- Aging causes many changes to the structures of the eye that can affect vision and eye comfort. These include yellowing of the sclera, decreased tear production, hardening and clouding of the lens, thinning of the vitreous humor, and loss of peripheral vision. However, central vision can typically be maintained with correction. - Common age-related visual changes are presbyopia requiring reading glasses, decreased contrast sensitivity and dark adaptation, increased floaters, and reduced color discrimination especially of blues. These changes are usually not medically significant. - Eye discomfort from dryness or strain may occur but headaches should be evaluated, as in elderly they could signal an ocular emergency like acute glaucoma needing prompt

1. AGING AND THE EYE
Mr. Mahendra Singh
PhD (Scholar)
M.Optom, FLVPEI
Assistant Professor and
consultant Optometrist.
CL Gupta Eye Institute. UP India

2. WHAT IS AGING……..?
• Decay of flesh, loss of vital substances,
entropy, the victory of catabolism over
anabolism.
• It is wisdom without tranquility, compassion
without passion .
• Every night we are poorer by a day .
• Aging is universal, progressive, inescapable,
mainly intrinsic and generally deleterious.

4. WHAT CAUSES AGING……..?
• THE GENETIC
APPARATUS.
• THE INTERCELLULAR
SUBTANCE.
• THE NOIONS EFFECTS
OF THE
ENVIRNOMENT.
• CELLULAR
HYPOFUNCTION.

5. • Sustained sub lethal injury leads to
intracellular inclusion of GLYCOGEN,COMPLEX
LIPIDS AND PIGMENTS.
• Intercellular accumulation of amyloid are seen
in aging tissues.
• Some tissues grow old as direct result of wear
and tear evident in teeth, bone, cartilage and
joints.

6. IS AGING A DISEASE……..?
• Normally aging affects
all body function
• It is difficult to
separate the
physiologic from
pathologic ischemia.
• Same effect can be
produced by trauma,
infection, toxins and
metabolic disorder.

7. 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.

9. • 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.
• (e.g. RHEUMATOID ARTHRITIS)

10. 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 KERATITIS SICCA for no specific reason.
• This change contributes to dry eye condition. Which
is manifested by a scratchy sensation and chronic
irritation.

12. • Often with increased redness from dilatation of blood vessels
in the conjunctiva.
• The increased redness commonly occurs because the
conjunctiva is heavily vascularised.
• Capillaries in the conjunctiva are fragile and burst easily.
Resulting in a pooling of blood in the space between the
sclera and the overlying conjunctiva.

13. 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 THE CANAL OF SCHLEMM.
• Which are important in maintaining correct
intra ocular pressure.

14. 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.

16. • The mechanism for this normal increase is
unknown.
• Glaucoma results if the cannal becomes
abnormally high.
• Aqueous humor itself does not change with
age

17. 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.

18. • This tugging stimulates the peripheral retina
mechanically, causing vertically oriented
flashing, almost always in the far temporal
visual field.

21. CORNEA
• The most important refractive portion 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.

22. • Corneal sensitivity to touch decreases with
age.
• The threshold to touch double between ages
10 and 80, with the largest changes occurring
after age 40.
• The patient does not notice this change.
Therefore , the cornea should always be
examined for asymptomatic changes.

26. 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.

27. • They also experience difficulty when going from a brightly lit
environment to a darker one.
• If V/A is normal . Patients need only reassurance that these
changes are normal.
• None of these changes results in decrease V/A.
• RELATIVE PUPILLARY SIZE AND REACTION TO LIGHT.

28. 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.

29. • 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

31. 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 paler than in younger persons because of a
loss of capillaries due to small-vessel disease secondary to
atherosclerosis

33. • 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.

35. • The arteries also demonstrate atherosclerotic
changes,
• The veins may show marked venous
indentation at the AV crossing with slight
proximal distention.

36. LIDS
• With age, the orbicular oculi muscles (which
squeeze the lids shut) decrease in strength.
• ECTROPION.
• Spasm of OOM may cause the lid margin to
turn in (ENTROPION)
• TRICHIASIS resulting in chronic irritation.

38. • 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.

39. 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
schemer test

40. ORBIT
• With age , there is loss of periorbital fat, which
surrounds and cushions the eye ball.
• This loss of fat often causes enophthalmos.
• An asymptomatic condition that often poses a
cosmetic problem and may be corrected with
surgery.

41. AGE-RELATED CHANGES IN OCULAR
FUNCTION.
• ARCOF may be divided into two groups.
• Those related to vision .
• Like refractive changes, visual acuity, contrast
sensitivity, glair, haziness, flashing lights,
moving spots, and visual fields.
• RELATED TO EYE COMFORT.
• Foreign-body sensation and headache.

42. REFRACTIVE CHANGES
• With age, the lens becomes denser and less
elastic , and accommodation is lessened.
• PRESBYOPIA, a universal age-related change in
vision beginning in persons in their 40s
• It is corrected in myopic and hyperopic
patients with separate reading or bifocal glass.

43. • Because accommodation is lost progressively
from about ages 45 to 65, the reading lens
usually must be changed every 2 or 3 years.

44. 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.
• These changes are independent of pupil and the lens changes
and are thought to be a function of neurological changes in
the visual pathways of the brain rather than of retinal
changes.

45. • 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.

46. CONTRAST SENSITIVITY
• CS decrease with age at middle-spatial and high-spatial
frequencies (>8 cycles/degree)
• This change was originally thought to be due to the fact that
elderly persons have smaller pupils and more lens opacities.
• The loss of CS is now thought to be due to a loss of neurons in
the visual pathway in the brain rather than to any retinal
changes.

47. • This loss of contrast sensitivity has very little
effect on the elderly persons life.
• Currently this loss cannot be prevented or
reversed.

48. HAZINESS, FLASHING LIGHTS, AND MOVING
SPOTS
• ARC in the vitreous humor can create
noticeable and disturbing changes in vision,
including haziness.
• Vertically oriented flashing lights may also
occur due to changes in vitreous.
• Flashing lights in only one eye at a time.
• No further evaluation needed if there is no
changes in the visual function .

49. • In patient with myopia and uveitis and in
many others in their late 50s and early 60s.
Opacities appear as lines, spots , or clusters of
dots moving slowly across the field of vision.
• These opacities represent bits of vitreous
humor that have coalesced and float freely in
vitreous cavity.

50. • These floaters has no clinical importance .
• If an ophthalmoscopic examination shows no
retinal detachment, the patient should be
reassured an encouraged to ignore the floater.

51. 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.

52. • In persons >60, this ARC results in a reduction
in discrimination of blue objects, which often
appear grey.
• People who use color discrimination in their
professions e.g. artists, electricians .
• Need to be alert to these changes and should
avoid using blue ink over light blue or grey
backgrounds.

53. DARK ADAPTATION
• With age dark adaptation decreases.
• This decline in sensitivity is due, almost
completely, to ARC in pupil size and to
increasing lens opacity.
• The resulting loss of light reaching the retina
due to the total decrease in dark adaptation
with age.

54. • The amount of ambient light needed for
reading by persons in their 60s is three times
that needed by those in their 20s.
• Therefore, increasing the amount of ambient
light in all rooms in the home improves safety
and productivity.

55. 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.

57. • To track visual field changes across time for
each patient, the examiner should perform VF
test early in the day.
• Before the patient tires, subsequent test
should be performed at the same time of day
to decrease variability in results

58. HEAD ACHE
• In the elderly patient, headache may be due
to ocular function.
• Eye strain can produce tension headaches.
• Headache in patients with acute glaucoma is a
true ocular emergency and requires
immediate attention.