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Cataracts and Glaucoma

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kyiria mercer

on 24 October 2013

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Transcript of Cataracts and Glaucoma

Etiology of
Cataracts

The Age Related Factors for Cataracts
By: Ashley, Alex, Anna, Courtney, Kyiria
Cataracts & Glaucoma

A Journey Through
the Human Eye
THE END
Our eye lens are made mostly of water and protein.
The protein in the eyes is arranged to allow light to pass through the lens, while keeping it clear.
But as we age, the lens becomes less flexible, less transparent and thicker; some of the protein may start clumping together and
cloud a small area of the lens.
This is a cataract.
Cataracts can also be caused by other medical or eye conditions including
diabetes
,
trauma
or
past eye surgery
.
Long-term use of steroid medications
, too, can cause cataracts to develop.

They
cannot
be passed from one eye to the other.
Risk Factors for Cataracts
Smoking
Family history
Long term, high sunlight exposure
Diabetes
Excessive alcohol use
Exposure to ionizing radiation used in X-rays and cancer radiation therapy
Eye injury (puncture, cut, intense heat or chemical burn to the eye)
Age related cataracts are responsible for nearly half of all blindness worldwide and half of all visual impairment in North America.
Most age-related cataracts develop from protein clumpings.
Age-related cataracts can affect
your vision in the follow two ways:
With age, clumps of protein reduce the sharpness of the image reaching the retina. With a small cataracts, the cloudiness affects only a small part of the lens. Cataracts tend to "grow" slowly as one ages, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
Two
The clear lens slowly changes to a brownish color.
As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting dosen't affect the sharpness of the image in the retina.


One
Cataract Stats
• This number is expected to increase to 5 million by 2031.
• Approximately 244,766 cataract operations were performed in Canada in 2001
More than 2.5 million Canadians currently have cataracts.
In the USA alone, surgery for age-related cataracts is the most expensive ocular surgical procedure, with expenditures exceeding USD 3 billion annually.
Food Sources of Healthy Eye Nutrients
Lutein, zeaxanthin
Broccoli, Brussels sprouts, collard greens, corn, eggs, kale, nectarines, oranges, papayas, romaine lettuce, spinach, squash
Omega-3 fatty acids
Flaxseed, flaxseed oil, halibut, salmon, sardines, tuna, walnuts
Vitamin A
Apricots, cantaloupe (raw), carrots, mangos, red peppers (raw), ricotta cheese (part-skim), spinach, sweet potatoes
Vitamin C
Broccoli, Brussels sprouts, grapefruit, kiwi, oranges, red peppers (raw), strawberries
Vitamin E
Almonds, broccoli, peanut butter, spinach, sunflower seeds, wheat germ
Zinc
Chickpeas, oysters, pork chops, red meat, yogurt

Glaucoma Risk Factors
People Over 60
African Descent
Steroid Users
Eye Injury
Family Members with Glaucoma

After cataracts, glaucoma is the leading cause of blindness among individuals of African descent. Glaucoma is six to eight times more common in African Americans than in Caucasians.

People Over 60


Glaucoma is much more common among older people. You are 6x more likely to get glaucoma if you are over 60yrs.

African Descent
Family Members with Glaucoma


The most common type of glaucoma, primary open-angle glaucoma, is hereditary. If members of your immediate family have glaucoma, you are at a much higher risk than the rest of the population.
Family history increases risk of glaucoma four to nine times.

Other Risk Factors
High myopia (nearsightedness)

Hypertension

Central corneal thickness less than .5 mm.

Age and Glaucoma

You're at a higher risk of glaucoma if you're older than age 60. You may be at higher risk of angle-closure glaucoma if you're older than age 40.

For certain groups such as people of African descent, however, the risk of developing glaucoma is much higher and occurs at a younger age than that of other groups.

If you're of African descent, ask your doctor when you should start having regular comprehensive eye exams.
People over the age of 40.

While glaucoma can develop in younger patients, it occurs more frequently as we get older.

