Nur 238 ch 25 and 26 test

Detached Retina

-Emergency situation -Separation of retina in back of eye

Nutrition Vitamin A (May help prevent macular degeneration)

-Green leafy vegetables -Carrots, green beans -Spinach, orange juice -sweet potatoes -Cantaloupe -Lutein/Zeaxantin -Tomatoes -Broccoli -Kale -Romaine Lettuce -Turnip Green

List five guidelines for assisting a blind person

-Orient the person to the room, the bed controls, call light, tv/radio, and bathroom -Speak to the person as you enter the room and tell him or her when you are leaving. -Remove hazards from the environment -Explain what you are going to do before doing it. -Feed the patient if necessary. Prepare plate and set up tray for patient who wishes to feed him or herself.

List the five danger signals of eye disease that should be looked for upon assessment of each patient.

-Persistent redness of the eye -Continuing pain or discomfort of the eye following an eye injury -Disturbances of vision -Crossing of eyes, especially in children -Growths on the eye or eyelids or opacities visible in the normally transparent part of the eye -Continuing discharge, crusting, or tearing of the eyes -Pupil irregularities, either unequal size or distorted shape

Cataract

-clouding of the lens -Like vaseline on glasses

Ms. Messina is scheduled for a cataract extraction with intraocular lens implant of the right eye. Assessment of Ms. Messina during preoperative care would include:

-degree of retained vision and history of previous hospitalizations -ability to instill eyedrops and perform self care -ability to understand and follow directions postoperatively.

The priority measures a diabetic patient must take following surgery for diabetic retinopathy are:

-maintain strict control of blood glucose levels -Maintain blood pressure within a normal range.

When administering preoperative mydriatic eye drops, you should wait -------- minutes between the instillation of one drop and the other.

5

A tonometer reading reflects the amount of pressure exerted by which component of the eye?

Aqueous humor The tonometer reads the pressure exerted by the aqueous humor in the anterior chamber. The sclera is the part of the eyeball that is opaque white and covers the posterior portion of the eyeball. The vitreous humor is the substance found in the posterior chamber of the eye between the lens and the retina. The cornea is a transparent structure in the eye that allows light to hit the lens. It is involved in the bending of light rays.

Anterior chamber

Between the lens and the cornea

How can people protect themselves from hearing damage?

By not putting cotton tipped applicators or other objects into the ear canal. -Obtaining medical assistance when ear pain occurs -Wearing ear protectors when constantly exposed to loud noises at work, loud music or loud motors.

For the patient undergoing assessment for a hearing loss, the nurse would explain that electronystagmography is performed in conjunction with:

Caloric testing.

The nurse's most important evaluation criterion for interventions to prevent complications of glaucoma surgery is:

Checking the degree of eye pain

Iris

Colored portion of the eye

Ciliary body

Connect the ciliary body to the lens

Tears

Contain an enzyme that kills bacteria

Which component in the eye refracts light rays to be directed to the lens?

Cornea The cornea bends or refracts the light rays onto the retina. The pupil acts to regulate the entrance of light into the eye. The ciliary body helps to change the shape of the eye for far and near vision. The retina is the inner coat of the eyeball and is found in the posterior portion of it. The retina contains several layers. The layer with rods and cones acts as the receptor for light images.

Fluorescein angiography is used as an assessment tool by the health care provider. Teaching for the patient about the procedure includes stating:

Dye will be injected intravenously and the blood vessels in the fundus examined

Ectropion

Eversion of the lower lid that may occur with aging

The nurse notices that the patient must hold the newspaper at arm's length and squint to read. The nurse understands that this finding is consistent with which eye problem?

Hyperopia The person with hyperopia is farsighted; the patient cannot see things up close and must change the distance from the eyes in order to focus. The person with myopia cannot see things in the distance. Presbyopia refers to the hardening of the ciliary bodies of the eyes. Astigmatism refers to a visual defect resulting from a warped lens or an irregular curvature of the cornea.

When assessing a patient who complains of a mild hearing loss, the nurse should first:

Inspect the ear canal for cerumen

The order of sound transmission form the outer ear to the brain is:

Pinna tympanic membrane middle ear organ of corti vestibulocochlear nerve medulla oblongata

Beginning usually around age 40, patients often develop an eye condition known as presbyopia. This condition is when:

Protrusion of the eyeball prevents close focus

Lacrimal gland

Secretes tears that moisten, lubricate, and cleanse the eye

Posterior chamber

Sits between lens and retina and contains vitreous humor

During examination of the fundus of the eye, the nurse assesses a choked disc. Which statement accurately explains the significant of this finding?

