Vision Flashcards
Exam 2
1
Q
What does visual function depend on
A
Visual function depends on a sequence of processes beginning with the perception of an external stimulus and ending with the processing of neural impulses into cerebral cortex.
2
Q
What does the visual system consist of?
A
The visual system consists of the external tissues and structures surrounding the eye,
that play an important role in protecting the eye include the eyebrows, eyelids, eyelashes, lacrimal system, conjunctiva, and sclera.
3
Q
The visual system consists of the external tissues and structures surrounding the eye, what role do they play?
What do they include?
A
The visual system consists of the external tissues and structures surrounding the eye,
that play an important role in protecting the eye include the eyebrows, eyelids, eyelashes, lacrimal system, conjunctiva, and sclera.
4
Q
Internal eye structures include?
A
iris,
lens,
ciliary body
choroid
retina
5
Q
What happens to light reflected from an object?
A
Light reflected from an object in the field of vision passes through the transparent structures of the eye and, in doing so, is refracted (bent) so that a clear image can fall on the retina.
6
Q
From the retina, where does visual stimuli travel?
A
From the retina, the visual stimuli travel through the visual pathway to the occipital cortex, where they are perceived as an image.
7
Q
What structures are subject to change with aging?
A
Every structure of visual system is subject to change with aging.
Age related changes in the nervous system and the eye support structures can reduce the visual acuity and visual function. Some changes are cosmetic- not effect vision.
8
Q
Age-Related Changes in appearance and tear ducts
Changes in appearance include:
A
arcus senillis
loss of orbital fat,
diminished elasticity of eyelid muscles
9
Q
Age-Related Changes in appearance and tear ducts
Changes in appearance include arcus senillis (photo bottom right), loss of orbital fat, and diminished elasticity of eyelid muscles
What is there impact on vision?
A
usually do not interfere with vision
10
Q
Age-Related Changes in appearance and tear ducts
Changes in appearance include arcus senillis (photo bottom right), loss of orbital fat, and diminished elasticity of eyelid muscles
usually do not interfere with vision
What is the exception?
A
(*exception –Blepharochalasis-can eventually impair vision)
11
Q
Age-Related Changes in appearance and tear ducts
What are other age related changes of the eye? What is treatment?
A
Diminished tear production (*Tx-use of artificial tears)
12
Q
Age-Related Changes in appearance and tear ducts
What structures do degenerative changes of the eye effect?
A
Degenerative changes affect all structures of the eye, the retinal–neural pathway, and visual cortex of the brain
13
Q
Age-Related Changes in appearance and tear ducts
What are corneal changes:
A
Changes in color of sclera
Less ability to dilate pupil
More light needed for reading)
14
Q
Age-Related Changes in appearance and tear ducts
Arcus senilis: What is it?
A
Eventually, the arc may become a complete ring around the colored portion (iris) of the eye.
15
Q
Age-Related Changes in appearance and tear ducts
Arcus senilis: What is it caused by?
A
It’s caused by fat (lipid) deposits deep in the edge of the cornea.
16
Q
Age-Related Changes in appearance and tear ducts
Arcus senilis: What does it effect?
A
Arcus senilis doesn’t affect vision, nor does it require treatment.
17
Q
Age related changes in the structure of the eye can affect the vision in older adults
Ciliary Body- What is it?
A
The ciliary body is a mass of muscles, connective tissue, and blood vessels surrounding the lens.
18
Q
Age related changes in the structure of the eye can affect the vision in older adults
Ciliary Body- What do they regulate? What is there primary function?
A
These muscles regulate the passage of light rays through the lens by changing the shape of the lens.
Primary functions of the ciliary body are production of aqueous fluid and control of the ability to focus.
19
Q
Age related changes in the structure of the eye can affect the vision in older adults
Ciliary Body- What happens with age?
A
Muscle cells are replaced with connective tissue, and the ciliary body gradually becomes smaller, stiffer, and less functional.
20
Q
Age related changes in the structure of the eye can affect the vision in older adults
Ciliary Body-
With age, what happens with aqueous humor? What does this lead to?
A
With advanced age, diminished secretion of aqueous humor interferes with the nourishment and cleansing of the lens and cornea.
21
Q
Age related changes in the structure of the eye can affect the vision in older adults
Vitreous- What is it?
A
The vitreous is a clear, gelatinous mass that forms the inner substance and maintains the spherical shape of the eye.
