XAVIER UNIVERSITY- ATENEO DE CAGAYAN

COLLEGE OF NURSING

In partial fulfilment of the requirements in NCM 116

CONCEPT MAP: Disturbances in Visual Perception

Submitted by:
Abragan, Camille Viktoria Ballares, Ma Therese P

Abucay, William Angelo C Canda, Brigette Keeshia V

Acabo, Gabrielle Jeanz A Canoy, Anna Isabella Lili B

Acac, Lance Alistair G Clarito, Kryschelle M

Afdal, Shamsa Hynra P Dagumbal, Jan Levin

Aparece, Dara Doreen S del Mar, Almira Louise M

Artajo, Lyka Nicole B

BSN 3 – NB

Submitted to:
Mrs. Jennifer O. Asio, RN, MN

February 2, 2021

CORNEAL DYSTROPHIES

Definition
● Corneal dystrophies are a group of genetic, often progressive, eye disorders in
which abnormal material often accumulates in the clear (transparent) outer
layer of the eye (cornea). Corneal dystrophies may not cause symptoms
(asymptomatic) in some individuals; in others they may cause significant vision
impairment.

Predisposing Factors
● Sex - more common in women than in men
● Age - typically the disease starts in the 30s and 40s, with symptoms developing
thereafter
● Genetics/Hereditary

Precipitating Factors
● -

Disease Process
● Normally, the cells lining the inside of the cornea (endothelial cells) help
maintain a healthy balance of fluid within the cornea and prevent the cornea
from swelling. But with Corneal Dystrophy, the endothelial cells gradually die or
do not work well, resulting in fluid buildup (edema) within the cornea. This
causes corneal thickening and blurred vision. Corneal Dystrophy is usually
inherited. The genetic basis of the disease is complex — family members can
be affected to varying degrees or not at all.

Signs and Symptoms

● Blurred or cloudy vision, sometimes described as a general lack of clarity of
vision
● Fluctuation in vision, with worse symptoms in the morning after awakening
and gradually improving during the day. As the disease progresses, blurred
vision either can take longer to improve or doesn't improve
● Glare, which can decrease your vision in dim and bright light
● Seeing halos around lights
● Pain or grittiness from tiny blisters on the surface of your cornea

Diagnostic Tests
● Corneal biopsy
● Light microscopy
● Anterior-segment optical coherence tomography (OCT)
Medical Management
● Antibiotic
● Bandage contact lens
● Hypertonic eye drops
● Ointments (5% NaCl)
● IOP lowered
● If erosion continues, other treatment options may include the use of laser
therapy or a technique for scraping the cornea

Nursing Diagnosis
1. Disturbed Sensory Perception: Visual related to impaired vision
2. Risk for self-care deficit related to impaired vision
3. Fear or anxiety related to sensory impairment

Nursing Interventions
● Tell patient to optimize other sensing devices that are not impaired.
● Visit frequently to determine the needs and alleviate anxiety.
● Educate people in the care and activities nearby.
● Limit noise and provide a balanced break
● Provide night light for the patient’s room and ensure lighting is adequate for the
patient’s needs.
● Provide large print objects and visual aids for teaching.
CONCEPT MAP
REFERENCES
Fuchs’ dystrophy - Symptoms and causes. (2020, June 19). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/fuchs-dystrophy/symptoms-
causes/syc-20352727
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K.H. (2010). Brunner &
Suddarth's Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Wolters
Kluwer
What is Corneal Dystrophy? | The Corneal Dystrophy Foundation. (2020). The
Corneal Dystrophy Foundation. https://www.cornealdystrophyfoundation.org/what-is-
corneal-
dystrophy#:%7E:text=Corneal%20dystrophies%20are%20a%20group,may%20caus
e%20significant%20vision%20impairment.
 Keratoconus
Definition
Keratoconus is a corneal disease that is characterized by paraxial stromal
thinning and weakening that distorts the corneal surface. It is progressive,
noninflammatory, and bilateral (but usually asymmetric). Irregular astigmatism and
myopia primarily cause visual loss in Keratoconus, and secondarily from corneal
scarring. The cornea progressively bulges outward, taking a cone shape.

