Victorio N.

Cajita,MD ACES Eye Referral Clinics Cebu & Dumaguete Cities

Frances Yap, MD Velez Hospital Cebu City

The Aging Eye

Victorio N. Cajita,MD ACES Eye Referral Clinics Cebu & Dumaguete Cities

Frances Yap, MD Velez Hospital Cebu City

Ang Mata sa mga Hamtong

Victorio N. Cajita,MD ACES Eye Referral Clinics Cebu & Dumaguete Cities

Frances Yap, MD Velez Hospital Cebu City

OUTLINE
 Introduction  Basic Anatomy  Common Age-related Eye Conditions
definition symptomalogy (complaints) clinical significance treatment

Age Related Eye Diseases (AREDs)

 Aging individuals are at risk for multiple eye problems  wear and tear  law of diminishing returns  Some are preventable and reversible but generally progressive

AREDs Significance
 Vision non-threatening (cosmetic blemish)  Vision threatening
associated with a myriad problems in older adults (falls, fractures, depression) affects quality of life economically crippling

BASIC ANATOMY

BASIC ANATOMY

Fundus Examination

COMMON COMPLAINTS
 Tearing, discomfort, foreign body sensation  Blurring of vision  Glare  Loss of central vision  Floaters

COMMON EYE CONDITIONS IN ELDERLY

 Dermatochalasia  Entropion/Ectropion  Dry Eye  Arcus Senilis  Cataract  Presbyopia  Vitreous Floaters  Age related Macular

Degeneration  Age Related Retinal Vasculopathies

Dermatochalasia
 Sagging eyelids/Eyebags  Excess of skin in upper or lower

eyelids  Cosmetic problem  Treatment

Nothing Blepharoplasty

Involutional Ectropion/Entropion
 an abnormal outward

or inward turning of the lid margin  Complaints

Tearing, foreign body sensation Exposure keratitis

 Potentially blinding  Treatment

Drops/ointment Surgery

Dry Eye Syndrome

 A disorder of the tear film which causes damage to the exposed ocular surface  Symptoms:
ocular discomfort, foreign body sensation, redness blurring of vision build up of debris Itchiness

Dry Eye
 Controllable chronic disease;

Not completely curable  Clinical significance

Mild - annoying, uncomfortable Severe - potentially vision threatening

Dry Eye
 Treatment
Eye drops: ocular lubricants or artificial tears, antiinflammatory eye drops Surgery: plugs Diet: increase intake of omega-3 essential fatty acids (flaxseed oil, fish oil, nuts)

Arcus Senilis
 yellow-white ring in

peripheral cornea  accumulations of cholesterol esters, triglycerides and phospholipids  No vision impairment  No treatment

PRESBYOPIA
 short arm syndrome AGE RELATED FOCUS DYSFUNCTION Signs of Presbyopia SYNDROME: PRESBYOPIA SHORT ARM Loss of ability to read up close Holding objects away to read

Need reading glasses or bifocals

Cataract
 Opacity of the

crystalline lens  May develop as a result of aging, metabolic disorders, trauma or heredity

Cataract
 Generally, decrease in visual acuity is directly proportionate to the density of the cataract

Cataract
 Most common cause of

bilateral blindness
 RP backlog: 0.7% (630,000)  Reversible  Treatment: surgery

Management
 Indications for surgery
visual defect interferes with daily activities Potential complications: glaucoma or uveitis to visualize the posterior segment

 Surgery: phacoemulsification with lens implantation (IOL)  NOT laser!!!

Phacoemulsification

Phacoemulsification
Outpatient Topical anesthesia No sutures No patch

Vitreous Floaters
 Small specks or dots

seen against a bright background  May be due to condensations of vitreous collagen or due to blood  Dilated fundus exam should be done

Vitreous Floaters
 not visually impairing  annoying  treatment: NONE

Macular Degeneration
 Degenerative disease of central retina  Clinical features
Blurring of the central vision Distorted vision Retinal exam
Drusens - yellowish deposits in center of retina Macular scar macular hemorrhages and lipid exudates

Risk Factors of macular degeneration

 Modifiable

Smoking High Blood Pressure Obesity Low levels of nutrients Sun exposure
 Non-modifiable

Aging Family History Female gender Caucasian

Age Related Macular Degeneration

Macular Degeneration
 Retinal and choroidal

angiography
Intraretinal hemorrhage and edema of macula Fluorescein angiogram with leakage Indocyanine green angiogram choroidal vasculature

