A 53-year-old man comes to the office because of difficulty reading fine print over the last year. He now has to hold books, menus, and magazines at an arms length in order to read them. He has never had visual problems before. Which of the following is most likely abnormal in this patient?

Question

A 53-year-old man comes to the office because of difficulty reading fine print over the last year.  He now has to hold books, menus, and magazines at an arms length in order to read them.  He has never had visual problems before.  Which of the following is most likely abnormal in this patient?

Quizplus · Accepted Answer

This patient is most likely suffering from presbyopia, which is a common age-related disorder that results from the loss of elasticity in the lens. This decrease in elasticity prohibits accommodation of the lens, which is required in order to focus on near objects. The tendency of patients to hold reading material at a further distance is classic for presbyopia. Patients often have no history of eye problems. Most patients will report the onset of presbyopia while they are in their forties, and symptoms typically peak at some point in their sixties. The poor near vision associated with presbyopia can easily be improved with reading glasses. (Choice A) A nonspherical cornea can lead to astigmatism, which typically presents with blurry vision both at a distance and up close. (Choice C) Increased lens opacity is the etiology of cataracts. Patients may have difficulty reading, but a history of difficulty with night vision or driving at night is more characteristic. (Choice D) Age-related macular degeneration is a common cause of visual loss in patients over the age of 50, but it is typically associated with central visual field loss. (Choice E) Disease located in the peripheral retina is usually secondary to diabetes, which can lead to either proliferative or non-proliferative retinopathy. This patient, however, has no known history of diabetes. (Choice F) Elevated intraocular pressure is the etiology of glaucoma. Primary open-angle glaucoma usually presents with peripheral visual field defects followed by central visual loss. Educational objective: Presbyopia is a common age-related decrease in lens elasticity that leads to difficulty with near vision. A history of a middle-aged individual who has to hold books at an arms length to read is classic.

A 53-Year-Old Man Comes to the Office Because of Difficulty