To date, visual impairments represent the 3rd highest cause of chronic problems in the elderly that forces them to require assistance with their basic daily tasks. In the United States, the four major diseases of visual disabilities in the elderly are cataracts, diabetic retinopathy, macular degeneration, and glaucoma.

An individual with any one of these four visual impairments may still have either his or her peripheral or central vision available for safe traveling and carrying out personal tasks given the appropriate devices and environmental modifications.

1. Macular Degeneration

Macular degeneration is the leading cause of vision loss in the aging population with a significant increase in the number of cases seen in people older than 65. It is also the number one cause of legal blindness in people over 60.

In this disease, the macula portion of the retina is damaged in both eyes. The exact cause is unknown, but it is believed to be due to an insufficient supply of nutrients to the macula. Studies now show that UV light from the sun may also be a contributor to the disease. There are two forms of macular degeneration - wet and dry. The dry form rather than the wet form is more commonly diagnosed in patients.

In the wet form, new blood vessels growing under the macula causes the vision loss. If this form is detected early enough, laser therapy can be used to treat the blood vessels and prevent further vision loss. Earlier this year, the FDA approved a cold laser therapy called Photodynamic Therapy to treat people who are in the early stages of the wet form. Unlike the conventional laser therapy, this method will not damage the healthy cells surrounding the leaking blood vessel. Unfortunately Photodynamic Therapy cannot reverse the damage that has already been done; it can only prevent further vision loss.

With the dry form, there is no treatment available because the vision loss is due to deterioration of cone cells (the cells responsible for color and central vision). People with macular degeneration usually experience diminished central vision in both eyes and the ability to see details.

Working with an occupational therapist who specializes with people who have low vision, has proven extremely helpful for some of our patients. They have reported back to us that it has made a difference like "night and day", in their ability to view objects.

The occupational therapist for vision gives the patient exercises to perform, which in effect retrains the brain to see out of the "eccentric field of vision" remaining, thus eliminating much eye strain from the process, where prior to the retraining, the brain was telling the eye to try to see out of the damaged areas.

2. Cataracts

This is the only eye disease that is a normal development of advanced age. Cataracts can also be caused by an infection, trauma, severe malnutrition, or developed at birth. They are painless and usually develop very gradually in one eye at a time. A cataract causes the lens of the eye to cloud and become opaque or dislocated. Scientists are not exactly sure how cataracts form, but believe that they may be due to a chemical or structural change in the lens protein.

As the cataract continues to mature, people experience reduced visual acuity, reduced peripheral vision, and more sensitivity to glare. The severity of these symptoms is very individualized. Although cataracts impair various aspects of vision, surgery is only recommended when the person's lifestyle is affected.

3. Glaucoma

The elderly population is at higher risk for developing glaucoma because optic nerves are more easily damaged with age. In glaucoma, an over production or blockage of the drainage of aqueous fluid causes a drastic increase in the intraocular pressure of the eyeball. This pressure increase damages the optic nerves and compresses the blood vessels responsible for carrying blood and oxygen to the retina. Without sufficient blood supply to the retina, peripheral vision is damaged.

Early detection and continued management with ocular pressure lowering medications and regular eye exams are vital in maintaining one’s vision and preventing blindness.

4. Diabetic Retinopathy

Diabetic retinopathy is a disease that progresses more quickly in elderly diabetic patients. It affects both eyes and mainly affects individuals who have had diabetes mellitus for at least 15 years. It is important to know that proper self-management of the disease early on may reduce the severity of the impairment and even delay its onset.

There are two types of diabetic retinopathy, proliferative and nonproliferative. In the proliferative type, new abnormal blood vessels grow and bleed into the retina and vitreous portions of the eye. The blood prevents the light that comes into the eye from going through the normally transparent vitreous. Because no light is able to penetrate through the vitreous, vision is affected and the person loses his or her ability to see. In the nonproliferative type, sight is disrupted when tiny pouches on capillaries develop, retinal nerve fibers become damaged, and the macula containing the cells responsible for color and black & white vision become swollen.

Depending on the extent of the damage, both types can result in reduced central and peripheral vision.

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