Gradual painless visual loss: retinal causes.

This article addresses retinal causes of gradual painless visual loss in older adults. The most common condition causing gradual vision loss is nonexudative age-related macular degeneration, for which no effective treatment exists. Diabetic retinopathy is another common cause of gradual visual loss in older adults, in which photocoagulation, as well as vitreous surgery, may be helpful in preserving or restoring vision. Macular hole and macular pucker, which may cause central visual loss, are treatable with intraocular surgery, and visual improvement may be achieved in the majority of patients. Inflammatory causes of gradual visual loss in older adults are less common, and may benefit from immunosuppressive therapy.