Question

Discussion Topic: Distinguish between common vision problems in the older adult (Age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma). What is the clinical presentation, risk factors, and treatment for each? Discuss the impact these vision changes have on functional abilities. What pharmacologic and non-pharmacologic interventions should be included in the plan of care of the client with the vision problem? What patient and family teaching should be included?

Each student may decide to pick one or more of the common issues for their initial post,

Answer 1

Age sometimes brings changes that weaken your vision and eyes, but there are things you can do to maintain lifelong eye and overall health. The solution may be as simple as using brighter lights around the house to help prevent accidents caused by weak eyesight or seeing your doctor more frequently to screen for age-related diseases.

Preventing eye problems

While eye problems and eye diseases become more prevalent with age, many can be prevented or corrected if you:

See your family physician regularly to check for diseases that could cause eye problems, like diabetes.

Visit your ophthalmologist every one to two years. Having a complete eye exa m with an eye specialist is important because most eye diseases can be treated when found in an early stage. The eye doctor may dilate or enlarge your pupils by putting drops in your eyes. You should also have a screening for glaucoma. The doctor will then test your eyesight, your glasses, and your eye muscles.

Have an eye exav m with pupil dilation, at least once every year, if you have diabetes or a family history of eye disease. See an eye doctor immediately if you have any loss of eyesight, blurred vision, eye pain, double vision, redness, swelling of your eye or eyelid, or fluids coming from the eye.

Common age-related eye problems

These are several eye problems that are more common as people age, but they can affect anyone. There are some simple measures that people of any age can take to help ease their discomfort and see better.

Presbyopia is the loss of ability to see close objects or small print. Development of presbyopia is a normal process that happens slowly over a lifetime. You may not notice any change until after age 40. People with presbyopia often hold reading materials at arm's length. Some people get headaches or "tired eyes" while reading or doing other close work. Presbyopia is typically corrected with reading glasses.

Floaters are tiny spots or specks that float across the field of vision. Most people notice them in well-lit rooms or outdoors on a bright day. Floaters often are normal, but can sometimes be indications of eye problems such as retinal detachment, especially if they are accompanied by light flashes. If you notice a sudden change in the type or number of spots or flashes, see your eye doctor as soon as possible.

Dry eyes happen when tear glands cannot make enough tears or produce poor quality tears. Dry eyes can be uncomfortable, causing itching, burning or even some loss of vision. Your eye doctor may suggest using a humidifier in your home or special eye drops that simulate real tears. Surgery may be needed in more serious cases of dry eyes.

Tearing, or having too many tears, can come from being sensitive to light, wind, or temperature changes. Protecting your eyes by shielding them or wearing sunglasses can sometimes solve the problem. Tearing may also mean that you have a more serious problem, such as an eye infection or a blocked tear duct. In addition, people with dry eyes may tear excessively because dry eyes are easily irritated. Your eye doctor can treat or correct both of these conditions.

Eye diseases and disorders common in aging adults

Cataracts are cloudy areas that develop in the lens in the front of the eye. The eye lens is clear like a camera lens. Cataracts keep light from easily passing through the lens to the back of the eye (the retina), causing the loss of eyesight. Cataracts usually form slowly, causing no pain, redness, or tearing in the eye. Some stay small and do not alter eyesight. If they become large or thick and have a significant impact on vision they can almost always be removed with surgery. Cataract surgery is very safe and is one of the most common surgeries done in the United States and around the world. During surgery, the doctor takes out the clouded lens and, in most cases, puts in a clear plastic lens, restoring normal sight if the eye is otherwise healthy.

Glaucoma is usually related to increased pressure inside the eye. If it is not treated, this condition can lead to permanent vision loss and blindness. Heredity is a significant risk factor for glaucoma, as is age, race, diabetes, and some medications. Glaucoma is less commonly caused by other factors such as a blunt object or chemical injury to the eye, severe eye infection, blockage of blood vessels, inflammatory disorders of the eye, and occasionally by corrective eye surgery. Most people with glaucoma have no early symptoms or pain from increased pressure. To detect glaucoma, the eye doctor will exa mine your eyes to assess the appearance of the optic nerve, measure the eye pressure and test the visual field. Also some people can have damage to the eye from glaucoma, even with normal pressure in the eye. Treatment may include prescription eye drops, oral medications, laser treatment, or surgery.

