Visual Impairment in the Elderly
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Questions and Answers

What symptoms are typically associated with acute angle closure glaucoma (AACG)?

  • Severe visual field loss with no pain
  • Severe ocular pain and nausea (correct)
  • Mild headache and watery eyes
  • Chronic eye irritation and redness

What is a common misdiagnosis for patients who are acutely unwell due to AACG?

  • Sinusitis
  • Chronic migraine
  • Respiratory infection
  • Acute abdominal problem (correct)

Which of the following best describes the physical examination findings in AACG?

  • Reduced intraocular pressure and normal pupil reaction
  • Mid-dilated pupil and edematous cornea (correct)
  • Normal eye pressure and clear cornea
  • Constricted pupil and painless eye

What is one treatment option for AACG after initial medical therapy?

<p>Bilateral peripheral iridectomies (A)</p> Signup and view all the answers

What is a significant risk factor for developing AACG?

<p>Hypermetropia and enlarged cataractous lenses (A)</p> Signup and view all the answers

What is an important aspect of patient advice post-attack of AACG?

<p>Legal implications of driving with impaired vision (A)</p> Signup and view all the answers

What characterizes the visual prognosis for treated AACG?

<p>Should not lead to visual impairment if treated promptly (D)</p> Signup and view all the answers

Which condition is mentioned as a significant cause of visual morbidity in the elderly?

<p>Diabetic retinopathy, particularly maculopathy (B)</p> Signup and view all the answers

What percentage of central retinal vein occlusions (CRVOs) are classified as non-perfused or ischaemic?

<p>30% (B)</p> Signup and view all the answers

What is the likelihood of neovascular glaucoma developing in ischaemic CRVO cases?

<p>40–60% (B)</p> Signup and view all the answers

What did the Central Retinal Vein Occlusion Study aim to investigate regarding prophylactic photocoagulation (PRP)?

<p>Its usefulness in preventing iris neovascularisation and neovascular glaucoma. (C)</p> Signup and view all the answers

What is the most common cause of central retinal artery occlusion (CRAO) in elderly patients?

<p>Embolic sources from carotid arteries (D)</p> Signup and view all the answers

What potential sign might be observed at the onset of CRVO related to the iris vessels?

<p>Dilation of iris vessels. (B)</p> Signup and view all the answers

What percentage of CRVOs are classified as non-ischaemic?

<p>70% (B)</p> Signup and view all the answers

Which of the following symptoms is often experienced prior to the onset of CRAO?

<p>Amaurosis fugax (C)</p> Signup and view all the answers

What is one of the conclusions of the Central Retinal Vein Occlusion Study regarding grid laser treatment?

<p>It helps in terms of visual acuity in CRVO cases. (A)</p> Signup and view all the answers

What is the typical clinical appearance of a CRAO?

<p>Retinal pallor with a cherry-red spot at the macula (B)</p> Signup and view all the answers

Which of the following is NOT part of the management plan for CRAO?

<p>Routine eye drops (D)</p> Signup and view all the answers

What is the definition of ischaemic CRVO as stated in the context?

<p>CRVO with &gt;10DD of retinal non-perfusion. (C)</p> Signup and view all the answers

How can the severity of carotid artery disease be assessed?

<p>Carotid doppler studies (D)</p> Signup and view all the answers

Which statement regarding iris vessel dilation in CRVO is true?

<p>It may occur but is not indicative of rubeosis iridis. (C)</p> Signup and view all the answers

What is the risk of permanent blindness following amaurosis fugax over 5 years?

<p>10% (B)</p> Signup and view all the answers

Which of the following conditions is a less common etiology for CRAO?

<p>Temporal arteritis (A)</p> Signup and view all the answers

Which procedure is performed to reduce intraocular pressure in CRAO management?

<p>Anterior chamber paracentesis (D)</p> Signup and view all the answers

What is the typical characteristic of elderly patients when providing medical history?

<p>They give a very helpful and detailed history. (C)</p> Signup and view all the answers

Which symptom may elderly patients with age-related macular degeneration struggle with?

<p>Mastering the use of the pinhole. (D)</p> Signup and view all the answers

What percentage of patients aged 70-74 have corrected vision of less than 6/7.5 despite having clinically normal eyes?

<p>14.5% (D)</p> Signup and view all the answers

Which of the following is NOT a recognized risk factor for age-related macular degeneration?

