LEARNING OBJECTIVES

A review of changes attributable to glaucoma versus changes due to ageing in general, a focused discussion on neurodegenerative effects

What’s New:

Diagnostic Challenges in ageing and dementia:

Author: Paul McCann MD PhD¹, Frank Bochmann MD PhD,², Augusto Azuara-Blanco MD PhD¹

1 Queen’s University Belfast, Institute of Clinical Sciences - Block A, Grosvenor Road, Belfast, BT12 6BA
2 Cantonal Hospital of Lucerne, Department of Ophthalmology, 6000 Lucerne 16, Switzerland

Core concepts

• The rate of retinal ganglion cell loss in normal ageing has been quantified in longitudinal studies.
• The effects of ageing on the optic nerve head (ONH) and retinal thickness are minimal and may not be of clinical significance when assessing glaucoma.
• Automated perimetry compares the results of a test with an agematched normal group of individuals. Nevertheless the influence of age in retinal sensitivity is minor.
• Current optical coherence tomography (OCT) devices can measure macular as well as circumpapillary retinal nerve fibre layer (RNFL) thicknesses and combine anatomical and functional data, which may be useful in diagnosing and monitoring glaucoma.
• RNFL thinning in Alzheimer’s disease (AD) and cognitive impairment is significantly greater than in normal age-matched controls and this potentially could have an impact on clinical decision making in glaucoma.