Predisposing Factors
 Genetics
 Age (late teens to early 20s )
 Chronic eye inflammation
 Corneal tissue damage
 Connective tissue disorders like Marfan syndrome and Ehlers-Danlos
syndrome

Precipitating Factors
 Eye rubbing

Disease Process
1. Epithelial abnormality.
2. Release of proteolytic enzymes that degrade stromal collagen to thin and
weaken the cornea.
3. Structural irregularities in the epithelium (blebbing and degeneration), breaks
in or complete absence of Bowman’s layer, collagen disorganization, scarring,
and thinning.
4. Progressive thinning of the cornea causes a cone-shaped bulge to develop
towards the center of the cornea in the areas of greatest thinning

Signs and Symptoms

Early stage
 mild blurring of vision
 slightly distorted vision, where straight lines look bent or wavy
 increased sensitivity to light
 Glare and halos around lights
 eye redness or swelling
 Eye irritation or headaches associated with eye pain
 Difficulty seeing at night
Late stage
 more blurry and distorted vision
 increased nearsightedness or astigmatism

Diagnostic tests
 Eye refraction. In this test your eye doctor uses special equipment that
measures your eyes to check for vision problems.
 Corneal topography. This is the most accurate way to diagnose early
keratoconus and follow its progression. A computerized image is taken that
creates a map of the curve of the cornea.
 Keratometry. In this test your eye doctor focuses a circle of light on your cornea
and measures the reflection to determine the basic shape of your cornea.
  Slit-lamp exam. This examination of the cornea can help detect abnormalities
in the outer and middle layers of the cornea.
 Pachymetry. This test is used to measure the thinnest areas of the cornea.

Medical Management

Early stage treatments

 Glasses. Earliest stages vision loss can still be alleviated by glasses.
 Hard contact lens. As vision loss progresses glasses are no longer
adequate to provide clear vision thus hard contact lenses are
recommended.
Intermediate stage treatments
 Collagen cross-linking. Application of a vitamin B solution to the
eye, which is then activated by ultraviolet light for about 30 minutes
or less. The solution causes new collagen bonds to form,
recovering and preserving some of the cornea’s strength and
shape.
Advance stage treatments
 Corneal ring. With severe keratoconus, a standard contact lens may
become too uncomfortable to wear. Intacs are implantable, plastic, C-
shaped rings that are used to flatten the surface of the cornea, allowing
improved vision. They may also allow a better contact lens fit. The
procedure takes about 15 minutes.
 Corneal transplant. In a corneal transplant, a donor cornea replaces
the patient’s damaged cornea. Corneal transplants are often performed
on an outpatient basis and take about an hour to complete. Vision
usually remains blurry for about three to six months after the transplant,
and medication must be taken to avoid transplant rejection. In almost all
cases, glasses or a contact lens are necessary to provide the clearest
vision after transplant surgery.

Nursing Diagnoses

 Disturbed visual sensory perception related to vision loss

 Risk for injury related to impaired vision
 Risk for falls related to impaired vision
 Anxiety related to impaired vision

