Middle Age

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Body changes you don’t like.

When you hit middle age, you object and so does your body. There are lots of changes, most of them subtle and gradual. You wake up one day and discover the changes have already occurred.

Vision changes are mild if no disease is involved. You can’t focus as well as you used to, particularly on close-up details. You have to hold things further away to get them within range.

But diseases are starting to take their toll. Glaucoma and macular degeneration can lead to blindness. Osteoporosis makes your bones more brittle.

Changes in hormones are natural but unwelcome. Men with lower levels of testosterone may have less energy. Women with fluctuating levels of estrogen have hot flashes and night sweats. Menopause starts in the early 50’s; some find it a relief, others find it difficult.

Here’s what is included in this lesson:

• Vision problems
• Macular degeneration
• Low T
• Menopause
• Osteoporosis

Mind Map

Notes

• Human Eye
  • Sclera
    • Greek for hard
    • White of the eye
    • 1 mm thick
    • Fibrous strands in parallel; like fiber strapping tape
  •  Cornea
    • Bulges out from sclera
    • Smooth, neatly organized
    • Nourished by tears (on outside)
      • aqueous humor (on inside)
    • 2/3 of focus of eye
    • Dome-shaped
    • Irregularity of cornea surface
      • Astigmatism = blurry lines
  •  Aqueous Humor
    • Spongy tissue (mostly water)
    • Keeps eye inflated
    • Removes waste
    • Also an antioxidant that protects from UV rays
    • Continuously refreshed
      • In from ciliary body
      • Drained into Schlemm’s canal
  •  Glaucoma
    • Blockage of aqueous humor
      • Damage to iris
      • Blindness
    • 2nd leading cause of blindness
    • Progressive optic nerve damage
    • Mostly over age 40
      • Loss of nerve tissue
      • Loss of vision
    •  Types
      • Primary open-angle glaucoma
        • Most common (90%)
        • Increase in fluid pressure
          • Too much for nerve
          • Not absolute pressure
        • Develops slowly, no symptoms
          • Peripheral vision first
        • “Open-angle” = angle where iris meets cornea is wide
        • Slowly gets clogged
      •  Acute-angle closure glaucoma
        • Angle between cornea & iris is narrow (less space)
        • Occurs suddenly
        • Emergency!
        • Rapid increase in pressure
        • See colored rings around lights & blurred vision
        • Red eye
        • Pain & nausea
    •  Other factors can cause glaucoma
      • Steroid-induced glaucoma
      • Neovascular glaucoma
      • Diabetic retinopathy
      • Restricts blood flow to eye
  •  Iris
    • 2 layers
    • Outer layer of pigment
      • Color part of eye
      • Can be translucent (albinos)
    • Inner layer of blood vessels
  •  Pupil of the Iris
    • Hole in middle of iris
    • Varies in size (4:1 ratio)
      • Allows 16: 1 ratio of light
      • Actual ratio changes with age
        • in dim light, 80 yr old has half as wide as 20 yr old
    • Advantages of small opening = depth of field
      • Lose depth of field as age
  •  Lens
    • Crystalline (bean shaped); diameter & thickness of large aspirin
    • Has no blood vessels
    • Mostly water & protein
    • Never stops growing
      • Adds fibers to edge
        • center becomes thin; some center fibers there at birth
    • As ages
      • more dense & hard (sclerosis)
      • less transparent (cataract)
  •  Vitreous Humor
    • Jelly-like, like raw egg whites
    • Not continuously renewed
    • Floaters
    • More liquid with age
    • Can become detached
    • posterior vitreous detachmentor (PVD)
  • Macula
    • Depression in retina
      • Unobstructed
      • Near center
      • Off to side
    • Degeneration has two causes:
      • Dry (nonexudative)
        • Cellular debris (drusen)
          • Yellow deposits
        • Grow between retina & choroid
        • Drusen deposits grow, retina becomes detached
        • Severity depends on size and # of drusen
      • Wet (exudative)
        • Choroid blood vessels grow
        • Retina becomes detached
        • More severe
    • Treatments
      • Laser coagulation and meds
    • Older adults
      • The major cause of blindness
      • Loss of vision in center
      • Can’t read or recognize faces
      • Lose most detail of images
• Hormones
  • As you age, reduced hormone level
    • Testosterone (mostly males)
    • Estrogen (mostly females)
    • Progesterone (mostly females)
  • Men
    • Testosterone
      • Gradually decreases as age
      • Men over 50, low levels
    • Treat with gel or injections
      • No pills (liver breaks it down)
    • 2-3 months for optimal levels
    • Shorter life span
  • Women
    • Menopause
    • Test FSH & LH levels
• Perimenopause
  • Years before menopause
  • Indications it’s coming
  • Late 30s
    • Ovaries
    • Make less estrogen
    • Make less progesterone
  • In 40s,
    • Menstrual periods irregular
      • longer or shorter
      • heavier or lighter
      • more or less frequent
    • Tender breasts
    • Vaginal dryness
    • Osteoporosis (some)
    • Back pain
    • Trouble regulating body temp
      • Hot flashes
      • Bed sweats
    • Forgetfulness
    • Mood changes
• Menopause
  • In 50s,
    • Women 40-60, 51 average in US
  • Natural process; not a disease
  • Adult woman
    • Not pregnant, not lactating, intact uterus
  • Amenorrhea for 1 year
    • No periods
  • After menopause
    • Potential Complications
      • Sexual function discomfort
      • Cardiovascular disease
      • Urinary incontinence
    • Osteoporosis
    • Weight gain
  • Treatment
    • Estrogen Therapy
      • Reduce hot flashes
      • Helps prevent bone loss
      • Help heart?
    • Low-dose antidepressants
      • SSRIs for hot flashes
    • Gabapentin (Neurontin)
      • Seizure medication
      • Use low dose for hot flashes
• Osteoporosis
  • Progressive bone disease
  • Decrease in bone mass
  • Decrease in bone density
  • Bones more likely to fracture
  • More likely to fall
• Types
  • Postmenopausal
    • AKA, primary type 1
  • Senile
    • AKA, primary type 2
    • 75+ years old
    • Twice as many females
  • Secondary osteoporosis
    • men & women equally
    • chronic form
    • any age
    • steroid medications

Terms

• acute-angle closure glaucoma
• amenorrhea
• aqueous humor
• astigmatism
• cataract
• choroid blood vessels
• ciliary body
• climacteric = menopause
• cornea
• crystallized intelligence = Cattell’s skills & task knowledge, in contrast to fluid intelligence
• depth of field
• diabetic retinopathy
• drusen
• dry macular degeneration
• estrogen
• estrogen therapy
• floaters
• fluid intelligence = Cattell’s abstract thinking, in contrast to crystallized intelligence
• Gabapentin (Neurontin); seizure medication
• glaucoma
• hardiness = opposite of frailty, theory that some people are genetically resistant
• hormone therapy = prescription of anabolic steroids to counter aging declines of hormones
• hormones
• hot flashes
• information-loss view = information processing theory of reduced cognition as age
• iris
• irregular menstrual periods
• lens
• low-dose antidepressants(SSRIs)
• macula
• menopause
• neovascular glaucoma
• neural network view = theory that changes in cognition in elderly are circuit-based
• open-angle glaucoma
• osteoporosis
• perimenopause
• peripheral vision
• posterior vitreous detachmentor (PVD)
• postmenopausal osteoporosis
• practical problem solving = doesn’t seem to diminish with age
• presbycusis = gradual loss of hearing high frequencies
• presbyopia = eye lens loses ability to focus (bend)
• primary open-angle glaucoma
• primary type 1 osteoporosis
• primary type 2 osteoporosis
• progesterone
• progressive bone disease
• pupil of the iris
• retina
• Schlemm’s canal
• sclera
• sclerosis
• secondary osteoporosis
• senile osteoporosis
• steoporosis
• steroid-induced glaucoma
• testosterone
• Type A behavior pattern = 1950’s pop theory that heart disease can be predicted by two personality types. Type A’s are status conscious overachievers. Type B’s are creative and steady workers.
• vitreous humor
• wet macular degeneration
• white of the eye

Quiz

• 1. What is the dome that covers the front of the eye:
  • a.           aqueous humor
  • b.           cornea
  • c.           lens
  • d.           iris
• 2. Dry macular degeneration is caused by the buildup of:
  • a.           choroid vessels
  • b.           bone density
  • c.           floaters
  • d.           drusen
• 3. Which is a progressive bone disease
  • a.           osteoporosis
  • b.           menopause
  • c.           Parkinson’s
  • d.           PVD
• 4. Blocking the flow of the aqueous humor causes:
  • a.           macular degeneration
  • b.           lateral integration
  • c.           segmentation
  • d.           glaucoma
• 5. For hot flashes women are prescribed:
  • a.           seizure medication
  • b.           antidepressants
  • c.           estrogen
  • d.           all of the above

Answers

• 1. What is the dome that covers the front of the eye:
  • a.           aqueous humor
  • b.           cornea
  • c.           lens
  • d.           iris
• 2. Dry macular degeneration is caused by the buildup of:
  • a.           choroid vessels
  • b.           bone density
  • c.           floaters
  • d.           drusen
• 3. Which is a progressive bone disease
  • a.           osteoporosis
  • b.           menopause
  • c.           Parkinson’s
  • d.           PVD
• 4. Blocking the flow of the aqueous humor causes:
  • a.           macular degeneration
  • b.           lateral integration
  • c.           segmentation
  • d.           glaucoma
• 5. For hot flashes women are prescribed:
  • a.           seizure medication
  • b.           antidepressants
  • c.           estrogen
  • d.           all of the above

Summary

Bonus

Photo credit

 

Photo by Hans Eiskonen on Unsplash