Loss/Low Vision

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


The four common causes of low vision in the elderly patients are age-related macular degeneration, glaucoma, cataract and diabetic retinopathy. Three million Americans 40 years and older are affected by blindness or low vision, and by 2020, the projected number will be 5.5 million. About 80% of legally blind Australians 50 years and older suffer from age-related macular degeneration. This chapter will provide an update on the four important causes of visual impairment and their management.


Age-related macular degeneration (AMD) Glaucoma Cataract Diabetic retinopathy 


  1. 1.
    Rosenberg EA, Sperazza LC. The visually impaired patient. Am Fam Physician. 2008;77(10):1431–6.PubMedGoogle Scholar
  2. 2.
    Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999;60(1):99–108.PubMedGoogle Scholar
  3. 3.
    Frohlich SJ. Age-related macula degeneration and diabetic retinopathy-differences in optic rehabilitation. Klin Monbl Augenheilkd. 2005;222(4):337–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Christoforidis JB, Tecce N, Dell’Omo R, Mastropasqua R, Verolino M, Costagliola C. Age- related macular degeneration and visual disability. Curr Drug Targets. 2011;12(2):221–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Ganley JP, Roberts J. eds. Eye conditions and related need for medical care among persons 1–74 years of age, United States, 1971–72. Hyattsville, Md: US Department of Health and Human Services, Public Health Services, National Center for Health Statistics,1983. DHHS Publication No.831676.Google Scholar
  6. 6.
    Sarks J, Sarks S. Age related macular degeneration. Australian doctor. 28, September 2001.Google Scholar
  7. 7.
    Klein R, Klein BEL, Linton KIE. Prevalence of age -related maculopathy. The Beaver Dam Eye Study. Ophthlamology. 1992a;99:933–43.CrossRefGoogle Scholar
  8. 8.
    Mitchell P, Smith W, Attchi K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountain Eye Study. Ophthalmology. 1995;102:1450–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Vingerling JR, Dielemans I, Hoofman A, Grobbee DE, Hijmering M, Kramer M, et al. The prevalence of age-related maculopathy in Rotterdam study Ophthalmology. 1995;102:205–210.CrossRefPubMedGoogle Scholar
  10. 10.
    Age-Related Eye Disease Study Group A randomized, placebo-controlled trial of high dose supplementation with vitamins C and E, beta carotene, and zinc forage-related macular degeneration and vision loss. AREDS report no.8 Arch Ophthalmol. 2001;119:1417–36.CrossRefGoogle Scholar
  11. 11.
    Yonekawa Y, Miller JW, Kim IK. Age-related macular degeneration: Advances in management and diagnosis. J Clin Med. 2015;4:343–359.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wikipedia Macular degeneration.
  13. 13.
    Guymer RH, Chong EWT. Modifying risk factors for age associated macular degeneration. Med J Aust. 2006;184(1):455–58.PubMedGoogle Scholar
  14. 14.
    Chakravarthy U, Wong TY, Fletcher A, Piault E, Evano C, Zlateva G, et al. Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol. 2010;l10:31. Scholar
  15. 15.
    Miller JW. Age-related macular degeneration revisited-Piecing the puzzle: The LXIX Edward Jackson memorial lecture. Am J Ophthalmol. 2013;155.
  16. 16.
    Sarks SH, Cherpanoff S, Killingsworth M, Sarks J. Relationship of basal laminar deposits and membranous debris to the clinical presentation of early age-related macular degeneration. Invest Ophthalmol Vis Sci. 2007;48:968–977.CrossRefPubMedGoogle Scholar
  17. 17.
    Zarbin MA. Age-related macular degeneration: review of pathogenesis. Eur J Ophthalmol. 1998;8(4):199–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Abdelsalam A, Del Priore L, Zarbin MA. Drusen in age-related macular degeneration: pathogenesis, natural course and laser photocoagulation-induced regression. Surg Ophthalmol. 1999;44(1):1–29.CrossRefGoogle Scholar
  19. 19.
    Kein ML, Ferris FL, III; Armstrong J, Hwang TS, Chew EY, Bressler SB, et al. Retinal precursors and the development of geographic atrophy in age-related macular degeneration. Ophthalmology. 2008; 115:1026–1031.CrossRefGoogle Scholar
  20. 20.
    Wu L. (n.d.) Choroidal – Neovascularisation: Practice Essentials, Background, Pathophysiology. Medscape. accessed 4 August 2016.
  21. 21.
    Jaffe GJ, Caprioli J. Ocular computerized tomography to detect and manage retinal diseases and glaucoma. Am J Ophthalmol. 2004;137:156–59.CrossRefPubMedGoogle Scholar
  22. 22.
