Geriatric considerations - Visual impairment: Nursing

Visual impairment is a leading cause of disability in older adults and it can have a negative impact on safety, social interactions, mobility and activities of daily living such as grooming and eating as the nurse, you'll recognize age related vision changes and provide patient centered care for your patient with visual impairment.

All right. So, eye structures commonly affected by age related changes include the eyelids, cornea, iris, lens, vitreous humor and retina, the eyelids which protect the eyes and help with tear distribution, lose elasticity and tone as an individual ages.

This can cause ptosis or drooping of the eyelids. If severe ptosis can interfere with vision by obstructing the visual field.

In addition, the muscles controlling the eyelids may spasm which can cause the eyelids to turn inward called entropion. This can result in scratching of the cornea by the lower lashes.

Other times the muscles can weaken which allows the eyelids to turn outward called ectropion. This can lead to dry eyes due to a disruption of tear distribution and an inability to fully close the eye.

Next, the cornea which is responsible for protecting the eye and performing the initial refraction of light onto the lens can thicken and become less curved, losing its ability to refract light efficiently.

This leads to blurry or distorted vision called astigmatism. The iris is a circular set of muscles that sits in front of the lens.

It controls the amount of light allowed into the eye through the pupil by constricting and bright lighting to allow less light in and dilating and low lighting to allow more light in with age.

The iris becomes less reactive, resulting in difficulty transitioning between bright and low lighting. The lens found behind the iris changes its shape to focused light onto the retina.

It tends to thicken and become rigid with age. In addition, the ciliary muscles which are responsible for changing the shape of the lens become weak together.

This leads to decreased depth perception, presbyopia, which means the eyes have a diminished ability to focus on near objects and impaired accommodation, which is the ability to change focus from near to far objects.

Additionally, protein build up within the lens increases its opacity decreases, adaptation to dark environments and may eventually result in cataracts, resulting in blurry vision glare and diminished night vision.

Now, the jelly like substance that fills the middle of the eye called vitreous humor decreases and becomes more liquid over time.

This is accompanied by the formation of cellular debris which appears as floaters that can look like dark specks or wiggly lines that move around the visual field.

These are a normal and harmless manifestation of vitreous degeneration. However, an increase in the number of floaters, especially if they are accompanied by light flashes, could mean the vitreous humor is beginning to pull away from the retina and could eventually detach called vitreous detachment.

Finally, the retina is located on the eye's interior surface and consists of visual receptor cells. These receptor cells reduce in number over time leading to impaired visual acuity, which requires an increased amount of light to see an object clearly.

Additionally, if the central part of the retina called the macula degenerates in a condition called macular degeneration, there can be progressive loss of central vision.

As the nurse, you'll provide patient centered care for your patient with a visual impairment by ensuring safety and promoting eye health.

Begin by clearly identifying yourself when you enter or leave your patient's room and make sure you have your patient's attention.

Before speaking. Next, identify how your patient's visual impairment affects their functional ability and quality of life and help your patient adapt to their environment to decrease the risk of injury and facilitate independence.

To decrease the risk of injury like falls. You can increase lighting intensity or use nightlights and orient your patient to the room.

You can also be a sighted guide while they ambulate if needed a method where your patient grasps your forearm or elbow to facilitate independence, use contrasting colors for certain items like toothbrushes and towels to make them easier to identify and offer large print books and magazines with assistive devices like magnifiers as needed during mealtime.

Use the clock method to describe where foods are on their plate. For example, you may tell your patient green beans are at 12 o'clock and mashed potatoes are at six o'clock.

Then discuss strategies to promote eye health. These include reviewing strategies for protecting their eyes by wearing sunglasses or a wide brimmed hat when outside and eating a diet rich in green leafy vegetables also be sure to encourage them to maintain their prescribed corrective lenses and to have regular eye exams to monitor for any worsening visual impairment or newly developing conditions.

Lastly recommend a referral to social services or community organizations if your patient needs assistance with resources or assistive devices.

All right, as a quick recap visual impairment due to age related vision changes is common in older adults. As the nurse, you'll recognize age related vision changes and provide patient centered care for your patients with visual impairment.

You can ensure safety and promote eye health by communicating clearly with your patient adapting their environment, facilitating independence and recommending routine eye examinations.