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Subspecialties Refractive

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Treating the elderly patient population often involves serving those with concomitant diseases, such as Alzheimer’s, dementia, heart conditions and even paraplegia. When these patients struggle with poor vision, it has a larger impact on their quality of life than on someone who may otherwise be healthy and mobile. In fact, research shows that correcting refractive error improves the quality of life and depressive symptoms in people aged 55 years or older (1).

"If their vision was to suddenly disappear, their whole world would be lost."

We know that many elderly patients with neurological diseases and physical disabilities are not running races or driving cars. Their needs are the kind of minimal day-to-day activities that healthy people sometimes take for granted – reading, watching a favorite television show, or browsing the Internet. These patients often forget where they put their glasses, and are sometimes incapable of using their hands to put them on once they have found them. If their vision was to suddenly disappear, their whole world would be lost. The fewer sensory cues they have, the less likely they are to function in the world that they live in, which leads to unhappiness and distress.

So what can we, as clinicians, do to treat this patient population? There are two things. The first is to correct their refractive error. In turn, you will improve their mental health. By offering an extended range of vision lenses like the TECNIS Symfony lens (Johnson & Johnson Vision), AcrySof IQ Restor Multifocal IOL (Alcon), or the AT LISA trifocal 839MP (Carl Zeiss Meditec), I can treat astigmatism, myopia and hyperopia, allowing these elderly patients to be glasses-free with a much better quality of vision. We can even consider small incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) for elderly patients with paraplegia, quadriplegia, dementia.

"I encourage all eye care providers to consider refractive lens and cornea-based surgeries – you might just give someone their life back."

The second part is simple – start talking. When I see elderly patients who are in nursing homes or not functioning well at home, I ask their family members what activities the patient likes and is capable of doing. It’s a very important point. Obtaining a thorough medical history is a critical part of tailoring vision correction for elderly patients. Families often come back to me and say they feel like they got grandpa or grandma back again. They realize that their loved ones can communicate better after refractive surgery, and are functioning at a much higher level.

As a physician, I feel strongly that enhancing patients’ quality of life is at the core of what we are called to do. Refractive surgery is far too often overlooked in patients who may benefit the most from these types of procedures. I encourage all eye care providers to consider refractive lens and cornea-based surgeries in the elderly when appropriate – you might just give someone their life back.

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  1. A Palagyi et al., “Depressive symptoms in older adults awaiting cataract surgery”, Clin Exp Ophthalmol, 44, 789-796 (2016). PMID: 27388788.
About the Author
Steven Vold
Steven Vold

Steven Vold is the Medical Director of Vold Vision, Fayetteville, Arkansas, US, and is a co-founder of the American-European Congress of Ophthalmic Surgery. Vold also co-founded the Silicon Valley-based ophthalmic device company Ocunetics, Inc. whose intellectual property was exclusively licensed by IRIDEX Corporation in 2011.

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