<p>Frequent use of digital devices (D)</p> Signup and view all the answers

Which factor has definitively contributed evidence to the causation of age-related macular degeneration?

<p>Cigarette smoking (D)</p> Signup and view all the answers

What is the classification of age-related macular degeneration as described in the content?

<p>A progressive disabling bilateral condition. (C)</p> Signup and view all the answers

What underlying aspect of age-related macular degeneration remains a challenge in understanding?

<p>The exact mechanisms of its aetiology. (B)</p> Signup and view all the answers

Which of the following factors is likely considered to NOT solely determine the risk of age-related macular degeneration?

<p>Eye color (C)</p> Signup and view all the answers

What is the primary role of a system mentioned in the content?

<p>To facilitate communication between different components (A)</p> Signup and view all the answers

Which feature is likely to be critical for ensuring process integrity?

<p>Data redundancy (D)</p> Signup and view all the answers

What does the term 'dynamic' refer to in the context of system design?

<p>Adjustable parameters that can change based on input (B)</p> Signup and view all the answers

In system operations, what could potentially affect the reliability of the output?

<p>The method of data collection (B)</p> Signup and view all the answers

Which of the following would be a significant factor in evaluating system performance?

<p>Efficiency of resource usage (C)</p> Signup and view all the answers

What is likely to hinder effective data management in a system?

<p>Uncontrolled data access (B)</p> Signup and view all the answers

Which method is typically used to enhance system security?

<p>Implementing multi-factor authentication (C)</p> Signup and view all the answers

What is a common challenge faced by systems when integrating new technology?

<p>Legacy system compatibility issues (B)</p> Signup and view all the answers

Which of the following statements is most accurate regarding system scalability?

<p>Scalability determines how well a system can adapt to growth. (C)</p> Signup and view all the answers

What aspect of the system is crucial for maintaining user trust?

<p>Regular updates and maintenance (A)</p> Signup and view all the answers

What is the primary demographic difference between the arteritic and non-arteritic forms of optic neuropathy?

<p>Arteritic patients tend to be older on average (B)</p> Signup and view all the answers

Which management strategy is effective for the arteritic form of AION?

<p>Management as for temporal arteritis (B)</p> Signup and view all the answers

What visual symptoms can occur after a cerebrovascular accident?

<p>Homonymous hemianopic or quadrantopic visual field loss (B)</p> Signup and view all the answers

What is a common challenge faced by patients during stroke rehabilitation related to vision?

<p>Uncorrected refractive errors (D)</p> Signup and view all the answers

What aids can benefit elderly patients with low vision due to age-related ophthalmic pathology?

<p>CCTV or Easyreader systems (A)</p> Signup and view all the answers

Why is it important to assess a patient's ophthalmic status after a cerebrovascular accident?

<p>Because such issues could complicate rehabilitation management (D)</p> Signup and view all the answers

For patients with low vision, what technology is recommended for reading?

<p>CCTV systems and spectacle magnifiers (A)</p> Signup and view all the answers

What factor does NOT contribute to visual impairment in post-stroke patients?

<p>Excessive screen time (C)</p> Signup and view all the answers

Flashcards

Age-related macular degeneration (AMD)

A progressive, disabling eye condition that causes blindness in the UK.

Elderly vision assessment

Assessment can often diagnose problems from the patient's history and is veri fied by visual examination.

Age-related eye changes

Changes in eye structures are natural components of aging.

AMD risk factors

Risk factors include age, smoking, high blood pressure, genetics, and potentially others.

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Low vision and no disease

14.5% of 70-74-year-olds have vision below 6/7.5 despite no clinical eye disease.

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Pinhole test issues in AMD

Patients with AMD may not benefit from a pinhole correction despite impacting acuity.

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Multifactorial AMD

AMD arises from multiple factors influenced by environmental triggers, particularly those with genetic predisposition.

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Eye Examination Importance

Understanding normal aging processes in eyes is crucial for accurate assessments in older people.

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Acute Angle-Closure Glaucoma (AACG)

A rapid onset of severe eye pain, redness, blurred vision, and high eye pressure.

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AACG Symptoms

Severe ocular pain, headache, red eye, blurred vision, nausea, vomiting, and a mid-dilated pupil.

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Visual Prognosis in Glaucoma

Patients often unaware of field loss and the driving risks until an accident or near miss.