Statistics About Glaucoma
Glaucoma affects more than 400,000 Canadians and 67 million people worldwide.
Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.
Older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United States).
The number of people blind from this disease is expected to double by 2031, reaching nearly 20,000.
Glaucoma - Nursing Care and Interventions
Treatment
eye drops
miotic eyedrops constrict pupil and contract cilary muscle to promote outflow of aqueous humor
medication
Beta blockers & carbonic anhydrase inhibitors reduce production of aqueous humor
osmotic agents (i.e. oral glycerin) in emergencies to reduce Intra-Ocular Pressure
surgery
laser, filtering treatment, cyclocryotherapy
Vision change or loss related to nerve fiber destruction as evidenced by visual field exam
interventions: activity therapy, communication enhancement, environmental management, fall prevention
Pain related to spasms and intra-ocular pressure as evidenced by patient expression
interventions: monitor BP, pulse and respirations, monitor pain and address appropriately with medication and other comfort measures
Anxiety related to altered health status, pain, vision loss (real or potential), unmet needs related to life changes because of altered vision as evidenced by verbalized concern
interventions: validate feelings of anxiety and explore coping mechanisms
Diagnosis of
Cataracts
Hx and risk factor assessment
Observable opacity of the lens
Slit-lamp exam
Tonometry
Perimetry
Dilated eye exam
Cataract Nursing Care and Interventions
Treatment
No cure except for surgery; dependent on the severity of impact on daily life of pt, some live and adjust their life without surgery

Median wait time in SK is 35 days, Saskatoon 32 days

Three types of procedures:
1. Intra or Extracapsular extraction
2. Phacoemulsification
3. Cryosurgery
Intracapsular extraction:
complete removal of lens and surrounding capsule in one piece.
- Rarely performed in most countries
- IOL (intraocular lens) placed in anterior chamber or sutured to sulcus


Extracapsular extraction:
differs from intracapsular in that the capsule (posterior part) is kept in place for IOL to be implanted.


Phacoemulsification:
- IOL not always implanted, instead special contacts are used or eyeglasses.
-with eyeglasses however; images will be increasingly magnified and binocular vision is not restored
Alternative Therapy
Bilberry: an AO that may have anti-inflammatory, muscostimulant and vasoprotective properties.
However, can also decrease BG and BP.
Collaborative Care

Cryosurgery:

- Rarely used
- Strong chance of damaging other cells.

Pre-op:
- acquire baseline visual acuity in both the to be operated and unoperated eye
- lifestyle adjustment
- treatment options available

Post-op:
- family support
- proper eye care
- S & S of infections
- Preventing increase in IOP
- AB or analgesic use
Surgical Considerations
Risks of surgery:
- Infection, bleeding, inflammation, loss of vision, double vision, high/low eye pressure
- Increased risk of retinal detachment - painless, increased flashes or floaters
- Risk of after-cataract
Cataract Surgery
Preventative Measures
No scientifically proven measures to prevent development; however,

Recommendations:
Have regular eye exams
Wear UV filtering sunglasses (polarized is even better!)
Wear eye protection
Reduce alcohol consumption
Maintain healthy weight
Manage other comorbidities
Consume diet high in fruits and veggies
Limited evidence for vitamin supplements
Types of Cataracts
1. Secondary:
formed as a result of other surgery, or comorbidities
2. Traumatic:
develop after eye injury, sometimes years later
3. Congenital:
although rare, babies can be born with them
4. Radiation:
result of exposure to certain types of radiation
Clinical Manifestations
- Cloudy, blurry, or 'dim' vision
- Colours seem faded, or inability to distinguish colours
- Increased glare
- Poor night vision
- Double vision (this symptom clears as cataract grows larger)
- Difficulty seeing details
- Poor central vision
- Frequent prescription changes in glasses or contact lenses


Cataracts and Glaucoma
Stephen T, Skillen D, Rene D, Jensen S. (2012) Canadian Jensen's Nursing Health Assessment. Lippincott, Wlliams &Wilkins.

CNIB (2013). Cataracts. Retrieved from
http://www.cnib.ca/en/your-eyes/eye-conditions/Cataracts/Pages/default.aspx.

Glaucoma Research Foundation (2013). Retrieved from
http://www.glaucoma.org/.

Mayo Clinic (2013). Cataracts. Retrieved from http://www.mayoclinic.com/
healthcataracts/DS00050.

MayoClinic (2013). Glaucoma. Retrieved from http://www.mayoclinic.com/health/glaucoma/DS00283

Boron & Boulpaep. (2009). Medical Physiology. Second edition. Saunders, Elsevier Inc.

National Eye Institute (2009). Facts About Cataract. Retrieved from
http://www.nei.nih.gov/health/cataract/cataract_facts.asp

Nettina, S. (2014). Lippincott manual of nursing practice. Ambler, PA: Wolters Kluwer
Health.

Saskatchewan Surgical Intiative (2013). Cataract Surgery. Retrieved from http://www.sasksurgery.ca/pdf/Benchmarks_Cataract.pdf.

WebMD (2013). Cataracts and Your Eyes. Retrieved from
http://www.webmd.com/eye-health/cataracts/health-cataracts-eyes.