22
Q
Age related changes in the structure of the eye can affect the vision in older adults
Vitreous- What happens with age?
A
With increasing age, the gelatinous substance shrinks, causing a proportionate increase in the liquid portion.
23
Q
Age related changes in the structure of the eye can affect the vision in older adults
Vitreous-
With increasing age, the gelatinous substance shrinks, causing a proportionate increase in the liquid portion.
Because of these changes, what happens?
A
Because of these changes, the vitreous body pulls away from the retina, resulting in symptoms such as floaters, blurred vision, distorted images, or light flashes.
24
Q
Age related changes in the structure of the eye can affect the vision in older adults
Retina: What is it composed of?
Because of these changes, what happens?
A
Composed of rods and cones which are required for color perception and acuity?
25
Age related changes in the structure of the eye can affect the vision in older adults
Retina:
What happens with age?
Although the number of cone cells diminishes with increasing age, the loss is primarily in the periphery rather than the fovea, and the effects are minimal.
The number of rod cells also declines, but the remaining rods increase in size and maintain their ability to capture light. Additional age-related changes in retinal structures include accumulation of lipofuscin and thinning and sclerosis of the blood vessels and pigment epithelium.
26
Age related changes in the structure of the eye can affect the vision in older adults
Cornea: What is it?
The cornea is a translucent covering over the eye that refracts light rays and provides 65% to 75% of the focusing power of the eye.
27
Age related changes in the structure of the eye can affect the vision in older adults
Cornea: What are characteristics of the cornea? What does it do? What part of the eye is it?
Smooth, clear, strong and durable;
Shields eyes from germs and dust
Outermost lens
28
Age related changes in the structure of the eye can affect the vision in older adults
Cornea: What happens to it with age?
Becomes opaque and yellow impairing passage of light
Lipid deposits lead to blurred vision
Altered curvature results in impaired refractility
29
Age related changes in the structure of the eye can affect the vision in older adults
Lens: Where is it? What does it do?
Situated behind the iris.
Focuses light onto the retina
30
Age related changes in the structure of the eye can affect the vision in older adults
Lens: What happens with age?
Becomes stiffer, denser, and more opaque
31
Age related changes in the structure of the eye can affect the vision in older adults
iris: What is it?
Colored part of the eye
32
Age related changes in the structure of the eye can affect the vision in older adults
iris: What does it control?
Controls light levels inside the eye (like aperture on camera)
33
Age related changes in the structure of the eye can affect the vision in older adults
iris: What is the round opening in the center?
pupil
34
Age related changes in the structure of the eye can affect the vision in older adults
iris: What is the iris embedded with? What does this do?
Iris embedded with tiny muscles that dilate and constrict pupil size?
35
Age related changes in the structure of the eye can affect the vision in older adults
iris: What happens with age?
Becomes less flexible and the pupil becomes smaller
36
Effects of age- related changes on vision
What is there a loss of:
Loss of accommodation
Diminished acuity
Reduced visual field
Diminished depth perception
37
Effects of age- related changes on vision
What is there a delay of? What is there an alteration of?
Delayed dark and light adaptation
Altered color vision:
38
Effects of age- related changes on vision
What is slower?
Slower visual information processing
39
Effects of age- related changes on vision
Loss of accommodation: What is the term?
presbyopia—
40
Effects of age- related changes on vision
Loss of accommodation: presbyopia—
What does this mean?
diminished ability to focus clearly on objects at various distances (far-sighted)
41
Effects of age- related changes on vision
Diminished acuity:
What does this mean?
diminished ability to detect details and discern objects
42
Effects of age- related changes on vision
Delayed dark and light adaptation:
What does this mean?
slower adaptive response to changes in lighting
43
Effects of age- related changes on vision
Altered color vision:
What does this mean?
perception blue objects look darker, and whites appear more yellowed
44
Effects of age- related changes on vision
What is visual impairment? What does it range from?
loss that cannot be corrected with glasses or contacts; ranges from mild to blindness
45
What is presbyopia?
A. The loss of accommodation
B. Diminished visual acuity
C. Delayed reaction to changes in light
D. A reduction in the visual field
A. The loss of accommodation
Presbyopia is the loss of accommodation, which is the ability to focus clearly on objects at various distances. Presbyopia is an initial and universal age-related vision change, which begins in early adulthood and affects all humans to some degree by their mid-fifties
46
Visual Impairment
Personal cost for older person with visual impairment
What occurs?
