It might be no coincidence but as the ‘baby boomers’ approach advanced middle age there has been a commensurate interest in the effects of aging on normal physiology as well as obvious concerns in pathological terms. Aging processes are associated with many widespread general conditions such as hypertension, non-insulin dependent diabetes mellitus, and cardiovascular disease.1 These conditions are, of course, widespread in developed countries but aging, indeed premature aging, affects many individuals in developing countries. Much of the ophthalmologist’s workload is taken up with age related ocular disease such as cataract (the commonest cause of blindness worldwide2) and age related macular degeneration (ARMD), the major cause of blindness in developed countries.34In economic terms cataract presents a considerable burden of disease in countries such as the USA where some 100 000 operations are performed each year5; in contrast, in the Indian subcontinent, it is estimated that 50% of middle aged and elderly patients die blind from cataract.6

However, several other disorders affecting vision are more common in the middle …