ham tong eye
TRANSCRIPT
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Victorio N. Cajita,MD
ACES Eye Referral Clinics
Cebu & Dumaguete Cities
Frances Yap, MD
Velez Hospital
Cebu City
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The Aging Eye
Victorio N. Cajita,MD
ACES Eye Referral Clinics
Cebu & Dumaguete Cities
Frances Yap, MD
Velez Hospital
Cebu City
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Ang Mata sa mga Hamtong
Victorio N. Cajita,MD
ACES Eye Referral Clinics
Cebu & Dumaguete Cities
Frances Yap, MD
Velez Hospital
Cebu City
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OUTLINE
Introduction
Basic Anatomy
Common Age-related Eye Conditions
definition
symptomalogy (complaints)
clinical significance
treatment
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Age Related Eye Diseases
(AREDs)
Aging individuals are at risk for multiple eye
problems wear and tear
law of diminishing returns
Some are preventable and reversible but
generally progressive
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AREDs Significance
Vision non-threatening (cosmetic blemish)
Vision threatening
associated with a myriad problems in older adults(falls, fractures, depression)
affects quality of life
economically crippling
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BASIC ANATOMY
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BASIC ANATOMY
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Fundus Examination
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COMMON COMPLAINTS
Tearing, discomfort, foreign body sensation
Blurring of vision
Glare Loss of central vision
Floaters
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COMMON EYE CONDITIONS IN ELDERLY
Dermatochalasia
Entropion/Ectropion
Dry Eye Arcus Senilis
Cataract
Presbyopia
Vitreous Floaters
Age related MacularD
egeneration Age Related RetinalVasculopathies
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Dermatochalasia
Sagging eyelids/Eyebags
Excess of skin in upper or lowereyelids
Cosmetic problem
Treatment
Nothing
Blepharoplasty
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Involutional Ectropion/Entropion
an abnormal outwardor inward turning of the lid margin
Complaints
Tearing, foreign bodysensation
Exposure keratitis
Potentially blinding
Treatment
Drops/ointment
Surgery
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Dry Eye Syndrome
A disorder of the tear film which causes
damage to the exposed ocular surface
Symptoms:
ocular discomfort, foreign body sensation,redness
blurring of vision
build up of debris
Itchiness
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Dry Eye
Controllable chronic disease;
Not completely curable
Clinical significance Mild - annoying, uncomfortable
Severe - potentially vision threatening
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Dry Eye
Treatment
Eye drops: ocular lubricants or artificial tears, anti-
inflammatory eye drops Surgery: plugs
Diet: increase intake of omega-3 essential fattyacids (flaxseed oil, fish oil, nuts)
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Arcus Senilis
yellow-white ring inperipheral cornea
accumulations of
cholesterol esters,triglycerides andphospholipids
No vision impairment
No treatment
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PRESBYOPIA
SHORT ARM SYNDROME: PRESBYOPIA
short arm syndromeAGE RELATED FOCUSDYSFUNCTION
Signs of Presbyopia
Loss of ability to read up close Holding objects away to read
Need reading glasses or bifocals
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Cataract
Opacity of thecrystalline lens
May develop as a resultof aging, metabolicdisorders, trauma orheredity
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Cataract
Generally, decrease in visual acuity is directlyproportionate to the density of the cataract
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Cataract
Most common cause of
bilateral blindness
RP backlog: 0.7% (630,000)
ReversibleTreatment: surgery
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Management
Indications for surgery visual defect interferes with daily activities
Potential complications: glaucoma or uveitis
to visualize the posterior segment Surgery: phacoemulsification with lens
implantation (IOL)
NOT laser!!!
