Normal changes in the lens, retina, and vitreous accompany aging, but loss of vision in late life is not an inevitable consequence of aging. Cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration (ARMD) account for most vision loss in the older population. Visual impairment reduces older patients' ability to function independently and increases their risk of depression and of injury due to falls. When older persons have a visual complaint, they tend to blame it on being old and do not tell their physicians. In the primary care office, simple screening questions and examination of the dilated eye can often reveal a need for further examination and/or referral.

Aged↗

PubMed1997

Keeping an eye on vision: new tools to preserve sight and quality of life. A roundtable discussion, Part 2.

Research is pointing the way to new therapies for the eye diseases of aging. A gene that appears related to glaucoma has been identified, and a safe and effective inhibitor for aldose reductase is being sought for patients with diabetic retinopathy. Refinements in cataract surgery continue to improve the high success rate of this procedure. Physicians can educate their patients to participate in vision protection, through control of blood sugars, compliance with glaucoma medications, and the use of the Amsler grid by those at risk for macular degeneration. When vision cannot be corrected to the normal range, low vision rehabilitation offers magnification and new high-tech devices for optimizing independent patient function.

Age Factors↗

PubMed1996

The emotional impact of mistakes on family physicians.

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Humans↗

PubMed1996

Significance of intracranial pressure waveform analysis after head injury.

The authors have investigated the relationships between the amplitude of the ICP pulse wave, the mean values of ICP and CPP, and the outcome of 56 head injured ventilated patients. The ICP was monitored continuously using a Camino transducer (35 patients) or subdural catheter (21 patients). The mean Glasgow Coma Score was 6 (range 3-13; 5 patients had a GCS > 8 after resuscitation). Patients were grouped according to their Glasgow Outcome Score assessed at 12 months after injury. The amplitude of ICP pulse waveform was assessed using the fundamental harmonic of the pulse waveform (AMP) to avoid distortion caused by different frequency responses of the pressure transducers used in the study. Statistical analysis revealed that in patients with fatal outcome the ICP pulse amplitude increased when the mean ICP increased to 25 mmHg and then began to decrease. The upper breakpoint of the AMP-ICP relationship was not present in patients with good/moderate outcome. The moving correlation coefficient between the fundamental harmonic of ICP pulse wave and the mean ICP (RAP: R-symbol of correlation between A-amplitude and P-pressure) was introduced to describe the time-dependent changes in correlation between amplitude and mean ICP. The RAP was significantly lower in patients who died or remained in the vegetative state. In 7 patients who died from uncontrollable intracranial hypertension RAP was oscillating or decreased to 0 or negative values well before brain-stem herniation. The combination of an ICP above 20 mmHg for a period longer than 6 hours with low correlation between the amplitude and pressure (RAP < 0.5) was described as an predictive index of an unfavourable outcome.

Adolescent↗

PubMed1996

Medical student teaching and family physicians' use of time.

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Education, Medical↗

PubMed1995

ICP reduction following decompressive craniectomy.

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Accidents, Traffic↗

PubMed1994

Testing of cerebral autoregulation in head injury by waveform analysis of blood flow velocity and cerebral perfusion pressure.

Thirty five head injured patients were subjected to day-by-day monitoring of intracranial pressure (ICP), arterial blood pressure (ABP) and blood flow velocity (FV) in middle cerebral artery. Parameters describing cerebral autoregulation: flow velocity time average, systolic, diastolic values, pulsatility index (PI), estimate of cerebrovascular resistance (CVR = CPP/FV) etc. were analyzed as functions of CPP (ABP-ICP). The results show that for CPP below 55 mmHg the evidence of exhausted autoregulation can be observed in FV, CVR, PI. The method is helpful in assessment ot the optimal level of CPP in order to reduce the probability of ischaemic brain insults.

Blood Flow Velocity↗

PubMed1992