GERIA WARD

CLASS

VISION
 OBJECTIVES
1. Explain the importance of good vision and the impact of visual
deficits on older adults.
2. Describe the effects of aging on vision
3. List measures to promote healthy vision in older adults
4. Identify signs of and nursing interventions for older adults with
cataracts, glaucoma, macular degeneration, detached retina,
and corneal ulcers.
Good vision and hearing are extremely valuable assets as it helps
people to protect themselves and the ability to hear and see
facilitates accurate perception of the environment. In addition, social
interaction, sharing of experiences, and exchange of feelings are
more complete when vision and hearing are intact. Through
communication, people share joys and burdens, derive feelings of
normalcy, validate perceptions, and maintain a link with reality.

Gerontological nurses must be aware of the factors that influence

sensory function in older adults and help to ensure that vision and
hearing problems are properly evaluated and corrected when possible.
 EFFECTS OF AGING ON VISION

Presbyopia – the gradual loss of ability to adequately focus on nearby

objects due to the reduced elasticity and stiffening of the muscle fibers
of the lens that begins in the fourth decade of life. This is a factor that
requires most older people to use some form of corrective lenses.

Visual acuity declines due to:

(1) reduced pupil size
(2) opacification of the lens and vitreous
(3) loss of photoreceptor cells in the retina
 EFFECTS OF AGING ON VISION

Light perception threshold decreases causing difficulty with

vision at night and in dimly lit areas
Dark and light adaptation takes longer
Sensitivity to glare increases due to cataract formation
Depth perception becomes distorted making judgment of the
height of walking surfaces challenging
Reduced peripheral vision
Drier eyes due to less tear production
 EFFECTS OF AGING ON VISION

Approximately half of all individuals identified as legally blind each

year are 65 years or older. Visual limitations can make
communication problematic due to misinterpretation of facial
expressions and gestures.

Remaining aware of current events through newspapers

and socialization are difficult.
SENSORY HEALTH PROMOTION
PROMOTING VISION
Corrective lenses
Routine and thorough eye examinations (e.g., tonometry)
Nurse discusses the importance of annual eye examination
Evaluate older adult’s financial ability to afford services
Nurse should review diet to ensure adequate intake of nutrients that
promote good vision
SENSORY HEALTH PROMOTION
PROMOTING VISION
Arteriosclerosis and Diabetes can damage the retina
Nutritional deficiencies and Hypertension can result in visual impairment
Evaluate symptoms that could indicate a visual problem
(1) Burning or pain in the eye
(2) Blurred or double vision
(3) Redness of the conjunctiva
(4) Spots
(5) Headache
SENSORY HEALTH PROMOTION
VISUAL DEFICITS
CATARACT
DEFINITION: Clouding of the lens or its capsule that causes the lens to lose its
transparency.
Exposure to UVB increases risk; importance of wearing sunglasses
Diabetes, smoking, high alcohol consumption, and eye injury are factors
EVERYONE develops some degree of lens opacity with age but more severe with
significant exposure to sunlight
SYMPTOMS: distorted vision, decreased night vision, objects appear blurred, nuclear
sclerosis (lens becoming yellow/yellow-brown), color of pupil changes from black to
cloudy white, increased nearsightedness
TREATMENT: Cataract surgery is the only cure for cataract
VISUAL DEFICITS
NURSING RESPONSIBILITIES
Sunglasses, sheer curtains over windows, furniture placed away from bright
light, and several soft lights instead of a single bright light source minimize
annoyance from glare
Place items within the visual field of the unaffected eye (food tray, furniture,
frequently used objects)
Reassure older patients and their families that age is no deterrent to cataract
surgery
The simple surgery and several weeks of rehabilitiation can result in years of
improved vision and consequently, a life of higher quality
Avoid use of low-tone colors and attempt to use bright ones
CATARACT
VISUAL DEFICITS
GLAUCOMA
DEFINITION: A degenerative eye disease in which the optic nerve is damaged from an
above-normal intraocular pressure (IOP).
A major eye problem in older adults
One of the leading causes of blindness in this population
Tends to occur in people over 40
Exact cause is unknown but associated with increased lens size, iritis, allergy,
endocrine imbalance, emotional instability, and family history of this disorder
Anticholinergics can exacerbate glaucoma due to pupil dilation effects
VISUAL DEFICITS
Acute Glaucoma (closed-angle or narrow-angle glaucoma)

