Effect of age on eye structure and function, Age related ocular diseases.

2. AGING AND THE EYE
By:
RABIA AMMER
OPTOMETRIST &ORTHOPTIST
GOLD MEDALIST

3. NORMAL AGING VISION
 What exactly is “normal” in people over the
age of 65?
 Definition: Having no immediately apparent
structural or pathological defect that could
account for reduced function
 Conditions that occur in most older people
(loss of accommodation, miosis) are
considered normal

4. WE KNOW THIS ALREADY
 Most older people
have “excellent”
vision
 Some eye problems
associated with age
are annoying but
do not cause visual
loss

5. 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

6. Aging Eye

7. AGE-DEPENDENT CHANGES
Physiological and Performance Based

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

9. 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

10. 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

11. 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

12. More Performance Changes
 Vitreous Humor
 Haziness
 Flashing Lights
 Moving Spots
 Color
 Discrimination as cones
 Dark
 Pupil and Lens
 Visual Field
 Size 1 to 3 degrees per decade

13. Near Point Changes

14. Pupillary Miosis & Light
 Diameter of pupil in
the dark minus
diameter of pupil in
bright light
becomes less & less
with age
 Consequence:
reduction in retinal
illuminance

15. Visual Difficulties
 < 50% of people
under the age of 40
wear refractive
correction
 Approximately 90%
of people in their
40s or beyond need
lens correction

16. Visual Function & Age
 Up to age 70, loss in static corrected
acuity can be explained by miosis & lens
changes
 As age increases, the # of people who
achieve normal corrected acuity
decreases
 VERY IMPORTANT: These people show no
signs of ocular disease

17. CORNEA
 Corneal sensitivity decreases with age
 Touch threshold almost doubles
between the ages of 10 and 80,
especially after 40
 Consider entropion & ectropion
 Advantages and disadvantages
regarding contact lenses
 Corneal curvature changes with age
 Astigmatism increases throughout life

18. ANTERIOR CHAMBER
 Depth of anterior chamber decreases
 At age 15-20, average depth = 3.6 mm
 At age 70, average depth = 3.0 mm
 This decrease in chamber depth could cause interference
with aqueous flow

19. LENS
 Lens grows
throughout life
 Axial thickness
increases by about
28% between the
ages of 20 & 70

20. LENS
 Yellow pigment of the lens absorbs
short wavelengths more than long
ones
 Older people have decreased
sensitivity in violet/blue end of the
spectrum
 White objects may appear yellow &
distinction between blues & greens is
decreased

21. LENS
 Older people need significantly more light to
achieve the same level of retinal illuminance
 Visual performance of an older individual will be
especially impaired at twilight
 Driving should be given much more thought
(testing conditions vs. reality)

22. RETINA & BEYOND
 In the absence of pathology, changes in the retina & further
upstream are not directly observable
 Inferences must be made on the basis of visual function
 There’s the rub! Which function(s)?

23. LIGHT, DARK & GLARE
 Older people
 Cannot reach the
levels of dark
adaptation that
younger people can

24. LIGHT, DARK & GLARE
 Older people - more sensitive to glare & take longer to
recover

25. VISUAL FUNCTION & AGE
 Inability to achieve at least 20/25 acuity cannot be explained
for about 10% of people between the ages of 75 & 85
 Visual acuity has long been understood (at least by the
rehabilitation community) to be an inadequate measure of
visual function

26. HIGH - LOW CONTRAST ACUITY

27. CONTRAST SENSITIVITY
 High-frequency cut-off
can be mimicked by
artificial pupils & neutral
density filters
 This means that the lens
and pupil changes are
responsible for upper
frequency loss.

28. VERNIER ACUITY
 Observer is asked to align objects, not recognize
them (hyperacuity task)
 Segments of a line, points of light, etc. are aligned
vertically or horizontally
 This ability remains intact throughout life

29. VERNIER ACUITY

30. STILES-CRAWFORD EFFECT
 Tests the directional sensitivity of the retina
 Relies on proper alignment of the retinal
receptors
 Light entering different points of the pupil is
differently absorbed by receptors

31. STILES-CRAWFORD EFFECT

32. STILES-CRAWFORD EFFECT

33. COLOUR PERCEPTION
 There has always been a debate
concerning colour vision changes
in older people
 Question:
 To what degree are changes in colour
perception due to optical media
(especially the lens) & to what extent
are they due to retinal changes?
 Are the short-wavelength (blue)
cones playing a big role?

34. OPTICAL CORRECTION

35. SYMMETRY PERCEPTION
 Detection of
symmetry is an
important visual
ability
 Consider how many
objects in our
environment are
approximately
symmetrical (faces,
butterflies etc)

36. SYMMETRY PERCEPTION
 Our data show a
decline in symmetry
perception in
people over 65 …
but it’s an
organized change

37. USEFUL FIELD OF VIEW

38. USEFUL FIELD OF VIEW

39. USEFUL FIELD OF VIEW

40. Age-Related Changes
Diseases and Syndromes

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

42. Cataracts

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

44.  Who is at higher risk?
 Most cataract are related to aging
 Other risk factors
• Diabetes
• Smoking
• Exposure to sunlight
Cataract

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

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

47.  Treatment options
 Glasses
 Better lighting
 Surgery
Cataract

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

49. Glaucoma

50.  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.
Glaucoma

51.  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.
Glaucoma

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

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

54.  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.
Glaucoma

55. Age-Related Macular
Degeneration (AMD)

56. 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.

57.  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.
Age-Related Macular
Degeneration (AMD)

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

59.  Symptoms
 No pain.
 Blurred vision.
 Drusen (can only be seen by an
eye care professional).
Age-Related Macular
Degeneration (AMD)

60. Normal
Dry AMD Wet AMD

62.  Treatment options
 Age-Related Eye Disease Study (AREDS) special
vitamins/minerals supplement formulation.
 Laser surgery.
 Eye injections.
 Photodynamic therapy.
Age-Related Macular
Degeneration (AMD)

63.  What can you do?
 Eat a healthy diet
 Don’t smoke, or stop smoking
 Maintain normal blood pressure
 Maintain a healthy weight
 Exercise
Age-Related Macular
Degeneration (AMD)

64. Diabetic Retinopthy

65.  What is it?
 A group of eye problems
associated with diabetes.
 Diabetic retinopathy is a leading
cause of vision loss and blindness.
Diabetic Retinopthy

66.  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.
Diabetic Retinopthy

67. Same scene as viewed by a
person with diabetic retinopathy
Normal vision
Diabetic Retinopthy

68. 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

69. 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.

70. 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.

71.  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.
Dry Eye

72.  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.
Dry Eye

73.  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.
Dry Eye

74.  Treatment options
 Using artificial tears, prescription eye drops, gels, gel
inserts, and ointments.
 Wearing glasses or sunglasses.
 Getting punctal plugs.
Dry Eye

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

76. Low Vision Aids
(Treatment Option In Old Age)

77. Low Vision Aids

78.  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.
Low Vision

79.  Who is at higher risk?
 People with eye disease.
 Old aged people.
 Some people develop vision loss
after eye injuries or from birth
defects.
Low Vision

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