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Driving and Glaucoma

Glaucoma patients often lack awareness of field loss, potentially increasing driving risks.

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Diabetic Retinopathy

A cause of significant vision problems in older adults, specifically affecting the macula.

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AACG Treatment

Immediate medical therapy followed by iridectomy procedures to lower eye pressure and prevent further damage.

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Glaucoma Field Loss

Gradual loss of peripheral vision, often unnoticed by patients with glaucoma.

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Risk Factors for AACG

Hypermetropia (farsightedness) and enlarged cataractous lenses.

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CRVO: Non-perfused

Central Retinal Vein Occlusion (CRVO) where blood flow is blocked, leading to retinal ischemia. This occurs in about 30% of CRVO cases.

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CRVO: Neovascular Glaucoma

A complication of ischemic CRVO, where new blood vessels grow abnormally in the eye, leading to increased pressure and possible blindness.

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Dilated Iris Vessels

An early symptom of CRVO, where the blood vessels in the iris become wider. However, this alone doesn't necessarily indicate the growth of new, abnormal vessels (rubeosis iridis).

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Prophylactic Photocoagulation (PRP)

A laser treatment used to prevent neovascular glaucoma in ischemic CRVO by destroying parts of the retina that might promote abnormal vessel growth.

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The Central Retinal Vein Occlusion Study

A major research study investigating the effectiveness of PRP and grid laser treatment in CRVO patients.

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PRP for Ischemic CRVO: Question 1

Does PRP effectively prevent the growth of abnormal vessels in the iris (iris neovascularization) and neovascular glaucoma in eyes with ischemic CRVO?

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Grid Laser for CRVO: Question 2

Does grid laser treatment improve visual acuity (sharpness) in patients with CRVO?

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Central Retinal Vein Occlusion (CRVO) Management

Clinicians manage CRVO by assessing the severity of the condition, determining if it's ischemic or non-ischemic, and deciding on appropriate treatment options, including laser therapy or other interventions.

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What is AMD?

Age-related macular degeneration (AMD) is a progressive eye condition that can lead to blindness, affecting the central part of the retina called the macula.

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Low vision without disease?

A significant percentage of older adults (14.5% of 70-74-year-olds) have vision below 6/7.5 despite having no clinical eye disease.

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Pinhole test and AMD

Patients with AMD may not benefit from a pinhole correction even though it can improve acuity in other vision problems.

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Importance of eye exams

Understanding normal aging changes in the eye is essential for accurate assessments in older people.

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What is Retinal Detachment?

Retinal detachment occurs when the retina, the light-sensitive tissue at the back of the eye, pulls away from the underlying layer.

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Symptoms of Retinal Detachment?

Symptoms of retinal detachment include flashes of light, floaters, and a shadow or curtain in your vision.

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Treatment for Retinal Detachment

Treatment for retinal detachment typically involves surgery to reattach the retina.

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Prevention of Retinal Detachment?

While there is no proven way to prevent retinal detachment, avoiding eye injuries and controlling eye conditions like diabetes can help reduce the risk.

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CRAO

Sudden, painless loss of vision in one eye caused by blockage of the central retinal artery, often due to an embolus from carotid arteries.

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Amaurosis Fugax

Temporary loss of vision in one eye, often a warning sign of a potential CRAO.

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Cherry-Red Spot

A distinctive feature of CRAO, appearing as a bright red spot in the center of the macula surrounded by a pale retina.

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Digital Massage

A technique used in CRAO management to dislodge the obstructing embolus by increasing blood flow to the eye.

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AION

Loss of vision caused by blockage of the posterior ciliary arteries, resulting in sudden and progressive vision loss.

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AION Cause

AION can result from either arteritic (inflammation of the artery) or non-arteritic causes.

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CRAO Management

Immediate measures are needed to dislodge the embolus, including digital massage, medication, and oxygen therapy.

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Optometrist Role in CRAO/AION

Optometrists play a vital role in identifying signs and symptoms of CRAO/AION and facilitating prompt referral to specialists.

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AION Age Difference

Patients with arteritic AION tend to be about 10 years older than those with the non-arteritic form.

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AION Sex Difference

Non-arteritic AION is more common in men, while arteritic AION is more common in women.

