Geriatric changes in human body and eyes

1. Geriatric changes
Presented by
Optom. Sagar kalamkar
(M. Optom 2nd year)
Bharti Vidyapeeth ( deemed university ) medical college

2. Objectives
• To understand that aging is not a disease ,
even though there are biological ,
psychological and sociological changes with
time
• To differentiate expected age related ocular
health changes and their functional
implication
2

3. Aging and the body
Evaluation of age-related ocular symptoms
and sign must be based on an understanding
of anatomy and physiology of the human
body
3

4. Cells replicate a specific number of
times and then die
Happens again and again in lab
experiments
4

5. Skin, hair, nails
• Loss of subcutaneous fat
• Thinning of skin
• Decreased collagen
• Nails brittle and flake
• Temperature regulation difficult
• Hair pigment decreases
• Hair thins
5

6. Loss of subcutaneous fat
One hypothesis is that as the vascular system weakens
with age
In most cases, affected individuals gradually
lose subcutaneous fat from the arms, legs and face 6

7. Thinning of skin
• thin skin that tears easily is a common problem in
older adults
• sun exposure and genetics all play a role in thinning skin
• medications, such as long-term use of oral or topical
corticosteroids, also can weaken the skin and blood vessels
in the skin
7

8. Decreased collagen
• Collagen gives skin its strength, and it makes skin firm and
flexible with the help of elastin
• The sun, pollution, smoke and other sources of free radicals
are also responsible for disintegrating collagen
• Our own body's enzymes break collagen down, in turn
causing skin to lose fullness and form wrinkles
8

9. 9

10. Nails brittle :
The lacking a B complex ( especially biotin ) , calcium
and zinc in the body
10

11. 11

12. Also underling the health condition may cause brittle
nails
Such As
Iron deficiency anemia, kidney disease which brown
discoloration on the nails can also indicate
12
Iron deficiency anemia Kidney disease

13. Less Sweat gland :
With increasing age the amount , function and
sensitivity of sweat gland is decreases
13

14. Temperature regulation difficulty :
Blood vessel dilation or constriction are normal
homeostatic mechanisms that help
individuals regulate body temperature during
extremes of cold or heat
Due to changes in sweat glands that occur with
age, older people experience a progressive decrease in
their ability
14

15. Hair pigment decreases :
With aging the follicles
make less melanin,
and this causes gray
hair
15

16. Hair thins :
Thin hair in older women is likely due to lower levels
of progesterone hormones, causing hair follicles
to thin and hair to fall out
16

17. EARS AND HEARING LOSS
• Irreversible, sensorineural loss with age
• Men more affected than women
17

18. 18
Irreversible, sensorineural loss with age
Causes of hearing loss

19. Irreversible, sensorineural loss with age
Age-related sensorineural
hearing loss resulting from
degeneration of the cochlea
or associated structures of
the inner ear or auditory
nerves
19

20. Men more affected than women :
Men in particular are at a greater risk of developing
hearing loss than women
the risk of hearing loss for men is five times greater
than it is for women
20
Fact :
• By 60 years, most adults have trouble hearing above 4000Hz
• Normal speech 500-2000Hz

21. RESPIRATORY SYSTEM
• Lungs become more rigid
• Pulmonary function decreases
• Number and size of alveoli decreases
• Vital capacity declines
• Reduction in respiratory fluid
21

22. Lungs become more rigid :
• Lung health in particular can change with age
• It's easy to imagine that you'll always breathe
easily, but as you get older, your lungs lose strength
• Age-related changes reduce elasticity in your lung
tissues and decrease muscle mass within your
diaphragm
22

23. 23
Aging effect :

24. Pulmonary function decreases :
The elderly population has less pulmonary
reserve, and cough strength is decreased in the
elderly population due to anatomic changes
and muscle atrophy
24

25. Number and size of alveoli decreases :
• Dead space increases with age because the larger
airways increase in diameter
• After the age of 40, the diameter of the small
airways decreases
25

26. 26

27. CARDIOVASCULAR SYSTEM
• Heart smaller and less elastic with age
• By age 70 cardiac output reduced 70%
• Arteries more rigid ( less elastic)
• Veins dilate
• Acceleration and retardation is low
(More arrhythmias)
27

28. Heart valves become sclerotic :
Sclerotic is thickening and tightening of the valve that
leads to the heart having to work harder and the
possibility of not enough blood being delivered to
the body.
28

29. GASTROINTESTINAL SYSTEM
• Reduced GI secretions
• Reduced GI motility
• Decreased weight of liver
• Reduced regenerative capacity of liver
• Liver metabolizes less efficiently
29

30. REPRODUCTIVE SYSTEM
Male:
• Reduced testosterone level
• Testes atrophy and soften
• Decrease in sperm production
• Seminal fluid decreases and more viscous
• Erections take more time
30

