Retina
Posted by recep on April 19th, 2009Ophthalmoscopy of the retina is difficult in elderly patients because of their small pupils, eye movement, and opacities, but providing a target to stare at may help. Such an examination provides the only opportunity to directly visualize a cranial nerve (optic nerve), the portion of the retina responsible for the highest level of visual acuity (the macula), and blood vessels (retinal artery and vein and capillary bed). Recognizing age-related changes in these structures is important.
The optic nerve tends to have less distinct margins and may appear slightly paler because of a loss of capillaries from small-vessel disease secondary to atherosclerosis. The macula, which in young people usually has a bright central foveal light reflex, may not have any foveal reflex. Also, yellowish-white spots (drusen) often appear in the macular area, and some disruption may occur in the pigmentation pattern (see AGE-RELATED MACULOPATHY, below). Unless these macular changes are accompanied by a distortion of objects or a frank decrease in visual acuity unexplained by other causes, they are not clinically important. The arteries also demonstrate atherosclerotic changes, including slight narrowing and an increased light reflex from thickened vessel walls. The veins may show marked venous indentation (nicking) at the arteriovenous crossings with slight proximal distention. In general, the retina, which glistens in younger people, becomes duller with aging.
Tags: Retina
