Vision And Aging Flashcards
1
Q
Resutls of visual impairment
A
Increases 5 year mortality risk Increases length of hospital sty Increase risk of nursing home placement Decreases performance of IADLs Decrease in physical activity
2
Q
Refractive error and age
A
- shift to hyperopia ag e20-70ish
- late shift towards myopia with cataract development
- younger adutls 80% WTR older adults 80% ATR
- mediated by lid tautness and corneal cylinder
- not a rotation but an increase
3
Q
Anisometropia and aging
A
Goes up with aging, mostly due to cataracts
4
Q
Lens changes
A
- lens paradox: refers to the lens becoming more curved with aging which should result in age-related myopia from age 30-60s but doesnt, thought to be due to refractive index gradient change from centeral to peripheral lens
- lens index decreases
- lens power decreases
- vitreous length unchanged
- aberrations increase
5
Q
AC and age
A
Smaller
6
Q
Elasticity and age
A
-Loss of elasticity
-Wrinkles laterally
-Moraxella blepharitis common?
—no staph is most common
Bag lids
-orbicularis muscle is getting thinner and orbital fat prolapses forward. Rule out thyroid eye disease, fatigue, etc
7
Q
Loss of orbital fat and age
A
- can give pseudoptosis appearance
- loss of fat pad around nose
8
Q
Ptosis and age
A
Increases
9
Q
Cherry angioma
A
A little red freckle thing. More common with age
10
Q
Dermatitis papulosa
A
Most common dermatologic Change in AA
Benign
11
Q
Keratosis
A
Actinic
-Precancerous
seborrhci
- dry, scaly, usually on lower lid
- not likely malignant
12
Q
Nevus
A
Highest risk of transformation
Make sure you measure it in slit lamp to monitor it
Intradermal
- eyelashes growing out of it, benign
Compound nevi
- usually darker in surrounding skin
- small risk of transformation
13
Q
Xanthelasma
A
Lipid deposit
Worth a lipid profile-if before 40, r/o lipid metabolism disorders
14
Q
Papilloma
A
- cauliflower, pedunculated (with stalk) or lobulated
- skin tag
15
Q
Basal cell
A
3 forms
- infiltrative (most aggressive)
- superficial
- nodular (most common)
Low chance of transformation
16
Q
Superficial basal cell
A
Pink area
Easiest to treat-can be cured with topical creams
17
Q
Squamous cell
A
- highest risk of metastasis (more commonly lungs)
- send to oculoplastics
18
Q
Melanoma
A
- often lower lid
- metastatic potential with growth. If larger than eraser on pencil, higher risk
Risk factors
- asymmetric
- irregualr border
- color change
19
Q
Ectropion
A
Lower lids
Dry eye syndromes
20
Q
Entropion
A
In turned laches
Constant or spastic
21
Q
Blepharitis
A
Anterior blepharitis -staph Posterior blepharitis -seborrheic -obstructive -mixed 73% or respondents had one symptom over a year
They don’t really have symptoms with age
22
Q
Posterior blepharitis
A
MGD
23
Q
Seborrheic blepharitis
A
Goes along with the dermatitis
Dry flaky skin
-common in Parkinson’s disease
24
Q
Anteiror blepharitis almost always ____ related
A
Staph or demodex
25
Eye movements in elderly
Upgaze pursuit range not as great
Saccades little change
Phoria largely unchanged
Vergence ranges decreases
26
Hudson stahli line
- iron deposit
- lower 1/3 line of cornea
- no clinical consequence
27
Arcus
- virtually everyone over 50, extremely common in US
| - if under 50, patient should have lipid work up
28
Crocodile shagreen
- typical in the elderly
- polygonal clouds in the midperiphery to peripheral cornea
- due to loss of collagen cross links
- no clinical problems
29
Limbal girdle of Vogt
- subepithelal in the 3 and 9 area
- has a bubbly white appearance on high illumination
- not significant
30
Guttata
- degeneration change on the endothelium
- common in midperiphreal cornea
- asymptomatic
- specials reflection Cn help identify
31
Fuchs dystrophy
- excessive guttat central cornea
- assocaited with corneal swelling
- stromal and epithelial edema
32
EBMD
- map dot finger print