31. REPRODUCTIVE SYSTEM
Female:
• Declining estrogen and progesterone levels
• Introitus constricts and loses elasticity
• Vagina atrophies - shorter and drier
( basically seen after menopause )
• Uterus shrinks
• Breasts pendulous and lose elasticity
31

32. NEUROLOGICAL SYSTEM
• Nerve transmission slows :
Nerve cells may begin to pass messages more
slowly than in the past
• Hypothalamus less effective in regulating body
temperature :
32

33. • Reduced REM sleep, decreased deep sleep :
We typically have 3 to 5 times of REM sleep per
night. They occur at intervals of 1-2 hours and are
quite variable in length. An episode of REM
sleep may last 5 minutes or over an hour
33

34. MUSCULOSCELETAL SYSTEM
• Adipose tissue increases
• Lean body mass or muscle decreases
• Bone mineral content diminished
• Less resilient connective tissue
• Synovial fluid more viscous
• May have exaggerated curvature of spine
34

35. 35
Decrease in height from
narrow vertebral spaces
Synovial fluid more viscous

36. May have change in curvature of spine
36

37. IMMUNE SYSTEM
• Decline in immune function
• Decreases antibody response
• Fatty marrow replaced red marrow
• Vitamin B12 absorption might decrease –
decreased hemoglobin and hematocrit
37

38. ENDOCRINE SYSTEM
• Decreased ability to tolerate stress - best seen in
glucose metabolism
• Estrogen levels decrease in women
• Other hormonal decreases include testosterone,
aldosterone, cortisol, progesterone
38

39. Age related changes in the ocular
structure
Eye lid :
Madarosis
Poliosis
Ptosis
Wrinkle
Dermatochalasis
Entropion
Ectropion
39

40. Eye lashes
Madarosis :-
Partial or complete loss of eye lashes or eye
brows
40

41. 41

42. 42

43. 43

44. •Local Causes
• Chronic blepharitis
• Trauma
• Burns
• Eyelid neoplasm
• Psychiatric condition
44

45. Poliosis :
Poliosis is due to a lack of
a pigment called melanin
in the hair follicles
45

46. 46

47. Wrinkle :
Wrinkles are creases, folds, or ridges in the skin
They normally appear as people get older, but they
can also develop after spending a long time in water
47

48. 48

49. Causes :
• Wrinkles are a natural part of the aging process
• As people get older, their skin gets thinner, drier,
and less elastic, and less able to protect itself from
damage. This leads to wrinkles, creases, and lines
on the skin
• Facial expressions
49

50. 50

51. Eye Lid
Ptosis :
Abnormal drooping of upper eye lid
51

52. 52

53. Causes :
• Third nerve palsy ( oculomotor )
• Mechanically – Chalazion ,stye and lid oedema
• In serious condition , such as brain tumor , stroke
and cancer
53

54. Lid edema Stye
54

55. Dermatochalasis :
Dermatochalasis is a medical condition, defined as
an excess of skin in the upper or lower eyelid
55

56. 56

57. • Dermatochalasis is very common
• Usually bilateral condition which tipically
affected elderly patients
• Lid have a baggy appearance
• Treatment in severe cases involve excision of
redundant skin (Blepharoplasty)
57

58. 58

59. Lid Laxity
Entropion
Definition :
In rolling or inward turning of eye lid
59

60. Entropion
60

61. Types
• Involutional (i.e. due to ^ age)
• Cicatricial (i.e. due to scarring)
• Congenital ( i.e. present at birth)
61

62. Symptoms
• Irritation
• Watering
• Redness
• FBS
Signs
• Lid (usually lower) turned in
• Lashes turned in and rubbing against the cornea
• Conjunctival congestion
• Horizontal lid and tendon laxity
62

63. Ectropion :
Out rolling or outward turning of the lid margin
• Types
• Involutional
• Cicatricial
• Paralytic
• Mechanical
63

64. Ectropion 64

65. This may be due to
• Horizontal lid laxity
(Demonstrated by the ‘Snap Back’ test)
• laxity of the lateral canthal ligament
• laxity of medial canthal ligament
65

66. Treatment :
• both can be successfully treated with surgery if
they produce discomfort or a threat to vision.
• Lubricants
66

67. Conjunctiva
• Degeneration and more yellowish
• Decrease in no. and height of epithelial cells
• Shortening of inferior fornix
• No. of mucus cell decrease – leading dry eye
• Pinguecula
• Pterygium
• Concretion ( due to accumulation of dead epithelia
cell )
67

68. 68

69. 69

70. 70

71. 71

72. 72

73. Cornea
• Decrease corneal sensitivity
• Increase against the rule astigmatism3
• Corneal endothelial cell decrease
• Arcus senilis
73

