10 - New Stuff Flashcards
Areas of demographic growth
Ethnicities with demographic growth
South and West USA
Urban areas - all ethnicities
90+ population is fastest growing segment of US pop
Non-white growing much faster than White
-Hispanic pop is fastest growing US pop (passed AA, now 2nd largest)
Theories of aging
-genetic
Telomere theory: telomeres shorten with each duplication, over time leads to accumulation of error
Programmed life span (rectangularization of aging)
Theories of aging
-wear and tear/mechanical
Human body is like a car - parts wear out
Entropy: errors accumulate with time
Some holes in the theory by itself
E.g. arthritis, heart valves
Theories of aging
-collagen cross link
Glucose binds to proteins -> damage to proteins -> incr collagen cross linking
Skin wrinkling
Brain aging
Theories of aging
-free radical
Build up in body -> cellular damage
Basis for all vitamin therapies
Has been proven in animal models of caloric restriction
Theories of aging
-cellular
Hayflick limit: human cells will only divide a certain number of times (~50) before dying
-can slow down by limiting calories
Development of auto-antibody with aging - supported by autoimmune disease
Membrane theory: cell membranes can’t pass lipid materials as easily with incr age -> incr in lipofuscin
-supported by Alzheimer’s
Theories of aging: match the visual problem with its theory of aging
- dry eye from Sjogrens
- presbyopia
- cataracts
- vitreous detachment
- macular degeneration
DE: cellular
P: wear-tear
C: cross-link
VD: collagen cross-link
MD: free radical/genetic/wear-tear
Psychophysics and aging
-neural cellular loss (4)
Decr quantum catching ability of PRs
PR loss and degenerative changes
GC loss and degenerative changes
Visual cortex cellular loss
Psychophysics and aging
- VEP and aging graphs
- S-cone function (blue)
Latency incr with age
Peak amplitude of S-cone impulse decr with age
Psychophysics and aging
-color and aging (3)
Hue discrimination stays similar with aging
Pure blue, pure red, pure white stay similar with aging
Pure green CHANGES with aging
Psychophysics and aging
-acuity (3)
Letter acuity loss
Accentuated at low light levels
Crowding effect
Psychophysics and aging
-optical effects from aging (5)
Incr in optical aberrations
Incr lens density
Incr intraocular light scatter
Senile miosis
Presbyopia
Psychophysics and aging -optical aberrations and aging —HOAs —decoupling of \_\_ —spherical aberrations —coma
HOAs incr with aging = corneal, lenticular, and total
Decoupling of lens compensation for corneal aberration with aging
Corneal incr in spherical aberration
Lens slight decr in negative compensating SA
Corneal coma stays stable, negative lens coma decreases
Psychophysics and aging
-spatial contrast sensitivity loss (3)
Accentuated at low light level
Most severe at high frequency
Both optical and neural effect
Psychophysics and aging
-temporal sensitivity (4)
Decr temporal contrast sensitivity
Decr CFF
Incr contrast threshold for motion
Incr problems with motion detection
Psychophysics and aging
-VF (4)
Constricted isopters with kinetic
Static loss throughout field
Static loss incr eccentrically
Loss of functional FOV
Psychophysics and aging
-useful FOV (5)
A form of divided attention task
Measures visual attention
See and ID a target
Many studies indicate as best predictor of crashes
Sensitvity high, specificity lower
Renal failure
- stage 4
- stage 5
4: severe reduction in GFR (15-29 mL/min)
5: kidney failure (GFR <15 mL/min)
Liver and pancreas
-drug metabolism is prolonged, e.g.
Benzodiazepines (valium)
Among the most common causes of hospitalization >65
CHF
Eye movement problems in Alzheimer’s (5)
Saccadic pursuits
Incr saccadic latency
Hypometric saccades
Fixation instability
Anticipatory saccades
Screening for dementia (3)
Folstein mini mental state exam
Short blessed
Mattis
Eye movement abnormalities in Parkinson’s (3)
Gaze palsy - frontal lobe
Saccadic pursuits
Pursuit abnormalities
Definition of depression (symptoms)
Depressed mood with 3 of:
- weight gain/loss
- insomnia
- psychomotor retardation
- feeling of worthlessness
- difficulty concentrating
- suicidal ideation
Vision and aging
-results of visual impairment (5)
Incr 5 year mortality risk
Incr length of hospital stay
Incr risk of nursing home placement
Decr performance of IADLs
Decr in physical activity
Vision and aging
-refractive error changes
Shift to hyperopia 20-70ish
Late shift towards myopia with cataract development
Younger adults 80% WTR
Older adults 80% ATR
-mediated by lid tautness and K cylinder
-not a rotation, but an incr
Vision and aging
-heavy glasses causing sores on nose
Loss of fat pad around nose
Vision and aging
-LOCS III
Lens opacities classification system
Vision and aging
-cataract sx considerations
Most common sx in USA (1.8 million/year)
Expensive to society
Oldest pt was 109 yo
-generally, cost-benefit is up to 95 in men and 96 in women - if pt is healthy/systemic condns are stable, no age limit
Vision and aging
-MFIOLs
Careful pt selection
Good for most pts wanting independence from glasses, but avoid in:
- night vision problems (not from cts)
- poor contrast sensitivity
- overly critical/exacting
- be sure to tx dry eye adequately before
Concerns:
- contrast sensivity decr significantly for MFIOL pts
- haloes and glare
- less room for error for surgeon with tilt/residual RE
Significant event in 2011 regarding aging
First baby boomers becaome 65yo
Most current older adults are (ethnicity); what effect does this have
White
Now: mac degen in older pops
Later: more glaucoma, etc
Life expectancies (general)
White > Black
Women > Men
