Vision loss in elderly

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Stephanie Dorsey
5 years ago
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1 Vision loss in elderly Erica Weir, February Burden Enter nursing homes 3 years earlier Twice the risk of falling 4x the risk of hip fracture Independent risk factor for delirium What are the leading causes? 2 1

2 Leading causes Cataracts Open angle glaucoma Age related macular degeneration Diabetic Retinopathy 3 Objectives Anatomy Vision literacy Definitions Signs and symptoms Risk factors and prevention Tests Treatment CNIB resources 4 2

see fine details clearly The vitreous clear gel fills the back of the eye

3 Light to vision 5 Anatomy of the Eye The retina senses light & transmits images to the brain The macula central part of the retina used to read and see fine details clearly The vitreous clear gel fills the back of the eye and sits in front of the retina Figure 1: The human eye seeing beyond vision loss 3

4 Hyperopia and myopia 7 What s this? 8 4

5 Eye prescription 9 What is presbyopia? 10 5

6 Cataracts - Definition Cloudiness in lens because of protein degeneration What are the signs and symptoms? 11 Cataracts signs and symptoms Gradual, progressive, painless blurring of vision and sensitivity to bright lights Worsening near sightedness, diminished colour vibrancy, night glare 12 6

7 Risk factors Age Family history Corticosteroids Sunlight, heat, radiation Diet, alcohol Smoking Atopic dermatitis 13 Treatment Front capsule excision Phacoemulsification (mechanical energy) to fragment lends, suctioned out Intraocular lens insertion 2% complication rate Secondary cataracts Most frequently performed operation in US 90% percentile wait time Ontario 123 days 14 7

8 Video 15 Open angle glaucoma 16 8

Open and Closed Angle 17 Open angle glaucoma Silent visual loss because of damage or death of the retinal ganglion cells and their axons through the optic

9 Open and Closed Angle 17 Open angle glaucoma Silent visual loss because of damage or death of the retinal ganglion cells and their axons through the optic nerve Increased ocular pressure associated with blockage of the ocular outflow channels such as the trabecular meshwork RF age (10% > 75), family hx 9.2x 18 9

10 Detection Central vision Peripheral vision Serial ocular pressure monitoring (21 mm Hg) Serial photos of optic nerves and their horizontal and vertical cups and rims 19 Visual Field testing 20 10

11 Pattern of loss 21 Arcuate scotoma 22 11

anhydrase inhibitors Increase outflow Prostaglandin analogs

12 Glaucoma 23 Treatment 40% compliance Suppress aqueous production Beta adrenergic blockers Alpha agonists Carbonic anhydrase inhibitors Increase outflow Prostaglandin analogs Laser opening of trabecular meshwork Trabeculectomy or tube shunt 24 12

13 Exacerbate Glaucoma Antidepressants Antihistamines Anticholinergics Benzodiazepines Caffeine Corticosteroids Decongestants Muscle relaxants Oxybutynin Antipsychotics Salbutamol Sulfonamides 25 Adult onset macular degeneration Drusen, yellow-white deposits of lipofuscin cholesterol at back or retina Abnormalities in pigmentation at back layer of retina Atrophic degenerative spots in the macula dry Exudates from fragile new blood vessels derived from vascular endothelial growth factor 26 13

14 Histology 27 Drusen 28 14

15 Dry and Wet 80% have dry form 90% of severe visual loss (>20/200) occurs in patients with the wet form 29 Risk factors Age Ethnicity Low levels of antioxidants Hereditary Smoking 30 15

16 Presentation Dry blurred vision, central scotoma Wet central scotoma, image distortion, increased glare sensitivity, decreased colour perception, formed hallucinations, blindness 31 Amsler grid 32 16

17 Treatment AREDS study (2001) Patients with intermediate or advanced AMD experienced 25% less subfoveal geographic atrophy or choroidal neovascularization over 5 years when treated with 500mg vit C, 400IU vit E, 15 mg beta-carotene, 80 mg zinc oxide and 2mg cupric oxide. Beta carotene, Vit A & E increased mortality 33 Wet AMD 2 VEGF antibody forms Ramibizumab recombinant humanized smaller immunoglobulin, intravitreal injection $1950/dose Bevacizumab full length monoclonal Ab, intravenous use $50/dose Verteprofin (Visudyne) Photosensitized, damages endothelium, occludes mature vessels 34 17

VEGF antibody injection 35 MOHLTC Visudyne Program Home Public Information Health Care Professionals News Room E-mail PrintAccessibility The Visudyne (Verteporfin) Program What does the program cover?

18 VEGF antibody injection 35 MOHLTC Visudyne Program Home Public Information Health Care Professionals News Room PrintAccessibility The Visudyne (Verteporfin) Program What does the program cover? This program covers the full cost of the drug verteporfin, used to slow the advance of age-related macular degeneration (an eye condition). The drug must be provided under specific circumstances. To learn more, see Section 8. (2.1) of Regulation 552 of the Health Insurance Act. Am I eligible? Talk to your doctor. To qualify, you must: live in Ontario and must have a valid health card to show that you are entitled to health care services paid for by OHIP. AND meet the criteria defined in Section 8. (2.1) of Regulation 552 of the Health Insurance Act

19 Summary Vision loss - Silent and progressive Cataracts effective surgery, wait times Glaucoma preventable, poor compliance ARMD great improvements in preventing progression of neovascularization Assess, ask, assist 37 CNIB

Vision loss in elderly. Erica Weir, April 2015

Vision loss in elderly. Erica Weir, April 2015 Vision loss in elderly Erica Weir, April 2015 1 Burden Enter nursing homes 3 years earlier Twice the risk of falling 4x the risk of hip fracture Independent risk factor for delirium What are the leading