TUTORIAL 3: Age-related eye disease

Question 1

Why does the risk of pathology increase with age?

Answer 1

Lifetime exposure to light and oxygen: oxidative damage e.g. to photoreceptors, mitochondria

RPE changes (e.g. lipofuscin build up, cell death)

Inflammation triggered by oxidative changes

Vascular changes (increased risk occlusions, hypoxia)

Bruch’s membrane changes (thickening, reduced permeability) reduces oxygen delivery to outer retina, delivery of metabolites, waste removal.

Hypoxia and inflammation linked to increased production growth factors (e.g. VEGF, which can cause neovascularisation)

Question 2

What questions are important in taking a structured history in older patient?

Answer 2

Visual symptoms – distortion? blurred vision? Cloudy?
Problems at near or distance?
Is it worse under low light levels, or when moving from low to high light levels?
One eye or both?
Onset (rapid or gradual?, when?)
Increased difficulty with tasks e.g. reading, cooking, mobility, shopping?

POH – AMD? Glaucoma? Cataract?

General health – e.g. diabetes, hypertension, cardiovascular disease, inflammatory disease (e.g. rheumatoid arthritis)

Medications – e.g. corticosteroids, metformin, tamoxifen, hydroxychloroquine

Family History – especially general health conditions listed above and AMD, glaucoma.

Risk factors -
History of smoking?
Taking any dietary supplements?
How would you describe your diet? Do you eat plenty of fresh fruit and vegetables?
Do you wear sunglasses on bright days?

Question 3

How can you clinically assess the lens and visual effects of cataracts?

Answer 3

Slit lamp
Retroillumination (from fundus)
Lens section
Ophathalmoscope / retinoscope
Retroillumination

Contrast sensitivity
VA
Colour vision
Monocular diplopia