Nursing Intervention
 Advise patients not to rub their eyes.
 Advise patients to avoid handling dangerous machinery and driving to avoid
accidents.
 Instruct patient to follow doctor’s orders (i.e. frequency of wearing glasses,
application of medication) religiously
 Ask patient whether assistance is required and offer arm or hand for support
 Assist patient in performing daily activities such as eating and drinking
 Provide support to patient and family
 Acknowledge the patient with visual impairment as a human being with the same
range of needs and feelings as a person who has normal sight
 Raise side rails of patient’s bed to prevent falls and injury
 Allow patient to express feelings of fear and anxiety regarding his/her condition
 KERATOCONUS CONCEPT MAP
Predisposing Factors
•Genetics
•Age (late teens to early 20s)
•Chronic eye inflammation
•Corneal tissue damage
•Connective tissue disorders
like Marfan syndrome and
Ehlers-Danlos syndrome
Diagnostic tests
•Eye refraction
•Corneal topography
•Keratometry
•Slit-lamp exam
•Pachymetry
Keratoconus- Intermediate
stage
• Collagen cross-linking
Keratoconus-Late stage
•More blurry and distorted vision
•Increased near-sightedness or
astigmatism
• Corneal ring
• Corneal transplant
Precipitating Factors
Epithelial abnormality.
•Eye rubbing
Release of proteolytic
enzymes
Degradation of
stromal collagen
Thinning and
weakening of the Keratoconus-Early stage
cornea
•Mild blurring of vision
Structural irregularities in •Slightly distorted vision,
where straight lines look bent
the epithelium (blebbing
and degeneration), breaks or wavy
in or complete absence of •Increased sensitivity to light
Bowman’s layer
•Glare and halos around
lights
Collagen disorganization, •Eye redness or swelling
scarring, and thinning
•Eye irritation or headaches
associated with eye pain
•Difficulty seeing at night
Cone-shaped bulge
developing towards
the centre of the
cornea
• Glasses
• Hard contact lens
Progressive thinning
of the cornea
 Nursing Interventions Nursing Diagnoses
 Advise patients not to rub their eyes. •Disturbed visual sensory
 Advise patients to avoid handling dangerous machinery and driving perception related to vision loss
to avoid accidents.
 Instruct patient to follow doctor’s orders (i.e. frequency of wearing •Risk for injury related to impaired
glasses, application of medication) religiously vision
 Ask patient whether assistance is required and offer arm or hand
for support •Risk for falls related to impaired
 Assist patient in performing daily activities such as eating and vision
drinking
 Provide support to patient and family •Anxiety related to impaired vision
 Acknowledge the patient with visual impairment as a human being
with the same range of needs and feelings as a person who has
normal sight
 Raise side rails of patient’s bed to prevent falls and injury
 Allow patient to express feelings of fear and anxiety regarding
his/her condition
 References
Keratoconus - Diagnosis and treatment - Mayo Clinic. (2020, July 10). Mayo Clinic -
Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/keratoconus/diagnosis-
treatment/drc-20351357

Keratoconus diagnosis and treatment. (2020, October 21). American Academy of

Ophthalmology. https://www.aao.org/eye-health/diseases/keratoconus-diagnosis

Keratoconus. (2020, June 19). EyeWiki. Retrieved January 30, 2021, from
https://eyewiki.aao.org/Keratoconus#Disease_Entity

Keratoconus. (n.d.). Johns Hopkins Medicine, based in Baltimore, Maryland.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/keratoconus

Keratoconus: Practice essentials, background, pathophysiology. (2020, May 8).

Diseases & Conditions - Medscape Reference.
https://emedicine.medscape.com/article/1194693-overview
Retinal Detachment

Definition
- Retinal detachment is an eye problem that happens when your retina (a light-sensitive
layer of tissue in the back of your eye) is pulled away from its normal position at the back
of your eye.
- Retinal detachment is an emergency situation in which a thin layer of tissue (the retina)
at the back of the eye pulls away from its normal position.

Predisposing Factors
● Aging — retinal detachment is more common in people over age 50
● Family history of retinal detachment
● Patients with chronic uveitis
● Chronic infections like tuberculosis and autoimmune diseases
● Patients with advanced stages of diabetic eye disease

Precipitating Factors

● Extreme nearsightedness (myopia)

● Previous retinal detachment in one eye
● Previous severe eye injury
● Previous eye surgery, such as cataract removal
● Previous other eye disease or disorder, including retinoschisis, uveitis or thinning of the
peripheral retina (lattice degeneration)