74. 74

75. 75

76. 76

77. Lacrimal Gland
• Stenosis (Contraction of nasolacrimal duct )
• Lacrimal gland atrophy
• Chronic Dacryocystitis ( Inflammation of lacrimal
gland )
77

78. 78

79. 79

80. Aqueous humour
Aqueous humour it self does not change with age,
the value of its resting level of intraocular pressure
can rise
It may be cause by an increase in the production of
rate of aqueous humour or partial obstruction of the
Schlemm’s canal , it may be lead to glaucoma
80

81. 81

82. Iris
• Miosis ( pupillary diameter decreases )
• Increase visibility of sphincter muscle
• Less difference in the diameter of the pupil in the
light and dark adapted state
• Less reactive to light
82

83. 83

84. 84

85. Lens
85
Decrease in function of
active transport pump
mechanism of lens
Reduce Oxidative
Reaction
Hydration of lens fiber Decrease Synthesis of protein
lens Fiber
Denaturation of
lens protein
Opacification of cortical
lens fibers

86. 86

87. Vitreous
• Floaters
• Posterior vitreous detachment
( separation of posterior vitreous from retina )
• Decrease support to the posterior lens surface
87

88. 88

89. 89

90. Optic disc
• Optic atrophy
• Large cupping due to loss of neurons
90

91. 91

92. 92

93. Retina
• RD ( Retinal Degeneration )
• ARMD ( Age Related Macular Degeneration )
• CRD ( Cystoid retinal Degeneration )
• CRVO ( Central retinal vein occlusion )
• Dull foveal reflex
93

94. Orbit
• With age, there is loss of periorbital fat, which
surround and cushions the eyeball
• The loss of orbital fat often cause Enophthalmos
94

95. 95

96. Age related changes in ocular
function
96

97. Visual acuity
Visual acuity should be correctable to 6/6 , even in
very old patient
97

98. Refractive changes
Presbyopia :
• Presbyopia is a universal age related changes in
vision
• Decrease Accommodation result Presbyopia
• It is corrected with near vision glasses or plus lens
or convex lens
98

99. Astigmatism :
• Due to upper tarsal plate constantly exerting pressure on
the horizontal meridian of the cornea, the with-the-rule
astigmatism develops during preschool years
• As the upper tarsal plate begins to lose its rigidity in
middle life or beyond, the horizontal meridian is allowed
to steepen so that the cornea again assumes an approx.
spherical shape, resulting in a small amount of against-
the-rule astigmatism
99

100. Contrast sensitivity
• Contrast sensitivity
decreases with age
• Due to loss of neurons in
the visual pathway in the
brain rather than to any
retinal changes
100

101. Glare
• Elderly patient often complaint of decrease visual
perception resulting from glare
• Due to changes in crystalline lens ( Cataract )and vitreous
humor ( vitreous opacity ) increases the scattering of light in
the ocular media
• Polarized lenses reduce glare
101

102. Color Vision
• Color Discrimination declines with age
• Colors appears to be less bright, and contrast between
colors are less noticeable
• Impaired color vision, also - especially greens and blues
• Because cones degenerate
102

103. Dark Adaptation
• Dark adaptation decreases with age
• Due to change in pupil size and to increase the lens
opacity
103

104. Visual Field
• The size of a normal visual field decreases by about
1 to 3 degree per decade
• Thus , for person’s in their 70s or 80s visual field
loss by 20 to 30 degree may result
104

105. Foreign body sensation
• Its may be related to-
- dry eye condition
- Entropion
- Fatigue of the eye muscle
( lack of sleep and poor health )
105

106. Special consideration in examining
and managing the older patient
• Analysis and evaluation of changes visual task
• Examine the patient with visual impairment or low
vision
• Environmental factor ( Illumination , color , glare ,
contrast )
• Evaluation and development needs in geriatric
patient care
106

107. Clinical assessment and
management
• Goals of geriatric patient care
• Modification of clinical procedure
• Managing common vision disorder
107

108. Goals of geriatric patient care
• Quality of life :-
- Prevention
- Maintenance
- Rehabilitation
- Enhancement
108

109. Modification of clinical procedure
• Optometric and functional case history
• Assessing visual acuity
• Refraction and Prescription
• Evaluating ocular health
• Assessing visual field
• Evaluating Binocularity
• Implication for special test –
1. Color contrast and glare testing
2. Laboratory and imaging testing
109

110. Managing common vision disorder
• Lens design option for refractive disorder
• Rehabilitation technique for elders with visual
impairment
• Drug therapy
• Nutrition and nutritional therapy
• Monitoring performance and ensuring continuity of
care
110

111. Thank you
111