There is increased intracranial pressure (ICP ANS: B Visualization of the optic disc provides information about the pressure within the eye and within the skull. When ICP gets higher, the optic disc appears "swollen" or "choked."

The nurse explains that a photorefractive keratectomy (PRK) is a very brief surgery that corrects myopia. Which statement indicates that the nurse's teaching about the procedure has been successful?

This procedure uses a laser to remove a thin layer of the cornea." A PRK uses a laser to remove a thin layer of the cornea. The LASIK procedure uses a laser to reshape the cornea and replace the outer layer. Making tiny cuts in the cornea to flatten it refers to a radial keratotomy.

If a foreign body is stuck into the eye, the best thing to do is to ------------, ----------- the eye, and to --------------.

To leave it in place patch the eye seek emergency treatment

What are four important steps in administering eye drops?

Verify that the bottle of drops is the correct medication ( five rights of medication administration) Wash the hands thoroughly without touching the eye or eyelashes, instill the drops into the small pouch created by pulling the lower lid downward -Do not contaminate the dropper or the top of the container.

Community teaching for the prevention of eye problems should include:

Wearing a hat when outdoors wearing sunglasses that block UVA and UVB rays when outdoors eating a diet rich in fruits and vegetables that contain antioxidants Obtaining regular glaucoma screening after age 40.

The nurse is caring for a patient who is experiencing diabetes-related visual changes. Which statement indicates that the patient accurately understands the nurse's teaching about the cause of vision changes in diabetes?

a. "Long-term exposure to high glucose levels can damage the blood vessels in my retina." Prolonged periods of hyperglycemia cause damage to the retina from bleeding. Insulin does not result in visual changes in the patient with diabetes. Lens opacity and corneal dryness will not promote vision-related complications in the patient with diabetes mellitus.

The nurse is teaching a patient who is scheduled to undergo surgery to manage glaucoma. Which statement indicates that the patient understands the nurse's teaching about the procedure?

a. "The surgery will increase outflow of aqueous humor." Glaucoma is a condition that causes increased ocular pressure. Surgical management for the condition seeks to provide an increased outflow of aqueous humor.

The patient with a corneal transplant asks how long he must wear the eye shield at night. The nurse instructs the patient that he should wear the shield for at least what period of time?

a. 1 month Nightly wearing of the eye shield following a corneal transplant is recommended for 1 month following surgery.

The nurse has completed the assessment on a newly admitted patient. Which finding(s) is/are risk factor(s) in the development of cataracts? (select all that apply.)

a. Cigarette smoking d. Long-term corticosteroid use Traumatic cataracts may occur from a physical blow, extreme heat, or chemical toxins. Cigarette smoking increases the risk of developing cataracts, and heavy drinking is also implicated. Chronic use of corticosteroids predisposes a patient to developing cataracts. Radiation therapy, hormone replacement therapy, and GERD are not risk factors for cataracts.

The nurse is caring for a patient with a frequent history of falls. The nurse notes that which problems in the patient's history may contribute to frequent falls? (Select all that apply.)

a. Diplopia b. Vertigo e. Ataxia Double vision affects visual acuity and depth perception, vertigo affects equilibrium and balance, and inability to control muscle movements leads to unsteady gait—all problems that may contribute to frequent falls. Ringing in the ears and cirrhosis do not overtly increase fall risk.

The nurse is teaching a patient about visual problems that require professional attention. Which symptom(s) indicate an underlying visual problem? (Select all that apply.)

a. Eyes that tire easily b. Burning c. Itching d. Reddening with use Underlying visual problems may manifest with eyes that tire easily, burn, itch, or redden with use. Exophthalmos (protruding eyes) is not usually a visual problem, but a sign of a systemic problem such as hyperthyroidism.