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Cerebrovascular Accidents and Vision

Cerebrovascular accidents (strokes) can significantly impact vision, commonly causing homonymous hemianopic or quadrantopic visual field loss.

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Stroke and Visual Symptoms

Patients may experience visual symptoms from a stroke without realizing they've had a cerebrovascular event.

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Low Vision Management

Low vision management for the elderly focuses on their overall health. Those with age-related eye problems without other health issues benefit from magnifiers.

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Motivation in Low Vision

Motivation and confidence in using assistive devices like magnifiers are crucial for successful low vision management.

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Low Vision: Assistive Devices

As elderly patients gain confidence, more advanced devices like CCTV and telescopic aids can be introduced.

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Study Notes

Visual Impairment in the Elderly

  • Elderly patients often provide detailed histories, allowing for diagnosis based on their account, confirmed by examination. Encouragement is key for some elderly patients.
  • Elderly patients, especially those with macular degeneration, may have difficulty using a pinhole for testing; refracting is helpful regardless.
  • Vision deterioration is common with age, with 14.5% of 70-74 year olds having corrected vision below 6/7.5 (LogMAR 0.1), despite clinically normal eyes.
  • AMD, first described in 1885, is a progressive, bilateral condition causing blindness in the UK, affecting 30–49% of new blind registrations yearly.
  • AMD is a common condition, yet its underlying cause was unknown until recently.
  • Risk factors include age, sex, race, height, social status, hypertension, cardiovascular and cerebrovascular disease, refractive error, and personal characteristics. Smoking, high blood pressure, and genetics are established factors.
  • Clinically, AMD is categorized into "dry" (atrophic, 80%) and "wet" (exudative, 20%) forms.
  • "Wet" AMD is more severe, leading to significant central vision loss. Dry AMD's hallmark are drusen, small, bright, round spots beneath the retinal vessels, often in the posterior pole.
  • Hard drusen are found in 83% of normal adults.
  • The symptoms of AMD can vary based on the type, including visual distortion, loss of central vision, and red-tinted vision.

Clinical Features of AMD

  • A heterogeneous disease
  • Dry AMD involves loss of photoreceptors, retinal pigment epithelium, or choriocapillaris. Advanced stage is geographic atrophy
  • Wet AMD shows choroidal neovascularization, involving blood vessel growth into the retina. Subretinal fibrosis, hemorrhage, and scarring are typical symptoms.
  • Both forms can cause visual loss; severity varies greatly depending on the subtype.

Treatment for AMD

  • Current treatments are most effective for "wet" AMD, using argon laser photocoagulation, but recurrence is common.
  • Geographic atrophy, a type of "dry" AMD, has no specific treatment options.
  • Low vision aids, large print, and good lighting can assist with managing the visual impairments common in this condition.

Other Visual Impairments in the Elderly

  • Cataracts: A clouding of the eye's lens, often gradual and affecting distance vision more than near vision. Surgery is a common treatment.
  • Glaucoma: Increased intraocular pressure, often asymptomatic until advanced, affecting the optic nerve. Screening is important.
  • Diabetic Retinopathy: Diabetic conditions can cause significant vision impairment, typically maculopathy in advanced stages. Ongoing treatment may be necessary.
  • Central Retinal Vein Occlusion (CRVO): Sudden vision loss due to blockage of the central retinal vein, often accompanied by other health issues; prompt treatment crucial.
  • Temporal Arteritis: A rare systemic inflammatory disease; characterized by sudden visual loss, headache, and jaw pain; rapid treatment crucial to prevent further visual impairment
  • Cerebrovascular Accidents: (CVA) (Stroke): Can cause various visual impairments such as hemianopia (loss of half the visual field) involving homonymous visual field loss, or oculomotor abnormalities, and perceptual irregularities.

Management of Visual Condition

  • Collaboration is crucial between optometrists, ophthalmologists, and other healthcare professionals for appropriate management of visual conditions
  • Patients should be involved in decisions regarding their treatment, and given encouragement to cope with visual loss
  • Strategies like low vision, sensory adjustments, and ongoing care are essential for overall wellbeing.

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Visual Impairment in the Elderly PDF

Description

This quiz covers the complexities of visual impairment in elderly patients, focusing on conditions such as Age-Related Macular Degeneration (AMD). Explore the diagnosis, risk factors, and implications of vision deterioration in older adults. Enhance your understanding of how age-related changes affect visual health.

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