1. SENSIONEURAL FUNCTION DISORDERS
NS 202A
Debra Dickinson

2. Impaired Vision Refractive errors Vision Impairment & blindness
Promoting coping efforts
Occupational therapy for spatial orientation and mobility
Braille, Print magnification, computer-assisted speech output
Service animals

3. Cataracts lights passes through cornea pupil lens
Geratrics Eye & Ear
10/9/2017
Cataracts
Part of the aging process
Clouding of the eye’s naturally clear lens
Effects approximately 1/2 of Americans ages 65-75
Normal vision
lights passes through cornea pupil lens
lens focuses light rays on the retina (the layer of light-sensing cells lining the back of the eye) to produce a sharp image of what we see
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4. Geratrics Eye & Ear
10/9/2017
Cataracts
Lens becomes cloudy, light rays cannot pass through it easily
Risk factors
age, diabetes, family history, previous eye injury, medications (corticosteroids), excessive alcohol, excessive sunlight exposure, smoking
some evidence that antioxidant vitamin supplements including vitamin C and E may play role in reducing risk of cataract
CScudmore

5. Geratrics Eye & Ear
10/9/2017
Cataracts
can develop in one or both eyes and may or may not affect an entire lens
symptoms
Blurred (cloudy) or dimmed vision, poor night vision, sensitivity to light and glare, reduced distance vision, need brighter lighting for reading and other activities, double vision
blinking
CScudmore

6. Treatment of Cataracts
Geratrics Eye & Ear
10/9/2017
Treatment of Cataracts
Treatment
Glasses, stronger bifocals, use of magnifying glass, surgery
Surgery allows lens implant brings light rays into proper focus upon the retina
usually outpatient procedure
local anesthesia typical
microsurgery (takes out the cataract but leaves much of eye’s natural lens capsule in place (the capsule helps support an artificial replacement lens that’s inserted)
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7. Geratrics Eye & Ear
10/9/2017
Cataract Surgery
A small opening is made in the front of the capsule that holds the natural lens
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8. Geratrics Eye & Ear
10/9/2017
Cataract Surgery
Ultrasound procedure (phacoemulsification) 3mm incision
the probe dissolves the cataract, allowing it to be gently vacuumed from the eye.
FDA approved use of laser (instead of ultrasound) to dissolve cataract along with the 1/8 inch incision to insert the folded implant.
CScudmore

9. Geratrics Eye & Ear
10/9/2017
Cataract Surgery
By using soft material that can be folded, the artificial lens (intraocular lens made of inert materials) can be inserted inside the eye through the original surgical incision.
CScudmore

10. Geratrics Eye & Ear
10/9/2017
Cataract Surgery
The lens unfolds to fill the capsule much as the natural lens of the eye had done prior to cataract surgery.
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11. Cataracts Post-op eye mildly inflamed
Geratrics Eye & Ear
10/9/2017
Cataracts
Post-op
eye mildly inflamed
feel a little scratchy and irritated for a few days
patient wears a patch for first 24 hours
return visit day after surgery
CScudmore

12. Treatment of Cataracts
Geratrics Eye & Ear
10/9/2017
Treatment of Cataracts
Post-op
patch removed at first visit
several more return visits over next 4-6 weeks
wear sunglasses outside
do not rub eye
improvement in vision gradual
Post-op complications
bleeding, swelling, inflammation, infection or retinal detachment
CScudmore

13. Treatment of Cataracts
Geratrics Eye & Ear
10/9/2017
Treatment of Cataracts
Post-op
call MD for any of following:
loss of vision, pain not relieved by OTC medication, marked increase in eye redness, light flashes or multiple new spots before your eye, nausea, vomiting or excessive coughing
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14. Geratrics Eye & Ear
10/9/2017
Eye
Optic nerve cells (made up of many nerve fibers) transform the light entering the eye into electrical impulses that are understood by the brain
Glaucoma
Group of eye diseases all which involve progressive damage to the optic nerve
Leading cause of blindness in world
CScudmore

15. Geratrics Eye & Ear
10/9/2017
Glaucoma
Clear liquid (aqueous humor) circulates inside front portion of eye.
Small amount of aqueous humor is produced constantly
Equal amount flows out of eye through a microscopic drainage system (maintains a constant level of pressure in the eye)
Aqueous humor is not part of tears on outer surface of eye
Eye is a closed structure
If drainage area (drainage angle) blocked, excess fluid cannot flow out of eye and fluid pressure within eye increases (pushes against optic nerve potentially causing damage
Note: Many people develop glaucoma with “normal” eye pressure
CScudmore

16. Glaucoma If enough of these cells die, then some vision may be lost
Geratrics Eye & Ear
10/9/2017
Glaucoma
If enough of these cells die, then some vision may be lost
Measuring only the intraocular pressure to diagnose glaucoma has been proven to be wrong
Diagnosis is made by detecting the presence of ocular tissue damage related to intraocular pressure or decrease blood flow to optic nerve
CScudmore

17. Geratrics Eye & Ear
10/9/2017
Glaucoma
The size of the optic cup is related to the presence or absence of glaucoma
Treatment usually designed to lower intraocular pressure to a level that will no longer damage the optic nerve
CScudmore

18. Most important risk factors of glaucoma
Geratrics Eye & Ear
10/9/2017
Most important risk factors of glaucoma
Age over 60 years
Diabetes
African ancestry
Asian or Eskimo ancestry higher risk for angle-closure glaucoma
Family history
Increased intraocular pressure
Previous eye injuries
Nearsightedness
Extensive steroid use
CScudmore

