2019 interim meeting presentation: the impact of vision ...preventing eye problems •see your...
TRANSCRIPT
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Noon–1:30 p.m. | Saturday, November 16
Room: Grand Hall C| Manchester Grand Hyatt San Diego
The Impact of Vision and Hearing Loss in the Senior Population – Why Seeing and Hearing
are Believing
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Sponsored by the
AMA’s Senior
Physicians Section
(SPS)
2
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
The AMA GME Competency Education Program
3
We take harassment and
conflicts of interest seriously. Visit
ama-assn.org/codeofconduct
to learn more.
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Chair-Elect, AMA-SPS Governing Council
Moderator
James F. Burdick, MD
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Objectives
Upon completion of this activity, the physician will
be able to:
• Explain the importance of testing for hearing and vision loss as one ages.
• Review current screening tests available for hearing impairment.
• Identify how hearing loss is associated with significant adverse effects on
a person’s social, psychological and physical well-being.
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
Speakers’ Disclosure
The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, there are no relevant financial relationships to disclose at this time.
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Speaker
Mihir (Max) Y. Parikh, MD
Board-certified ophthalmologist
Former president of the San Diego County Medical Society
Chief surgeon for NVision San Diego
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Study Conclusions
• 88% of 220 participants ranked SIGHT as most valuable sense
• Hearing was SECOND
• Participants preferred 4.6 years of perfect health over 10 years without
sight
vs. 6.8 years of perfect health over 10 years without hearing
• Mean difference of 2.2 more years of life
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Population Distribution in the World
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22.8% of US population over 60 29% of the MD population in US over 60
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• Older Age
• Lower Educational attainment
• Greater Disability
• More medical co morbidity
• Poorer Memory
Associated with significant VI in
most L/MI countries
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• Reduced functioning
• Decreased quality of life
• Increased risk of falls
• Possibly increased risk of depression
• Reducing VI would be an important
public health benefit
• BUT vision screening alone is not an
effective tool. Does not lower VI
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What is Visual Impairment?
• Vision Impairment: worse than 20/40 in
the better seeing eye
• Legal Blindness: vision worse than
20/200 or Visual Field less than 20
degrees
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MaculaOptic nerveFovea
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Most Common Cause of Visual Impairment in USA, 2015
• Non-Hispanic White Population
Cataracts (42%) (141/1000 people)
Age-Related Macular Degeneration (28%) (15.6/1000 people)
Others (22%)
Diabetic Retinopathy (5%) (39.8/1000 people)
Glaucoma (2%) (23.2/1000 people)
19
Data from the University of Chicago (UIC)
https://www.aao.org/clinical-statement/eye-disease-statistics-2#CausesofVisualImpairment
https://www.healthypeople.gov/2020/topics-objectives/topic/vision/objectives
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MACULAR
DEGENERATION
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Vision with Macular Degeneration
• Insert example of central scotoma
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Normal Anatomy of the Retina
ChoriocapillarisCampochiaro. J Cell Physiol. 2000;184:301.
Cross section of normal retina
RPE
Bruch’s
membrane
Photoreceptors
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Drusen Formation
Cross section of retina with drusen
Campochiaro. J Cell Physiol. 2000;184:301.
Johnson et al. Invest Ophthalmol Vis Sci. 2003;44:4481; Reproduced with permission.
Choriocapillaris
RPE
Bruch’s
membrane
Photoreceptors
Drusen
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Normal Drusen
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Normal Drusen
Geographic
atrophy
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Causes of severe vision loss
Wet
90%
Dry
10%
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Strategies for Preventing Progression to
Advanced AMD
• Early detection, diagnosis, and treatment
important to maximize visual outcomes
• Lifestyle modifications may slow progression
– Smoking cessation
– Exercise
– Maintain healthy weight
– Maintain normal blood pressure
– Proper nutrition
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• Nutritional considerations
– Evidence supports the role of nutrition in decreasing the
risk of progression
– Fruits and vegetables high in vitamins C and E, selenium,
and carotenoids (beta carotene, lutein, and zeaxanthin) are
recommended
• Dark green, leafy vegetables (e.g. spinach)
• Other colorful fruits and vegetables (e.g. carrots, peas,)
Strategies for Preventing Progression to Advanced
AMD (cont’d)
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Neovascular AMD
State of the Art 2012
• Intravitreal pan-VEGF blockers:• Ranibizumab (Lucentis)-FDA approved
• Bevacizumab (Avastin)-Off label
• Aflibercept (Eylea)-FDA approved
• Frequent intravitreal injections
• Frequent follow-up and testing
• Limitations:– Not all patients have improved visual acuity
– Duration of therapy unknown: Disease control-not cure
– Inconvenient
– Costly
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AMD
The Future
• Genetic testing
• Treatment options for dry AMD
• Stem cell therapy
• New medications for wet AMD
• Sustained release devices
• Combination treatment
• Intraocular telescope
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Telescope Prosthesis for Macular
Disease
12
Implantable Telescope Technology
for End-Stage AMD
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GLAUCOMA
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Optic nerve
Contains up to 1.7 Million Nerve Fibers
Optic nerve
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Glaucoma • Groups of diseases typically associated with high eye pressure
• Defined by damage to the optic nerve
• Loss of peripheral vision
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Aqueous Humor
• Secreted by the ciliary body
• Provides nutrients and oxygen to
the front of the eye
• Maintains intraocular pressure
• Drains out via the anterior
chamber angle
• Balance between production and
drainage is key
• Sustained high pressure can
damage the retina and optic
nerve
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MIGS: Minimally Invasive Glaucoma Surgery
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DIABETIC
RETINOPATHY
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Proliferative Diabetic Retinopathy
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CATARACTS
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Cataracts
• Over 40% of people over 70
have significant cataracts
• Leading cause of blindness
• Symptoms:
• Cloudy vision
• Difficulty at night
• Glare
• Fading of color
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Cataracts
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Cataracts
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Cataract Surgery
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Preventing eye problems
• See your family physician regularly
• Visit your ophthalmologist yearly for routine screening
• See an eye doctor immediately for any loss of vision,
blurred vision, eye pain, double vision, redness, swelling,
or discharge
• Eat well, exercise, and control any other medical problems
well
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Healthy People 2020 VISION: Healthypeople.gov
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Have you seen your ophthalmologist recently??
