1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17: Vision

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Vision and the Older Adult Visual function and performance of ADLs Safety considerations Quality of life Gradual age-related changes Compensatory mechanisms Effect of disease processes

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Changes That Affect Vision Eye Appearance and Tear Ducts –Minimal effect on actual vision –Arcus senilis –Enophthalmos –Blepharochalasis –Ectropion/Entropion –Dry eyes

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Changes That Affect Vision (cont’d) Changes in the Eye –Cornea –Lens –Iris –Pupil –Ciliary body –Vitreous –Retinal-neural pathway

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about age-related changes that affect vision is true? A. Gradual age-related changes in vision have an immense impact on the older adult’s quality of life. B. Age-related changes affect all the structures involved in visual function. C. The size of the pupil enlarges, which causes more light to reach the retina. D. Arcus senilis is a rare age-related change associated with protein accumulation.

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. Age-related changes affect all the structures involved in visual function. Rationale: Age-related changes affect all the structures involved in visual function and alter visual perception for the older adult. In the absence of disease processes, these gradual changes have only a subtle impact on the daily activities of the older person.

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Age-Related Changes on Vision Age-related changes in vision as a biomarker of aging Age-related visual changes are universal. Visual impairment Compensatory mechanisms

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Age-Related Changes on Vision (cont’d) Presbyopia: loss of accommodation Diminished visual acuity Delayed dark and light adaptation Increased sensitivity to glare Reduced visual field

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Age-Related Changes on Vision (cont’d) Diminished depth perception Altered color vision Diminished critical flicker fusion Slower visual information processing

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Presbyopia is best described as: A. The loss of accommodation B. Diminished visual acuity C. Delayed reaction to changes in light D. A reduction in the visual field

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. The loss of accommodation Rationale: 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-50s.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Opacification and yellowing of the lens cause an altered perception of which colors? A. Red and orange B. Blue and green C. Brown and black D. Yellow and white

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. Blue and green Rationale: Age-related changes that interfere with retinal illumination − including opacification of the lens, pupillary miosis, and retinal or retinal-neural changes − can interfere with accurate color perception. Opacification and yellowing of the lens interfere most directly with shorter wavelengths, causing an altered perception of blues, greens, and violets.

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors That Affect Visual Wellness Environmental factors Smoking Chronic conditions Medications

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Cataracts Leading cause of visual impairment in older adults Cataract formation Risk factors Actual changes in vision Treatment

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Macular Degeneration Leading cause of severe vision loss in older adults Risk factors Types Signs and symptoms Effects on vision Treatment

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Glaucoma Second leading cause of blindness in the United States Role of aqueous humor and damage to the optic nerve Types Signs and symptoms Treatment

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Mrs. W. complains of a loss of peripheral vision. Which of the following should she be evaluated for? A. Cortical cataracts B. Nuclear cataracts C. Macular degeneration D. Glaucoma

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: D. Glaucoma Rationale: The term glaucoma refers to a group of eye diseases in which the ganglion cells of the optic nerve are damaged by an abnormal build-up of aqueous humor in the eye. Damage to the optic nerve then causes a loss of peripheral vision.

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Functional Consequences Affecting Visual Wellness Effects on Safety and Function –ADLs –IADLs –Changes in gait, balance, and postural stability –Increased risk of falls and injury

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Functional Consequences Affecting Visual Wellness (cont’d) Effects on Quality of Life –Withdrawal from normal activities –Decreased psychological well-being –Fear –Negative attitudes –Hopelessness

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Functional Consequences Affecting Visual Wellness (cont’d) Effects on Driving –Safety –Independence –Consequences while driving for the older adult with vision impairment

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Consequences of visual impairment while driving include all the following except: A. Slower dark and light adaptation B. Interference with peripheral vision C. Increased illumination with tinted windows D. Difficulty with perception of the colors of traffic lights

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: C. Increased illumination with tinted windows Rationale: Consequences of visual impairment while driving include slower dark and light adaptation, a decrease in peripheral vision, and interference with the perception of red and green traffic lights in bright sunlight. There is actually a diminished illumination in cars with tinted windows.

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Assessment of Vision Goals of assessment Interviewing about vision changes Assessment of usual eye care practices Early detection of disease Identification of risk factors Observing cues to visual function Utilization of vision tests

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Disturbed Sensory Perception: Visual Anxiety Ineffective Coping Self-Care Deficit Risk for Injury Impaired Social Interaction Readiness for Enhanced Coping Readiness for Enhanced Self-Care

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning for Wellness Outcomes Vision compensation behavior Sensory function: vision Coping Adaptation to physical disability Self-care: ADLs

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning for Wellness Outcomes (cont’d) Stress level Knowledge: personal safety Fall prevention behavior Risk control: visual impairment

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Visual Wellness Health Promotion for Visual Wellness –Elimination or reduction of risk factors –Smoking cessation –Visual examinations –Use of educational materials for teaching

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Visual Wellness (cont’d) Comfort Measures for Dry Eyes –Over-the-counter remedies –Cold compresses –Wraparound glasses –Humidification –Avoidance of irritants

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Visual Wellness (cont’d) Environmental Modifications –Proper lighting –Color contrast –Reduction of glare

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Visual Wellness (cont’d) Low-Vision Aids –Best when used to improve focus, contrast, magnification, or illumination –Used in conjunction with environmental modifications –Specific examples of low-vision aids

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Visual Wellness (cont’d) Maintaining and Improving Quality of Life –Interventions that allow compensation for visual changes –Increased ability to perform activities that enhance function –Support groups

34. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluating Effectiveness of Nursing Interventions Observation of compensatory behaviors Assessment for improvement of independence Evaluation of quality of life and ability to participate in activities Referrals for vision services

35. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins