Practice 10-Minute Consultation

Gradual loss of vision in adults

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2093 (Published 08 June 2015) Cite this as: BMJ 2015;350:h2093
  1. Shyamanga Borooah, clinical research fellow in ophthalmology1,
  2. Arjun Dhillon, general practitioner, clinical lead ophthalmology23,
  3. Baljean Dhillon, professor of ophthalmology1
  1. 1Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh EH3 9HA, UK
  2. 2Argyle Surgery, London, UK
  3. 3Ealing Clinical Commissioning Group, South Greenford, UK
  1. Correspondence to: S Borooah shyamanga{at}aol.com
  • Accepted 9 April 2015

The bottom line

  • Although cataract is a common cause of gradual vision loss in older patients, consider other treatable red flag conditions in this age group, such as giant cell arteritis, macular degeneration, retinal detachment, and vitreous haemorrhage, and refer urgently if you suspect these

  • Do not refer patients for cataract surgery if their cataracts do not affect their daily life or if they are not keen to have surgery

How patients were involved in the creation of this article

In the process of writing this article we sought the opinions of patients who had recently undergone cataract surgery. They were asked what they would have liked to have known before the surgery. Their responses were taken into account when writing box 2. They were also asked what symptoms have improved since their surgery. Their input was used to modify the history section.

A 70 year old man presents with gradual blurry vision in both eyes. He has recently noticed increasing glare when looking at lights.

What you should cover

Gradual loss of vision has many causes, and cataract is one of the most common causes in this age group. A logical history and examination can help to exclude sinister causes that require urgent treatment.

History

How quickly has your vision become blurry?Sudden visual loss within weeks is unlikely to be caused by age related cataract. Symptoms of age related cataract usually develop over months to years.

Does the blurring affect only part of your vision?Patients who describe a central dark spot probably have wet age related macular degeneration and require urgent ophthalmic referral. Consider intracerebral or glaucomatous causes of visual loss in patients with bilateral field defects.

Do you have any other changes to your vision?—New floaters or flashing lights (suggesting posterior vitreous detachment, retinal detachment, or a vitreous haemorrhage) or visual changes that cause the patient to note the bending …

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