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Vision loss in the older adult
The speed of visual loss points to the diagnosis: gradual and painless — cataract, dry macular degeneration or glaucoma; sudden — retinal detachment, retinal artery occlusion or wet macular degeneration, all of them emergencies.
Why it matters in the exam
Family medicine papers ask when to operate on a cataract (by functional impairment), how to slow macular degeneration, about the course of diabetic retinopathy and the screening intervals, and about a patient with a "curtain" or shadow in the visual field. Other questions describe transient blindness in one eye and ask about investigating the neck arteries.
Know the side effects of glaucoma drops (prostaglandin analogues — iris darkening; beta-blockers — bradycardia and bronchospasm).
The family doctor is usually the first to hear about failing vision; his role is to separate gradual loss, referred for a routine examination, from sudden loss, which is an emergency, and to make sure diabetic patients have regular retinal examinations.
Visual loss in an older person also raises the risk of falls, isolation and depression, so it is worth asking about at every periodic visit and referring for regular eye examinations. Further questions deal with side effects of glaucoma drops and with a patient with new double vision, which needs a neurological work-up.
Key points
- Gradual — cataract, dry macular degeneration, glaucoma; sudden — emergency.
- Cataract is operated on according to functional impairment.
- Wet macular degeneration — urgent anti-VEGF injections.
- Flashes and new floaters — retinal detachment, today.
- Type 2 diabetes — retinal examination at diagnosis and then every 1–2 years.
Summary table
| Condition | Presentation | Finding | Treatment |
|---|---|---|---|
| Cataract | Gradual blurring, glare when driving at night | Cloudy lens, weak red reflex | Surgery when vision impairs daily function |
| Dry macular degeneration | Gradual loss of central vision | Drusen | Stop smoking; AREDS2 supplements at intermediate stage |
| Wet macular degeneration | Straight lines look distorted, rapid loss | New vessels under the macula | Intravitreal anti-VEGF injections — urgent |
| Open-angle glaucoma | No symptoms until late, peripheral field loss | Increased cup-to-disc ratio, intraocular pressure usually raised | Prostaglandin analogue drops; laser |
| Retinal detachment | Flashes, new floaters, a curtain over the field | — | Referral the same day |
| Central retinal artery occlusion | Abrupt, painless monocular vision loss | Cherry-red spot, relative afferent pupillary defect | Emergency — a stroke equivalent; exclude giant cell arteritis |
Free exam questions
מבין המטופלים הבאים הסובלים מסוכרת לא מאוזנת שנים רבות למי הסיכון הגבוה ביותר לפתח רטינופתיה סוכרתית? (the question as examined, in Hebrew)
- א. מטופל עם מחלת לב איסכמית
- ב. תת פעילות של בלוטית התריס לא מאוזנת
- ג. עישון מעל 10 .סיגריות ליום
- ד. מטופל עם ממאירות של המעי הגס
גלאוקומה כיצד נראת התפלגות הלחצים התוך עיניים באוכלוסיה הכללית ? (the question as examined, in Hebrew)
- א. התפלגות גאוסית( Gaussian distribution )
- ב. התפלגות מוטה( skewed )לכיוון לחצים גבוהים
- ג. התפלגות מוטה( skewed )לכיוון לחצים נמוכים
- ד. ההתפלגות אינה מושפעת מגזע האוכלוסיה
גלאוקומה גברת בת 70 , ללא היסטוריה עינית מגיעה למיון בשל עין אדומה וכואבת .בבדיקה לישכה רדודה ,בגוניוסקופה זוית סגורה . לחץ 50 . בבדיקת העין השניה לישכה עמוקה וזוית פתוחה . איזה מבין המנגנונים הוא הסביר ביותר לסגירת הזוית? (the question as examined, in Hebrew)
- א. שימוש בתרופה טופירמט
- ב. גלאוקומה סגורת זוית ראשונית
- ג. פאקומורפיק גלאוקומה
- ד. ICE syndrome
In the full version for subscribers
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Sources
- American Academy of Ophthalmology Preferred Practice Pattern, 2019–2024 — Cataract in the adult eye; Age-related macular degeneration; Primary open-angle glaucoma; Diabetic retinopathy
- AREDS2 Research Group, JAMA, 2013 — Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration
- American Diabetes Association, Standards of Care in Diabetes, 2025 — Retinopathy, neuropathy and foot care
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.