Practical ophthalmology for senior pets

In this dvm360 interview, Alex Sigmund, DVM, DACVO, shares practical tips for assessing ocular changes in senior pets, balancing treatment risks and benefits, and recognizing when to refer to specialty care.

Transcript

Alex Sigmund, DVM, DACVO: I’m Alex Sigmund. I’m a veterinary ophthalmologist based in Atlanta, Georgia. I focus on the practical application of ophthalmology, helping general practitioners feel more comfortable with ophthalmic problems, apply that knowledge in the real-world environment of general practice, and know when a case is outside their scope so they can communicate expectations to clients and refer appropriately. Most of my talks concentrate on the basics—the bread-and-butter of general practice ophthalmology: corneal ulcers, glaucoma, entropion, cherry eye, dry eye—and how to make those topics practical and accessible.

That particular talk came from having a senior dog myself and being more involved in the care of aging patients. Pets are living longer, which is wonderful, but they also accumulate more issues as they age, including eye problems that cause cloudiness and changes in vision or light perception. When we examine senior patients, I prioritize their comfort. That helps guide decisions about whether to pursue surgery or to take a more conservative approach. It’s important to define realistic goals for each patient and to assess frailty: age alone isn’t a disease, but frailty often accompanies age. I’ve seen 10-year-old dogs that were too frail for surgery and 16-year-old dogs that were not frail and did well with cataract surgery. Evaluating frailty helps gauge which interventions are appropriate.

When examining senior patients, dilated ophthalmic exams are especially helpful. Dilation lets us assess the lens to determine the cause of cloudiness (for example, age-related nuclear sclerosis versus cataract) and allows a better fundic exam to look for retinal degeneration that can cause night-vision problems. Retinal disease can make a pet hesitant in low light. Corneal deposits—such as mineral or calcium—can be painful and predispose to corneal ulcers, so be attentive to surrounding white deposits when you see an ulcer; a calcium-associated ulcer may require different treatment than a routine corneal ulcer.

Overall, most topical ophthalmic medications are well tolerated, but they have potential systemic effects to consider. Topical timolol (a glaucoma medication) can cause bradycardia and, in susceptible patients, bronchoconstriction—so use caution in animals with preexisting cardiac or pulmonary disease. The carbonic anhydrase inhibitor dorzolamide has been associated with hypokalemia in cats (and has been flagged in some dogs), so if you use it in patients at risk, consider monitoring electrolytes. Topical steroids are systemically absorbable but usually do not produce clinically significant liver changes; still, it’s worth considering systemic absorption when patients have concurrent disease or are on interacting medications. Some topical NSAIDs have been linked to gastrointestinal adverse effects comparable to systemic NSAIDs in some studies, so choose therapies carefully for patients with GI sensitivity and consider monitoring.

Decisions about whether to use a medication come down to a patient-specific risk–benefit analysis: how likely is an adverse effect in this patient, can we monitor for it, or should we choose an alternative therapy? Doing due diligence—informing owners, adjusting monitoring, and choosing the least risky effective option—helps us provide safe care.

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