Glomerular Filtration and determinants of glomerular filtration .pptx
Aging and The Eye
1.
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
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
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
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
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
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
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?
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
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
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)
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)
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
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