19. Glaucoma Ophthalmologist evaluation
Geratrics Eye & Ear
10/9/2017
Glaucoma
Ophthalmologist evaluation
Tonometry-measures intraocular pressure
Gonioscopy-inspects drainage area of eye; determines type
Opthalmoscopy-examines optic nerve
Optical coherence tomography-imaging technique which shows cross sectional images of retina
Visual field test-tests the peripheral vision of eyes
variety of possible symptoms such as decreased peripheral vision, decreased ability to perceive motion and recognize color, etc
CScudmore

20. Types of glaucoma Chronic open-angle glaucoma
Geratrics Eye & Ear
10/9/2017
Types of glaucoma
Chronic open-angle glaucoma
The Canal of Schlemm is somehow clogged, fluid does not drain and pressure builds up
Result is build up of IOP which can damage the optic nerve and lead to vision loss
CScudmore

21. Types of glaucoma Open-angle glaucoma
Geratrics Eye & Ear
10/9/2017
Types of glaucoma
Open-angle glaucoma
most people who develop this form notice no symptoms until vision is impaired
peripheral vision loss
Usually responds well to medications
CScudmore

22. Types of glaucoma Angle-closure glaucoma
Geratrics Eye & Ear
10/9/2017
Types of glaucoma
Angle-closure glaucoma
Drainage angle of eye becomes completely blocked.
Iris may drop over and completely close off the drainage angle
Treated with laser or conventional surgery to remove a small portion of the bunched up outer edge of iris.
acute closed angle-closure glaucoma
sudden IOP build up
an emergency because optic nerve damage and vision loss occurs very quickly
nausea, vomiting, rainbow-colored haloes around lights, sudden eye pain, blurred vision, headache
CScudmore

23. Geratrics Eye & Ear
10/9/2017
Types of Glaucoma
Chronic angle-closure glaucoma
may cause vision damage without symptoms
Both angle-closure and open-angle glaucoma can be primary or secondary.
CScudmore

24. Treatment choices for glaucoma
Geratrics Eye & Ear
10/9/2017
Treatment choices for glaucoma
Medications (eye drops) that decrease aqueous humor production
Prostaglandins-increases outflow of aqueous fluid through uveoscleral route
Xalatan
Beta-blockers-reduces production of aqueous humor
Betoptic, betagan, timopotic
Alpha-2 adrenergic agonists- activates receptors in ciliary body, inhibiting aqueous secretion and increasing uveoscleral aqueous outflow.
Alphagan
CScudmore

25. Treatment choices for glaucoma
Geratrics Eye & Ear
10/9/2017
Treatment choices for glaucoma
Medications (eye drops) that decrease aqueous humor production
Carbonic anhydrase inhibitors (drop form; pill form seldom used)-reduces fluid flow into the eye by inhibiting enzyme carbonic anhydrase
Medications (eye drops) that increase outflow of aqueous humor
Miotics-stimulates ciliary muscles, leading to increases in contraction of the iris sphincter muscle (constricts pupil)-seldom used anymore
Pilocarpine
Sympathomimetics-increases rate of fluid flow out of eye and decreases rate of aqueous humor production
Epinephrine
CScudmore

26. Treatment of choices for glaucoma
Geratrics Eye & Ear
10/9/2017
Treatment of choices for glaucoma
Surgery
Open-angle (when meds no longer work)
selective laser trabeculoplasty-modifies the drain thus controlling IOP
Very small burn (opening) made at opening of fluid channel (Schlemm’s canal)
not a cure but helps
Closed-angle
Iridectomy-laser creates hole in iris to improve flow of aqueous fluid to the drainage area
CScudmore

27. Treatment Choices for glaucoma
Geratrics Eye & Ear
10/9/2017
Treatment Choices for glaucoma
If trabeculectomy and medications fail, an aqueous shunt may be required.
Glaucoma drainage device (an implant) creates an alternate aqueous pathway
CScudmore

28. Hearing loss in the geriatric population
Geratrics Eye & Ear
10/9/2017
Hearing loss in the geriatric population
1/3 of U. S. adults over 65 (nearly 10 million people) are hearing impaired
Noise-induced hearing loss
Conductive hearing loss
Sensorineural loss is mostly age-related hearing loss results from damage to cochlea or vestibulocochlear nerve
CScudmore

29. Hearing loss Speech deterioration Fatigue, Indifference
Social withdrawal, Insecurity
Indecision and procrastination
Suspiciousness, False pride
Loneliness and unhappiness
Tendency to dominate conversations

30. Communication Chart 64-4 Hearing impaired with speech difficulty
Hearing impaired and reads speech

31. Aural Rehabilitation Speech (lip) reading Listening skills
Speech training
Implanted Hearing Devices
Hearing Guide Dogs
Hearing Aids

32. Hearing Aids Basic styles of hearing aids behind-the –ear in-the-ear
Geratrics Eye & Ear
10/9/2017
Hearing Aids
Basic styles of hearing aids
behind-the –ear
in-the-ear
in-the canal
completely-in-the-canal
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33. Hearing Aids The digital age can reprogram hearing aids from distance
Geratrics Eye & Ear
10/9/2017
Hearing Aids
The digital age
can reprogram hearing aids from distance
requires that hearing aid is interfaced through patient’s home computer attached to modem
software packages temporarily takes control of the modem (costly)
CScudmore

34. Geratrics Eye & Ear
10/9/2017
Future of hearing aids
Studies looking at regenerating tiny hair cells in the ear
Advanced Electron microscopy and Imagery Center (AEMI) at House Ear Institute doing a lot of research as well as other major centers
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