Silent Stealers of Sight

As seen in the Consultant Connection June - July 2014 Issue
By; Irene Sours, RN, WCC

Vision loss among the elderly is a major health problem.  Approximately one person in three has some form of vision-reducing eye disease by the age of 65.  The most common cause of vision loss among the elderly is age-related macular degeneration, glaucoma, cataract and diabetic retinopathy.  These diagnoses have been referred as “silent stealers of sight” because they progress so gradually that they are frequently unnoticed until vision loss has become severe.  Like so many medical conditions, early detection is key to effective treatment. 
Four leading eye diseases:
  • Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. AMD affects the macula, the part of the eye that allows seeing fine detail and is characterized by the loss of central vision.
There are two types: wet and dry. Wet AMD happens when abnormal blood vessels grow under the macula. These new blood vessels often leak blood and fluid. Wet AMD damages the macula quickly. Blurred vision is a common early symptom. Dry AMD happens when the light-sensitive cells in the macula slowly break down.  A common early symptom is that straight lines appear crooked.  Risk factors include smoking, excessive sunlight exposure and family history. 
  • Cataract is a common cause of vision impairment among the elderly, but surgery is often effective in restoring vision. Cataract is the 5th most common chronic condition in adults over age 75.  Resident with visually significant cataracts may complain of blurred vision or glare.  Cataract progression is typically slow, with gradual loss of vision over months to years.  Exposure to ultraviolet light may contribute to the progression of cataract formation.
  • Diabetic retinopathy is the most common diabetic eye disease and a leading cause of vision loss and blindness in American adults age 65 and older.  Diabetic retinopathy may be classified as early or advanced depending on the symptoms.  Symptoms may include the following: spots or dark strings floating (floaters), blurred vision, fluctuating vision, dark or empty areas in their vision, vision loss and difficulty with color perception.  Diabetic retinopathy usually effects both eyes.
  • Glaucoma is a potentially serious form of eye disease.  The majority of cases of glaucoma are open angle glaucoma (95%).  Increased intraocular pressure leads to atrophy and cupping of the optic nerve head causing visual field deficits that can progress to blindness.  Vision changes include loss of peripheral vision, intolerance to glare, decreased perception of contrast and decreased ability to adapt to the dark. 

Safety is a major concern for or elderly residents in our facilities with vision impairment.  Low vision loss can affect resident quality of life if interventions are not implemented.

Nursing care strategies include the following:
  • Avoid disruption in the management of chronic eye conditions by obtaining past history and assuring continuation of ongoing regimens, such as eye drops for glaucoma.
  • Encourage the use of good lighting in resident rooms.  Avoid glare whenever possible.
  • Encourage the use of the resident’s eyeglasses.  Have family provide lighted magnification if needed (these are the large magnifiers with a light attached).
  • Add contrast to the fixtures in the room if light switches blend into the wall or faucets blend into the sink.
  • Encourage annual eye exams either with Optometrist or Ophthalmologist.
  • Annual dilated exam for resident with diabetes and hypertension by ophthalmologist. 
  • Notify the primary care provider of any acute change in vision:
    • Sudden hazy or blurred vision
    • Double vision
    • Seeing flashes of light
    • Seeing halos around lights
    • Unusual, even painful, sensitivity to light or glare
    • Changes in the color of the iris
    • Sudden development of persistent floaters
    • Recurrent pain in or around the eye
Vision loss threatens older adults’ independence and quality of life. By being aware, the interdisciplinary team can be proactive in helping individual residents with vision problems live a safe and productive life in our facilities.

Treating Low Vision by Eleanor Faye, MD, FACS

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