Macular Degeneration
 Clinical Advances
Laser treatments for choroidal neovascularization Radiation treatment may preserve near vision and contrast sensitivity Anti-angiogenesis eg. Avastin, lucentis, macugen Prevention: High dose Zn and Vit A,C,E,lutein, zeaxanthine

Age-related Eye Comorbities

 Retinal vascular diseases due to underlying

medical conditions common with age

Diabetes Hypertension High cholesterol others

Retinal Vein Occlusion (Retinal Stroke)

 Painless decreased vision due to obstructed retinal veins  2nd most common sight threatening vascular disorder  Types:
Branch retinal vein occlusion (BRVO) Central retinal vein occlusion (CRVO)

Retinal Vein Occlusion (Retinal Stroke) Predisposing factors high blood pressure high blood cholesterol high blood sugar hahayyyy

Retinal Vein Occlusion (Retinal Stroke)

 Types:
Branch retinal vein occlusion (BRVO) Central retinal vein occlusion (CRVO)

Branch Retinal Vein Occlusion (BRVO)

Central Retinal Vein Occlusion (CRVO)

RVO treatment
Medical
Treat the underlying cause

ophthalmic
Treat the complications (macular edema, vitreous hemorrhage, retinal detachment, glaucoma) Eye drops, laser, surgery

Collaboration between the ophthalmologist and other physicians for management

Retinal Artery Occlusion

 Painless sudden blurring

of vision due to blockade in the retinal artery  Associated witd Atherosclerosis, DM, HPN, dysrrhythmias

Retinal Artery Occlusion

 A true ocular emergency  Treatment is usually ineffective

Diabetic Retinopathy
 Retinal complication of prolonged, poorly controlled diabetes  Most common retinal vasculopathy  Potentially blinding

Diabetic Retinopathy

Longer diabetes + poor control =

worse retinopathy

Non-proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Diabetic Retinopathy Treatment

 Medical
Strict diabetic control Treat other medical problems

 Ophthalmic
Laser - mainstay of treatment Anti-vegf eg avastin, lucentis Surgery

Summary / take home message

Prevent what is preventable Treat what is treatable Accept what has to be accepted

Do not regret growing older. It is a privilege denied to many. ~Author Unknown

Thank you!

 People like you and I, though mortal of course like everyone else, do not grow old no matter how long we live... [We] never cease to stand like curious children before the great mystery into which we were born." (Letter to Otto Juliusburger) Albert Einstein

A man s age is something impressive, it sums up his life: maturity reached slowly and against many obstacles, illnesses cured, grieve and despairs overcome, and unconscious risks taken; maturity formed through so many desires, hopes, regrets, forgotten things, loves. A man s age represents a fine cargo of experiences and memories." Antoine de Saint-Exupry

 Age is a high price to pay for maturity." Tom Stoppard  ..and the odds are never good enough, for all we know nothing lasts forever in this life . 

How can we help

 Significantly reduce the level of disability caused by visual problems by
Increase public awareness about age related eye problems Integrate and coordinate timely screening, diagnosis and treatment to prevent or correct vision loss Ensure continuity of care Monitor status of visual impairment

Age-Related Cataract
 Nuclear cataracts

 Nuclear sclerosis resulting from the normal condensation process in the lens nucleus  Earliest symptom: improved near vision without glasses ( second sight )
- results from increase in focus power of the central lens, creating a myopic shift in refraction

 Most are bilateral, but may be assymetric

Age-Related Cataract
 Cortical cataracts

 Opacities in the lens cortex  Changes in the hydration of lens fibers create clefts in a radial pattern around the equatorial region  Tend to be bilateral, but often assymmetric  Visual function is variably affected, depending on how near the opacities are to the visual axis

Age-Related Cataract
 Posterior subcapsular cataracts

 In the cortex near the central posterior capsule  Tend to cause visual symptoms early in their development due to visual axis involvement  Common symptoms: glare, reduced vision under bright lighting conditions  Can result from: trauma, corticosteroid use, inflammation, exposure to ionizing radiation

Basic ANATOMY

BASIC ANATOMY

Dry Eye

Cataract
 protein alterations result in yellow or brownish

discoloration

 There may be vesicles between lens fibers,

migration and aberrant enlargement of epithelial cells