Main visual conditions in the elderly

Cataract is a total or partial opacity of the lens that prevents light from passing to the retina clearly and that, consequently, produces a progressive deterioration in the quality of vision of those who suffer from it.

When this condition begins to manifest itself, the ability of the lens to focus on near and distant objects on the retina is impaired, to the point of causing a loss of visual acuity.

Cataract, which is usually associated with the natural aging of the eye, can also be congenital or can occur due to trauma or disease.

The progression of most cataracts is usually slow and gradual. In fact, in its initial phase, the patient may not have noticeable symptoms in the quality of their vision.

However, there are several risk factors that may contribute to accelerate the process of cataract development, such as diabetes, smoking, previous eye diseases, eye trauma or prolonged exposure to ultraviolet radiation, among others.

According to the World Health Organization (WHO), unoperated cataracts continue to be the leading cause of blindness in the world.

The first manifestations of cataract have to do with a decrease in vision that makes it difficult or limits the patient to carry out their usual activities. In these cases, you often experience cloudy or blurred vision of objects, the outline of which is not clearly distinguishable, photosensitivity, halos around light sources, a dimmer perception of colors, or a loss of night vision.

These difficulties impair the quality of their vision and lead to a deterioration in their quality of life in general. For this reason, from the age of 50 it is advisable to undergo periodic check-ups, in order to detect cataract in early stages and determine the optimal time to perform surgery depending on its degree of evolution.

If the cataract is not intervened within a reasonable time, it runs the risk of hardening excessively, which may hinder the surgery and compromise the results obtained. For this reason, ophthalmology nowadays tends to avoid long waiting periods for the patient and to resolve cataracts before their visual deterioration is at its maximum. In this way, surgery is simpler and safer and visual recovery is faster.

It is a disease of degenerative origin of the macula (central area of the retina), which causes a progressive deterioration of the tissues of the eye, particularly the retinal pigment epithelium, and is generally associated with aging.

AMD is the leading cause of severe visual impairment over the age of 50 in the Western world. In Spain, this chronic condition affects some 700,000 people (1.5% of the population) and it is estimated that its prevalence will triple within 25 years.

The main risk factors for the onset of AMD are age, genetic predisposition, smoking, alcohol, hypertension or high cholesterol levels.

AMD does not cause pain, but may present various visual disturbances affecting the center of the field of vision, such as distorted vision of objects(metamorphopsia), blurred vision, increased sensitivity to light or sudden loss of central vision, among others.

When the disease is in a more advanced stage, the patient reports seeing a dark spot in the area of central vision that may darken and enlarge the more advanced the AMD is.

In order to confirm the appearance of the first symptoms, the patient can resort to the use of a simple test known as the Amsler Grid, which consists of looking at the central point of a grid with one eye and then with the other. If a central spot appears or the grid lines look distorted instead of straight, a complete examination with the ophthalmologist is required.

Glaucoma, also known as silent blindness, is a potentially serious disease that slowly, progressively and irreversibly damages the optic nerve. As a result of the damage caused to the nerve fibers of the retina, responsible for transmitting information from the eye to the brain, there is a milder or more severe loss of vision depending on the degree of degeneration of this nerve. At first, peripheral vision is affected, and over time, central vision is affected.

The main risk factor for developing glaucoma is high intraocular pressure, which occurs when it exceeds 22 millimeters of mercury (mm Hg). For intraocular pressure (IOP) to remain constant, there needs to be a balance between the amount of aqueous humour (colourless liquid with nourishing properties and responsible for eye tone) that is produced and eliminated, thus contributing to the proper functioning of the eye. Intraocular pressure can be elevated when the removal of aqueous humor is ineffective or when its production increases.

People with a family history of glaucoma and myopia are other risk groups that should be especially vigilant, undergoing periodic ophthalmological evaluations, in order to rule out the disease or diagnose it as soon as possible.

In most cases, glaucoma is characterized by the absence of symptoms. Hence, this disease is also known as silent blindness.

In chronic glaucoma, which is the most common, vision loss occurs very slowly and progressively. In addition, the signs that the patient can perceive are not very specific, almost imperceptible, since it does not cause discomfort until the disease is in a very advanced stage.

The general symptoms are headache above the eyebrows, loss of peripheral vision, generating what is called tunnel vision, or night blurriness.

On many occasions, the person suffering from glaucoma does not notice the presence of this disease until the damage caused to the optic nerve is irreversible. The absence of appreciable symptoms and the fact that the loss of vision is irreparable make the ophthalmologist advise to carry out complete ophthalmological check-ups periodically from the age of 45 to keep intraocular pressure and the state of the optic nerve under control. If the patient follows these preventive guidelines to detect and treat the disease in time, the visual loss it causes can be stopped.

In the particular case of angle-closure glaucoma, this acute form of glaucoma is accompanied by more severe symptoms such as severe eye pain, halos around bright lights, nausea and vomiting or sudden loss of vision, which is why ophthalmological emergencies are usually visited.

Patients with risk profiles such as people with a family history of glaucoma, diabetes, high blood pressure or cardiovascular disease, high myopia, hyperopia, and in general, those over 40 years of age should remain especially vigilant, undergoing routine examinations to rule it out or facilitate its early diagnosis. In fact, aging is one of the most important factors that predispose to suffering from this disease, since with age the drainage system of the aqueous humor stops working properly, which leads to an increase in intraocular pressure.

It is an ocular and vascular complication of diabetes mellitus that originates when the vessels that irrigate the retina deteriorate. It can affect any patient with type 1 and type 2 diabetes. Insufficient control of this disease by the patient and high blood glucose levels cause microcirculatory alterations that can affect the retina in different ways, resulting in two types of diabetic retinopathy.

Diabetic retinopathy is the most common retinal disease and the main cause of blindness in the western world. Two of the main risk factors that can condition the early onset of this pathology and aggravate its development are diabetes, when it is suffered for a prolonged period of time with metabolic decompensations , or arterial hypertension.

In the early stages of the disease, people with diabetic retinopathy do not perceive any visual alteration. However, as the disease progresses, it causes a loss of vision that, in very advanced cases, is not recoverable.

When the vision of a person with diabetes is slowly and progressively affected, it usually indicates the formation of macular edema, which is the presence of fluid accumulated in the central area of the retina. The blood vessels begin to fail and it is then that the patient notices a decrease in their visual capacity and can also see deformed objects(metamorphopsia). Macular edema is the main cause of vision loss in diabetics.

Other times, diabetic retinopathy results in macularischemia caused by the narrowing or occlusion of small blood vessels in the retinal area, which stops functioning properly because it does not receive enough blood flow. When this occurs, the patient’ s vision becomes blurred.

In the most severe cases, when a vitreous hemorrhage situation occurs, the main symptom is the sudden appearance of spots that partially or totally obscure vision.