Ocular Changes with Aging

Arcus senilis, or corneal arcus, is a hazy, white or yellow arc or deposit in the peripheral cornea. It has many causes and is more common in older adults. The deposit is composed of cholesterol and other lipids and does not generally indicate an underlying systemic abnormality. It does not interfere with vision or eye function. In white patients, this finding may indicate lipid abnormalities and an increased propensity for cardiovascular disease. No such clear correlation has been identified in African Americans, who are much more likely to have an arcus. The pupil becomes miotic and does not respond well to dilation or darkness. The vitreous body detaches from the retina, resulting in the perception of flashing lights secondary to retinal traction. The retinal pigment epithelium atrophies, making the choroidal vessels more visible. The lens becomes progressively stiffer with age. Symptoms begin in the mid-40s, with increasing difficulty in near-vision focusing. By age 60, most patients have had a major reduction in accommodative amplitudes. The universal stiffening of the lens with age causes the well-known symptoms of presbyopia, requiring the use of reading glasses.

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