Introduction:
Hypertension or elevated blood pressure is a risk factor for developing specific organ damage. Eyes are commonly affected organs as conditions such as retinopathy, optic neuropathy, and choroidopathy occur in the eye due to uncontrolled hypertension. Hypertensive retinopathy or damage to the retina because of high blood pressure occurs when the delicate blood vessels of the retina are destroyed due to hypertension.
What Is Hypertensive Retinopathy?
It is a progressive condition where the blood vessels of the eye get damaged due to high blood pressure leading to visual impairment. When the blood pressure becomes uncontrollable in the walls of the retina’s blood vessels, the innermost layer of the eye which is sensitive to light may get thickened, resulting in the narrowing of blood vessels of the retina. Gradually the blood vessels get damaged, interrupting the retina's function and causing vision loss. Hypertensive retinopathy comes under the spectrum of hypertensive eye diseases.
Hypertensive retinopathy is graded on a scale of 1 to 4.
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Grade 1: Mild narrowing of blood vessels without any symptoms. This phase is also known as the vasoconstrictive phase.
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Grade 2: Blood vessels get hardened, and tighter constrictions of arteries will occur. Symptoms like dim vision occur, and this phase is also known as the sclerotic phase.
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Grade 3: Symptoms like retinal edema, retinal hemorrhages or bleeding, and microaneurysms appear. Exudates made of lipids and proteins may leak out of the retina. Hence, this phase is called the exudative phase.
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Grade 4: Swelling will be present in the macula (center of the retina) and optic nerve, eventually leading to bleeding and vision loss. Patients in this stage are at higher risk for stroke and kidney or heart disease. Hence, this is known as malignant hypertension.
Is Hypertensive Retinopathy Common in Older People?
In general, hypertensive retinopathy is prevalent among adults above 40 years, especially females above 65 years. This is because women commonly develop hypertension after menopause. Among middle-aged people, men are found to be more affected than women. Studies found that hypertensive retinopathy can be a risk factor for the development of stroke or other cardiovascular diseases, especially for people between the ages of 50 and 73 years. Hypertensive retinopathy is common in the African, American and Chinese populations.
What Are the Causes of Hypertensive Retinopathy in Older People?
As the term suggests, prolonged hypertension is the main etiology or the cause of hypertensive retinopathy. The following are the risk factors associated with hypertensive retinopathy:
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High blood pressure.
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Family history of hypertension.
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Atherosclerosis (Hardening or narrowing of arteries due to build up of plaques).
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Heart disease.
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Alcohol and smoking.
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Being overweight or obese.
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Diabetes.
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High cholesterol.
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Overconsumption of salt.
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Unhealthy lifestyle.
What Are the Symptoms of Hypertensive Retinopathy?
The symptoms of hypertensive retinopathy appear in the late stages. Following are the common signs and symptoms:
1. Vision problems:
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Dim vision.
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Double vision.
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Progressive vision loss.
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2. Bleeding in the eyes due to burst blood vessels.
3. Edema or swelling in the eyes.
4. Eye pain.
5. Headaches.
6. Chest pain.
7. Shortness of breath.
How Is Hypertensive Retinopathy Diagnosed?
Hypertensive retinopathy will be diagnosed by ophthalmologists or eye doctors. Initially, the blood pressure of the patient is checked. A thorough neurological and cardiovascular assessment is also done. Many diagnostic methods have been developed to diagnose hypertensive retinopathy. Some of them are:
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Fundoscopic Examination: It is also known as ophthalmoscopy. This method is used by eye doctors to examine the retina, optic disc, choroid, and blood vessels. Fundoscopy is useful for diagnosing macular degeneration, diabetic and hypertensive retinopathy, glaucoma (eye disease that leads to the damage of optic nerve and vision loss), retina detachment (an emergency condition where retina of the eye gets pulled away from its normal position), and melanoma (a serious skin cancer that affects the cells that produce melanin).
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Fluorescein Angiography: This method is used to check the blood flow in the retinal blood vessels. Special eye drops are applied to dilate the pupil, and a few pictures are taken. Following this, fluorescein dye is injected into the vein, preferentially the arm vein. As the dye moves through the retina, pictures are taken.
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Visual Acuity Tests: These tests are performed to examine the sharpness and clarity of the vision.
Conditions such as diabetic retinopathy, hyperviscosity syndrome, retinal venous obstruction, ocular ischemic syndrome, and radiation retinopathy will be ruled out by eye doctors to diagnose hypertensive retinopathy.
How Is Hypertensive Retinopathy Treated in Older Adults?
Although hypertensive retinopathy is not completely treatable, it can be managed if blood pressure is controlled. People who reach grade 4 will experience permanent vision loss. However, people who fall under previous grades have the chance to recover. Medications and lifestyle modifications are advised for the management of hypertensive retinopathy. These treatment methods are focused on controlling high blood pressure.
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Medications: Antihypertensive drugs such as diuretics, beta-blockers, and ACE (Angiotensin converting enzyme) inhibitors are the prescribed medications.
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Lifestyle Modifications: Following lifestyle changes can reduce the severity of hypertension, reducing hypertensive retinopathy.
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Regular exercise.
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Eating a healthy diet and reducing the intake of salt.
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Consumption of more fruits and vegetables.
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Avoiding smoking.
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Avoiding alcohol and caffeine.
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Managing stress.
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Maintaining a healthy weight.
What Are the Complications of Hypertensive Retinopathy in Older People?
If left untreated, hypertensive retinopathy can end up in severe complications to the retina, such as:
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Ischemic Optic Neuropathy: It occurs due to the obstruction of blood flow to the optic nerve due to high blood pressure that leads to the optic nerve damage. People above 60 years of age are at high risk for ischemic optic neuropathy.
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Retinal Artery Occlusion: Due to increased blood pressure, blood clots may be formed in the arteries of the retina, resulting in blockage or occlusion. Retinal artery occlusion can progress to vision loss.
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Retinal Vein Occlusion: When blood clots are formed in the veins of the retina, retinal vein occlusion occurs.
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Nerve Fiber Layer Ischemia: Ischemia (restricted blood and oxygen supply to an organ or tissue) of nerve fibers leads to their damage, resulting in cotton wool spots in the retina.
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Malignant Hypertension: This occurs in the grade 4 phase of hypertensive retinopathy. Malignant hypertension is a life-threatening condition that causes a sudden increase in blood vessels leading to permanent or irreversible vision loss.
Conclusion:
Hypertensive retinopathy is a severe condition of the eye which is caused due to uncontrolled hypertension. The symptoms of the disease do not appear during the early stage, which delays its diagnosis. With a diagnosis at the proper time, treatment can be started to prevent permanent damage to the retina. The treatment concentrates on controlling blood pressure with the help of medications and lifestyle changes. However, older adults can prevent hypertensive retinopathy by leading a healthy lifestyle and always keeping their blood pressure under control.