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Phacoemulsification
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Phacoemulsification
Outpatient
Topical anesthesia
No sutures
No patch
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Vitreous Floaters
Small specks or dotsseen against a brightbackground
May be due tocondensations of vitreous collagen ordue to blood
Dilated fundus examshould be done
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Vitreous Floaters
not visually impairing
annoying
treatment: NONE
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Macular Degeneration
Degenerative disease of central retina
Clinical features
Blurring of the central vision Distorted vision
Retinal exam
Drusens - yellowish deposits in center of retina
Macular scar
macular hemorrhages and lipid exudates
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Risk Factors of macular degeneration
Modifiable
Smoking
High Blood Pressure
Obesity
Low levels of nutrients
Sun exposure
Non-modifiable
Aging
Family History
Female gender
Caucasian
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Age Related Macular Degeneration
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Macular Degeneration
Retinal and choroidalangiography
Intraretinal hemorrhage
and edema of macula Fluorescein angiogram
with leakage
Indocyanine green
angiogram choroidalvasculature
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Macular Degeneration
Clinical Advances
Laser treatments for choroidal neovascularization
Radiation treatment may preserve near vision and
contrast sensitivity
Anti-angiogenesis eg. Avastin, lucentis, macugen
Prevention: High dose Zn andVit A,C,E,lutein,
zeaxanthine
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Age-related Eye Comorbities
Retinal vascular diseases due to underlyingmedical conditions common with age
Diabetes
Hypertension
High cholesterol
others
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Retinal Vein Occlusion (Retinal Stroke)
Painless decreased vision due to obstructed
retinal veins
2nd most common sight threatening vascular
disorder Types:
Branch retinal vein occlusion (BRVO)
Central retinal vein occlusion (CR
VO)
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Retinal Vein Occlusion (Retinal Stroke)
Predisposing factors
high blood pressure
high blood cholesterol high blood sugar
hahayyyy
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Retinal Vein Occlusion (Retinal Stroke)
Types:
Branch retinal vein occlusion (BRVO)
Central retinal vein occlusion (CRVO)
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Branch Retinal Vein Occlusion (BRVO)
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Central Retinal Vein Occlusion (CRVO)
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RVO treatment
Medical Treat the underlying cause
ophthalmic
Treat the complications (macular edema, vitreous
hemorrhage, retinal detachment, glaucoma)
Eye drops, laser, surgery
Collaboration between the ophthalmologist andother physicians for management
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Retinal Artery Occlusion
Painless sudden blurringof vision due toblockade in the retinal
artery
Associated witdAtherosclerosis, DM,H
PN, dysrrhythmias
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Retinal Artery Occlusion
A true ocular emergency
Treatment is usually ineffective
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Diabetic Retinopathy
Retinal complication of prolonged, poorly
controlled diabetes
Most common retinal vasculopathy Potentially blinding
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Diabetic Retinopathy
Longer diabetes + poor control =
worse retinopathy
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Non-proliferative Diabetic
Retinopathy
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Proliferative Diabetic Retinopathy
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Diabetic Retinopathy
Treatment Medical
Strict diabetic control
T
reat other medical problems Ophthalmic
Laser - mainstay of treatment
Anti-vegf eg avastin, lucentis
Surgery
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Summary / take home message
Prevent what is preventable
Treat what is treatable
Accept what has to be accepted
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Do not regret growing older. It is a privilegedenied to many. ~Author Unknown
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Thank you!
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People like you and I, though mortal of course
like everyone else, do not grow old no matter
how long we live... [We] never cease to standlike curious children before the great mystery
into which we were born." (Letter to Otto
Juliusburger) Albert Einstein
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A mans age is something impressive, it sums up
his life: maturity reached slowly and against
many obstacles, illnesses cured, grieve anddespairs overcome, and unconscious risks
taken; maturity formed through so many
desires, hopes, regrets, forgotten things,
loves. A mans age represents a fine cargo of experiences and memories." Antoine de
Saint-Exupéry
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Age is a high price to pay for maturity."Tom
Stoppard
..and the odds are never good enough, for allwe knownothing lasts forever in this life.
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How can we help
Significantly reduce the level of disability
caused by visual problems by
Increase public awareness about age related eyeproblems
Integrate and coordinate timely screening,diagnosis and treatment to prevent or correctvision loss
Ensure continuity of care
Monitor status of visual impairment
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Age-Related Cataract
Nuclear cataracts
Nuclear sclerosis resulting from the normalcondensation process in the lens nucleus
Earliest symptom: improved near vision withoutglasses (second sight)
- results from increase in focus power of the central
lens, creating a myopic shift in refraction
Most are bilateral, but may be assymetric
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Age-Related Cataract
Cortical cataracts
Opacities in the lens cortex
Changes in the hydration of lens fibers createclefts in a radial pattern around the equatorialregion
Tend to be bilateral, but often assymmetric
Visual function is variably affected, depending onhow near the opacities are to the visual axis
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Age-Related Cataract
Posterior subcapsular cataracts
In the cortex near the central posterior capsule
Tend to cause visual symptoms early in theirdevelopment due to visual axis involvement
Common symptoms: glare, reduced vision underbright lighting conditions
Can result from: trauma, corticosteroid use,inflammation, exposure to ionizing radiation
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Basic ANATOMY
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BASIC ANATOMY
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Dry Eye
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Cataract
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Cataract
protein alterations result in yellow or brownishdiscoloration
There may be vesicles between lens fibers,migration and aberrant enlargement of epithelial cells
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