A patient comes to the ambulatory care clinic after getting hay into the eyes while farming. Which action(s) should the nurse implement? (select all that apply.)

a. Flush the eye with warm saline. b. Hold the eyelids open. c. Tilt the head back. d. Use a moistened sterile cotton swab. If the foreign body is not deeply embedded in the tissues of the eye, it can easily be removed by irrigation. Irrigation with clear, lukewarm water or sterile water or saline is used to remove a foreign body sticking to the cornea. Have the patient tilt the head back. Hold the eyelids open to prevent blinking. Sometimes a speck of foreign matter on the cornea can be removed with a moistened, sterile cotton swab. The goals of treatment will be to remove the foreign objects from the eyes and to prevent further injury to the eye. Rubbing an irritated eye may cause a corneal abrasion.

The patient who had a corneal transplant is taught that inflammatory changes (redness, swelling, and pain) in the corneal graft are best indicators of which complication?

a. Graft rejection Inflammatory symptoms are indicative of graft rejection.

The student nurse is ambulating with a blind patient. Which technique(s) indicate(s) that the student nurse requires further instruction? (Select all that apply.)

a. Holding the patient's dominant arm b. Instructing the patient to put both hands on his shoulders d. Holding the patient's hand e. Walking just behind the patient The safest and most effective technique when ambulating a blind patient involves allowing the patient to hold the nurse's arm, as the patient follows. The nurse should not hold the patient's arm, instruct the patient to place his hands on the nurse's shoulders, or hold the patient's hand, so these actions would require additional teaching.

The nurse is teaching a group of schoolchildren about the relationship between diet and vision. The nurse encourages the ingestion of foods rich in vitamin A. Which food choice should the nurse recommend?

a. Kale Vitamin A protects against night blindness, slow adaptation to darkness, and glare blindness. The carotenoids are the precursors for vitamin A and are found in green leafy and yellow vegetables.

The nurse is reviewing the plan of care for a patient following a tympanoplasty. Which intervention should the nurse implement in the immediate postoperative period?

a. Keep the patient flat in bed. Postoperative care involves keeping the patient quiet and flat in bed for at least 12 hours. Coughing and sneezing should be avoided, or if unavoidable, should be accomplished with the mouth open to decrease pressure in the ear. Position changes should be accomplished slowly. The head is turned so that the affected ear is uppermost.

The nurse is caring for a patient who has come to the ambulatory care clinic after experiencing a chemical burn to the eye. The nurse should irrigate the patient's eye with which solution?

a. Normal saline The preferred solution for use when irrigating the eye is an intravenous bag of normal saline. In the event that normal saline is not available, the next option would be tap water.

The nurse is caring for a patient in the postoperative period after enucleation. Which intervention is most important?

a. Provide emotional support. Postoperatively, the nurse should observe for signs of complications such as excessive bleeding, swelling, increased pain, elevated temperature, or displacement of the implant. Losing an eye is a devastating experience even when there has been a long period of painful blindness preoperatively. Understanding of the emotional impact and support of the patient are prime nursing responsibilities. The permanent prosthesis is placed about 6 weeks after the surgery, and while it is important to teach the patient about prosthetic placement and medications, providing support is most important

The nurse is performing postoperative teaching for a patient who underwent a left cataract removal. Which information should the nurse include in the teaching plan? (select all that apply.)

a. Sleep on the right side. b. Take a stool softener to avoid straining during bowel movements. d. Wash hands before instilling eyedrops. e. Follow the prescribed medication schedule exactly. The patient should sleep on the unaffected side, use a stool softener to prevent straining, wash hands before instilling eyedrops, and follow the prescribed medication schedule exactly. The patient should not bend from the waist as the position increases intraocular pressure.

Following a scleral buckling procedure, which intervention(s) should the nurse include in the postoperative care? (select all that apply.)

a. Speak before touching the patient. b. Administer a laxative. c. Warn the patient that vision does not return immediately. d. Instruct the patient to wear an eye shield at night and while napping. The patient will return from the surgery with an eye patch in place. The nurse should speak before touching the patient so the patient is not startled. The nurse should administer a laxative to prevent straining during bowel movements. The nurse should warn the patient that vision does not return immediately and instruct the patient to wear an eye shield at night or when napping. This procedure does not require changing an eye patch twice daily.

The nurse is caring for a patient following a left corneal transplant. When positioning the patient, the nurse correctly assists the patient into which positions? (select all that apply.)

a. Supine b. Supine with head on small pillow d. Right side-lying The patient may lie only on his back and nonoperative side postoperatively. Flat on his back, on his back with his head on a small pillow, and positioned on his nonoperative side are acceptable as all these positions place no undue pressure on the transplant. Allowing the patient to rest on the operative side or in high Fowler position would place excessive pressure on the operative site.