WebMD (2013). Glaucoma and Your Eyes. Retrieved from http://www.webmd.com/eye-health/glaucoma-eyes
References
What is Glaucoma?
Glaucoma is not just one eye disease, but a group of eye conditions resulting in optic nerve damage, which may cause loss of vision.
Glaucoma is one of the leading causes of blindness.
Glaucoma can damage your vision so gradually you may not notice any loss of vision until the disease is at an advanced stage.
Vision loss from glaucoma is not reversible with treatment or with surgery.
Pathophysiology of Glaucoma
The ciliary epithelium constantly secretes aqueous humor into the posterior chamber of the eye.
The aqueous humor then flows between the iris and the anterior surface of the lens and reaches the anterior chamber through the pupil.
The canals of Schlemm drain the aqueous humor through trabecular meshwork
Excess pressure in the posterior chamber produces the disease Glaucoma.
Pressure damages and kills ganglion cell axons at the optic disk, where they leave the eye and enter the optic nerve.
Types of Glaucoma
1) Open-angle Glaucoma
2) Angle-closure Glaucoma
3) Normal Tension Glaucoma
4) Developmental Glaucoma
5) Pigmentary Glaucoma

Both open-angle and angle-closure glaucoma can be primary or secondary conditions.


Open-Angle Glaucoma
Most common form of Glaucoma

Drainage angle formed by the cornea and the iris remains open.

The drainage channels (trabecular meshwork) in the angle are partially blocked, causing the fluid to drain out of the eye too slowly.

This causes fluid to back up in your eye, and pressure gradually increases.

The exact cause of primary open-angle glaucoma remains unknown.
Clinical Manifestations of Open-angle Glaucoma
Typically no early warning signs or symptoms

Develops slowly and sometimes without noticeable sight loss for many years.

Initial loss of vision is of peripheral vision

Visual acuity is maintained until late in the disease.

Tunnel vision in the advanced stages
Angle-Closure Glaucoma
Occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and the iris.

Fluid can't adequately flow through and exit your eye, and your eye pressure may increase abruptly.

Angle-closure glaucoma usually occurs suddenly (acute) but it can also occur gradually (chronic).

Some people with an abnormally narrow drainage angle may be at risk of developing angle-closure glaucoma.
Clinical Manifestations of Angle-Closure Glaucoma
Hazy or blurred vision
The appearance of rainbow-colored circles around bright lights
Severe eye and head pain
Nausea or vomiting
Sudden sight loss
Reddening of the eye
Symptoms are very noticeable and damage occurs quickly
Diagnostic Tests
Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma.

A complete eye exam includes five common tests to detect glaucoma:

Tonometry: examines the inner eye pressure
Ophthalmoscopy (dilated eye exam): examines the shape and color of the optic nerve
Perimetry (visual field test): examines the complete field of vision
Gonioscopy: Examines the angle in the eye where the iris meets the cornea
Pachymetry: a simple, painless test to measure the thickness of your cornea. Corneal thickness has the potential to influence eye pressure readings

Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

What does IOL stand for and what is it's purpose?
An IOL, or intraocular lens, is an artificial lens, permanently implanted in a person's eye to replace the natural one affected by a cataract
Nursing Diagnoses & Care
As a nurse, you want to first assess the patient to determine if they likely have glaucoma (patient history, physical & psychosocial)


Can anyone tell us how cataracts is formed?
Cataracts
Cataracts is formed when the proteins of the eye clump together and form a cloudy area in the eye.
Question
What is the cause of open-angle Glaucoma?
a) The drainage channels are blocked off, which does not allow the fluid to flow out of the eye at all

b) The drainage channels in the angle are partially blocked, causing the fluid to drain out of the eye too slowly.

c) Increased intercranial pressure

d) The iris bulges forward to narrow or block the drainage angle formed by the cornea and the iris.
Etiology of Glaucoma
Increased intraocular eye pressure
Blunt or chemical injury to the eye
Severe eye infection
Blockage of blood vessels in the eye
Inflammatory conditions of the eye
Eye surgery for another eye condition
Primary Health Care Principles

Accessibility - does everyone have access to eye health care?

Health promotion - how can eye health be promoted?

Appropriate technology - what are current technological deficits in eye care?

Community participation - how can the community facilitate better eye health?

Partnerships - who can nurses partner with to promote eye health?


Key Points
Cataracts is the clumping of proteins in the eye causing cloudy vision
Glaucoma is damage to the optic nerve due to increased IOP
Obtaining a baseline visual acuity and measuring its changes with your eye care professional is key
Cataracts can be "cured" through surgery, while glaucoma can only be managed
Non-surgical options: new eyeglasses/contacts, brighter lighting, anti-glare sunglasses, magnifying glasses for reading, etc.
Managing Risk Factors
regular eye appointments
healthy diet/exercise
eye protection
b) The drainage channels in the angle are partially blocked, causing the fluid to drain out of the eye too slowly.
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