Cataracts


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Cataracts Essay, Research Paper

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Cataracts In Elderly

Introduction

What is a cataract? A cataract is a cloudy or opaque area in the normally

transparent lens of the eye. Its effect on vision depends on the extent of the cloudiness.

Small spots in the lens may cause little or no vision loss. As the opacity thickens, it

prevents light rays from passing through the lens and focusing on the retina, the light

sensitive tissue lining the back of the eye. Early lens changes or opacities may not disturb

vision. But as the lens continues to change, several specific symptoms including blurred

vision; sensitivity to light and glare; increased nearsightedness; or distorted images in

either eye, may develop. Cataracts are usually associated with aging. As a person grows

older, the lens becomes less flexible and loses some of its ability to focus light onto the

retina. As the lens becomes harder, it tends to develop cataracts. Cataracts can eventually

become milky white and fill the lens. The patient is then considered blind. Doctors do not

know how to prevent or cure most types of cataracts. But surgery to remove the diseased

lens can improve vision for most cataract patients. After such surgery, some patients.

After such surgery, some patients must wear strong glasses or contact lenses to see well

enough to carry on normal activities. In most cases, however, surgeons replace the

diseased lens with a plastic intraocular lens. A patient who receives an intraocular lens

may or may not need glasses or contact lenses to see well.

Physiology Of A Normal System

The eye normally consist of a lens that is located behind the iris, the colored

portion of the eye, and the pupil, the dark center of the eye. Tiny ligaments, called

zonules, support the lens capsule within the eye (American Academy of Ophthalmology,

10). The lens has three parts, the capsule, the nucleus, and the cortex. The outer

membrane, or capsule, surrounds the cortex which in turn surrounds the center or nucleus

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of the lens. If you imagine the lens as a piece of fruit, the capsule is the skin, the cortex is

the fleshy fruit, and the nucleus is the pit (American Academy of Ophthalmology, 10).

There are various ways to help prevent cataracts, but it has been found that if

people would “watch their weight they might see.” Evidence shows that what the scale

says really can affect a persons future. This time, research suggests that lower weights

could mean clearer vision (Wilson, 1996, 28). When scientist studied the eyes of 17, 764

men for five years, they saw that the guys who were the heaviest were nearly twice as

likely to get cataracts as were the lightest guys (Archives of Opthalmology, September,

1995). So considering that cataracts are the leading cause of blindness in the world,

cutting risks in half is a big deal (Wilson, 1996). For now, it’s a smart thing to eat a diet

that will keep you at a disease fighting trim weight so that the good normal eye can stay

healthy.

Pathophysiology

The lens of the eye is usually transparent, so the light can pass through it.

Biochemical changes may occur within the lens, or trauma may cause fiber changes that

cause the lens to become cloudy and finally opaque, thus blocking the light rays from

reaching the retina (Long, 1993, 1313). A mature cataract is one that separates easily

from the lens capsule. It used to be thought that a cataract had to be mature before it

could be extracted. Now they can be removed whenever the vision loss interferes with the

persons activities of daily living. Cataracts may develop in both eyes, such as with senile

cataracts, but usually they do not develop at the same time (Long, 1993, 1313).

Interview and Case Study

Mrs. M.A. Williams, a very independent 81-year-old widowed woman, under went

cataract surgery on her left eye in 1987. She said “the right one had a small cataract on it

and has not gotten any worse so I get a general check up on it once a year. My vision has

improved to were I can read everything but fine print without my glasses.”

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She has a pair of reading glasses to read the fine print, but says “I have really good sight

for being 81 years old almost 82.” She reported to Dr. Fry’s office the day before the

surgery and they gave her drops to put in that night. She stayed in a motel in Garden City

and went in the next day for surgery. She went for a postoperative check-up with her

surgeon, Dr. Fry, one day following surgery. She cheerfully said, “now I am one in six

hundred members of “The Cataract Club,” which has a convention for follow-up

information for us once a year in Garden City, Kansas.”

