About the Anatomical and physiological changes in eyes with ageing.

1. Jayendra Jha
Optometrist
C L Gupta Eye Institute
Moradabad (U.P)
AGE RELATED VISUAL CHANGES
AND PROBLEMS.
Presenter

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. • 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. 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.

14. 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.

15. 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

16. 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.

17. 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

18. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. KEY NOTES
40s
Be 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.
50s
Risks 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 field
Becomes narrow.
Cataract surgery

29. REFRENCES
THANK YOU
• Internet
• Visual perception, 2nd
edition
- Stephen J Schwartz
• Primary Care Optometry
- Theodore Grosvenor
• Geriatric ophthalmology
- Andrew G. Lee/Beaver A. Hilary