Question

1. Cataract

2. Retinopathy

3. Glaucoma

4. Macular Degeneration

Answer 1

1.       Cataract:

A cataract is a clouding or capacity that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to capacity and obstructing the passage of light. The term cataract is derived from the Greek word cataractos, which describes rapidly running water or falling water.

Causes of cataract

• Old age (commonest)>65 Year

• Ocular & systemic diseases – Diabetes mellitus, Uveitis, Previous ocular surgery

• Systemic medication – Steroids, Phenothiazines

• Trauma & intraocular foreign bodies

• Ionizing radiation – X-ray, UV

• Congenital – Part of a syndrome, Abnormal galactose metabolism, Hypoglycemia

• Inherited abnormality – Myotonic dystrophy, Marfan’s syndrome, Rubella, High myopia

Management:

• Withhold any anticoagulants the patient is receiving, if medically appropriate. In some cases, anticoagulant therapy may continue.

• Administer dilating drops every 10 minutes for four doses at least 1 hour before surgery. Antibiotic, corticosteroid, and anti-inflammatory drops may be administered prophylactically to prevent postoperative infection and inflammation.

• Provide patient verbal and written instructions about how to protect the eye, administer medications, recognize signs of complications, and obtain emergency care.

• Explains that there should be minimal discomfort after surgery, and instruct the patient to take a mild analgesic agent, such as acetaminophen, as needed.

• Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively.

2.       Retinopathy:

Retinopathy occurs when blood vessels in the back of the eye, the retina, become damaged. When the blood vessels become damaged they can leak and these leaks can cause dark spots on our vision. The main causes of retinopathy tend to be sustained high blood glucose levels and high blood pressure as well.

Retinopathy risk factors include the following.

• Poor blood glucose control

• Protein in urine

• High blood pressure

• Prolonged diabetes

• Raised fats (triglycerides) in the blood

Management:

•A key requirement for systematic screening is accurate identification in primary care of all those known to have diabetes and the transfer of this information to invite the target population for screening. Nurses can certainly help encourage patients to actively engage with screening.

•They also have an invaluable role in patient education. We know that progression to more advanced retinopathy is related to the control of diabetes and its risk can be reduced by intensive blood sugar and blood pressure control.

• It is therefore important to engage with patients in optimising their diabetic control and approach wider health issues holistically, such as weight, diet and exercise.

• A personalised HbA1c target should be set in conjunction with the patient and visits should include analysing achievement towards the goal set.

•Furthermore, practice nurses are in a great position to help ensure co-ordinated care for patients, ensuring they are having regular diabetic reviews and are on appropriate medications. •Finally, chronic illness such as diabetes, especially when coupled with sight loss and difficult control, can significantly alter mood and affect quality of life. To be mindful of this is key and nurses may also have such a rapport with patients that allows gentle exploration of these issues.

3.       Glaucoma:

It is not one disease but rather a group of disorder characterized by

1. Increased IOP and the consequences of elevated pressure

2. Optic nerve atrophy

3. Peripheral visual field loss

Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.

Primary glaucoma has mainly two forms :

1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)

2. Angle –closure glaucoma( Acute or narrow angle glaucoma)

Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.

Risk Factors for Glaucoma

1. Family history of glaucoma

2. African American race

3. Older age

4. Diabetes mellitus

5. Cardiovascular disease

6. Migraine syndromes

7. Near-sightedness (myopia)

8. Eye trauma

9. Prolonged use of topical or systemic corticosteroids

Management:

•Nursing care of the client with glaucoma focuses on normalization of IOP, maintenance of optimal vision, absence of complications, and adequate knowledge to comply glaucoma with treatment and follow-up.

• For the client with angle –closure glaucoma, give medications as ordered and prepare physically and psychologically for laser iridotomy or iridectomy.

• Administer prescribed pain medication.  After trabeculectomy give medications as ordered to dilate the pupil.

•After surgery protected affected eye by applying an eye patch and eye shield.

•Monitor the client IOP regularly.

• Fear related to potentinal for blindness.

•Identify source of fear

•Seek knowledge about glaucoma from an appropriate source to help reduce his / her fear. •Explain all procedures and treatment, especially surgery, to help reduce the client anxiety.

•The medical and surgical management of glaucoma slows the progression of glaucoma but does not cure it. The lifelong therapeutic regimen mandates patient education.

•The nature of the disease and the importance of strict adherence to the medication regimen must be explained to help ensure compliance.

4.       Macular degeneration:

This is often age-related macular degeneration (AMD or ARMD), is a medical condition that usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina.

There are two basic types of Macular Degeneration: “dry” and “wet.” Approximately 85% to 90% of the cases of Macular Degeneration are the “dry” (atrophic) type, while 10-15% are the “wet” (exudative) type.

Risk factors:

•Heredity

• Nutrition

•Smoking

• Hypertension

•Exposure to sunlight

• Hyperopia

•Blue eyes

•Cataract

Management:

•No effective treatment

•Measures tried-

1-dietary supplements & antioxidants

2-smoking cessation

3-Advice amsler grid regularly

4-low viosion aid

•Intraviteral anti-VEGF therapy:

Bevacizumab

Ranibiuzumab

Pegaptanib

•Photodynamic therapy-PDT

• Transpupillary thermotherapy

•Double frequeny YAG 532NM photocoagulation

•Surgical treatment