The Ageing

Although the eye and its supporting structures undergo a number of well-defined changes with age, the distinction between these involutional changes and disease is not always clear cut. For the elderly patient, it is often reassuring to know that the problem is part of a "normal" process rather than the result of a specific illness and perhaps sometimes an artificial demarcation is drawn for the benefit of the patient.

The increase in number of elderly people presents problems in ophthalmology. A high proportion of elderly people instill drops into their eyes, either prescribed for them or as self-medication. It is important that adequate advice is received. Advising the elderly is often time consuming and might entail speaking to a younger relative or neighbour, but an adequate explanation of the disease or problems will avoid anxiety and probably the need for further subsequent unnecessary consultation.

The three commonest diseases of the elderly eye are cataract, glaucoma and age-related macular degeneration (AMD). The first can be cured, the second arrested or prevented, while the third generally tends to run a progressive course and treatment is unsatisfactory at present, although significant progress has been made recently. Attempts to measure the incidence of these problems have produced a wide range of figures. Out of a population of elderly persons complaining of impaired vision, about 30% turn out to have a cataract and a similar number to have AMD, whereas 5% or less have chronic open-angle glaucoma. Visual impair ment owing to glaucoma is more prevalent and occurs at an earlier age in blacks than in whites. Although there is an unexpectedly high incidence of cataract in patients with chronic simple glaucoma, the association of macular degeneration with cataract or glaucoma is more random.

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