Case Study

afaibor

NSG360CH11VISION.pptx

Home >Nursing homework help >Case Study

CHAPTER 11

VISION

Changes in Vision With Age

Changes in eye structure begin early, are progressive, and affect both function and structure

Presbyopia (decreased near vision) is a common change of aging

Nearly 95% of those over 65 years of age wear glasses

Changes in Vision With Age

Extraocular changes

Eyelids lose elasticity contributing to drooping

Entropion: inward turning of the lower lid

Ectropion: outward turning of the lower lid (Figure 11-1)

Xerophthalmia: excessively dry eyes

Changes in Vision With Age

Ocular changes

Cornea becomes flatter, less smooth, thicker, and loses luster

Increased astigmatism

Chambers that control the movement of aqueous fluid decrease in size and volume capacity, leading to development of glaucoma

Iris is slower to respond to changes from light to dark

Glare is a major problem

Decreased ability of the lens to accommodate

Development of cataracts from ultraviolet exposure

Changes in Vision With Age

Intraocular changes

Deterioration of vitreous humor may lead to development of “floaters” (lines, webs, spots, dots)

Retinal changes affect color, with red, orange, and yellow seen more easily

Color clarity diminishes by 59% in the eighth decade, secondary to yellowing of the lens

Drusen spots may appear on the macula

Changes in Vision With Age

Vision loss is not an inevitable part of aging, but age-related changes contribute to decreased vision (Table 11-1)

Even older persons with good visual acuity need accommodations to enhance vision and safety

Visual Impairment

Blindness and visual impairment are major causes of disability in older adults

As the population ages, rates of blindness and visual impairment in disadvantaged and minority populations will increase in prevalence

World Health Organization’s Universal Eye Health: A Global Action Plan 2014-2019

Consequences of Visual Impairment

Associated with cognitive and functional decline, decreased quality of life, and depression

Associated with increased risk for injury and falls

“Snowball” effect, impacting families, caregivers, and society at large

Prevention of Visual Impairment

Have yearly dilated eye examination

Get routine eye examinations

NEHEP/NEI

Diseases and Disorders of the Eye

Cataracts

Opacity of the lens causing the lens to lose transparency and scatter light

Often caused by oxidative damage

Cardinal sign is appearance of halos around objects as light is diffused

Very blurry image of two small children hugging and holding soccer balls.

Diseases and Disorders of the Eye

Treatment of cataracts

Requires surgery under local anesthesia

95% return to excellent vision

Education regarding vision and adaptation to light changes

Post-surgery avoid heavy lifting, straining, bending at the waist

Fall prevention

Diseases and Disorders of the Eye

Glaucoma

Affects over 2.3 million persons over the age of 40 and almost half don’t know they have it

African Americans at greater risk for developing glaucoma at an early age

Primary open angle glaucoma is most common and is the second leading cause of legal blindness in the United States

Other types include congenital, low and normal tension, secondary, and acute angle closure

Diseases and Disorders of the Eye

Primary open angle

Progressive, asymptomatic with visual field loss

May complain of headache, poor vision in dim lighting, tired eyes

Increased intraocular pressure damages optic nerve

Vision loss can be prevented if detected early

Acute angle closure

Emergency

Angle of iris obstructs flow of aqueous humor

May be related to infection or trauma

Intraocular pressure rises rapidly

Eye is red and painful, severe H/A, N/V

Avoid anticholinergics

First image of two boys hugging and holding soccer balls; the image is clear. Second image of same boys but the edges of the image are dark with a bright circle around the boys’ heads to signify the vision changes associated with glaucoma.

Diseases and Disorders of the Eye

Screening and treatment of glaucoma

Adults over the age of 65 or those at risk should have an annual eye examination with dilation

Treated with oral or topical eye drops to decrease intraorifice pressure (IOP) (beta-blockers first line of therapy), trabeculoplasty, and filtration surgery

Diseases and Disorders of the Eye

Diabetic retinopathy

Occurs in both type 1 and type 2 diabetes

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy.

Blood and lipid leakage leads to macular edema and hard exudates (composed of lipids).

In advanced disease, new fragile blood vessels form and hemorrhage easily.

Same image of the boys, but the image is indecipherable due to black spots signifying diabetic retinopathy.

Diseases and Disorders of the Eye

Screening and treatment of retinopathy

Early detection is essential

Annual fundoscopic dilated eye examination

Fundoscopic evaluation includes microaneurysms, flame-shaped hemorrhages, cotton wool spots, hard exudates, and dilated capillaries

Maintain strict control of blood sugar, cholesterol, and blood pressure

Diseases and Disorders of the Eye

Diabetic macular edema (DME)

Thickening of the center of the retina

Most common cause of visual loss due to diabetes and leading cause of legal blindness

Treat with cortisone drugs, growth factors, and laser therapy

Retinal vessels become leaky and fluid accumulates within the macula

Annual dilated retinal examination

Diseases and Disorders of the Eye

Detached retina

Emergency medical treatment required to save vision

Actual areas of the retina are torn that lead to retinal detachment

May have gradual increase in floaters and/or light flashes in the eye

Repair requires surgery

Early intervention improves vision results

Diseases and Disorders of the Eye

Age-related macular degeneration

Most common cause of new visual impairment among persons greater than 50 years and increases with age

Progressive loss of central vision

Caused by systemic changes in circulation, accumulation of cellular waste, tissue atrophy, and growth of abnormal vessels in choroid layer beneath the retina

Fibrous scarring affects nourishment of photoreceptor cells

Diseases and Disorders of the Eye

Dry AMD

90% of cases

Rarely causes severe impairment

Can lead to wet

Three stages

Common early sign: Drusen bodies seen on fundoscopic examination

Wet AMD

Also called neovascular

Abnormal blood vessels grow under the macula, causing its displacement

Affects central vision

Progression can be rapid with resultant blindness within 2 years

Diseases and Disorders of the Eye

AMD screening and treatment

Early diagnosis is key

Amsler grid to determine clarity of vision helps identify central vision problems

Treatment: photodynamic therapy, laser photocoagulation, and anti-vascular endothelial growth factor (VEGF) therapy

Diseases and Disorders of the Eye

Dry eye (keratoconjunctivitis sicca)

A common complaint rather than a disease

Tear production diminishes with age