Vision Loss in Older Persons

摘要

Adults with low vision are at high risk of depression, social withdrawal, and isolation. 1,3 Vision loss in older persons is an independent risk factor for falls.4 Progressive vision loss can be associated with a syndrome of hallucinations which, although benign, can be disturbing to patients.5 Older persons with visual impairments are more likely to be institutionalized.6,7 Adults who are visually impaired are at risk of self-administered medication errors, which may result in an increased rate of hospitalization.8 A retrospective study of adult Medicare beneficiaries found that those with impaired vision incur significantly higher treatment costs for eye- and non-eye-related disease.9 Family physicians have an essential role in assessing, identifying, treating, and preventing or delaying vision loss in the aging population. Figure 2 will aid in the differential diagnosis of sudden vision loss in older persons.n The UKPDS demonstrated that lowering blood pressure to below 150/85 mm Hg in persons with diabetes reduces the risk of progressive diabetic retinopathy, irrespective of A1C level.33 A 10 mm Hg decrease in systolic blood pressure provided an 11 percent relative risk reduction in the incidence of photocoagulation or vitreous hemorrhage; however, unlike intensive blood glucose control, blood pressure lowering must be sustained over time to preserve any benefit.34,35 Hypertension (with or without a diagnosis of diabetes) is associated with a higher risk of ischemic eye events, such as central retinal vein occlusion.36 LIPID MANAGEMENT Hyperlipidemia is an independent risk factor for central retinal artery and vein occlusion.36,37 Observational studies suggest that control of hyperlipidemia in older persons with and without diabetes may independently reduce the risk of vision loss; however, this has not been confirmed in randomized controlled trials.1,3 SMOKING CESSATION Smoking has been linked to a variety of causes of visual impairment in older persons, including AMD,38 cataracts, 39 and progressive diabetic retinopathy.40 For ophthalmic health, as well as numerous other benefits, older persons who smoke should be advised to quit and offered smoking cessation counseling.