Medical Treatment

There are many different types of treatment for cataracts, but some have proven to

be more affective than others. As you grow older, you need more light, whether you have

vision problems or not (Larson, 1996). Different types of eyeglasses such as bifocals or

trifocals that are stronger than normal may better help an elderly person to see in the early

stages of cataracts. There are also many magnifiers that come in many different styles

these can be hand-held, freestanding, mounted on a headband, or worn around the neck.

Everything from magnifiers to items such as clocks, telephones, playing cards that have

extra large letters or numbers, and large size game boards are available from mail order

catalogs and stores throughout the United States (Larson, 1996).

Cataract surgery is really considered to be the best of all treatments. Before a

patient can have this surgery their eye physician and surgeon should have concurrently

agreed that this is medically possible for that particular patient. The patients eye will be

measured to determine the proper power of the intraocular lens that will be placed in their

eye during surgery (American Academy of Ophthalmology, 5). The day of surgery the

patient is brought in on an outpatient basis. They are then given eye drops, and

medication to help them relax. A local anesthetic makes the operation painless. Though

they may see light and movement, they will not be able to see the surgery while it is

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happening, and will not have to worry about keeping their eye open or closed (American

Academy of Ophthalmology, 5). After the operation the surgeon places a guard over the

eye. After a short time in the recovery room the patient is ready to go home.

“Cataract surgery is probably the best rehabilitative operation n all of medicine,”

says Dr. Zarbin (Miller, 1996, 51)

After cataract surgery, a patients vision might gradually decrease because of a thin

membrane (the posterior lens capsule) within the eye becoming clouded (Larson, 556).

The posterior lens capsule is left in the eye during most cataract surgeries because it

supports the implanted lens and is safer for the eye. If the capsule is causing clouding of

vision it may be treated with laser. There can be many other reasons for decreased vision

so people should stay in close contact with their ophthalmologist (Larson, 556).

Cataract surgery is usually done in less than an hour under local anesthesia. In the

first form of lens extraction call extracapsular cataract extraction, the surgeon would make

an incision where the cornea and sclera meet. Then he would carefully enter through that

incision and open the front of the capsule and remove the nucleus of the lens (American

Academy of Ophthalmology, 3). Finally he would enter with a microscopic instrument

and suction out the soft lens cortex, leaving the capsule in place. Now with the newest

form of lens extraction, called phacoemulsification, ultrasound vibrations break apart the

cataract. The surgeon then suctions out the small pieces through an incision less than

one-half inch long (Mayo Clinic Health Letter, 1995, 3)

The next question one might ask is, when is the laser used? If for some reason the

posterior capsule turns cloudy several months or years following the operation. If this

causes a persons vision to blur, the surgeon can make a painless, clear opening in the

center of the membrane with a laser (American Academy of Ophthalmology, 6). Laser

surgery is never part of the original cataract operation (American Academy of

Ophthalmology, 6).

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The final wonder that cross each cataract patients mind is, will cataract surgery

improve my vision? Over 95% of cataract surgeries improve vision, but a small number

of patients may have problems. Symptoms including infection, bleeding and swelling or

detachment of the retina are some of the more serious complications that may affect their

vision (American Academy of Ophthalmology, 6). These patients should call their

physician if they have any of the following abnormal symptoms: pain not relieved be

medication, loss of vision, nausea, vomiting, excessive coughing, or injury to the eye.

Nursing Care

Assessment

Subjective and objective data must include the following: Acquired cataracts,

either from aging or disease, usually develop gradually (Long, 1993, 1313). The main

symptom is gradual loss of vision; the extent of the loss depends on were the cataract is

located and the opacity of the cataract. People with an opacity in the center of the lens

can see better in dim light, when the pupil is dilated. The people with presbyopia can

possibly read without glasses in the early stages because of myopia. People who wear

glasses may continually think that they are dirty and clean them a lot because they can’t see

as good as usual, this is a common complaint which cause the elderly to seek medical

advise. If cataracts result from trauma, then blurring may be immediate (Long, 1993.)