    Imrie FR, Bailey C. New treatments for age-related macular degeneration. Age Ageing. 2007;36(1):8–10.CrossRefPubMedGoogle Scholar
  23. 23.
    National Eye Institute. Statistics and Data. Website:
  24. 24.
    Cohen MM. Age-related macular degeneration and its possible prevention. Letters MJA. 2005;182(3): 310–311.PubMedGoogle Scholar
  25. 25.
    Alves-Rodrigues A, Shao A. The science behind lutein. Toxicol Lett. 2004;150:57–83. [pub Med].CrossRefPubMedGoogle Scholar
  26. 26.
    Cassim R. The ageing eye. CME. 2007;25(10):484–489.Google Scholar
  27. 27.
    Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kin RY, ANCHR Study Group. et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. NEJM. 2006; 55(14):1432–1444.CrossRefGoogle Scholar
  28. 28.
    Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, MARIN Study Group, et al. Ranibizumab for neovascular macular degeneration. NEJM. 2006; 355:1419–1431.CrossRefPubMedGoogle Scholar
  29. 29.
    Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90(3):262–267.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Rochtchina E, Michell P. Projected number of Australians with glaucoma in 2000 and 2030. Clin Exp Ophthalmol. 2000;28:146–148.CrossRefPubMedGoogle Scholar
  31. 31.
    Klein BG, Klein L, Sponsel W, Franke T, Cantor LB, Martone J, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992b;99(10):1499–504.CrossRefPubMedGoogle Scholar
  32. 32.
    Ramakrishna L, Nirmalan PK, Krishnadas R, Thulasiraj RD, Tielsch JM, Katz J, et al. Glaucoma in a rural population in South India: the Aravind Comprehensive Eye Survey. Ophthalmology. 2003;110(8): 1484–90.CrossRefGoogle Scholar
  33. 33.
    Stone EM, Fingert JH, Alward WLM, Nguyen TD, Polansky JR, Sunden SL, et al. Identification of a gene that causes primary open glaucoma. Science. 1997;275:668–670.CrossRefPubMedGoogle Scholar
  34. 34.
    Litcher PR. Genetic clues to glaucoma’s secrets. The L Edward Jackson Memorial Lecture. Part 2. Am J Ophthalmol. 1994;117:706–27.CrossRefGoogle Scholar
  35. 35.
    Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma. A Review. JAMA. 2014;311(18):1901–1911.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Spry PG, Sparrow JM, Diamond JP, Harris HS. Risk factors for progressive visual field loss in primary open angle glaucoma. Eye. 2005;19:643.CrossRefPubMedGoogle Scholar
  37. 37.
    Friedman DS, Wilson MR, Liebmann JM, Fechtner RD, Weinreb RN. An evidence – based assessment of risk factors for the progression of ocular hypertension and glaucoma. Am J Ophthalmol. 2004;138:S19.CrossRefPubMedGoogle Scholar
  38. 38.
    Rivera JL, Bell NF, Feldman RM. Risk factors for primary open angle glaucoma progression. What we know and what we need to know. Clin Opin Ophthalmol. 2008;19(2):102–6.CrossRefGoogle Scholar
  39. 39.
    Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711–1720.CrossRefPubMedGoogle Scholar
  40. 40.
    Fechtner RD, Weinreb RN. Mechanisms of optic nerve damage in primary open angle glaucoma. Surv Ophthalmol. 1994;39(1):23–42.CrossRefPubMedGoogle Scholar
  41. 41.
    Margalit E, Sadda SL. Retinal and optic nerve disease. Artif Organs. 2003;27:963.CrossRefPubMedGoogle Scholar
  42. 42.
    Fazio D. (n.d.) What are the symptoms of glaucoma? accessed 4 August 2016.
  43. 43.
    Boland MV, Ervin AM, Friedman DS, Jampel J, Hawkins BS, Vollenweider D, et al. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2013;158(4):271–279.CrossRefPubMedGoogle Scholar
  44. 44.
    Akpek EK, Smith RA. Current treatment strategies forage-related ocular conditions. Am J Manag Care. 2012;19:S76-S84.Google Scholar
  45. 45.
    European Glaucoma Society. Revised treatment guidelines 2009.
  46. 46.
    Austalian Institute and Health Welfare (AIHW). retrieved 10 January 2015.
  47. 47.
    Maclean H. Management of ocular problems in older people. Aust J Hosp Pharm. 1997;27:701–704.Google Scholar
  48. 48.
    Thylefors B, Negral AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organisation. 1995;73:115–21.Google Scholar
  49. 49.
    Cummings RG, Mitchell P. Hormone replacement therapy, reproductive factors and cataract- the Blue Mountains Eye Study. Am J Epidemiol. 1997;145:242–249.CrossRefGoogle Scholar
  50. 50.
    McCarty CA, Mukesh BN, Fu C, Taylor HC. The epidemiology of cataract in Australia. Am J Ophthalmol. 1999;128:446–65.CrossRefPubMedGoogle Scholar
  51. 51.