Loss of independence
Social isolation
Depression
Decreased quality of life
47
Risk Factors That affect Visual Wellness
Lifestyle, nutrition, environment: exacerbate age-related vision changes
48
Risk Factors That affect Visual Wellness
Factors that interfere with visual wellness:
Poor nutrition, smoking, sunlight exposure
Warmer environmental temperatures, wind, low humidity, secondhand smoke
Lighting, color contrast
Chronic conditions ( Hypertension, Diabetes, Parkinson's LBD)
Medications
49
Functional Consequences Affecting Visual Wellness:
Effects on Safety, function and overall health ,QOL and Driving
Available lighting needs are three to five times more than previously required
Difficulty with Effect on driving in general
Night driving (Particularly with Glaucoma)
Increased risk for unsafe mobility and falls
Increased difficulty in performing usual activities
Anxiety, depression, and lower levels of psychological well-being
50
Common Disease Conditions Affecting Vision include:
Cataracts:
Age-related macular degeneration (AMD):
Glaucoma:
Diabetic retinopathy:
51
Common Disease Conditions Affecting Vision include:
Cataracts:
leading, reversible cause of vision impairment
52
Common Disease Conditions Affecting Vision include:
Cataracts: What would the patient report?
Pt. will report cloudy, hazy vision
53
Common Disease Conditions Affecting Vision include:
Cataracts: How does this happen?
The development of a Cataract occurs when the lens of the eye loses its transparency.
54
Common Disease Conditions Affecting Vision include:
Age-related macular degeneration (AMD):
leading cause of severe vision loss
55
Common Disease Conditions Affecting Vision include:
Age-related macular degeneration (AMD): How does this occur?
occur in the eye when the macula of the retina become damaged and impair the central vision-
56
Common Disease Conditions Affecting Vision include:
Age-related macular degeneration (AMD): What does the patient report?
Loss of central vision
57
Common Disease Conditions Affecting Vision include:
Glaucoma:
causes loss of peripheral vision leading to blindness if untreated
58
Common Disease Conditions Affecting Vision include:
Glaucoma: What is it caused by? What does it result in?
caused by increased intraocular pressure that results in damage to the optic nerve.
59
Common Disease Conditions Affecting Vision include:
Diabetic retinopathy:
blurred, hazy, spotted or fluctuating vision
60
Common Disease Conditions Affecting Vision include:
Diabetic retinopathy: How does this occur?
This eye disorder occurs from uncontrolled high blood glucose levels which lead to retinal damage.
61
Common Disease Conditions Affecting Vision include:
Diabetic retinopathy: What will the patient report?
Pt. will report: Black spots in vision
62
What is the most common cause of irreversible severe central vision loss and blindness?
AMD is most common cause of irreversible sever central vision loss and blindness in people over 60
63
Age-Related Macular Degeneration
What are the two forms?
Dry/atrophic AMD
Wet/ advanced neovascular AMD
64
Age-Related Macular Degeneration
Dry/atrophic AMD
is slower to progress and more common (80%)
65
Age-Related Macular Degeneration
Wet/ advanced neovascular AMD
is more severe and rapid (20%)
66
Age-Related Macular Degeneration
Wet/ advanced neovascular AMD: What is the cause?
No one knows the exact cause of wet macular degeneration
67
Age-Related Macular Degeneration
Wet/ advanced neovascular AMD: Who does it develop in?
it develops in people who have had dry macular degeneration
68
Age-Related Macular Degeneration
What is it caused by?
Caucasian ,smoking, family Hx, obesity, exposure to sunlight
69
Macular Degeneration Signs and Symptoms : Dry:
Blurred Vision
Scotomas
Metamorphpsia
blurring (trouble with street signs and fine newsprint, recognizing faces, haziness), colors aren’t as bright, “grey” spot in center of visual field (scotoma)
70
Macular Degeneration Signs and Symptoms : Dry:
Scotomas
( Blind Spots) in central vision
71
Macular Degeneration Signs and Symptoms : Dry:
Metamorphpsia
( Distortion of Vision –items appear larger/smaller than they usually are
72
Macular Degeneration Signs and Symptoms : Dry:
Metamorphosia: What is required for it?
Require light for reading
73
Macular Degeneration Signs and Symptoms : Dry:
Metamorphosia: What are other symptoms of it?
