RESUMO
Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.
Assuntos
Catarata/terapia , Retinopatia Diabética/terapia , Glaucoma/terapia , Degeneração Macular/terapia , Transtornos da Visão/terapia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Ácido Ascórbico/uso terapêutico , Bevacizumab/uso terapêutico , Cegueira/diagnóstico , Cegueira/etiologia , Cegueira/terapia , Catarata/complicações , Catarata/diagnóstico , Extração de Catarata , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Fenofibrato/uso terapêutico , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Hipolipemiantes/uso terapêutico , Injeções Intravítreas , Fotocoagulação , Degeneração Macular/complicações , Degeneração Macular/diagnóstico , Programas de Rastreamento , Guias de Prática Clínica como Assunto , Ranibizumab/uso terapêutico , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Baixa Visão/diagnóstico , Baixa Visão/etiologia , Baixa Visão/terapia , Vitamina E/uso terapêutico , Vitaminas/uso terapêuticoRESUMO
A 46-year-old Caucasian female with a history of epilepsy came into our family medicine center complaining of weakness, fatigue, and arthralgia that made it difficult for her to walk. She'd had these symptoms for 6 months and reported having amenorrhea and hot flashes for the past 2 years.
