visual loss in the elderly. aetiology sudden –retinal retinal vascular occlusion wet amd...
TRANSCRIPT
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VISUAL LOSS IN THE ELDERLY
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Aetiology
• Sudden– Retinal
• Retinal vascular occlusion
• Wet AMD
– Neurological• AION
• Neurological visual field loss
• Gradual – Cataract
– Glaucoma
– Dry AMD
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Cataract
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Cataract
• Slow, painless decrease of vision
• Glare
• Occasionally, monocular multiple images
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Types of Cataract
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Management
• Interfering with daily activities
• Cause of other ocular diseases
– glaucoma
– uveitis
• Prevents examination or treatment of pre-existing ocular condition
– DR
– Glaucoma
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7
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Aqueous Outflow
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Glaucoma
• Primary open angle– Reduced outflow and
poor optic nerve perfusion
• Secondary open angle– Ocular disease
• Ocular inflammation
• Trauma
• Intraocular haemorrhage
– Drugs• Steroids
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Symptoms
• Often none until extensive loss of V F
• ‘Bumping into things’
• Gradual deterioration of near vision
• Pain very uncommon unless IOP very high
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Treatment
MEDICAL• ß-Blockers(side effects!)• PG agonist• α2 adrenergic agonist• Parasympathomimetics• CAIs• Osmotic agentsSURGICAL• Trabeculectomy• Laser
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AION
• Arteritic– Older patients
– Second eye involved 75%
– Polymyalgia Rheumatica
• Non-arteritic– Younger
– HT, DM
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Arteritic IAON
• Headache, scalp tenderness
• Thickened temporal artery
• Jaw claudication• Weight loss, anorexia,
fever, night sweats, malaise, depression
• Raised ESR• CRAO, CN palsy
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Retinal Vein Occlusion
• Sudden, painless– VF defect
– loss of vision
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Retinal Artery Occlusion
• Sudden, painless– VF defect
– loss of vision
• Amaurosis fugax• CVA, TIA
Cherry spot
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Investigations for retinal vascular disease
• Visual acuity, pupil reflexes, visual field
• BP, pulse, ECG
• BSL, FBC, U/Es
• Protein electrophoresis
• Carotid doppler
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Macular Disease
• Commonest cause of untreatable visual loss in the elderly
• Distortion
• Deterioration of central visual acuity
• Normal pupil reflexes
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Dry AMD
Drusen
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Exudative AMD