Other Symptoms: blurring (trouble with street signs and fine newsprint, recognizing faces, haziness), colors aren’t as bright, “grey” spot in center of visual field (scotoma)
74
Macular Degeneration Signs and Symptoms : Dry:
How is progression of vision loss?
Slow and painless progression of visual loss
Straight lines appear crooked or wavy
75
Macular Degeneration Signs and Symptoms :
Late stage DRY and WET:
How is progression of vision loss?
relatively sudden change in vision, blurred, distorted, and darkened vision
with visual field blind spots resulting in serious vision loss.
76
Macular Degeneration Signs and Symptoms :
Dry
Does it effect one or both eyes?
Dry macular degeneration usually affects both eyes.
77
Macular Degeneration Signs and Symptoms :
What kind of visual distortion occurs?
What type of vision impairment occurs? What is there difficulty with?
Visual distortions, such as straight lines seeming bent
Reduced central vision in one or both eyes.
Increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant
Increased blurriness of printed words
Decreased intensity or brightness of colors
Difficulty recognizing faces
78
Macular Degeneration Signs and Symptoms : Dry:
What test should be used and how often?
To use Amsler Test twice a week
79
Macular Degeneration Signs and Symptoms : Dry:
Amsler Test twice a week: What does it provide?
An Amsler grid is a tool to assess macular degeneration that often provides the earliest sign of a worsening of the condition.
80
Macular Degeneration Signs and Symptoms : Dry:
Amsler Test twice a week: What kind of results should you look for that are bad?
If the lines of the grid become distorted or faded, the client should call the ophthalmologist.
81
Age-Related Macular Degeneration -Treatment
Dry and Wet AMD treatment
What treatment should be effective?
No effective treatment have been found. However, patient will benefit from taking these vitamins and minerals daily:
Vitamin C (500 mg)
Vitamin E (400 IU)
Lutein (10 mg)
Zeaxanthin (2 mg)
Zinc (80 mg)
Copper (2 mg)
Eating Eye-healthy foods
82
Age-Related Macular Degeneration -Treatment
Dry and Wet AMD treatment
Eating Eye-healthy foods
Dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with AMD.
83
Age-Related Macular Degeneration -Treatment
Dry and Wet AMD treatment
What can slow the progression?
Getting regular exercise, and quitting smoking can slow the progression.
84
Age-Related Macular Degeneration -Treatment
Dry and Wet AMD treatment:
Which one (dry or wet) is more common and progresses at a faster rate among smokers?
Dry AMD is more common and progresses at a faster rate among smokers than among nonsmokers. Thus, quitting smoking can slow the rate of AMD progression.
85
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Laser photocoagulation
Photodynamic Therapy ( PDT) -
Medications called anti-VEGF
86
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Laser photocoagulation: What does it do?
Laser photocoagulation destroys leaking blood vessels that have grown under the macula and halts the leakage.
87
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Laser photocoagulation: What percent of people with wet does it help?
Laser therapy helps treat about 10%-20% of people with wet macular degeneration.
88
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Laser photocoagulation:
What may occur when using this treatment? What do people who do this treatment need?
Some vision loss may occur, because this treatment creates scar tissue that is perceived as blind spots;
however, even more vision would be lost without any treatment at all. Up to half of patients who elect laser therapy may need repeat treatments.
89
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Photodynamic Therapy ( PDT) -
What is used together?
Verteporfin (Visudyne) IV & cold Laser are used together.
90
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Photodynamic Therapy ( PDT) -
How does PDT work?
PDT works by using a light-sensitive medicine called verteporfin that “turns on” when hit by a specific type of laser (sometimes called a cold laser).
MD will shine the laser on a very small area in the back of the eye, causing the verteporfin to break down the blood vessels that are causing the vision loss.
91
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Photodynamic Therapy ( PDT) -
Pt teaching:
The medication become active when exposed to low levels of laser light waves –until it is totally excreted from the body it can be activated by sunlight and can cause the patient A chemical skin burn.
92
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Photodynamic Therapy ( PDT) -
Pt teaching: The medication become active when exposed to low levels of laser light waves –until it is totally excreted from the body it can be activated by sunlight and can cause the patient A chemical skin burn.
What do you tell patient?
Pt. to avoid sunlight and other forms of lights ( halogen ) for 5 days after Tx
Be fully covered head to toe when exposed to light.
93
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Photodynamic Therapy ( PDT) -
How common is it?
