ophthalmology - Andrew G. Lee/Beaver A. Hilary