Rosenberg Eric A, Sperazza Laura C
Weill Medical College of Cornell University, New York, New York, USA.
Am Fam Physician. 2008 May 15;77(10):1431-6.
Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting.
失明或视力低下影响着300多万40岁及以上的美国人，预计到2020年这一数字将达到550万。除了治疗患者的视力丧失和合并的医疗问题外，医生还必须了解与视力丧失相关的身体限制和社会问题，以优化视力受损患者的健康状况和独立生活能力。在美国，40岁及以上人群中最常见的四种视力丧失病因是年龄相关性黄斑变性、白内障、青光眼和糖尿病视网膜病变。渗出性黄斑变性采用激光治疗，晚期非渗出性黄斑变性的进展可通过高剂量抗氧化剂和锌制剂减缓。青光眼筛查的价值尚不确定；这种疾病的治疗依赖于局部眼部用药。白内障的症状包括视力下降、色觉减退、对比敏感度降低和眩光障碍。生活方式和环境干预可以改善白内障患者的功能，但如果病情恶化通常会进行手术。糖尿病视网膜病变通过严格控制血糖来治疗，以黄斑水肿为特征的严重病例采用激光光凝治疗。视力增强装置可以帮助放大物体，非光学干预措施包括特殊滤光片和增强照明。