Photodynamic therapy (PDT) is a much less common treatment for wet AMD that doctors sometimes use along with anti-VEGF injections.
94
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Anti-VEGF (vascular endothelial growth factor):
What protein does the eye contain?
The eye contains a protein called vascular endothelial growth factor, or VEGF.
95
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Anti-VEGF (vascular endothelial growth factor):
ROle of VEGF
The role of VEGF is to help grow new blood vessels.
96
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
Anti-VEGF (vascular endothelial growth factor):
What causes wet AMD?
Wet AMD is caused by an excess of VEGF.
This leads to the abnormal blood vessel growth that can cause vision problems
97
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
What is the most common treatment doctors use to slow vision loss from wet AMD?
The most common is called anti-VEGF injections.
98
Age-Related Macular Degeneration -Treatment
Wet AMD treatment ONLY:
What does anti-VEGF do?
These medicines help stop bleeding and leaking from blood vessels in the back of the eye.
Most people with wet AMD will get anti-VEGF injections as their only treatment.
99
Age-Related Macular Degeneration –Treatment ( Cont.-)
LUCENTIS : What is it for? How often is it given?
It was approved in 2006 to treat wet age-related macular degeneration (wet AMD).
is recommended to be administered by intravitreal injection once a month (approximately 28 days)
100
Age-Related Macular Degeneration –Treatment ( Cont.-)
LUCENTIS : What does it do?
administered by intravitreal injection once a month (approximately 28 days) is a prescription medicine that is designed to block vascular endothelial growth factor (VEGF) from inside the eye.
101
Age-Related Macular Degeneration –Treatment ( Cont.-)
LUCENTIS : How successful is it?
**Clinical studies have documented a definite success of intraocular injections for wet macular degeneration. After one year of intraocular therapy, the vision improved by about 25-34% compared with 5% in those who did not choose intraocular injections. Sep 25, 2020
102
Age-Related Macular Degeneration –Treatment ( Cont.-)
EYLEA: What does it do?
treatment that works by blocking the growth of abnormal blood vessels.
By blocking the growth of these additional blood vessels, regular treatments of EYLEA help to lessen or stop the causes of vision loss associated with Wet AMD.
103
Age-Related Macular Degeneration –Treatment ( Cont.-)
EYLEA: How often is it given?
administered by intravitreal injection every 4 weeks
104
Age-Related Macular Degeneration –Treatment ( Cont.-)
How long do eye injections last?
The frequency of the eye injections depends on the condition, the severity of retinal swelling, and the potency of the medication used.
Some can be repeated every 3 months while the most common ones must be administered every 4-6 weeks to maximize the efficiency of the therapy.
105
Age-Related Macular Degeneration –Treatment ( Cont.-)
What are complications with treatments?
Complication: problems related to blood clots, such as heart attacks or strokes.
106
Age-Related Macular Degeneration –Treatment ( Cont.-)
On October 22, 2021, the FDA approved Susvimo™ (ranibizumab injection) 100 mg/mL for intravitreal use via ocular implant for the treatment of people with wet AMD who have previously responded to at least two anti-vascular endothelial growth factor (VEGF) injections.
107
Risk Factors for ARMD
And what is treatment?
Age (above the age of 50)
Cigarette smoking
Family history of ARMD
Obesity
Increased exposure to ultraviolet light
Caucasian race and light colored eyes
Hypertension or cardiovascular disease
Lack of dietary intake of antioxidants and zinc
Treatment: laser tx for wet ARMD
108
ARMD Preventive Measures
Nurses should encourage
Wearing ultraviolet protective lenses in sun
Smoking cessation
Exercising routinely
Eating a healthy diet consisting of fruits and vegetables
109
ARMD Preventive Measures
Treatment for macular degeneration focuses on supportive measures :
including large-print books,
use of public transportation,
magnifying devices used with activities.
Amsler grid use twice a week, any sudden changes in vision MUST be evaluated
an Org. called Low-vision centers will send representatives to the client's home or work to make recommendations about improving lighting, thereby improving the client's vision and safety.
Any intervention that can help increase vision should be included in the teaching such as bright lighting in the house
110
Cataract
What are the steps to development?
Lens clouding --> decreased light to retina --> limited vision
111
Cataract
How is development (speed)
Development is slow and painless
112
Cataract
What makes it difficult to see?
Clouding and blurring of lens
Opacity makes it difficult to see
113
Cataract
What is the most common surgical procedure for those over 65?
