Chapter 19Diseases Affecting Vision and HearingCopyrig.docx

Chapter 19
Diseases Affecting Vision and Hearing
Copyright © 2018, Elsevier Inc. All rights reserved.
Visual impairment has a negative impact on the quality of
lifeMore than two-thirds of those with visual impairment are
older than 65 years of ageThose older than 80 years of age
account for 70% of the cases of severe visual
impairmentSignificant racial and cultural disparities in vision
impairment
Vision Impairments
*
GlaucomaCataractsDiabetic retinopathyDiabetic macular
edemaMacular degenerationDetached retinaDry eye
Diseases of the Eye
*
A clouding of the eye’s normally clear crystalline lens, causing
the lens to lose transparency or scatter lightMost common
causes are heredity and advancing ageCategorized by their

locationNuclear cataract
Most common type
Incidence increases with age and cigarette smokingCortical
cataract
More common with age
Related to a lifetime exposure to ultraviolet lightPosterior
subcapsular
Cataracts
*
Most common symptom is cloudy or blurred visionOther
symptoms include glare, halos around lights, poor night vision,
perceiving that colors are faded or that objects are yellowish,
and the need for brighter light when readingRed reflex may be
absent or may appear as a black area
Signs and Symptoms
*
*
Surgery is the most commonInvolves removing the lens and
placing a plastic intraocular lens (IOL)Usually done on an
outpatient basisNursing interventions includeTeaching
Avoid heavy lifting, straining, or bending at the waist
Wear glasses during the daytime and a shield at nightAdminister
eye drops to aid the healing process and to prevent infection

Treatment
*
Natural fluids of the eye are blocked by ciliary muscle rigidity,
pressure builds, and damage to the optic nerve occursSecond
leading cause of blindness in the United StatesTypes include
congenital glaucoma, primary open-angle glaucoma, low-tension
or normal-tension glaucoma, secondary glaucoma, and acute
angle-closure glaucoma (medical emergency)
Glaucoma
*
Most common formRisk varies by race and ageOther high-risk
groups include those with diabetes, hypertension, history of
corticosteroid use, and family history of glaucoma Usually
affects side vision first and may go unnoticed for years
Primary Open-Angle Glaucoma
*
HeadachesPoor vision in dim lightingIncreased sensitivity to
glareComplaints of “tired eyes” Impaired peripheral visionA
fixed and dilated pupilFrequent changes in prescriptions for
corrective lenses
Signs and Symptoms
*

Occurs when the angle of the iris causes obstruction of the
aqueous humor through the trabecular networkMedical
emergency; blindness can occur in 2 days Those with smaller
eyes, Asians, and women are most susceptibleMay occur with
infection or trauma Symptoms include redness and pain in and
around the eye, severe headaches, nausea and vomiting, and
blurred vision
Angle-Closure Glaucoma
*
Adults older than 65 years of age need annual eye
examinationsThose with medication-controlled glaucoma should
be examined every 6 monthsThose with a family history of
glaucoma and African Americans should be screened annually
after age 40 years
Glaucoma Screening
*
Oral or topical eye drops that lower eye pressureEither decrease
the amount of aqueous fluid produced within the eye or improve
the flow through the drainage angleBeta blockers are the first-
line therapy followed by prostaglandin analogs Second-line
agents include topical carbonic anhydrase inhibitors and α2-
agonistLaser surgery treatments may be recommended
Treatment
*

Complication of diabetesLeading cause of blindness in the
United StatesBlood and lipid leakage leads to macular edema
and hard exudatesNo symptoms occur in the early stagesEarly
findings observed in funduscopic examination are
microaneurysms, flamed-shaped hemorrhages, cotton-wool
spots, hard exudate, and dilated capillaries
Diabetic Retinopathy
*
Annual dilated fundoscopic examination should begin 5 years
after diagnosis of diabetes type 1 and at the time of diagnosis of
diabetes type 2Laser treatment can reduce vision lossStrict
control of blood glucose, cholesterol, and blood pressure
Screening and Treatment
*
Thickening of the center of the retinaLeading cause of legal
blindness Affects 1 in 25 adults age 40 years and older with
diabetesIncidence is higher in African Americans and
HispanicsTreatments include medications (cortisone-type
drugs), laser therapy, and anti-VEGF therapy (Lucentis)
Diabetic Macular Edema
*

Leading cause of vision loss in Americans who are 60 years of
age and olderAge is the greatest risk factorOther risk factors
include genetic predisposition, smoking, hypertension, obesity,
and a family historyCauses progressive loss of central vision,
leaving only peripheral vision intact
Macular Degeneration
*
Geographic atrophy (dry age-related macular degeneration
[AMD])Rapid, severe loss of central vision Many will be legally
blind within 2 years of diagnosisNeovascular AMD (wet
AMD)Occurs when abnormal blood vessels behind the retina
start to grow under the maculaThese new blood vessels often
leak blood and fluid, which raise the macula from its normal
place at the back of the eye
Types of Age-Related Macular Degeneration
*
Causes the progressive loss of central vision, leaving only
peripheral vision intact Awareness of a blurry spot in the
middle of vision; blurred areas grow larger, and blank spots
develop, leading to difficulty reading and writingIncreased need
for bright lightColors appear dim and gray
Signs and Symptoms
*