    Reidy A, Minassian DC, Vafidis G, Joseph J, Farrow S, Wu J, et al. Prevalence of serious eye disease and visual impairment in north London population based cross sectional study. BMJ. 1998; 316:1643–6.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Fong DS, Aiello L, Gardner TW, King GI, Blankenship G, Cavallerano JD, et al. Diabetic retinopathy. Diabetes Care. 2003;26:S99.CrossRefPubMedGoogle Scholar
  53. 53.
    Tarr JM, Kaul K, Chopra M, Kohner EM, Chibber R. Pathophysiology of diabetic retinopathy. Ophthalmol 2013.
  54. 54.
    Mathews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM. Risks of progression of retinopathy and vision loss related to tight blood control in type 2 diabetes mellitus. cUKPDS 69. Arch Ophthalmol. 2004;122(1):1631–1640.Google Scholar
  55. 55.
    Garner A. Developments in the pathology of diabetic retinopathy: a review. J Roy Soc Med. 1981;74(6):427–423.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    PPP-2014. Diabetic Retinopathy. Am Acad Ophthalmol.
  57. 57.
    Early Treatment Diabetic Retinopathy Study (ETDRS) Research Group. Photocoagulation for diabetic macular oedema. Early treatment of diabetic retinopathy for Study Report Number 1. Arch Ophthalmol. 1985;103:1796–1806.CrossRefGoogle Scholar
  58. 58.
    Liang JC, Goldberg MF. Treatment of diabetic retinopathy. Diabetes. 1980;29:841–851.CrossRefPubMedGoogle Scholar
  59. 59.
    Kumar B, Gupta SK, Saxeena R, Srivastava S. Current trends in the pharmacotherapy of diabetic retinopathy. J Postgrad Med. 2012; 58(2):132–139.CrossRefPubMedGoogle Scholar
  60. 60.
    Keech AC, Mitchell P, Summanen PA, O’Day J, Davis TM, Moffitt M, et al. FIELD Study investigators. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet. 2007;370:1687–1697.CrossRefPubMedGoogle Scholar
  61. 61.
    Sjolie AK, Klein R, Porta M, Orchad T, Fuller J, Henrick H, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Project 2): a randomised: placebo controlled trial. Lancet. 2008; 372:1385–1393.CrossRefPubMedGoogle Scholar
  62. 62.
    Simo R, Hernandez C. Advances in the medical treatment of diabetic retinopathy. Diabetes Care. 2009;32(8):1556–1562.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Giese MJ, Speth RC. The ocular renin-angiotensin system: A therapeutic target for the treatment of ocular disease. Pharmacol Therapeutics. 2014; 142(1):11–32.CrossRefGoogle Scholar
  64. 64.
    Mohamed Q, Gillies MC, Wog TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298:902–916.CrossRefPubMedGoogle Scholar
  65. 65.
    Ford JA, Lois N, Royle P, Clar C, Shyangdan D, Waugh N. Current treatments in diabetic macular oedema: a systematic review and meta-analysis. BMJ Open. 2013;3:e002269 Scholar
  66. 66.
    Abu El-Asrar AM, Al-Mezaine HS. Advances in the treatment of diabetic retinopathy. Discov Med. 2010;9(47):363–73.PubMedGoogle Scholar
  67. 67.
    Sarao V, Veritti D, Boscia F, Lanzetta P. Intravitreal steroids for the treatment of retinal disease. Scientific World. J 2014,8;2014:989501. eCollection 2014.
  68. 68.
    Australian Institute of Health Welfare. Vision problems among older Australians. Bulletin Issue 27. July 2005.Google Scholar
  69. 69.
    Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI. The psychosocial impact of macular degeneration. Arch Ophthalmol. 1998;116(4):514–520.CrossRefPubMedGoogle Scholar
  70. 70.
    National Advisory Eye Council, Vision Research, A National Plan, 1994–1998. Betheseda, Md: US Dept of Health and Human Services. 1993; NIH publication 93-3186.Google Scholar
  71. 71.
    Lee BL, Wilson MR. Health-related quality of life in patients with cataract and glaucoma. J Glaucoma. 2000;9(1):87–94.CrossRefPubMedGoogle Scholar
  72. 72.
    Ramulu P. Glaucoma and disability: Which tasks are affected and at what stage of disease? Curr Opin Ophthalmol. 2009;20(2):92–98.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Shalicky S, Goldberg I. Depression and quality of life in patients with glaucoma I. Depression and quality of life inpatients with glaucoma: cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision and the Glaucoma Quality of Life-15. J Glaucoma. 2008;17(7):546–50.CrossRefGoogle Scholar
  74. 74.
    Fenwick EK, Pesudovs K, Khadka J, Dirani M, Rees G, Wong TY, et al. The impact of diabetic retinopathy on quality of life: qualitative findings from an item bank development project. Qual Life Res. 2012;21:1771–1782.CrossRefPubMedGoogle Scholar
  75. 75.
    Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmol Epidemiol. 2007; 14:179–83.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

Personalised recommendations