title: Vision Loss in Older Adults.
abstract: Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.
authors.affiliation: Medical College of Georgia at Augusta University, Augusta, GA, USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Pelletier
authors.affiliation: Medical College of Georgia at Augusta University, Augusta, GA, USA.
authors.forename: Ledy
authors.initials: L
authors.lastname: Rojas-Roldan
authors.affiliation: Medical College of Georgia at Augusta University, Augusta, GA, USA.
authors.forename: Janis
authors.initials: J
authors.lastname: Coffin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D001766:Blindness / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002386:Cataract / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002387:Cataract Extraction; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011345:Fenofibrate / Q000627:therapeutic use; D005901:Glaucoma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D058449:Intravitreal Injections; D008028:Light Coagulation; D008268:Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D000069579:Ranibizumab / Q000627:therapeutic use; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014810:Vitamin E / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D014815:Vitamins; D014810:Vitamin E; D000068258:Bevacizumab; D001205:Ascorbic Acid; D011345:Fenofibrate; D000069579:Ranibizumab