Amsler grid is used to determine the clarity of visionIn early
AMD, exercise, avoiding smoking and a diet high in green leafy
vegetables and fruits may help keep vision longer Treatment
includes photodynamic therapy, laser photocoagulation, and
anti-VEGF therapy
Screening and Treatment
*
*
Medical emergencyCan occur spontaneously or after recent
cataract surgery or eye traumaExhibits a “curtain coming down”
over the line of vision and a gradual increase in floaters or light
flashesSmall holes or tears are treated with laser surgery or
cryopexy Retinal detachments treated with surgery
Detached Retina
*
Not a disease but a frequent complaint among older
adultsCauses can include medications such as antihistamines,
diuretics, beta blockers, and sleeping pillsCommon treatment is
artificial tears or saline gelManagement includes using a home
humidifier and avoiding wind and hair dryers
Dry Eye
*

Which disorder would the nurse suspect in a patient
complaining of intense headaches, bloodshot eyes, and blurred
vision?
Cataracts
Detached retina
Macular degeneration
Angle-closure glaucoma
Question
*
D—Symptoms of acute angle-closure glaucoma include redness
and pain in and around the eye, severe headaches, nausea and
vomiting, and blurred vision.
Answer
*
*
Use warm incandescent lightingIncrease the intensity of
lightingControl glare by using shades and blindsUse yellow-to-
amber lenses to decrease glareWear sunglasses to block out
ultraviolet lightUse reading materials in large, dark printChoose
sharply contrasting colors

Interventions to Enhance Vision
*
Financial and social governmental programsInsulin-delivery
systemsTalking clocks and watchesLarge print
booksMagnifiersTelescopes with handheld devices or attached
to eye glassesElectronic magnification
Low-Vision–Assisted Devices
*
Vision deficiencies affect communication, functional abilities,
safety, and quality of lifeNursing concernsAppropriate
assessmentEnvironmental adaptation to enhance vision and
safetyCommunicating appropriatelyProviding appropriate health
teachingProviding appropriate referrals for prevention and
treatment
Implications for Gerontology Nurses and Healthy Aging
*
*
Third most chronic condition in U.S. older adultsOf those who
are 80 years of age and older, 80% have hearing lossRacial and

gender disparities exist in hearing impairmentRisk factors
include noise exposure, ear infections, smoking, and chronic
disease (e.g., diabetes, chronic kidney disease, heart disease)
Hearing Impairments
*
Diminishes the quality of lifeIncreases social
isolationDecreases function Increases likelihood of
hospitalizations, miscommunication, depression, falls, loss of
self-esteem, and safety risksIncreases cognitive decline and
dementia
Consequences
*
Conductive lossInvolves abnormalities of the external and
middle ear, which reduces the ability of sound to be transmitted
to the middle earIs caused by otosclerosis, infection, perforated
eardrum, fluid in the middle ear, or cerumen
accumulationSensorineural lossResult of damage to any part of
the inner ear or the neural pathways to the brain Includes
presbycusis and noise-induced hearing loss
Types of Hearing Loss
*
Perception of sound in one or both ears or in the head when no
external sound is presentDescribed as a “ringing in the
ears”May be described as buzzing, hissing, whistling, cricket

chirping, bells, roaring, clicking, pulsating, humming, or
swishing soundsMay be constant or intermittent
Tinnitus
*
Exact cause can be unknownExposure to loud noises is the
leading causeExacerbated by caffeine, alcohol, smoking, stress,
and fatigueHigh-pitched tinnitus common with sensorineural
lossLow-pitched tinnitus reported in Meniere diseaseMaintain a
diary for times when noise is heardAssess medication
historyLifestyle modifications and treatments
Assessment and Treatment
*
Hearing aids to amplify soundCochlear implants to bypass
damaged portions of the ear and stimulate the auditory nerve in
those with sensorineural hearing lossAssisted listening and
adaptive devices
Interventions to Enhance Hearing
*
What information will the nurse include when teaching a patient
about using a hearing aid?
“This amplifies sound and directs it into the ear canal.”
“You will be able to hear better in noisy or crowded rooms.”
“It will assist you to interpret the incoming sounds more

effectively.”
“This will bypass damaged portions of the ear and stimulate the
auditory nerve.”
Question
*
A—Hearing aids amplify sound in part by directing sound into
the ear canal.
Answer
*
Hearing impairment affects communication, safety, and quality
of lifeNursing concernsAppropriate assessmentCommunicating
appropriatelyProperly caring and maintaining hearing
aidsProviding appropriate health teachingProviding appropriate
referrals for prevention and treatment
Implications for Gerontology Nurses and Healthy Aging
*
*

Chapter 19Diseases Affecting Vision and HearingCopyrig.docx

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