Lindex #1555

Kornzweig AL, Feldstein M, Schneider J

The Eye in Old Age: IV. Ocular Survey of Over One Thousand Aged Persons with Special Reference to Normal and Disturbed Visual Function

American Journal of Ophthalmology

1957; 44:29-37

This study was undertaken to determine the types of ocular disabilities affecting a group of elderly Jewish men and women at the Home for the Aged and Infirm Hebrews of New York City. This population originally sought institutional care mainly for physical reasons. Ages in the study ranged from 65 to over 90 years. Complete eye examinations were done annually.

Visual acuity was determined by retinoscopy and refraction. Good to adequate vision was present in 86.1% of all 1068 examined eyes. Poor vision to no light perception was found in 13.9%. Chart 1 demonstrates that good to useful vision declines as fair to adequate vision increases in each increasing age group. Poor and very poor vision also increase in the older age groups.

Cataract formation has been shown to be inevitable if a person lives long enough. Residents with cataracts, excluding anyone with glaucoma or other macular diseases, were grouped according to visual function. The study group was further divided into the over 80 years old and under 80 group. A total of 1300 eyes possessed cataracts. An increasing incidence of cataracts was found with increasing age. While 121 eyes were classified as operable, only 95 were operated upon. This probably occurred because many older individuals are content with their limited vision.

An ocular tension of 25 mm Hg was set as the normal value. Patients with tension higher than 30 mm Hg were considered to have glaucoma, while those with tension between 25 and 30 were considered possibly or potentially glaucomatous. In a survey of 1897 eyes, 5.3% had glaucoma, 10.2% possibly or potentially had glaucoma, and 84.5 were normal. In an earlier study by Duke-Elder, onset was found to increase with age from 50 to 70 years but is less common after 70 years. In the current study, tendency toward glaucoma remained fairly stable at 5% in all age groups older than 65. A slight increase of the disease occurred in the possible and potential group between the 70 to 80 and 80 to 90 age groups, but the limited number of eyes made the numbers statistically insignificant.

Earlier, scleral elasticity was shown to decrease with age, particularly after age 40. The effect of scleral rigidity on intraocular pressure was observed in this study. However, results must be considered preliminary since the test must be repeated at least four to six times in doubtful cases to be accurate. In this case, 1618 eyes were tested for rigidity at least once. Increased rigidity was found in 38.5% and decreased rigidity was found in 5.5%.

Macular disease was found in 29.3% with a greater proportion in the over 80 age group than the under 80 age group. Thus expectancy for disease increases with increasing age.