From the Guidelines
Unilateral vision loss in elderly patients is most commonly caused by age-related macular degeneration (AMD), which can present asymmetrically, and other conditions such as retinal vascular occlusions, glaucoma, and diabetic retinopathy, that require prompt medical attention to prevent permanent blindness. The potential causes of unilateral vision loss in the elderly can be categorized into several groups, including:
- Degenerative conditions:
- Age-related macular degeneration (AMD) 1
- Diabetic retinopathy
- Vascular conditions:
- Retinal vascular occlusions (central or branch retinal artery or vein occlusions)
- Ischemic optic neuropathy
- Inflammatory conditions:
- Giant cell arteritis (temporal arteritis)
- Uveitis
- Traumatic conditions:
- Ocular trauma
- Retinal detachment
- Infections:
- Herpes zoster ophthalmicus
- Endophthalmitis
- Neoplastic conditions:
- Ocular tumors
- Medication-induced conditions:
- Hydroxychloroquine or ethambutol toxicity Any sudden unilateral vision loss warrants immediate medical evaluation, as conditions like giant cell arteritis require urgent treatment with high-dose corticosteroids (typically prednisone 60mg daily initially) to prevent permanent blindness 1. Retinal artery occlusions represent ocular emergencies that must be addressed within hours of onset. The underlying pathophysiology often involves vascular compromise, inflammatory processes, or degenerative changes that disproportionately affect one eye before potentially progressing to bilateral involvement. Early treatment of AMD is associated with a more favorable prognosis, and anti-vascular endothelial growth factor (VEGF) treatment given within 2 years after diagnosis of neovascular AMD has been shown to reduce legal blindness and visual impairment 1.
From the Research
Potential Causes of Unilateral Vision Loss in the Elderly
The potential causes of unilateral vision loss in the elderly can be attributed to various factors, including:
- Age-related macular degeneration (AMD) 2, 3
- Glaucoma 2, 4
- Ocular complications of diabetes mellitus 2
- Age-related cataracts 2
- Giant cell arteritis 4, 5
- Retinal detachment 4
- Retinal artery occlusion 4
- Optic neuritis 4
- Central retinal artery occlusion (CRAO) 5
- Cilioretinal artery occlusion 5
Risk Factors and Diagnostic Approaches
Risk factors for these conditions include older age, smoking, dyslipidemia, obesity, white race, female sex, and a family history of AMD 3. Diagnostic approaches may involve regular eye examinations, visual field testing, fluorescein angiography, and optical coherence tomography 3, 6.
Treatment Options
Treatment options for unilateral vision loss in the elderly depend on the underlying cause and may include:
- Vitamin supplements to delay the progression of AMD 2
- Intravitreal injection of a vascular endothelial growth factor inhibitor for wet AMD 2, 3
- Medicated eye drops to reduce intraocular pressure in glaucoma 2
- Laser trabeculoplasty to lower intraocular pressure in primary open-angle glaucoma 2
- Tight glycemic control and fenofibrate to slow the progression of diabetic retinopathy 2
- Panretinal photocoagulation and vascular endothelial growth factor inhibitors for diabetic macular edema 2
- Immediate initiation of empiric steroids for giant cell arteritis 4, 5
- Surgical intervention for retinal detachment 4
- High-dose steroids for optic neuritis 4