The nurse is assessing a patient's visual field. Which action(s) demonstrate(s) correct technique? (Select all that apply.)

a. The nurse faces the patient. c. The nurse moves a finger from an area outside the line of peripheral vision into the line of vision. e. The nurse instructs the patient to look directly into her eyes. To assess visual field, the examiner should face the patient and ask him to look directly into his eyes. The examiner covers the right eye while the patient covers the left eye. The examiner moves his finger from outside of the peripheral vision into the line of vision. The patient should detect the finger about the same time as the examiner. The test is repeated with the other eye covered. The Snellen chart is not used for a visual field test.

After teaching a patient about a new eye medication, the nurse observes the patient applying eye ointment. Which technique indicates that the nurse's teaching has been successful?

a. The patient applies the ointment from the inner to outer canthus. A thin line of eye ointment should be applied from the inner canthus to the outer canthus along the lower eyelid inside the conjunctival sac.

The nurse is assessing an 84-year-old patient. Which finding is consistent with aging?

a. Thick cerumen Thickened, hard cerumen collections in the outer ear can disrupt sound conduction and impair hearing. Age-related changes may include reduced perception of low-frequency sounds. Pain in the outer ear is not a normal change related to aging, nor is increased hair on the pinna.

Which medication(s) may cause ototoxicity? (Select all that apply.)

a. Vancomycin b. Furosemide d. Ibuprofen Commonly administered drugs that can be ototoxic are many of the antibiotics, nonsteroidal anti-inflammatory drugs, chemotherapy agents, and potent diuretics, such as furosemide (Lasix) (Box 25-3). Acetaminophen and amoxicillin are not ototoxic.

Cataract surgery is performed when the loss of vision -------- the person's life.

affects the quality of

suspensory ligaments

allow for focusing of light on lens and retina

The nurse clarifies to the patient with an eye disorder that the fluid in the anterior chamber is called __________ humor, whereas the fluid in the posterior chamber is called __________ humor.

aqueous; vitreous The fluid in the anterior chamber is aqueous humor and the fluid in the posterior chamber is vitreous humor.

The nurse is caring for a patient who presents to the clinic a small, hard lesion on the eyelid. Which condition is consistent with these findings?

b. Chalazion Chalazion is an internal stye caused by infection of the meibomian gland.

The patient is experiencing frequent attacks of vertigo. When planning care, which activity should the nurse encourage?

b. Consider a smoking cessation program. Cessation of smoking will decrease incidence of vertigo in the person with middle-ear disorders. Tobacco is vasoconstrictive and can affect the blood supply to the inner ear and nerves. When increased fluid pressure in the inner ear is suspected as the cause of dizziness, the provider may order a low-sodium diet and limit fluid intake. Alcohol intake does not combat vertigo.

Which manifestation is the classic early warning symptom of a detached retina?

b. Flashing colored lights in the eye Seeing flashing colored lights is an early warning symptom of retinal detachment.

The nurse is caring for a patient who has developed keratitis. When planning care, the nurse should implement which action to improve the patient's comfort?

b. Instill artificial tears. Keratitis is an inflammation of the cornea caused by irritation or infection. Artificial tears will reduce the irritation. Antibiotics can be given in the event of a bacterial infection. Eye shields and compresses are not indicated in the management of this condition.

The nurse is caring for a patient who is receiving dipivefrin (Propine). Which abnormal finding is an expected side effect of this medication?

b. Pulse 112 Sympathomimetic drugs such as dipivefrin are used to reduce intraocular pressure by increasing aqueous outflow. They can cause tachycardia and hypertension.

The nurse recalls that the Healthy People 2020 objectives for vision include directives for which goals? (Select all that apply.)

b. Reduction of uncorrected refractive errors c. Reduction of diabetic retinopathy d. Reduction of visual impairment related to cataracts e. Increased use of protective eyewear Healthy People 2020 includes many objectives to prevent vision problems, including reduction of uncorrected refractive errors, diabetic retinopathy, and cataract-related visual impairment, along with increased use of protective eyewear. Vision screening for children should begin at age 5.

