IM25.{15,17} | Geriatric Sensory Loss — Summary & Reflection

KEY TAKEAWAYS

Age-related vision loss:
- Presbyopia — universal (hardened lens, near vision loss); corrected with reading glasses
- Cataract — most common in India; painless, gradual, nuclear opacity; lost red reflex; surgery (phacoemulsification + IOL) curative; free under NPCB+VI
- Dry AMD — drusen, geographic atrophy, central vision loss; AREDS2 supplements to slow
- Wet AMD — choroidal neovascularisation; metamorphopsia (wavy lines); emergency — anti-VEGF injections (ranibizumab/bevacizumab) urgently
- POAG — asymptomatic peripheral field loss; optic disc cupping; elevated IOP; topical prostaglandin analogues (latanoprost) first-line
- Diabetic retinopathy — annual dilated fundal exam in all elderly diabetics; anti-VEGF for macular oedema

Age-related hearing loss:
- Presbycusis — bilateral, symmetrical, high-frequency SNHL; progressive; affects speech intelligibility (consonants)
- Investigate: whisper test, Rinne/Weber, pure-tone audiometry; MRI for asymmetrical/unilateral SNHL (exclude acoustic neuroma)
- Treatment: digital hearing aids (bilateral); cochlear implant for profound loss
- Consequences: dementia risk (largest modifiable risk factor), depression, social isolation, falls

Common trap: untreated sensory loss attributed to 'normal ageing' — both vision and hearing impairment have treatable/correctable causes in the majority of elderly patients

REFLECT

Revisit Saradha from the opening hook. Her progressive visual and hearing impairment have driven a cascade: reduced outdoor activity → falls → social withdrawal → isolation → likely depression emerging. None of this was necessary — her cataract is surgically curable, and her hearing loss is manageable with hearing aids. Yet the 7-year delay to first medical consultation (the average for hearing loss in India) and the failure of the ophthalmologist to link the glasses prescription to her overall functional assessment meant that opportunities were missed. Reflect on how a comprehensive geriatric approach — combining CGA-style sensory screening with the disease-specific management framework you have now learned — would have changed Saradha's trajectory. When you next see an elderly patient, make it a habit to ask: 'How is your hearing? Can you hear people easily on the telephone? And your vision — can you read without difficulty?' These two questions, asked routinely, can identify the single largest modifiable risk factor for dementia and a leading cause of preventable falls in the same breath.