A 50-year-old woman who has had mild myopia for decades comes to the office for a routine physical examination. The patient has no chronic medical conditions and eats a healthy diet consisting of a variety of organically grown foods. She is excited because she rarely has to wear glasses or contacts anymore. Her visual acuity at 20 feet is 20/30 in both eyes without wearing her glasses. Which of the following conditions has the same etiology as the changes causing this patient's visual improvement?

Question

A 50-year-old woman who has had mild myopia for decades comes to the office for a routine physical examination.  The patient has no chronic medical conditions and eats a healthy diet consisting of a variety of organically grown foods.  She is excited because she rarely has to wear glasses or contacts anymore.  Her visual acuity at 20 feet is 20/30 in both eyes without wearing her glasses.  Which of the following conditions has the same etiology as the changes causing this patient's visual improvement?

Quizplus · Accepted Answer

11ec160b_3cd5_ab1e_9249_857444cb5f36_MD0001_00 The improvement in this patient's mild myopia is likely due to age-related changes. Normally, in accommodation, when focusing on near objects (eg, reading), ciliary muscle contraction relaxes the zonular fibers, allowing the lens to become more convex so the image focuses on the retina. Starting around age 40-50, almost all individuals develop an inability to focus on near objects. In this condition, called presbyopia, progressive denaturation of lens proteins and changes in lens curvature cause the lens to become less elastic and lose its accommodating power. In most patients, this causes the image of near objects to focus behind the retina resulting in difficulty reading fine print and the need to hold objects farther away in order to see them clearly. However, in patients with mild myopia (increased axial length with an image focused in front of the retina), presbyopia can compensate for myopia by displacing the image backward, so that it focuses on the retina. These patients often note improvement in visual acuity with age as presbyopia develops. Skin rhytides (wrinkles) are also directly caused by chronological aging (with a contribution from the harmful effects of ultraviolet light). With aging, skin becomes atrophic and fragile, with reduced elasticity and subdermal fat. There is dermal and epidermal thinning, flattening of the dermoepidermal junction, a decreased number of fibroblasts, and reduced synthesis and increased breakdown of collagen and elastin. (Choices A, B, and C) Although age is a risk factor for actinic keratoses, angle-closure glaucoma, and atherosclerosis, age-related changes themselves do not cause these conditions. Actinic keratoses (ie, premalignant lesions increasing squamous cell carcinoma risk) are rough, scaly, erythematous papules on sun-exposed areas that result from ultraviolet damage. Angle-closure glaucoma occurs due to impaired aqueous humor flow. Atherosclerosis is primarily attributable to hyperlipidemia, hypertension, and genetic (familial) predisposition. (Choice D) Femoral head osteonecrosis is associated with vasculitis (lupus), corticosteroid therapy, sickle cell disease, and alcohol use disorder. It is not an age-related condition and can occur in children (eg, Legg-Calve-Perthes disease). Educational objective: Presbyopia and skin wrinkles are age-related changes. Presbyopia occurs due to denaturation of structural proteins within the lens, leading to loss of lens elasticity which can result in improved vision in patients with mild myopia. Decreased synthesis and increased breakdown of collagen and elastin contribute to the development of skin wrinkles.

A 50-Year-Old Woman Who Has Had Mild Myopia for Decades