Age Related Macular Degeneration

A 79-year-old female patient, well known to you from 5 years of treating her hypertension, presents to your office with concerns about her vision and hearing. Over the last year, she has noticed worsening vision in her left eye. She denies eye pain, tearing, and redness. She wears bifocals and last had an eye exam 3 years ago. At that time, she recalls her eye doctor saying her vision was “stable.”  Which of the following is true regarding common visual problems in older adults?

A) Initial symptoms of macular degeneration include decreased visual acuity and central visual field distortion.
B) Cataracts are less common in the older population than is macular degeneration.
C) Symptoms of open-angle glaucoma are dramatic and manifest early in the disease.
D) Initial symptoms of central retinal artery occlusion include severe pain and sudden loss of vision.
E) If a cataract is detectable on physical exam, it should be removed.

Answer:



A : Initial symptoms of macular degeneration include decreased visual acuity and central visual field distortion.

Explanation: By age 65, approximately one person in three has some form of eye disease that results in vision loss. The most common cause of blindness in older Americans is age-related macular degeneration (AMD). The disease typically presents with loss of vision in the central field with preservation of peripheral vision.

Answer “B” is false. Cataracts are more common than is macular degeneration. However, the availability of cataract surgery in the United States has reduced cataract-related vision loss in older Americans so that, even though cataracts are more common, they are less likely than AMD to cause blindness.

Worldwide, cataracts are the leading cause of visual impairment. Surgery is indicated when vision loss due to the cataract is interfering with function—not simply because the physician discovers the cataract, so “E” is incorrect.

Open-angle glaucoma, the most common form of glaucoma, progresses slowly over time. Significant visual field loss may occur, but is only recognized late in the disease.

Central retinal artery occlusion presents with sudden onset of painless monocular blindness. Severe eye pain and loss of vision would be more consistent with acute closed angle glaucoma.