This presentation discusses the impact of aging on eyesight and how proper lighting can enhance the living conditions of the elderly. It covers the physical changes in the eye with age, common diseases, and evidence-based lighting solutions that improve health and well-being. Participants will learn practical strategies for designing lighting environments that support the visual needs of older adults, including recommendations from the IESNA Lighting Handbook.

2. And the Aging Eye

3. Copyright Materials
This presentation is protected by US and International Copyright laws. Reproduction, distribution, display and
use of the presentation without written permission of the speaker is prohibited.
© Visa Lighting 2015

4. Credit(s) earned on completion of this course will be
reported to AIA CES for AIA members. Certificates of
Completion for both AIA members and non-AIA
members are available upon request.
This course is registered with AIA CES for
continuing professional education. As such, it does
not include content that may be deemed or
construed to be an approval or endorsement by the
AIA of any material of construction or any method or
manner of
handling, using, distributing, or dealing in any
material or product.
___________________________________________
Questions related to specific materials, methods, and services will
be addressed at the conclusion of this presentation.

5. Credit(s) earned on completion of this course will be reported to AIA CES
for AIA members. Certificates of Completion for both AIA members and
non-AIA members are available upon request.
This course is registered with AIA CES for continuing professional
education. As such, it does not include content that may be deemed or
construed to be an approval or endorsement by the AIA of any material of
construction or any method or manner of
handling, using, distributing, or dealing in any material or product.
___________________________________________________
Questions related to specific materials, methods, and services will be addressed at the
conclusion of this presentation.

6. As our population continues to age so do our eyes. The visual requirements of older persons
are much different than the younger population. Increased light levels, attention to contrast,
detail and the healing attributes of lighting are all important factors in designing lighting for the
elderly. This presentation will identify ways in which the eye ages, common diseases and what
we can do with lighting as a tool in designing for the aging eye.

7. At the end of the this course, participants will be able to:
1. Understand the terminology and physical factors of the eye.
2. Describe the phases of the aging eye and common diseases.
3. Look at lighting solutions where lighting can be used as a tool when
designing for the elderly.
4. Describe evidence based research on ighting that can improve human
health.

9.  Baby boomers account for the largest
percentage of acute care patients
 In 2012, 22% of patients 65 and older made a
trip to the emergency room
 The healthcare industry is bracing for what’s
been dubbed the “silver tsunami”
http://www.healthcaredesignmagazine.com/article/generational-shift

11.  Apartments or units vs. large nursing homes
 Smaller units add marketability to the
community
 Adds connectivity to the larger community by
having seniors use neighborhood amenities
and facilities
 80 is the new 65!
Communal Spaces
Acute Care Settings

12.  Baby boomers will live longer, happier
in their own homes

13.  Now that we know the trends, how do we light the spaces?

15. LENS

16. Cone of Light
 Causes less ability
to focus

17.  The lens is responsible for allowing your eyes to focus
 The lens is in a constant state of adjustment
 With age, the lens looses a lot of its elasticity
 At roughly age 50, the lens can no longer change shape

18. 70 Years20 Years

19. Normal Diabetic Eye Disease Dry Eyes
Cataracts Age Related Macular
Degeneration
Glaucoma

21. -
PHOTORECEPTORS

23. Photopic Vision – Cones
High Light Levels – Daytime

24. Peak Sensitivity – 555nm

25. Scotopic Vision – Rods
Low Light Levels - Nighttime

26. Peak Sensitivity – 498 nm

27.  IPRGC- third photo-receptor discovered
 Intrinsically photosensitive retinal ganglion cells
 Turns light energy into brain signals that control the
circadian clock
 Intrinsically photo-sensitive retinal ganglion cells
 Peak Sensitivity at 484 nm
http://brown.edu/Administration/News_Bureau/2001-02/01-080.html

29.  Photopic Vision/Cones –
Photopsin
 R 564 nm
 G 533 nm
 B 437 nm
 Scotopic Vision/Rods –
Rhodopsin
 G 533 nm
 Circadian/Retinal Ganglion Cells
(ipRGC’s) – Melanopsin
 B 459-484.
 Peak sensitivity at 484 nm

36.  Circadian Rhythm: A roughly 24 hour cycle in the physiological processes
of living beings, including plants and animals.
 Photoreceptors in the eye allow light and environmental cues to help
regulate core body temperature and melatonin production.

37. Controls:
 Temperature
 Hunger
 Thirst
 Fatigue
 Hormone levels
 Circadian Cycles

39.  Brain
 Liver
 Lungs
 Kidney
 Heart
 Pancreas
 Gastro-Intestinal Tract

40. Light that mimics nature can improve:
 Circadian system functions
 Sleep
 Mood
 Performance
 Health

42.  In elders less light reaches the back of the eye
because the pupil size decreases with age
 They lose retinal neurons that are needed to see
light & dark patterns that keep our biological
rhythms in line
 Due to physical limitations they may be deprived of
natural sunlight

44. So what can we do to help design for the aging eye?

45. GET OUTSIDE – Sunlight allows the body to maximally utilize
calcium and optimize muscle function

48. Exposure Increases:
 Seratonin (impulse control)
 Cortisol (stress)
 Gaba (calm)
 Dopamine (alertness)
 Follicle Stimulating Hormone (reproduction)
 Gastrin Releasing Peptide (GRP)
 Neuropeptide Y (hunger)
 TSH (metabolism)
 Suppresses melatonin

49. In the Northern Hemisphere there is insufficient UVB sunlight
radiation/Vitamin D available in the months between November and
March
• 2% in Florida
Vs.
• 10% in New
Hampshire

