1. Blindness or low vision effects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and co-morbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. Vision problems are common with aging and the goal is to maintain functional vision, independence, and prevent injuries, MVAs and falls. Common vision problems include cataracts, glaucoma, aging-related macular degeneration, and diabetic retinopathy and many are treatable. Eye medications should be recorded and continued during hospitalization New visual symptoms should be evaluated promptly, including a funduscopic exam and referral to an ophthalmologist. Older patients should be examined for aging related vision-threatening disease every year. Age-related macular degeneration (AMD). (Fig. 1) AMD is the most common cause of blindness in Americans over 50, and risk factors include older age, smoking, and hypertension. Vision is lost in central visual fields, and diagnosis is made by exam, which shows macular exudates (drusen) in dry AMD, and macula hemorrhage in wet AMD. There is a range of treatments, including vitamin, antioxidant and zinc supplementation, intra-ocular injection of monoclonal antibodies, and laser therapy. AMD may be preventable with risk factor reduction (smoking cessation) and a diet rich in anti-oxidants (green leafy vegetables). Primary Open Angle Glaucoma. (Fig. 2) Primary open angle glaucoma occurs more in African Americans, and may cause peripheral vision loss (tunnel vision). Funduscopic exam shows increased diameter and cupping of the optic disc, with vision loss due to loss of central retinal ganglia. Intraocular pressure is usually elevated and thought to be caused by reduced aqueous humor drainage through the trabecular meshwork and Canal of Schlem. Treatment reduces intraocular pressure, and is primarily topical ocular medications or surgical iridectomy. Narrow angle glaucoma, an ocular emergency, occurs more commonly in Asians and presents with eye pain, nausea, acute vision loss and rapid increase in intraocular pressure. Cataracts. (Fig. 3) Cataract is the most common cause of blindness worldwide. Cataracts are central (nuclear) or peripheral clouding of the ocular lens, leading to decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Risk factors include age, smoking, UV radiation exposure, and corticosteroid use. Treatment is lens replacement with an intra-ocular lens using phakoemulsification, and visual function is restored in the majority of patients. Diabetic retinopathy (DR). (Fig. 4) Among US adults 40 years and older known to have DM, the estimated crude prevalence rates for retinopathy and vision-threatening retinopathy were 40.3% and 8.2%, respectively. Early DR is characterized by background changes, exudates, and progresses to proliferative stage and finally retinal hemorrhage, which produces traction on the retina and blindness. There is no convincing evidence that diabetic retinopathy responds to very tight glucose control, and severe DR marked by macular edema is treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and non-optical interventions include special filters and enhanced lighting. REFERENCES Jager, R. D., W. F. Mieler, et al. (2008). "Age-related macular degeneration." N Engl J Med 358(24): 2606-17 Solomon R, Donnenfeld ED. ( 2003 ). “Recent Advances and Future Frontiers in Treating Age-related Cataracts.” JAMA; 290(2): 248-251 Kwon, Y. H., J. H. Fingert, et al. (2009). "Primary open-angle glaucoma." N Engl J Med 360(11): 1113-24 Rosenberg, E. A. and L. C. Sperazza (2008). "The visually impaired patient." Am Fam Physician 77(10): 1431-6. Funded by The Donald W. Reynolds Foundation Figure 4: Diabetic Retinopathy (DR)Figure 3: Cataracts Figure 2: Primary Open Angle Glaucoma Figure 1: Age Related Macular Degeneration Vision Loss and Aging Insert age-related macular degeneration picture Insert cataracts picture Insert primary open angle glaucoma picture Insert diabetic retinopathy picture