cataracts
True or False: As a cataract matures, ophthalmoscopy reveals a dark area instead of a red reflex.
-TRUE
What is the greatest single risk for cataracts?
-age is the greatest single risk factor for cataracts.
What is the simplest test to aid in the diagnosis of cataracts? -
-is made based on the history and eye examination -SIMPLE test to aid in the diagnosis of cataracts is the VISUAL ACUITY TEST Opthalmoscope confirms the diagnosis by identifying the location and extent of a cataract.
By age 80, what percentage of the population is affected by cataracts?
-nearly half or 50% of the population is affected by the age of 80
9. True or False: If a patient needs bilateral cataract surgery, both eyes are done at the same time.
-surgery is performed on only one eye at a time.
etiology of cataracts
2.5% aged 40-49 6.8% aged 50-59 20% aged 60-69 68.3 % aged 80 and over
Healing from cataracts will be complete in_______ weeks.
7-8 weeks.
evaluation
Client Makes informed decision regarding cataract surgery Verbalizes concerns about home care Verbalizes appropriate home care activities Demonstrates correct medication administration
How are early cataracts managed?
Early cataracts can be managed with • Magnifying glass, • Stronger prescription lenses • Brighter lighting • Antiglare sunglasses
.When is surgical removal of a cataract necessary?
It is necessary when the cataract and lens has developed to the point that vision and activities of daily living are affected. A mature cataract also may be removed when it causes a secondary condition such as glaucoma or uveitis.
care in the community
Ophthalmologist at least every 2 years Clients with diabetes, history of visual problems, use of corticosteroids Smoking cessation Appropriate eye protection with tools, sun Eye, vision assessment at each visit Clients 65 and older
etiology of cataracts
affects individuals at the ages of 65 and 74 will develop increasing over the age of 70 -men are affected more than women african americans with this loses their vision at a rate twice that of caucasian due to lack of or delay in treatment. -majority are senile cataracts
blindness affects which race more
african americans more often than caucasians
age related cataracts etiology
aging causes proteins in the lens to deteriorate and become cloudy -by age 75 most people will have cataracts that affects vision -factors that speeds formations are : diabetes UVA/UVB exposure smoking family history
congenital cataracts
appear in a child at birth or in childhood usually in both eyes.
at what age should african americans should have a comprehensive dilated eye exam at least every 2 years
by age 40. and if theres a diagnosis of diabetes it should be at least once a year.
secondary cataracts
can form after a surgery to treat another eye disorder such as glaucoma or as an effect of medication or another primary disorder ex. clients who requires regular or recurring doses of corticosteroids.
age related cataracts clinical manifestation
cloudy/opaque lens -may cause cloudy vision halos diplopia or photophobia.
congenital cataracts clinical therapies
diagnosis confirmed by opthalmologist -treatment depends on the severity -if mild and doesnt seem to affect vision it may just be monitored especially if bilateral -if moderate to severe and seems to affect vision or if unilateral surgical removal is usually recommended -in most cases an intraocular lens is also implanted at the time of surgery.
age related cataracts clinical therapies
early cataracts or those with minimal effect on vision may require no surgical intervention -encourage UVA/UVB protection -utilize safety measures for decreased visual acuity -surgery is recommended if cataracts interferes with ADLS.
what is the surgical procedure of choice for cataracts
extracapsular extraction
cataracts etiology
forms asa result of the aging process -lens ages, its fibers and proteins change and degenerate. -proteins clump clouding the lens and reducing light transmission to the retina -begins at the periphery of the lens gradually spreading to involve the central portion -as it continues to develop, entire lens may become opaque -when only a portion is affected of the lens this is called immature cataracts -mature cataracts is opacity of the entire lens. lens may also be discolored overtime affecting the ability to accurately discriminate colors.
what are serious problems within the african american community that can lead to blindness
glaucoma and cataracts
if artifical lens or intraoclar lens needs to be replaced the diseased lens then what
it is to be implanted during surgery the corneal curvature will be measured via keratometry and anterioposteror diameter of the eye will be measured via A-scan prior to surgery.