Most common surgical procedure for those aged over 65
114
Cataract
Immature cataracts?
are not completely opaque and thus allow some light to pass providing the patient with some useful vision.
115
Cataract
Mature cataracts?
Mature cataract occurs when the lenses are completely opaque, and vision is greatly reduced or absent.
116
Clinical Manifestations
What is it a decline in?
Cataracts—decline in visual acuity :
117
Clinical Manifestations
Common symptoms of cataracts include:
blurry vision.
trouble seeing at night.
seeing colors as faded.
increased sensitivity to glare.
halos surrounding lights.
double vision in the affected eye.
a need for frequent changes
in prescription glasses.
118
Clinical Manifestations
Common symptoms of cataracts include:
What is helpful for detecting cataracts?
will be done by using a slit-lamp
119
Clinical Manifestations
Common symptoms of cataracts include:
Why is slit-lamp helpful?
The slit-lamp is helpful with detecting cataracts because it enlarges the front area of the eye so the doctor can observe the cornea, iris, lens etc.. This is particularly useful with detecting cataracts (*because remember in cataract the lens has lost transparency) so with this type of exam the lens will appear cloudy.
120
Cataracts
Surgery: What is given?
Prior to cataract surgery (day of procedure) eye drops from the Cycloplegic family are given
to paralyzes the ciliary muscle of the eye (which results in the loss of accommodation) and to dilate the pupil.
121
Cataracts
Surgery: All cycloplegics are also...
All cycloplegics are also mydriatics (=pupil dilation)- (phenylephrine, cyclopentolate, and/or tropicamide) typically have sympathomimetic or anticholinergic properties, or both, and are frequently administered before and during cataract surgery to maintain adequate pupillary dilation and paralyzation of the ciliary muscle.
122
Cataracts
Cycloplegics cause ...
Cycloplegics cause cycloplegia (paralysis of the muscles that are responsible for accommodation)
*accommodation =to focus on nearby objects.
123
Cataracts
Post surgery: What should patients avoid?
Lifting any heavy objects (over 10 LB)
Straining at stool
Blowing the nose forcefully
Bending at the waist
124
What is the second leading cause of blindness in the US? and African Americans?
Glaucoma
Leading cause of blindness in African Americans
125
Glaucoma:
Leading cause of blindness in African Americans - why
Many are unaware
Family Hx
Long term use of Corticosteroids
Incidence increases with age
Preventable
Genetic traits
126
Glaucoma
What are the two types?
Chronic Glaucoma (open angle glaucoma)
Acute (closed or narrow angle)
127
Glaucoma
Chronic Glaucoma (open angle glaucoma)
Slowed flow of aqueous humor through trabecular meshwork --> build up --> increased IOP --> damage to optic nerve fiber --> loss of vision
128
Glaucoma
Chronic Glaucoma (open angle glaucoma)
Painless vision loss
Mid-peripheral visual field loss
129
Glaucoma
Acute (closed or narrow angle)
Severe eye pain, headache, nausea, and vomiting
Rapid increase in tension and edema, dilated pupil
Sudden vision changes (halos around lights or blurred vision)
Need for early treatment to prevent blindness
Sever rapid increase in pressure in the eye - IPO >50 mm Hg
Eye pressure:
Diagnosis with tonometry to measure IOP
Normal range is 10-20 mm Hg
130
Glaucoma
Important Nursing Care Implications:
What kind of drugs should be avoided?
Drugs with anticholinergic properties can exacerbate glaucoma due to their effects of dilating the pupil
131
Glaucoma
Some commonly used drugs in older adults that have anticholinergic effects:
Tricyclic antidepressants
Lasix
Anti-Parkinson drugs
Antipsychotics
131
Slide 23 bottom
132
Diabetic Retinopathy: What are the steps?
Microvascular disease of the eye --> damage to the ocular microvascular system --> impairing transportation of oxygen and nutrients to the eye in diabetics
132
Diabetic Retinopathy:
Symptoms
Gradual vision loss
Generalized blurring
Areas of focal vision loss
133
Diabetic Retinopathy:
Treatment and therapy
Treatment: laser therapy
Manage hypertension and hyperlipidemia
134
Diabetic Retinopathy:
Treatment and therapy: Nursing
Good control of diabetic and better Glycemic control
If not treated ---Retinal detachment and Glaucoma
