Sensory Perception:Cataracts and Macular Degeneration

Functional ability

Nursing diagnoses and interventions related to: Mobility Falls Nutrition Self care IADLs

glaucoma cont.

African Americans over age 40 Everyone over age 60, especially Mexican Americans People with a family history of glaucoma At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.

Cataracts

Clouding of the lens of the eye which prevents clear vision. Most cases of cataract are related to the ageing process Occasionally children can be born with the condition, or a cataract may develop after eye injuries, inflammation, and some other eye diseases. Cataracts are responsible for 51% of world blindness, which represents about 20 million people (2010). Although cataracts can be surgically removed, in many countries barriers exist that prevent patients to access surgery. Cataract remains the leading cause of blindness.

AMD: Treatment

Early Stage: There is no treatment for early AMD. Lifestyle modifications such as BMI reduction, cholesterol intake reduction, increased ω-3 fatty acid intake, and smoking cessation Intermediate stage: high-dose antioxidant vitamin and mineral supplementation. This supplementation has not been shown to have any affect for early AMD. The original AREDS study employed a supplement consisting of high doses of vitamins C and E, β-carotene, zinc, and copper. Further research with atorvastatin Advanced Dry AMD: Monoclonal antibody and protein D Advanced Wet AMD: Photodynamic therapy using intravenous verteporfin. The patient is slowly injected intravenously with a verteporfin over 10 minutes. After the medication has had a chance to absorb into the neovascular membrane beneath the retina (5 minutes) a laser light of a specific wavelength is applied to the retina.

AMD: Symptoms

Early and intermediate AMD are typically asymptomatic. The earliest detectable symptoms of macular degeneration are mild central blur and/or distortion. Late AMD presents with a range of symptoms, including visual distortion and/or blur, reduced contrast sensitivity, reduced color vision, decreased vision in low-light conditions, slower adaptation to low-light conditions, and reduced central vision. AMD only affects central vision, with peripheral vision remaining unaffected. Dry and wet AMD share very similar symptomatology, with the main difference being that wet AMD symptoms tend to be more severe and have a more rapid onset.

Glaucoma

Glaucoma is one of the leading causes of blindness in the United States, affecting an estimated 2.7 million Americans. Asymptomatic nature of the disease, only 50% of people with glaucoma even know they have the condition. Thief in the night Once glaucoma is detected, appropriate management can slow disease progression and save remaining vision, although lost vision cannot be restored. Early detection and appropriate management are essential to controlling the disease. In addition to lack of early symptoms, detection and management of glaucoma are challenged by difficulties in reaching high-risk populations and by the lack of simple, cost-effective screening plans. Tonometry measures pressure in the eyes.

Pathophysiology of Glaucoma

In glaucoma, aqueous production and drainage are not in balance When aqueous outflow is blocked, pressure builds up in the eye Increased IOP causes irreversible mechanical or ischemic damage Normal outflow of aqueous humor

Age-related Macular Degeneration

Leading cause of blindness in persons aged 65 years and older. "Dry" AMD is typified by geographic atrophy of sensory retinal tissues without evidence of neovascularization "Wet" AMD denotes the presence of a pathologic sub-retinal neovascular membrane. "Wet" AMD accounts for only 20% of all AMD cases but causes nearly 90% of cases of blindness from AMD of any form. Annual dilated eye examination is the most effective tool in the diagnosis and monitoring of AMD.

Common ocular medications

Lubricants (artificial tears) Ointments Mydriatic drops for pupil dilation Cyclopegic drops to paralyze iris sphincter Cholinergics (pilocarpine) drops for glaucoma Beta-blockers (timolol) drops for glaucoma 5 minutes between different types of ocular preparations Proper method of instillation (review Chart 63-5)

AMD: Risk factors

Nonmodifiable risk factors for developing late AMD (both dry and wet) are: 1) advanced age, 2)white ethnicity, and 3) genetic factors. Modifiable risk factor: Cigarette smoking has been found to be the primary modifiable risk factor that is most consistently reported across studies. Smoking cessation has been associated with both decreased risk of developing AMD and decreased risk of AMD progression. Nursing implications?

Cataract surgery: Nursing interventions

Preoperative care Usual preoperative care for ambulatory surgery Dilating eye drops or other medications as ordered Postoperative care Patient education Provide written and verbal instructions Instruct patient to call physician immediately: 1) if vision changes; 2)continuous flashing lights appear, 3)redness, swelling, or pain increase, 4) type and amount of drainage increase, 5) or significant pain is not relieved by acetaminophen.

Cataract treatment

Reduction of cigarette smoking and ultraviolet light exposure may prevent or delay the development of cataract. Diabetes mellitus and high body mass index are identified as additional risk factors. The opaque lens is removed and replaced by an artificial intraocular lens.

Cataracts: Discharge teaching

Wear glasses or eye shield Always wash hands before touching postoperative eye Avoid lying on side of surgery at night Keep activity light Avoid lifting, pushing or pulling objects greater than 15 pounds Avoid bending or stooping Be careful to climb or descend stairs Know when to follow up with ophthalmologist Danger signs: vision changes, continuous flashing lights, redness, significant pain or swelling in eye, change in eye drainage, eye injury Driving/activity instructions