Diagnosed through tonometer in the anesthetized cornea to measure IOP

(20-25 mmHg = potential glaucoma) and,
Gonioscopy that uses contact lens and a binocular microscope to differentiate
closed-angle from open-angle glaucoma
SYMPTOMS: severe eye pain, headache, nausea, vomiting, edema of ciliary body,
pupil dilation, blurred vision, and blindness if not corrected within a day.
TREATMENT: carbonic anhydrase inhibitors, iridectomy
VISUAL DEFICITS
Chronic Glaucoma (open-angle glaucoma)

More common than acute glaucoma

Occurs gradually
SYMPTOMS: peripheral vision slowly but increasingly impaired, bump or know over
items at their side, may need to change eyeglasses frequently, tired feeling in
eyes, headaches, misty vision, seeing halos around lights – symptoms are more
pronounced in the morning, cloudy cornea, fixed and dilated iris
Same diagnostic procedures with acute glaucoma
TREATMENT: Miotic and carbonic anhydrase inhibitor, surgery
*Glaucoma screening is important for chronic glaucoma can be asymptomatic until
an advanced stage.*
VISUAL DEFICITS
NURSING RESPONSIBILITIES

Avoid any situation/activity that increases IOP

Prevent physical straining and emotional stress
Mydriatics, stimulants, and agents that elevate the blood pressure must not
be administered
Make the patient carry a card or wear a bracelet indicating their problem to
prevent mistakes when they are unconscious or unable to communicate
Nurses need to teach patients about the importance of compliance with its
care

GLAUCOMA
VISUAL DEFICITS
MACULAR DEGENRATION
IDEFINITION: Involves damage or breakdown of the macula which results in a loss of
central vision
Most common cause of blindness in people over 65
Most common form: involutional macular degeneration
Causes: associated with aging process; can also result from injury, infection, or
exudative macular degeneration
SYMPTOMS: A loss of central vision accompanies macular degeneration
TREATMENT: laser therapy but involutional type does not respond well to this
procedure; magnifying glasses, high intensity reading lamps, and other aids help
patients
VISUAL DEFICITS
DETACHED RETINA
DEFINITION: A forward displacement of the retina from its normal position against the
choroid.
SYMPTOMS: can be gradual or sudden; perception of spots moving across the eye,
blurred vision, flashes of light, and a feeling that a coating is developing over the eye,
blank areas of vision progress to complete loss of vision
Severity of symptoms depends on degree of detachment. There is usually no pain.

TREATMENT: bed rest and use of bilateral eye patches for maximun amount of
“reattachment”, surgery may be planned (electrodiathermy, cryosurgery, scleral
buckling, photocoagulation), minority of patients undergo second procedure
VISUAL DEFICITS
NURSING RESPONSIBILITIES
Initial measures can be frightening to the older patient, who may react with
confusion and unusual behaviour,
Nurse should help patient feel secure as possible with frequent checks and
communication
Easy access to call light or other means of assistance
Full and honest explanations will help provide a sense of well-being
Patient needs frequent verbal stimuli to minimize anxiety and enhance
psychological comfort
Physical and emotional stress must be avoided
It is important for patient to understand the importance of periodic examination
for some patients later suffer detached retina in the other eye
DETACHED RETINA
VISUAL DEFICITS
CORNEAL ULCER
DEFINITION: Inflammation of the cornea, accompanied by a loss of substance
febrile states, irritation, dietary deficiencies, lowered resistance, and
cerebrovascular accident tend to predispose this problem
extremely difficult to treat in older persons and may scar or perforate
leading to corneal destruction and blindness
SYMPTOMS: affected eye may appear bloodshot and show increased
lacrimation, pain, and photophobia
TREATMENT: Cyclopegics, sedatives, antibiotics, and heat, corneal
transplants
VISUAL DEFICITS
NURSING RESPONSIBILITIES

Advice patient to seek prompt assistance for any irritation, suspected

infection, or other difficulty with the cornea as soon as it is identified
Cyclopegics, sedatives, antibiotics, and heat may be prescribed to treat
a corneal cancer
Make patient wear sunglasses to ease discomfort associated with
photophobia

CORNEAL ULCER
 A

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