50.  Decreased Serotonin
(Neurotransmitter)
 Increased Melatonin
(Hormone) Levels

51.  Light Treatments
 Timing
 Duration
 Wavelength
 Age dependent and
individualistic
 Sources must be UV
filtered

52. Absence of Blue
Increases:
 Melatonin (sleep)
 Vasointestinal
peptide (lowers
blood pressure)
 Growth Hormone
(metabolism and
repair)

53.  Keep sleep disturbances to a minimum
 Maintain sleep schedule, decrease naps as needed
 Exposure to bright white light in the morning
(2 hours when possible)
 Amber/Red light at night only (650nm)
 Blue light exposure in early evening (470nm)

54.  Alzheimer’s disease is the most common
form of dementia – Damages the SCN part
of the Brain
 Memory loss
 Sleep disorders
 Impaired logic & cognition
 Inappropriate social behavior
 Agitation
 Mood swings

55. Elderly and Alzheimer Facilities
Sisters of St. Francis Study, 2010
– Stella Niagara Health Center, NY
 Exposure to enhanced interior and outdoor daylight
 Removed all white light from hallways at night
 Utilized red, warmer wavelengths

56. Sisters of St. Francis Study
Results of removal of white light in corridor
 Slept through the night
 Awake during the day
 Reduced Insomnia
 Lower incidence of flu & colds
 Reduction and stabilization of blood pressure
 Lower incidence of night wandering
 Hallucinations ceased
 Improved lucidity
 Increased social participation

58. The IESNA Lighting Handbook
10th Edition Handbook (2011)
Lighting and the Visual Environment for Senior Living
RP-28-07
Location and Task Age 25 - 65 Age 65+ Senior Living
Exterior Entry (Night) 10 20 10
Stairways (High Activity) 10 20 30
Elevator Interiors 5 10 30
Reading/Waiting Areas 30 60 30 waiting
Group Dining 30 60 50
Bedroom 15 30 30
Bathroom (Fixtures) 15 30 30
Kitchen Area 30 60 30
Hallways (Active) 10 20 30
Hallways (Sleeping) 5 10 10
Nurse Stations 50 100 30 (10 at night)
Physical Therapy 30 60 30 (50 task)
Examination Rooms 100 200 30 (100 task)
Laundry 30 60 30 (50 task)

59. Area Ambient Light Task Light
Dining 50
Living 30 75 (Reading)
Bedroom 30 75 (Reading)
Bathroom 30 60 (Grooming)
Kitchen 30 50
Halls (& path to bathroom**) 30 day/10 at night
Entrance 30
Closet 30
Laundry 30

60. For healthcare you typically need
80 CRI +

61.  Falls account for 25% of all hospital admissions, and
40% of all nursing home admissions. 40% of those
admitted do not return to independent living; 25% die
within a year
 Others have their quality of life greatly reduced

62. Light Reflectance Values
Yes
NoNo

63. Chromatic Contrast : When the color can
produce contrast and enhance visibility
 Use complimentary hues (those which lie
directly opposite each other on the color wheel)

64.  Elders will perceive strips as steps or changes in elevations

66. Disability GlareReflective Glare

67. Use lensed fixtures over
reflective surfaces

68. Reflections may be confusing
for those with vision or mental
health problems.

72.  Light path from bed to
the bathroom
 Provide amber lights at
floor level all night
 Provide amber ambient
light from above that
can be turned on when
needed
 Provide pre-set
dimmers with fade

73. Adaptation: The ability of the eye to adjust to various light levels
 As the eye ages there is a delay in this adjustment
(30 min.) - Full light to dark adaptation in a 20 yr old
(45 min.) - Full light to dark adaptation in a 50 +
 Important at points of Egress to the outdoors
 Lobbies and corridors should be dimmed according to time of
day to allow for adaptation

74. Provide a pre-set dimmer with fade to allow eyes
time to adjust between brightness levels.

75. Flicker: Noticeable periodic or irregular changes in
source luminance
 Can cause discomfort glare, migraines, Epilepsy triggers
 Check age of lamp and Lamp/Ballast/Driver compatibility

77.  30 f.c.
 Even light from above

78.  75 f.c.
 Shade
 Blue light
 Even

79.  30 f.c.
general
 75 f.c. task
 Dimming

80.  30 f.c.
general
 75 f.c. task
 Amber night
light

81.  75 f.c.
 Close to task
 Shielded
source

82.  30 f.c.
 Amber night light

83.  60 f.c.
 Best 3
sides
 2 sides
 Top

84.  50 f.c.

85.  30 f.c.
 50 f.c.
task

86.  30 f.c.
 Key hole
 Wayfinding

87.  30 f.c. day
 10 f.c. night
 Amber night
light

88. The Lighting Handbook – IES 10th Edition
 Has recommended lighting levels by age
ANSI/IESNA RP 28-07
 Lighting and the Visual Environment for Senior Living
ASHRAE
 Energy and lighting power density code requirements
 Check local code

89.  Increase light levels when designing for the elderly
 Pay attention to source and color
 Decrease white light and bright light sources at night
 Maintain regular sleep patterns
 Increase exposure to daylight

90.  Center of Design for an Aging Society
 Institute for Patient Centered Design
 The Center for Health Design
 Research Department American Health
Care Association
 Lighting Research Center
 Center for Human Centric Lighting

91. This concludes The American Institute of Architects
Continuing Education Systems Course

92. Lauren Roberts, LC, EDAC, IES
Healthcare Market Development Manager
lroberts@visalighting.com