From the Guidelines
The best approach to diagnose and manage vision problems in older adults involves comprehensive eye examinations by an eye care professional at least annually, as recommended by the US Preventive Services Task Force 1. These exams should include:
- Visual acuity testing
- Intraocular pressure measurement
- Dilated fundus examination
- Visual field testing when indicated
Common age-related vision conditions include:
- Presbyopia, which can be corrected with reading glasses or progressive lenses
- Cataracts, which may require surgical extraction when they significantly impair vision, typically as an outpatient procedure with lens implantation
- Glaucoma, managed with pressure-lowering eye drops such as latanoprost (Xalatan) 0.005% one drop daily or timolol 0.5% twice daily
- Age-related macular degeneration, which may be treated with AREDS2 vitamin supplements (containing lutein, zeaxanthin, vitamin C, vitamin E, zinc, and copper) for dry AMD or anti-VEGF injections like ranibizumab (Lucentis) or aflibercept (Eylea) for wet AMD
Diabetic retinopathy screening is essential for diabetic patients. Proper lighting, magnifying devices, and electronic reading aids can help manage vision impairment. Vision problems often develop gradually, so monitoring changes between appointments is important, as is addressing modifiable risk factors like smoking cessation, blood pressure control, and diabetes management to preserve vision health. The American Academy of Ophthalmology recommends a comprehensive examination conducted by an ophthalmologist every 1 to 2 years in patients 65 years or older 1.
From the Research
Diagnosis of Vision Problems in Older Adults
- Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years 2
- The most common causes of vision loss among the elderly are age-related macular degeneration, glaucoma, cataract, and diabetic retinopathy 2, 3
- Family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment 2
- A careful history and in-office tests of visual acuity can help primary care practitioners identify patients with visual problems 4
Management of Vision Problems in Older Adults
- Vitamin supplements can delay the progression of age-related macular degeneration 2
- Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration 2, 5
- Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma 2
- Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma 2
- Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults 2
- Fenofibrate also slows progression of diabetic retinopathy 2
- Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema 2
Prevention of Vision Loss in Older Adults
- Regular screening examinations are recommended for elderly patients to detect vision problems early 3
- Cataract surgery is often effective in restoring vision in older adults with cataracts 3
- Patients with diabetes should undergo eye examinations with dilation when diabetes is diagnosed and annually thereafter 3
- A large scale-up of eye care provision is needed to address avoidable vision loss in older adults 6