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Vision Changes with Aging
Mark Swanson, OD, MSPH
Associate Professor
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Visual Impairment Low Vision and Blindness
Blindness – USA <20/100 or 20 degrees VF– WHO <20/400– The Chart Issue
Low Vision– Various definitions <20/40 to <20/60– Varies by State and At Times Agency within
the State
Legal Driving – Varies by State
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Refractive Error
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Refractive Error
50% of US population wears optical correction for distance viewing- $15B/yr
Hyperopia increases
(farsightedness) with aging
Shift to myopia (nearsightedness) with cataracts
Astigmatism-shifts with aging
Leading cause of correctable visual impairment in older adults along with cataract
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Refractive Error and Visual Impairment
Estimates of Visual Impairment in the US Population Due to Uncorrected Refractive Error(<20/30 better eye) Source:NEI
Age Groups(Rate/1000)
Persons aged 12 to 19 years 155.9
Persons aged 20 to 39 years 96.6
Persons aged 40 to 59 years 84.3
Persons aged 60 years and older 145.7
Source: WHO
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Reduced Visual Acuity Reduced AccommodationReduced Contrast SensitivityReduced Dark AdaptationReduced Light AdaptationIncreased Intraocular Light ScatterReduced Light TransmissionReduced Retinal Sensitivity
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Visual Acuity
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Reading Rate
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Visual Acuity Reduction in the Elderly
Increased risk of 5 year mortality
Increased risk of nursing home placement
Increases hospital length of stay in by two days
Increased risk of falls
Increased risk of hip fracture
50% of low vision patients have clinical depression
Increased risk social Isolation
Decrease in physical activity
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Presbyopia
Loss of Accommodation
Prevalence 100%
Symptomatic at 40-45
By 55 completely dependent on reading glasses
Anti-cholinergic drugs make it worse
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Contrast Sensitivity
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Contrast Sensitivity
Driving
Falls
Face Discrimination
IADL performance
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Light and Dark Adaptation
Going In to The Movie
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Reading a Face