This document discusses various age-related changes that can occur in the eye and vision. It begins by defining what is considered "normal" aging vision in those over 65. It then discusses general physiological changes that commonly occur, such as a thinning lens and decreased pupil size. Specific diseases that are more prevalent with age, like cataracts, glaucoma, macular degeneration, and diabetic retinopathy, are also outlined. Treatment options and risk factors for these conditions are provided. Other topics covered include dry eye, low vision aids, and general visual performance changes associated with the aging process.

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

6. Aging Eye

7. AGE-DEPENDENT CHANGES
Physiological and Performance Based

8. General Aging Changes
 Mostly affect appearance
 Seldom affect performance
 Some need monitoring with age
Lens
Aqueous Humor
Retina
Macula

9. General Aging Changes
 Sclera- thinner, pigment change
 Aqueous Humor- intraocular pressure
 Vitreous Humor- thins, opacity
 Cornea- arcus senilis (Ca and cholesterol),
sensitivity
 Iris- muscles weaken, smaller pupil
 Lens size and thickness , elasticity
 Conjunctiva- dry eye

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

13. Near Point Changes

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

19. LENS
 Lens grows
throughout life
 Axial thickness
increases by about
28% between the
ages of 20 & 70

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

26. HIGH - LOW CONTRAST ACUITY

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

29. VERNIER ACUITY

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

31. STILES-CRAWFORD EFFECT

32. STILES-CRAWFORD EFFECT

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?

34. OPTICAL CORRECTION

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

37. USEFUL FIELD OF VIEW

38. USEFUL FIELD OF VIEW

39. USEFUL FIELD OF VIEW

40. Age-Related Changes
Diseases and Syndromes

41. Cataracts
 Symptoms: increase in lens opacity
 Peripheral to nuclear
 Causes/Risk Factors:
 UV light/free radicals
 Glycation
 Corticosteroids
 Diabetes

42. Cataracts

43. Cataract
 What is it?
 Clouding of the eye’s lens that
causes loss of vision.

44.  Who is at higher risk?
 Most cataract are related to aging
 Other risk factors
• Diabetes
• Smoking
• Exposure to sunlight
Cataract

45. Same scene as viewed by a
person with cataract
Normal vision
Cataract

46.  Symptoms
 Cloudy or blurred vision.
 Colors that may not appear as
bright as they once did.
 Glare.
 Poor night vision.
Cataract

47.  Treatment options
 Glasses
 Better lighting
 Surgery
Cataract

48.  What can you do?
 Eat a healthy diet.
 Wear sunglasses and a brimmed hat when
outdoors.
 Don’t smoke.
Cataract

49. Glaucoma

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

55. Age-Related Macular
Degeneration (AMD)

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)

60. Normal
Dry AMD Wet AMD

62.  Treatment options
 Age-Related Eye Disease Study (AREDS) special
vitamins/minerals supplement formulation.
 Laser surgery.
 Eye injections.
 Photodynamic therapy.
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)

64. Diabetic Retinopthy

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

76. Low Vision Aids
(Treatment Option In Old Age)

77. Low Vision Aids

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