Age-related changes affect all structures of the eye, and while age-related changes may influence the quality of vision, it is important to distinguish age-related physiological changes from pathological changes. This is important particularly when identifying pathological changes that may be treatable. The prevalence of visual loss increases substantially after 60 years of age and poor vision is the second most prevalent physical disability in older people. This review describes the normal ageing changes of the eye and outlines common ophthalmic diseases affecting older people. We refer to recent advances in diagnosis and treatment, and relevant current research.

Recent cross-sectional studies have reported strong associations between visual and cognitive function, and longitudinal studies have shown relationships between visual and cognitive decline in late life. Improvement in cognitive performance after cataract surgery has been reported in patients with Mild Cognitive Impairment. We investigated whether improving visual function with cataract surgery would improve neuropsychological performance in healthy older adults. A randomized clinical trial of cataract surgery performed at acute hospitals was conducted on 56 patients (mean age 73) with bilateral cataract, after excluding a total of 54 patients at the screening stage, of whom 53 did not meet visual acuity criteria and one did not have cataract. In-home assessments included visual and neuropsychological function, computerized cognitive testing and health questionnaires. Results showed no cognitive benefits of cataract surgery in cognitively normal adults. We conclude that visual improvement following cataract surgery is not strongly associated with an improvement in neuropsychological test performance in otherwise healthy adults. Joint associations between visual and cognitive function in late life are likely to be due to central factors, and unlikely to be strongly related to eye disease. Short-term increased neural stimulation from improved visual function does not appear to affect cognitive performance. (JINS, 2006, 12, 632–639.)

This article describes the anatomy of the visual pathways and how they should be assessed under anaesthesia. The differential diagnosis of asymmetrical pupils is illustrated with clinical examples and a strategy as to how they should be examined.

Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. We describe two cases of temporary monocular visual loss caused by sinusitis. In one case the visual loss was due to orbital cellulitis; while in the other patient it was due to incompletely developed orbital apex syndrome. This later mode of presentation is called ‘partial orbital apex syndrome’ by some authors and ‘posterior orbital cellulitis’ by others.

The relationship between sinusitis and blindness is discussed.