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The most vulnerable age group for vision impairment is the elderly. According to prevalence estimates based solely on vision acuity criteria of less than 20/40, as many as 10% of older adults (65 to 84 years of age) have vision impairment. At the same time, national health surveys of adults show that between 13% and 20% of those aged 65 and older, and 25% of those aged 75 and older, self-report vision problems even when wearing corrective glasses or lenses. These self-reported figures include vision impairments caused by eye disorders as well as those caused by improper refraction and a lack of access to medical or surgical treatments. Given the implications of vision impairment for functional ability and psychological well-being in older adults, vision impairment in later life is a major public health concern.

Normal changes in vision occur with age, as do pathological changes caused by eye disorders. To maximize functional independence for older people with age-related vision loss, it is critical to understand the distinction and provide appropriate interventions for both.

Normal Age-Related Vision Changes

Presbyopia is the most common age-related vision change. The cornea becomes denser, less elastic, and yellows, making it difficult to focus on near-vision tasks and necessitating the use of reading glasses. Furthermore, the pupil shrinks in size, implying that less light is processed and that adaptation to changing light conditions is slower. As a result, with each passing decade, older adults require more light to complete the same tasks.

Colors appear less vivid in older adults, and their contrast sensitivity is reduced. All of these normal changes can be accommodated by wearing eyeglasses or contact lenses, using additional lighting, and/or giving the eyes more time to adjust to changing light conditions.

Common Age-Related Disorders

Various eye disorders affect an individual’s visual function differently, causing overall blur, central vision loss, and/or peripheral field loss. Low vision refers to impairments caused by eye disorders that cannot be corrected through refraction, medical, or surgical interventions.

CATARACTS

The most common age-related eye disorder, cataract, causes overall blur. Cataract causes clouding of the lens, and as the lens darkens, it becomes difficult to perform visual tasks. Cataract extraction with an intraocular lens implant, on the other hand, is a highly successful procedure that restores visual function for those who are able to undergo the surgical procedure.

DIABETIC RETINOPATHY

One of the potential complications of long-term diabetes is diabetic retinopathy, which causes hazy, splotchy, or distorted vision. It is caused by leaking blood vessels in the eye, which can be sealed with laser therapy. Scar tissue, on the other hand, forms at the site of the laser intervention and obstructs vision in that part of the retina. Diabetes patients may experience fluctuating vision at different times of the day as a result of unstable blood sugar levels.

AMD

The leading cause of vision impairment in older adults in the United States is age-related macular degeneration (AMD), which affects one’s central vision. A scotoma (blind spot) obscures the central field of vision, making it difficult to read, write, recognize faces, or perform any other near-distance task. AMD is classified into two types: “wet” and “dry,” with the latter accounting for 90 percent of cases. The dry form has a gradual onset and course, and while it may begin in one eye, it will affect both eyes. The wet form is caused by leaking blood vessels beneath the retina and can be severe. There is no cure for either type of AMD, but new treatments for both types are becoming available.

GLAUCOMA

Glaucoma is the most common age-related vision disorder that causes loss of peripheral vision. It gradually destroys the optic nerve cells. Although the cause is unknown, medications, laser treatments, and/or surgery can be used to slow or stop the disease’s progression. This type of field loss has an impact on safe mobility in the home and community, but it does not affect the near tasks of reading and writing.

HEMIANOPIA

A stroke or a head injury can cause hemianopia, or vision loss in half of the visual field. It could be the upper, lower, or right half of the visual field. Whatever the location, half of the visual field in both eyes is blocked, making all visual tasks difficult and rehabilitation necessary to compensate for the loss.

Consequences of Vision Impairment

Recent research has shown that age-related vision loss can have far-reaching consequences for older adults in functional, psychological, and health-related domains of daily life. The link between vision loss and functional disability later in life is well established. Vision impairment is linked to concurrent disability in activities of daily living (ADLs) and is a significant predictor of future functional decline. Vision impairment also increases the risk of depression in older adults, with as many as one-third being found to have significant depressive symptomatology. This is higher than that of the general population of older people in the community and equal to or greater than the prevalence of depression in other groups of medically ill older adults.

There is emerging evidence that vision impairment has significant consequences in terms of health-care utilization, secondary health conditions, and mortality. Vision impairment, as measured by clinical indicators and self-report, has been found to increase the risk of falls and hip fractures in older adults. Vision impairment has been linked to longer hospital stays, more physician visits, and increased use of emergency room services. Finally, several studies have found that poor vision is associated with an increased risk of death in older adults.

Vision Rehabilitation

Vision rehabilitation services are provided by specially trained professionals in a variety of settings, including hospitals, vision rehabilitation organizations, private optometry and ophthalmology practices, and university facilities. Low vision specialists are optometrists or ophthalmologists who have received specialized training in assessing residual functional vision. To maximize usual residual vision, they prescribe optical devices such as magnifiers, telescopic lenses, and other adaptive aids such as computer technology.

Learning compensatory methods to perform ADLs, function at work, participate in social activities, and travel safely both inside and outside the home is an important component of vision rehabilitation. Vision rehabilitation therapists, orientation and mobility instructors, and occupational therapists with specialized training in vision rehabilitation teach these skills. Counseling and/or psychotherapy are frequently essential components in assisting with the emotional adjustment to vision loss.

The goal of any vision rehabilitation intervention is to maximize functional independence and prevent excessive disability in individuals with vision impairment. Despite the fact that there is currently only a limited research literature on the effects of vision rehabilitation for older adults, recent studies show that these services are effective in maximizing functional ability and slowing functional decline.

 

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