Aged eyes: Ocular findings in individuals 90 years of age and older

Background: The elderly population in the United States is rapidly expanding. It is estimated that the number of individuals over the age of 85 will exceed 4 million by the year 2000. We investigated the visual function and ocular findings of individuals 90 years of age and older. Methods: A consecutive series of patients 90 years of age and older received complete eye examinations including best corrected visua acuity, slit lamp biomicroscopy, tonometry, and dilated ophthalmoscopy. Results: Thirty- one individuals 90 years of age and older were evaluated. The average age was 93 years (range 90- 102 years). Sixty-eight percent of those evaluated were women, 32% were men. A vision of 20/40 or better was present in at least one eye of 58% of individuals. Sixteen percent of individuals had vision of 20/200 or worse in both eyes. The main causes of bilateral loss of vision to 20/200 or worse were age-related macular degeneration with extensive geographic atrophy (10%), glaucoma (3%), and cataracts (3%). Seventy-one percent of individuals had cataract surgery performed on one or both eyes. Other external and anterior segment findings included glaucoma (19%), brow ptosis (16%), and Fuchs' corneal dystrophy (16%). Posterior vitreous detachment was present in one or both eyes of 58% of individuals. Retinal changes were observed frequently. The most common findings included macular drusen with mild retinal pigment epithelial alterations (48%). Significant geographic atrophy was present in 23% and exudative macular degeneration was found in 6% of eyes. Nonproliferative diabetic retinopathy was observed in one of the three diabetic patients examined. Other retinal changes included peripheral reticular pigmentary alterations (32%) and macular branch retinal vein occlusion (10%). Conclusion: The majority of individuals 90 years of age and older enjoy good visual function with at least one eye. The most common causes for visual loss include age-related macular degeneration with geographic atrophy, cataract, and glaucoma.