- bilateral upper and lower third of cornea usually
- very common caucasians
- rarely symptomatic
33
Fibrovascular placque
- closed loop of neo associated with superficial fibrosis
- usually inferior
- assocaited with chronic dry eye
34
Other corneal age findings
- loss of sensitivity with aging-less sensitive to abrasions
- loss of endothelial cells: typical is 1200-1500 cells/mm
- below 1000, cornea decompensated and may have edema
- at risk: dystrophy pts, glaucoma pts, uveitis pts
35
Dry eye and age
- ubiquitous in older people (1/3ish population)
- common pathway is hyperosmoarity
- asymptotic patients rarely take drops
36
Conjunctiva and age
- dishesence
- dis-insertion of the conjunctiva, associate with dry eye syndromes in older adults
- surgical repair an option
37
Episcleritis in older
No good numbers on prevalence
38
Senile scleral plaque
Grayish patch over the insertion of medial or lateral rectus, can have a yellow outline
39
Miscellaneous conjunctival pigmentation
Primary acquired Melanosis
Silver nitrate
Complexion-associated Melanosis
40
AC and age
- becomes shallower and angles becomes narrower with cataracts and aging
- trending a bit more towards cataract surgery rather than PI
- many of cytokines in the AC decrease with age
- zinc and TGF-B increase with cataracts
41
TM and age
- angle crowding with cataracts
- filtration is less efficiency
- IOP however does not increase statistically with normal aging
42
Lens water vacuoles
- throughout lens but common around posterior cortex, can be confused with PSC
- rarely symptomatic
43
Lens-cortical
- very commn age related cataract
- less likely to go to surgery
- glare is most common complaint
44
PCS
- most visually disconcerting
- occurs at a younger age
- multicolored “splattered sand”
- use retro
45
Nuclear cataract
- judge by opalescence
- judge by colro
- by far the most common reason for cataract surgery
46
Grading cataracts
Use the LOCS III
47
Cataract surgery
```
Most common surgery in the US
1.8 million per year
Its expensive to society
Oldest cataract surgery patient was 109
Generally, cost benefit is up to 95 in men and 96 in women-if pateitns are healthy/systemic conditions are stable, there is no age limit
```
48
Bette quality of life and cataract
Great healthy of life gain
49
One vs two eyes cataract surgery
61% greater increase in VF-14 over one eye
50
MFIOLs
Be careful with patient selection. MFIOLs are good for most patients wanting independence from glasses, but avoid in
- patients who suffer from night vision problems due to conditions other than cataracts
- patients that have poor contrast sensitivity
- patients who are overly critical/exacting
- treat dry eye adequately before-15% of pateitns who were unsatisfied had dry eyes
MFIOLs today are much better designed than previously-most use a diffractive design that can give good distances intermediate, and near
51
Spec indentence and cataract surgery
- after 2011, showed between 75-100% spectacle independence
| - generally patients who needed glasses neede them for near only
52
Contrast sensitivity and cataract surgery
- contrast sensitivity decreases significantly for pateitns wearing MFIOLs
- the amount of focused light reaching the retina is decreases
53
Asteroid hyalosis
- usually unilateral
- cholesterol deposit
- may be only in periphery
- shorten your viewing distance to see around
54
Retina/optic nerve
- FLR more likely to be absent
- ILM reflections absent
- arterial light reflex widens
- AV ratio decreases
- optic nerve changes little ophthalmoscopically
55
Atherosclerosis risk in community
Higher risk of mini strokes (white matter lesions) if you have CWS, etc
If someon has both retinopathy and WML, then they are a lot more likely to get a clinical stroke (2000% more likely). Do MRIs to look for strokes
56
MESA
Blood pressure nad aging both thin arteries
