Refractive Changes in Older Adults

Refractive Changes in Older Adults

• Older adults often experience changes in refractive error, including an increase in against-the-rule astigmatism.
• Spherical component of refraction shifts towards hyperopia.
• Prevalence of oblique astigmatism and anisometropia increases.
• Cataracts can cause rapid changes in refraction.
• Cataract surgery dramatically alters refractive status.

Challenges in Refractive Error Measurement (Objective Refraction)

• Retinoscopy can be difficult due to small pupils, media irregularities, and opacities in older patients.
• Radical retinoscopy involves moving closer to the patient and using off-axis viewing to obtain a better retinoscopic reflex, sometimes necessary in high myopia or hyperopia.
• When retinoscopy proves inadequate, alternative approaches involve:
  • Reducing the working distance to as close as 5 cm.
  • Using a high positive lens (+14.00 D) to find a retinal reflection in high hyperopia.
• Adjusting the working distance requires appropriate adjustments when estimating the power of the corrective lens.
• Off-axis viewing can introduce inaccuracies in both spherical and astigmatic components.
• Lenticular irregularities caused by cataracts can make obtaining consistent or accurate results impossible.
• A spot retinoscope may be more useful than a streak retinoscope in these cases.
• Automated refractors and objective optometers rely on light reflected from the retina.

Refractive Changes in Older Adults

• Older adults often experience a shift towards against-the-rule astigmatism and hyperopia.
• The prevalence of oblique astigmatism and anisometropia increases with age.
• Cataracts can significantly alter refractive error.
• Cataract surgery can lead to substantial changes in refractive status.

Challenges with Refraction in Older Adults

• Smaller pupils and media irregularities make retinoscopy more challenging.
• Radical retinoscopy may be necessary to overcome these challenges.

Techniques for Difficult Retinoscopy

• Reduce working distance by moving closer to the patient's eye, particularly with suspected high myopia.
• Use a highly positive lens (e.g. +14.00D) to facilitate reflection in high hyperopia.
• Off-axis viewing can be used when axial viewing is inadequate, but may lead to inaccuracies in spherical and astigmatic components.

Retinoscopy with Cataracts

• Lenticular irregularities caused by cortical or posterior subcapsular cataracts can make obtaining consistent and accurate readings difficult.
• Spot retinoscopes may be more effective than streak retinoscopes in these situations due to fragmented reflection.

Limitations of Automated Refractors

• Objective optometers and automated refractors depend on light being reflected from the retina.
• Their accuracy may be compromised by lenticular irregularities.

This quiz explores refractive errors commonly observed in older adults, including shifts towards hyperopia and the prevalence of astigmatism. It also covers challenges in measuring refractive error and techniques used in objective refraction assessments. Test your understanding of these important optical changes in the aging population.