Retinal disorders are a leading cause of blindness in the United States and in other developed countries. The retina is a thin lining on the back of the eye made up of cells that detect visual images and pass them on to the brain. Retinal disorders interrupt this transfer of images. Common ones include age-related macular degeneration, diabetic retinopathy, and retinal detachment.

Age-related macular degeneration (AMD). The macula is the small central portion of the retina containing millions of nerve cells (cones) that are sensitive to light. This area of the retina is responsible for detailed vision, such as facial recognition and reading. AMD is characterized by the loss of cells in this area causing blurred central vision. It contributes to vision loss but does not cause total blindness. If advanced, there is no cure but in early stages there is benefit from nutritional supplements. People with the more severe type of AMD may benefit from laser or injection of medication.

Diabetic retinopathy. This disorder is a complication of diabetes. It occurs when small blood vessels stop feeding the retina properly. In the early stages of diabetic retinopathy, the blood vessels may leak fluid, causing blurred vision or no symptoms at all. As the disease advances, you may notice floaters, blind spots or cloudiness of vision. New blood vessels may grow and bleed into the center of the eye, causing serious vision loss or blindness. For diabetic swelling of the retina, drug injections and laser may improve or preserve vision. In most advanced cases, laser treatment can prevent blindness. It is very important that people with diabetes have an eye exa m with pupil dilation every year. Very importantly, the likelihood of diabetic retinopathy is significantly decreased with good blood sugar control.

Retinal detachment. Retinal detachment occurs when the inner and outer layers of the retina become separated. Without a retina, the eye cannot communicate with the brain, making vision impossible. Symptoms of retinal detachment include: a sudden appearance of spots or flashes of light; vision that appears wavy, as if you were under water; and a dark shadow anywhere in your field of vision. With surgery or laser treatment, doctors often can reattach the retina and bring back all or part of your eyesight.

Conjunctivitis happens when the tissue that lines the eyelids and covers the sclera becomes inflamed. It is sometimes called "pink eye" or "red eye." It can cause redness, itching, burning, tearing, or a feeling of something in the eye. Conjunctivitis occurs in people of all ages and can be caused by infection, exposure to chemicals and irritants, or allergies.

Corneal diseases and conditions can cause redness, watery eyes, pain, reduced vision, or a halo effect. The cornea is the clear, dome-shaped "window" at the front of the eye. It helps to focus light that enters the eye. Disease, infection, injury, toxic agents, and other elements can damage the cornea. Treatments include using medicated eye drops. Some corneal diseases may require surgery.

Eyelid problems can be the result of different diseases or conditions. The eyelids protect the eye, distribute tears, and limit the amount of light entering the eye. Pain, itching, tearing, and sensitivity to light are common symptoms of eyelid problems. Other problems may include drooping eyelids (ptosis), blinking spasms (blepharospasm), or inflamed eyelids near the eyelashes (blepharitis). Eyelid problems often can be treated with medication or surgery.

Temporal arteritis causes the arteries in the temple area of the forehead, as well as other areas of the body, to become inflamed and possibly obstructed. It can begin with a severe headache, pain when chewing, and tenderness in the temple area. Patients may have a chronic fever, shoulder or hip weakness, and scalp tenderness. It may be followed by sudden vision loss, which is usually permanent. It is more commonly diagnosed in elderly women. People with any of these symptoms should see their physician.

Low-vision aids

Many people with sight complications find low-vision aids helpful. These are special devices that are stronger than regular eyeglasses. Low vision aids include telescopic glasses, lenses that filter light, and magnifying glasses. There are also some useful electronic devices that you can either hold in your hand or put directly on your reading material. E-Books, iPads® and similar electronic devices often can be adjusted to provide large dark fonts and are helpful for many patients with moderate impairments. Some people with only partial sight are able to increase their vision significantly by using these devices.

Whether or not you have an age-related sight condition, there are simple things you can do to help improve your vision and maintain good eye health. See your eye health care provider more frequently for screenings, and take special precautions if you have diabetes or a family history of eye disease.