Impaired vision and hearing in the elderly

Chapter 36 Impaired vision and hearing in the elderly



Case 36.1



1. Select no more than five questions which will help you determine the type (not the cause) of visual disturbance Martha is complaining about
i Is your vision blurred? (may be a disorder of visual acuity)

ii Do you see ‘double’? (may be a disorder causing asymmetry of the visual axes)

iii Have you noticed that you have any ‘gaps’ in your vision when you are looking at something (eg: are you losing your peripheral vision)? (may be a visual field defect)

iv Do you have to hold a book further away from yourself when you read, or, are you having more difficulty than usual seeing objects that are far away? (may be a refractive error)

v Do you ever have spots, floating objects or flashing lights appear in front of your eyes? (possible retinal detachment or condensations of vitreous humour)

2. You discover that the problem is a decrease in visual acuity. What does this mean?

Visual acuity refers to a decrease in the ‘sharpness’ or clarity of vision. In other words, objects appear blurry.


3. What are some of the more common causes of diminished visual acuity in elderly people?

Refractive errors and cataracts are the most common. There are many other causes, including glaucoma, keratitis and macular degeneration.


4. What do you wish to examine?
• The external eye and extra-ocular apparatus.

• Cranial nerves II, III, IV, VI.

• Fundoscopic examination.

5. Physical examination of Martha’s eye was normal. She was referred to an optometrist for further assessment, as the diagnosis of many eye disorders require the use of specialised equipment. His report stated that Martha had some opacification of her lens. What is the name of this disorder? Martha has a cataract.

6. What are the most common causes of this disorder?

Degeneration which occurs with age and diabetes mellitus are the most common causes. Some drugs also increase the likelihood of developing a cataract. There are many other causes and pre-disposing factors in its development, such as an underlying eye pathology, trauma, drugs and other systemic diseases.


7. Why does it cause a decrease in visual acuity?

The lens must remain transparent in order to refract light through the eye. Any opacity within the lens can distort or block the passage of light, and thus interfere with its projection on the retina.


8. Do you need to refer this patient?

Yes — there are management options available.



Case 36.2



1. What do you think the patient may be referring to? What will you ask him in order to clarify what his problem may be?

He is describing what seems to be a visual field defect. To determine the nature of the problem, the following questions should be asked:


• How long have you noticed the change? Has it been gradual or sudden?

• Have you had any visual problems in the past?

• Where are the ‘gaps’ that you have? Is it in the middle of your field of vision, or to the periphery?

• Do you need to move your head (or the book) in order to follow the words on a page?

• Do straight lines ever appear crooked to you?

• Do some objects appear as a different colour or shape than you would expect?

• Do you ever see double?

Note: You should enquire about any changes that have occurred to his health since his last appointment.


2. What are you going to examine in this man? Why?

The visual fields need to be examined. This can detect if there is a loss of peripheral vision, central vision, half of a visual field or a quarter of a visual field. One or both eyes may be affected, depending on the type of disorder that the patient has.


This testing can be done by the health practitioner (as part of a cranial nerve examination), or by an optometrist or ophthalmologist using specialised equipment. In addition, ophthalmoscopy should be done.


3. Your results indicate a small area in the centre of both visual fields, where he is unable to see an object. What is the most likely diagnosis?

Age-related macular degeneration.


4. What is the most common cause of this disorder?

Degeneration occurring as a result of age.


5. Are there any known predisposing factors for the development of this condition?

Smoking, obesity, sleep apnoea, metabolic syndrome, exposure to excessive sunlight, significant myopia, and some drugs.


For more information, please refer to the further reading section at the end of this chapter.



Case 36.3



1. What questions do you need to ask to determine the cause of his symptoms?
• When was the first time that these episodes occurred?

• How frequently do these episodes occur?

• How long do they last?

• Is there always pain or discomfort involved?

• How severe is the pain?

• Do you ever feel nauseated with it?

• Where exactly is the redness?

• Is there a discharge associated with these episodes?

• Are there any other symptoms which occur at around the same time?

• Did you do anything different at around the time that these episodes commenced?

• Do your eyes water a lot, in between these episodes?

• What was the ointment that you were using?

• Are you currently on any medications?

2. What is the most likely diagnosis, based only on the history?

Conjunctivitis.


3. What would you expect to find when you examine him?
• Redness of the palpebral and bulbar conjunctiva.

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Impaired vision and hearing in the elderly

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