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Learning Objectives

  • Understand the prevalence of vision impairment among older adults, its functional implications, as well as the costs to the older adult who develops it, to the family, and to society.

  • Understand the normal age-related vision changes, and recognize functional indications and losses of the most prevalent age-related eye diseases.

  • Care for older adults who have vision loss with evaluations, recommendations, supportive education, and appropriate referrals to eye care and rehabilitation providers.

  • Assure that older adults with low vision who are in long-term and palliative care have their specific visual needs addressed.

Key Clinical Points

  1. Visual impairment among older adults is treated through examination, prescription, and recommendation of assistive devices and interventions, rehabilitation training, and education of family and other health professionals.

  2. Vision loss among older adults is associated with depression, comorbid health problems, and other disabilities. Treatment and rehabilitation for vision loss increase independence and mental health.

  3. Geriatricians can play an important role in assuring that older adults receive low-vision rehabilitation and supporting the full range of services that can be provided.

  4. Addressing visual impairment and assuring that older adults maintain their visual abilities and strategies can be included as a part of long-term and palliative care plans.


Population Studies

Many large, population-based, cross-sectional studies have documented the increase in prevalence of eye disease and visual impairment with increasing age, particularly in people older than 75 years. Greater prevalence of vision loss in the population with advancing age is a common feature across available data reports, despite a fair degree of variability in estimates and projections as a function of data type, source, definitions, and approach. Year 2020 prevalence estimates for vision loss in the United States, for instance, are 4.8% (16 million) of the population and 10% of those age 50 and older (12 million; International Agency for Prevention of Blindness Vision Atlas, The Centers for Disease Control and Prevention (CDC) and the National Centers for Health Statistics (NCHS) estimate the prevalence of significant visual impairment among Americans age 18 to 44 is 5.5%; the prevalence in those age 45 to 74 is approximately 12% and is rising to more than 15% for those age 75 and older. Indeed, according to a 2016 National Academies of Sciences, Engineering, and Medicine Report, of all adults with vision impairment or blindness who were 40 years and older in 2015, nearly half (48% or 2 million) were at least age 80. Projections for the year 2050 indicate the proportion of US adults age 80 and older will expand to account for 63% (5.6 million) of adults age 40 and older with vision impairment or blindness. After age 85, one in four older people are vision-impaired—unable to read, drive, recognize faces, and perform everyday activities without assistive devices and rehabilitation training. The prevalence of all forms of vision loss ...

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