Medicina Baseada em Evidência. Geriatria: O Desafio de Envelhecer com Dignidade, Visão e Autonomia

Population aging is one of the greatest transformations in human history. Modern medicine has shifted its primary goal from simply increasing life expectancy to seeking to increase healthspan—the years lived with health, independence, and quality of life. In geriatrics, the focus is not only on treating diseases but also on preserving functionality. More important than chronological age is knowing whether the patient can walk, see, manage their medications, feed themselves, take care of their own home, and maintain their autonomy. From an ophthalmological point of view, aging causes physiological changes such as reduced accommodation, decreased tear production, poorer adaptation to darkness, reduced contrast sensitivity, and senile miosis. Furthermore, it significantly increases the incidence of diseases such as cataracts, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy, ischemic optic neuropathy, and temporal arteritis. Visual loss goes far beyond difficulty seeing. It is associated with increased falls, fractures, depression, social isolation, cognitive impairment, institutionalization, and loss of independence. For many elderly people, restoring vision means restoring safety, mobility, and quality of life. The masterclass also highlights frequently neglected aspects such as depression in the elderly, dementia, Alzheimer's disease, abuse, osteoporosis, and the impact of falls, which can trigger a cascade of events leading to the permanent loss of autonomy. Another important point is that the ophthalmologist is often the first doctor to identify signs of cognitive impairment, functional frailty, or systemic diseases during a routine consultation, reinforcing their role as an essential professional in the comprehensive care of the elderly. In surgical evaluation, especially for cataract surgery, the decision should consider not only the eye disease but also the functional status, frailty, cognition, comorbidities, family support, and the potential benefit to the patient's quality of life. The future of geriatrics points towards increasingly personalized medicine, supported by artificial intelligence, aging biomarkers, telemedicine, remote monitoring, and preventive strategies aimed at preserving the independence of the elderly. Final Message Aging is inevitable, but losing autonomy is not always. The true role of modern medicine is to preserve what makes life dignified: the ability to see, walk, decide, relate, and live freely. Closing phrase: "The greatest achievement of medicine will not be to make people live to 100 years old. It will be to allow them to reach 100 seeing, walking, deciding, and living with dignity."