what is a cataract
its an opacification or clouding of the lens of the eye -it can interfere with light transmission to the retina and the ability to perceive images clearly -it is a common cause of visual deficits
written instructions for clients prior to and after surgry
limitations such as avoiding reading lifting bending to pick up objects strenous activity and sleeping on operative side. 2. importance of not disturbing the eye dressing 3.prescribed medications and side effects 4. importance of follow up appointments 5. manifestations of post op complications such as eye pain decreased visual acuit or other change in vision headache nausea itching and redness of affected eye 6. administration of eyedrops and application of eyepatch or shield. 7. care insertion and removal of contact lenses as appropriate 8. visual changes associated with thick-lensed eyeglass as appropriate.
congenital cataracts clinical manifestations
may be different from age-onset cataracts -gray or white cloudy pupils -may have nystagmus( repetitive uncontrolled movements of eye) -may not have the "red eye" glow in photos
convex corrective glasses or contact lenses
may be used to correct vision after cataract removal if an intraocular lens cannot be implanted.
what does nurses should recognize about cataracts
not all cataracts needs to be removed in the early stages but many may eventually surgically correct them
congenital cataracts etiology
rare -usually unknown cause -may occur with other birth defects such as congenital rubella trisomy 21(down syndrome) pierre robin syndrome trisomy 13 (patau syndrome)
phacoemulsification lens removal
requires a smaller incision and usually is preffered over extracting the lens intact. the remaining capsule protects the retina.
traumatic cataracts
results from injury to the eye
radiation cataracts
results from long term exposure to radiation
limbal relaxing incision
secondary procedure performed at the same time as the cataract surgery or at another time. -helps clients reduce or even eliminate the need for eyeglasses.
what charts are used for the visual acuity to diagnose cataracts
snellen and rosenbaum charts are used.
what is the only treatment of cataracts at this time
surgical removal is the only treatment used at this time. no medical tx is available to prevent or treat them.
extracapsular extraction
the anterior capsule,nucleus and cortex of the lens are removed leaving the posterior capsule intact is the procedure of choice.
how to prevent injury prior to surgery
wear sunglasses with UVA/UVB protection when outdoors. -use reading or prescription glasses or contact lenses as necessary -maximize lighting for reading cooking and other indoor activities -limit or discontinue night time driving.
dilated eye exam provides what
with an opthalmoscope or slit lamo examination provides a magnified view of the structures of the eye.
13. What types of nursing interventions should be carried out in a client who has self-care issues postoperatively?
• Administering eyedrops due to chronic condition • Administering insulin injections • Application of eye patch or shield • Care insertion and removal of contact lenses as appropriate • Visual changes associated with thick-lensed eyeglasses as appropriate
What might we teach a client expect to experience after cataract surgery?
• Client may experience mild to moderate discomfort and some fluid discharge. • The nurse should explain that these symptoms normally subside in 1 or 2 days but that the client should call the office if the symptoms persist or become intolerable • Instruct the client to continue to wear eye protection as orderd • Avoid rubbing eye • In most cases healing will be complete in 7-8 weeks.
What are the risk factors for cataracts?
• Genetics • Environmental and lifestyle factors play a role • Long term exposure to UVB rays increases the risk for cataracts • Cigarette smoking • Heavy alcohol consumption • Eye trauma, including injury to the lens capsule by a foreign body, • Blunt trauma • Or exposure to heat or radiation • Diabetes mellitus associated with earlier developments of cataracts esp. when blood glucose level is not carefully controlled at or near normal levels. • Certain drugs such as systemic or inhaled corticosteroids, • Lovastatin(mevacor) • Phenytoin (Dilantin) • Chlorpromazine(thorazine) • Busulfan(Myleran)
What are the clinical manifestations of cataracts?
• Visual acuity decreases as the cataract interferes with light transmission through the lens. Affects both close and distance vision. • Glare • Color discrimination is impaired particularly in blue or purple range. • When it is mature, pupil may appear cloudy gray or white rather than black, -Tend to occur bilaterally at definite rates Light rays scattered as they pass through lens