Diagnosis, Goals, Interventions, and Evaluations

1. Body image disturbance related to negative self image inappropriate use of

cosmetics, inappropriate dress in light of safety and comfort, reluctance or refusal to wear

corrective lenses, and unwillingness to acknowledge physical changes associated with

aging. The pt will develop a client-managed plan of care to address the need of the altered

body structure and function. The nurse will talk with the pt about the meaning of the

altered body structure and function. Each client may have a unique perspective of the

alteration and its significance.

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2. Ineffective individual coping related to inability to solve problems or adapt to

demands of daily living as manifested by disheveled appearance, frequent accidents,

hypersensitivity to normal aging process, inability to meets basic needs, isolation poor

personal hygiene, and reports of increased stress in daily life. The pt will verbalize an

understanding of the events that trigger ineffective coping. The nurse will identify support

systems and how these systems are perceived to function. The support from others can

increase the client’s ability to cope.

3. Anticipatory grieving related to perceived potential loss of eye as manifested by

altered activity level, altered communication pattern, anger, changes in sleep pattern,

denial of significance of potential loss, difficulty taking on new or different roles,

expression of distress, expression of guilt, sorrow, and altered libido. The pt. will express

emotions of grief. The nurse will teach personal coping skills to the pt. The level of

individual coping may be predictive of ability to face and do grief work.

4. Health maintenance alteration related to perceptual or cognitive impairment as

manifested by impaired perceptual or cognitive functioning, impaired short or long term

memory, inability to concentrate or follow instructions, lack of adaptive behaviors to

internal or external environmental changes, and lack of interest in health maintenance. The

pt. will make responsible decisions and follow through to maintain or enhance health. The

nurse will identify the pts. ability to learn health related skills and information. Serves as a

basis for determining teaching approach and content.

5. Risk for injury related to lack of awareness of environmental hazards. The pt

will willingly use safety precautions when at risk for injury. The nurse will identify with

pt. and family internal and external factors that place client at risk for injury. By

eliminating these factors the pt. can remain free of injuries

6. Visual sensory or perceptual alteration related to altered sensory reception,

transmission, or integration as manifested by altered conceptualization, anger, anxiety,

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change in behavioral pattern, change in response to visual stimuli, and clinical evidence of

impaired visual ability. The pt. will learn ways to compensate for sensory impairments.

The nurse will verbally explain all things to the pt with visual deficits. This will assist the

client to be more in control of his environment.

Conclusion

What is a cataract? Through these various studies one may have learnt many new

things about cataracts; how they affect the normal eye, a personal experience of cataract

surgery, the various treatments, and most of all how nurses can be a part of this diagnosis

and prevention process. Knowing this information hopefully will help other elderly people

understand the signs and symptoms to look for cataracts and ways that cataracts can be

prevented. About half of Americans between ages 65 and 74, 70% of those older than age

75, have cataracts (Mayo Clinic Health Letter, 1995, 3).

Bibliography

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References

American Academy of Ophthalmolgy. (1996-1997). Eyenet. Eye Conditions &

Diseases. 1-11, http://www.eyenet.org/public/faqs/cataract/cat_prevention.html.

Larson, D. E. (1996). Mayo Clinic Family Health Book, 2nd Ed. 238-239, 266,

553-556.

Long B., Phipps W., Cassmeyer V. (1993). Medical Surgical Nursing, 3rd Ed.

1313.

Mayo Clinic Health Letter. (Oct. 1995). Vision and Your Eyes. 1-8.

Miller, M. (July 1996). Your Aging Eyes. Better Homes and Gardens. 46, 48,

50-51.

Wilson, K. (March 1996). Weight and See. Prevention. 26, 28, 30.

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