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Low and Loss of Vision in the Elderly

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Abstract

Age-related changes occur in all structures of the eye causing varied effects. With ageing, lens opacities and changes in the vitreous occur and the vitreous gel undergoes liquefaction. A number of changes occur in the retina including accumulation of lipofuscin, thickening of Bruch’s membrane, narrowing of the choroidal arteries and accumulation of material forming soft drusen. The four main causes of low or loss of vision are age-related macular degeneration (AMD), glaucoma, cataract and diabetic retinopathy. The pathophysiology of AMD is complex and unclear, and the pathological processes implicated are accumulation of lipofuscin, formation of drusen, neovascularisation and inflammation. Complement system plays a vital role in the pathology of AMD. In glaucoma, elevated intraocular pressure and vascular dysfunction are said to contribute to initial insult and the ultimate result is death of the retinal ganglion cells causing irreversible visual loss. Cataract of old age is multifactorial with genetic, environmental and biochemical factors which act synergistically. A number of biochemical pathways have been proposed as possible links between hyperglycaemia and diabetic retinopathy (DR). The instrumental pathways include increased polyol pathway, activation of protein kinase C and increase exposure of growth factors such as vascular endothelial growth factor (VEGF).

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Author information

Authors and Affiliations

  1. Sydney Medical School (Westmead), The University of Sydney, North Rocks, Australia

    Nages Nagaratnam

  2. Norwest Specialist Medical Group, Bella Vista, New South Wales, Australia

    Kujan Nagaratnam

  3. Blacktown-Mt Druitt Hospital, Blacktown, New South Wales, Australia

    Gary Cheuk

Authors
  1. Nages Nagaratnam
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  2. Kujan Nagaratnam
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  3. Gary Cheuk
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Appendices

Multiple Choice Questions

  1. 1.

    In aged-related macular degeneration (AMD), the following pathological changes that occur are true, EXCEPT:

    1. A.

      Dysfunction of retinal pigment epithelium (RPE) occurs early.

    2. B.

      Membranous debris accumulates on either side of the RPE.

    3. C.

      Membranous debris is believed to be lipoprotein derived and the lipoproteins are dietary and systemic.

    4. D.

      Soft drusen are larger and tend to be confluent.

  2. 2.

    The following are true in aged-related macular degeneration (AMD), EXCEPT:

    1. A.

      Focal pigmentation and systemic hypertension increase risk of developing choroidal neovascularisation (CNV).

    2. B.

      Hard drusen pose a low rate of CNV.

    3. C.

      Progression to CNV results from angiogenic factors such as vascular endothelial growth factor (VEGF).

    4. D.

      Complement system plays an important role in the pathogenesis of AMD.

  3. 3.

    The following are true of diabetic retinopathy (DR), EXCEPT:

    1. A.

      There is a close association between chronic hyperglycaemia and development and progression of DR.

    2. B.

      Macular oedema always occur early in DR.

    3. C.

      Vascular endothelial growth factor (VEGF) plays an important role in ischaemic retinal vascularisation.

    4. D.

      Microvascular leakage and microvascular occlusion are responsible for the development of DR.

  4. 4.

    The following statements are true in glaucoma, EXCEPT:

    1. A.

      In acute angle close glaucoma in certain situations of pupillary dilatation, the flow of aqueous is obstructed.

    2. B.

      Normal tension glaucoma causes visual field loss due to nerve damage.

    3. C.

      Elevation of the intraocular pressure (IOP) is a primary risk factor for the development of glaucoma.

    4. D.

      The ultimate result of glaucoma is irreversible visual loss.

Answers to MCQs

1 = C; 2 = B; 3 = B; 4 = C

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© 2016 Springer International Publishing Switzerland

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Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Low and Loss of Vision in the Elderly. In: Diseases in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-25787-7_16

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  • DOI: https://doi.org/10.1007/978-3-319-25787-7_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25785-3

  • Online ISBN: 978-3-319-25787-7

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