The nurse is caring for a patient with Ménière disease. Which action is most important for the nurse to take?

b. Restrict sodium intake. Treatment of Ménière disease focuses on relieving symptoms; there is no cure for this condition, although the disorder does disappear spontaneously in some cases. To control edema and reduce pressure in the inner ear, the patient may be placed on a low-sodium diet. The patient's fluid intake may be restricted, and diuretics may be ordered. The nurse should avoid turning on bright overhead lights, making loud noises, or having the patient reposition unnecessarily.

The nurse is caring for a blind patient. Which action is most appropriate when entering the patient's room?

b. Speak to the patient by name when entering the room to avoid startling her. Speaking to the person by name allows the patient to know someone has entered the room and will avoid startling the patient.

The nurse assesses the age-related changes that occur in the eye. Which finding(s) is/are consistent with aging? (Select all that apply.)

b. The cornea flattens and increases astigmatism. c. Water loss occurs from the lens. d. Presbyopia occurs. e. Ectropion occurs. Age-related eye changes include corneal flattening, water loss from the lens, and occurrence of presbyopia and ectropion. Subcutaneous fat decreases with aging.

The nurse is caring for a patient with suspected macular degeneration. During the assessment the patient is asked to focus on an image. Which finding supports the diagnosis?

b. The patient sees a dark spot in the center of what is viewed. The person with macular degeneration sees a dark spot in his central vision. Peripheral vision is not affected until later in the disease.

Which manifestation(s) is/are symptoms of a cataract? (select all that apply.)

b. Troubled by glare c. Increased myopia d. Color distortion e. Night blindness A cataract is opacity of the lens that produces an effect similar to one a person would get when looking through a sheet of falling water. A cataract causes a blurring of vision because the lens, which is normally transparent, becomes cloudy and opaque. Nystagmus is not a symptom of a cataract. All other options are classic symptoms of a person with a developing cataract.

Uncontrolled glaucoma causes

blindness

An office assistant tells the nurse his job requires him to work at his computer for 7 to 8 hours each day. Which statement indicates that the nurse's teaching about preventing eyestrain has been successful?

c. "I will close my eyes every few hours." To prevent eyestrain, the patient should rest the eye muscles periodically when working at the computer or performing any activity that demands intensive visual effort. Resting the eye muscles every several hours helps prevent eye fatigue. Protective goggles do not help prevent eyestrain. Nutrients such as lutein and zeaxanthin are found in carrots and cooked spinach and are good for the eyes but do not reduce eyestrain. Overuse of artificial tears is not recommended, and proper usage works to combat dry eyes.

The nurse is discussing the postoperative period with a patient with a corneal transplant. Which statement indicates that the patient displays realistic expectations about vision improvement?

c. "My vision will show improvement in about 2 weeks." Increasing visual acuity may take up to 2 weeks before improvement in vision is noted.

The nurse is caring for a 40-year-old patient. How often should the nurse recommend that this patient undergo testing for glaucoma?

c. Every 5 years Glaucoma testing should be done every 2 to 3 years for people over age 40.

How often should eye cosmetics be discarded?

c. Every 6 months Eye cosmetics should be discarded every 6 months to prevent infection.

The nurse is reviewing the health history of a 26-year-old patient who denies corrective lenses. Which scenario indicates that the patient follows preventive eye examination recommendations?

c. The patient had a baseline eye examination at age 25. Starting at age 25, adults should have an eye examination every 5 to 10 years until age 40, every 2 to 4 years from 40 to 54, and every 1 to 3 years from 55 to 64. After age 65, eyes should be examined by an eye specialist every 1 to 2 years (AHRQ, 2014).

The patient with glaucoma is prescribed an Ocusert miotic. How often should the medication be replaced?

c. Weekly Eye medications that are delivered per Ocusert are replaced every week.

Pupil

central opening allowing light into interior

Assessment findings that may indicate the presence of a cataract

cloudy or opaque appearance to the lens of the eye. -blurring of vision -Distortion of vision when looking at distant objects -Vision may be better in low light when pupil is dilated -photophobia may occur

If a chemical splashes into the eye, the eye should be treated with, ----------- for at least --------------- with -------------- or -------------.

continuous irrigation 30 minutes normal saline water

When assessing for macular degeneration, the nurse should use which assessment tool?

d. Amsler grid test The Amsler grid test assesses the extent of macular degeneration by noting the patient's perception of missing or wavy lines on the grid. The Snellen eye chart is used to assess visual acuity. Visual field assessments may be used to assess peripheral vision.