Thank you,
Mihir Parikh MD
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Speaker
S. Bobby Mukkamala, MD
Board-certified otolaryngologist—head and neck
surgeon
Elected to the American Medical Association Board
of Trustees in June 2017
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Hearing Loss in the Senior Population
aka…
"Pardon me?”
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Discussion today will include:
Reviewing types of hearing loss, evaluation of
hearing loss, treatment options and other
related issues.
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Hearing loss in the Elderly -
Why are we talking about it?
Prevalence:
• Adults 70 years of age and older have a 65% incidence of
significant hearing loss
Consequences:
• Hearing loss has significant association with chronic
conditions: Dementia, Falls
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Ear - Brain Connection
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Types of Hearing Loss
• Conductive
• Sensorineural
• Central
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Evaluation of Hearing Loss
History
• Acute or Chronic
• Unilateral or Bilateral
• Noise Exposure
Family History
• Bothering the patient or those around them (severity)
• Other symptoms: Drainage, Pain
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Evaluation of Hearing Loss
Exam:
External Ear Findings
Cerumen
Fluid
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Evaluation of Hearing Loss
• Tuning Forks
• 512Hz
• Rinne
• Louder in back = Conductive Loss
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Audiogram
• Frequencies
• Severity
• Type (Conductive vs Sensorineural)
• Asymmetry
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Most Common Scenario in Seniors
• Chronic
• Gradual Onset
• Bilateral
• Progressive
• Trouble in Social Settings more than one-on-one
• Possible Hx of Noise Exposure
• Possible Family Hx
• Family / Spouse more bothered than patient
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Options
• Turn up Television
• Assisted Listening Telephones
• Hearing Aids
• Surgery
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Hearing Aids
Satisfaction varies
Issues to consider:
• Vision
• Dexterity
• Cerumen
• Features
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
Cochlear Implantation
• Surgical procedure that taps directly into the auditory nerve and bypasses the
hair cells within the cochlea (which aren’t working)
• Indications have evolved
• Severe to profound hearing loss in both ears (now cleared for single sided
deafness)
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Recent Data on “Collateral Damage”
Dementia
Alzheimer's
Theories:
• Both HL and Dementia caused by a common process
• HL may cause Dementia (cognitive exhaustion)
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Recent Data on “Collateral Damage”
If indeed there is a causal relationship…
(if you don’t use it …you lose it theory)...
then it makes sense to amplify early to keep that part
of the brain working
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Tinnitus
• The perception of noise in the ears
o Ringing, Buzzing, Humming, Electronic Hum, Crickets / Cicadas
• Most often due to Sensorineural Hearing Loss
• Can be due to Conductive Hearing Loss (the lucky ones)
• Can be Non-Ear Related
o Central
o Salt, Caffeine, Nicotine, Aspirin
• Options include masking devices, nutritional supplements (nothing great out
there)
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Vertigo
• Sensation of movement
• Central or Peripheral (Ear) Related
• Senior Population has many reasons to have it
o Ear causes (infection, BPPV)
o Non ear causes (cerebrovascular, tumor, migraine)
• Treatment
o Supportive
o Physical Therapy
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
Chair, AMA-SPS Governing Council
Facilitator
Louis Weinstein, MD
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Questions from Audience Members
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
Your opinion matters!
Provide feedback on your meeting experience:
bit.ly/amainterimsurvey
Or, access the eval link for our session in the CrowdCompass AttendeeHub App
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© 2017 American Medical Association. All rights reserved.© 2017 American Medical Association. All rights reserved.
CME Credit
Communications Requirements
Be sure to pick up instructions for claiming
CME credit on your way out today.
The deadline for claiming CME Credit is
December 31, 2019.
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