visual impairment
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Introduction
- a decrease in visual function that is subjectively &/or objectively demonstrable.
- any person may be considered visually impaired if
- corrected distant visual acuity in the better eye is 20/80 or less, or
- if visual fields are significantly restricted
* see visual function.
Etiology
- Acute visual loss lasting > 1 hour
* associated with red eye (+) accompanied by ocular pain
- Major causes of impairment (USA)
* Most common reversible cause of visual impairment
Epidemiology
- 50% of persons > 75 years of age (excluding presbyopia)
Pathology
- lens cloudiness, lens opacity[13]
Clinical manifestations
(patterns)
- slow central vision loss
- peripheral loss: advanced open-angle glaucoma
- hemianopsia
- scotoma suggests lesions in the retinas or visual pathways
- blurry vision (reduced visual acuity)
- micropsia
Complications
- depression
- potentially modifiable risk factor for dementia[14][15]
- functional limitations due to cognitive decline are more common among adults with vision impairment (RR=3)[10]
- patterns of cognitive decline differ by type of visual impairment
- impaired contrast sensitivity is associated with decline across more cognitive domains than other measures of visual function[11]
- psychoactive substance use common in visually impaired adults of all ages[12]
- disease interaction(s) of dementia with hearing loss & visual impairment
- disease interaction(s) of visual impairment with cognitive impairment
Management
- screening:
- comprehensive eye exam every 1-2 years adults >= 65 years (American Academy of Ophthalmology)
- inconclusive evidence for visual screening elderly (USPTF)
- screening elderly (>= 65 years) does not improve function or quality of life[9] (CMAJ)
- visual impairment in the elderly
- refer to optometrist or ophthalmologist[3]
- see specific etiology
- sudden visual loss: refer to ophthalmologist
- progressive or permanent visual impairment
- address treatable causes with ophthalmologist
- refer to vision rehabilitation specialist as needed
More general terms
More specific terms
- blindness
- blurry vision (decreased visual acuity, DVA)
- color vision impairment (includes chromatopsia)
- hyperopia (hypermetropia, farsightedness)
- loss of central vision
- loss of peripheral vision
- micropsia
- photopsia
- transient monocular blindness (TMB); amaurosis fugax
- transient visual loss
- visual field loss
Additional terms
References
- ↑ nlmpubs.nlm.nih.gov/hstat/ahcpr/
- ↑ Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 35
- ↑ Jump up to: 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
- ↑ Mangione CM, In:UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Helenius J et al. Concurrent acute brain infarcts in patients with monocular visual loss. Ann Neurol 2012 Aug; 72:286. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22926859
- ↑ US Preventive Services Task Force (USPSTF) Screening for Impaired Visual Acuity in Older Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(9):908-914 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26934260 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2497913
- ↑ Daien V, Peres K, Villain M et al Visual impairment, optical correction, and their impact on activity limitations in elderly persons: the POLA study. Arch Intern Med. 2011 Jul 11;171(13):1206-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21482828 Free PMC Article
- ↑ Dagnelie G. Age-related psychophysical changes and low vision. Invest Ophthalmol Vis Sci. 2013 Dec 13;54(14):ORSF88-93. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24335074 Free PMC Article
- ↑ Jump up to: 9.0 9.1 Wilson BJ, Courage S, Bacchus M et al Screening for impaired vision in community-dwelling adults aged 65 years and older in primary care settings. CMAJ Vol. 190, Issue 19, 14 May 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29759965 <Internet> http://www.cmaj.ca/content/190/19/E588
- ↑ Jump up to: 10.0 10.1 Saydah S, Gerzoff RB, Taylor CA, Ehrlich JR, Saaddine J. Vision Impairment and Subjective Cognitive Decline-Related Functional Limitations - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019;68:453-457 https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a2.htm
- ↑ Jump up to: 11.0 11.1 Varadaraj V, Munoz B, Deal JA et al Association of Vision Impairment With Cognitive Decline Across Multiple Domains in Older Adults. JAMA Netw Open. 2021;4(7):e211741. July 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34269806 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781965
Gupta P, Vu TA, Lamoureux EL Beyond Visual Acuity - A Comprehensive Assessment of Vision and Cognition in Older Adults With Visual Impairment. JAMA Netw Open. 2021;4(7):e2119033. July 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34269812 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781971 - ↑ Jump up to: 12.0 12.1 Han BH, Leddy JF, Lopez FA et al. Prevalence of psychoactive substance use among middle-aged and older adults with visual impairment in the US. JAMA Ophthalmol 2021 Nov 11; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34762104 PMCID: PMC8587212 (available on 2022-11-11) https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2785903
- ↑ Jump up to: 13.0 13.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Jump up to: 14.0 14.1 Ehrlich JR, Goldstein J, Swenor BK et al Addition of Vision Impairment to a Life-Course Model of Potentially Modifiable Dementia Risk Factors in the US. JAMA Neurol. Published online April 25, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35467745 https://jamanetwork.com/journals/jamaneurology/fullarticle/2791268
Deal J, Rohas JC Visual Impairment as a Modifiable Risk Factor in Dementia Prevention and Management. JAMA Neurol. Published online April 25, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35467705 https://jamanetwork.com/journals/jamaneurology/fullarticle/2791267 - ↑ Jump up to: 15.0 15.1 Killeen OJ, Zhou Y, Ehrlich JR. Objectively Measured Visual Impairment and Dementia Prevalence in Older Adults in the US. JAMA Ophthalmol. Published online July 13, 2023. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37440238 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2807125
- ↑ Pelletier AL, Rojas-Roldan L, Coffin J. Vision Loss in Older Adults. Am Fam Physician. 2016 Aug 1;94(3):219-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27479624 Free article. Review.
- ↑ Thompson J, Lakhani N Cataracts. Prim Care. 2015 Sep;42(3):409-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26319346 Review.
- ↑ Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet. 2023 Feb 4;401(10374):377-389. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36565712 Review.