A patient presents to a walk-in clinic with a small piece of rock deeply embedded in his right eye. What should the nurse do first?

d. Cover both eyes with a dressing. If a foreign body is sticking out of the eye, no attempt to remove it should be made. Both eyes should be patched to prevent further eye movement, and then the patient should be referred to the emergency department or to an ophthalmologist. For foreign bodies not deeply embedded in the tissues of the eye, irrigation can easily remove them. Irrigation with clear, lukewarm water or sterile water or saline is used to remove a foreign body sticking to the cornea.

A patient tilts her head to the side while reading a pamphlet. The nurse recognizes that this action may be an attempt to compensate for which problem?

d. Diplopia ANS: D Tilting the head may indicate a visual disturbance such as double vision or that one eye is stronger than the other. Tilting the head to read would not affect tinnitus (ringing in the ears) or nystagmus (involuntary eye movements). Shading the eyes may be noted with photophobia.

The nurse is orienting a visually impaired patient to a meal plate. Which action is most appropriate?

d. Identify food according to an imaginary clock face. Identifying food location by position on an imaginary clock face is helpful to the visually impaired patient.

The nurse is caring for patient who presented to an ambulatory care clinic with a large amount of sand in his eyes following an all-terrain vehicle accident. After the nurse completes eye irrigation, the patient reports that his eyes still hurt and feel irritated. What action is most appropriate?

d. Notify the physician. The continued sensation of grittiness or irritation may signal the presence of a corneal abrasion. To prevent further injuries, the nurse should notify the physician.

The visually impaired person has entered the outpatient clinic with a guide dog. What action is most appropriate for the nurse to take?

d. Refrain from interacting with the patient and dog until the dog leads the patient to a seat. The dog should not be distracted while it is working. The dog will seat the patient if possible; if not, the nurse can ask how best the patient can be directed.

An intervention for setting up a dinner tray for a blind person would be to:

describe where each type of food is located using the "clock" method.

When assessing a patient for vision problems, subtle signs of decreasing vision are:

developing a bruise on the shin from the open door to the dishwasher.

The patient who has just had eye surgery should be positioned with the head ------------- and should not lie on the ------ side.

elevated affected

Drugs to used in the treatment of glaucoma act to ------------ of ---- or decrease --------------.

enhance the outflow aqueous humor production

Eyelashes

help trap foreign particles, keeping them out of the eye

The term for inability to see objects close at hand is

hyperopia

Keratitis may be caused by ---------- or -----------.

irritation infection

Accommodation is accomplished through the interaction of the ciliary bodies and the _____.

lens Ciliary muscles and ligaments change the shape of the lens to provide accommodation, which is the bending of light rays to focus on the retina.

A cataract causes a blurring of vision because the ----------- becomes ------------.

lens cloudy and opaque

Decreases in hearing often occur with aging because of :

loss of elasticity of the tympanic membrane nerve cell atrophy in the ear and brain arteriosclerosis and decreased blood flow.

Retinopathy is often a disorder that occurs in patients with diabetes mellitus and is either from -------------- of blood vessels or ------------- of blood vessels with -----------------.

overgrowth rupture bleeding

The most important nursing intervention in the recovery period before discharge from the day surgery unit to ensure success of eye surgery is :

positioning the patient per orders.

aural

relating to the ear

The sudden occurrence of flashes of colored light is a sign of -------------.

retinal detachment

The receptors of light and color in the eyeball are the __________ and the __________.

rods; cones cones; rods

The characteristic sign of narrow angle glaucoma is -------------.

severe eye pain

The nurse interviewing a patient with macular degeneration will inquire about the patient's habits, especially __________, which is a significant contributor to the disorder.

smoking Smoking is a significant contributor to macular degeneration.

Glaucoma is often ------- until damage to vision has occurred from ---------- and pressure on the ------------.

unnoticed intraocular pressure optic nerve

What are five common medications that are potentially ototoxic and may cause hearing loss?

various antibiotics salicylates such as aspirin Diuretics such as furosemide Anticonvulsants such as phenytoin Antiarrhythmics such as quinidine sulfate

Early symptoms of macular degeneration are inability to see ------------ of ----------------- and --------------.

vividness colors details