| Summary: | Visual disturbance affects a significant proportion of the elderly, and although there is an increase in ocular pathology with age (diabetic retinopathy, cataracts, glaucoma, etc.), 91.5% of isolated vision loss in the elderly is due to refractive error. Visual acuity screenings in the primary care setting is a recommended geriatric screening tool to detect undiagnosed visual changes. Adults with visual acuity loss have deterioration in quality of life and have difficulty with activities of daily living, as well as increased risk of social isolation, depression, anxiety, falls, hypertension, heart disease, and stroke. These difficulties have been found to be amplified 6 to 41 fold in patients with bilateral visual loss. Aging causes a decrease in visual acuity in mesopic conditions or conditions with glare, as well as worsening color discrimination and a diminishing useful field of view (area of field that the patient can recognize and react to visual stimuli). The predominant cause of visual impairment in the world and second most common cause of blindness in the world is uncorrected refractive error. In the developing world, this can sometimes be due to surgical aphakia or inadequate pseudophakic correction and problems largely stem from access to affordable health care. However, correctible vision loss is still an enormous problem for the elderly in developed nations as well. Even in patients with ocular comorbidities, a spectacle prescription taking into account the patient's visual goals can minimize age related visual field and acuity changes. It should be noted that not all patients with glasses have the correct prescription for their current visual acuity and are essentially using their current glasses as simple magnifiers. Correcting their prescription can have profound impacts on their quality of life and prevent deterioration.
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