Disease Process
- Retinal detachment happens when the retina (a light-sensitive layer of tissue at the back
of your eye) is pulled away from its normal position. There are 3 types of retinal
detachment. 1. Rhegmatogenous retinal detachment, When the retina has a tear or
break, the gel-like fluid in the center of the eye (called vitreous) can get behind the
retina. The vitreous then pushes the retina away from the back of the eye, causing it to
detach. 2. Tractional retinal detachment. This stems from high blood sugar from
diabetes. The blood vessels in the back of the eye can become damaged and scar the
retina. As the scars get bigger, they can pull on the retina and detach it from the back of
the eye. 3. Exudative retinal detachment. This happens when fluid builds up behind the
retina, but there aren’t any tears or breaks in your retina. If enough fluid gets trapped
behind the retina, it can push the retina away from the back of the eye and cause it to
detach.

Signs and Symptoms

- Retinal detachment itself is painless. But warning signs almost always appear before it
occurs or has advanced, such as:
 ● The sudden appearance of many floaters — tiny specks that seem to drift through
your field of vision
● Flashes of light in one or both eyes (photopsia)
● Blurred vision
● Gradually reduced side (peripheral) vision
● A curtain-like shadow over your visual field

Diagnostic Tests
a. Retinal examination. The doctor may use an instrument with a bright light and
special lenses to examine the back of your eye, including the retina. This type of
device provides a highly detailed view of your whole eye, allowing the doctor to
see any retinal holes, tears or detachments.
b. Ultrasound imaging. Your doctor may use this test if bleeding has occurred in the
eye, making it difficult to see your retina.

Medical Management
- Depending on how much of your retina is detached and what type of retinal detachment
you have, your eye doctor may recommend laser surgery, freezing treatment, or other
types of surgery to fix any tears or breaks in your retina and reattach your retina to the
back of your eye. Sometimes, your eye doctor will use more than one of these
treatments at the same time.
a. Cryopexy. ​Another option is cryopexy, which is freezing with intense cold. For
this treatment, your doctor will apply a freezing probe outside of your eye in the
area over the retinal tear site, and the resulting scarring will help hold your retina
in place.
b. Retinopexy.​ A third option is pneumatic retinopexy to repair minor detachments.
For this procedure, your doctor will put a gas bubble in your eye to help your
retina move back into place up against the wall of your eye. Once your retina is
back in place, your doctor will use a laser or freezing probe to seal the holes.
c. Scleral buckling.​ For more severe detachments, you’ll need to have eye surgery
in a hospital. Your doctor may recommend scleral buckling. This involves placing
a band around the outside of your eye to push the wall of your eye into your
retina, getting it back into place for proper healing. Scleral buckling may be done
in combination with a vitrectromy. Cryopexy or retinopexy is performed during the
scleral buckle procedure.
 d. Vitrectomy.​ Another option is vitrectomy, which is used for larger tears. This
procedure involves anesthesia and is often performed as an outpatient
procedure, but may require an overnight stay in the hospital. Your doctor will use
small tools to remove abnormal vascular or scar tissue and vitreous, a gel-like
fluid from your retina. Then they’ll put your retina back into its proper place,
commonly with a gas bubble. Cryopexy or retinopexy is performed during the
vitrectomy procedure.

- Treatment for retinal detachment works well, especially if the detachment is caught early.
In some cases, you may need a second treatment or surgery if your retina detaches
again — but treatment is ultimately successful for about 9 out of 10 people

Nursing Diagnosis
1. Disturbed sensory perception (visual).
2. Anxiety.
3. Risk for injury.

Nursing Interventions

1. Assess visual status and functional vision in the unaffected eye to determine self care
needs.
2. Prepare the client for surgery by explaining possible surgical interventions and
techniques to alleviate some of the client's anxiety.
3. Discourage straining during defecation, bending down and hard coughing, sneezing or
vomiting to avoid activities that increase intraocular pressure.
4. Assist with ambulation, as needed, to help the client remain independent.
5. Approach the clients from the unaffected side to avoid startling him.
6. Provide assistance with activities of daily living to minimize frustration and strain.
7. Orient the client to his environment to reduce the risk of injury.
8. Postoperatively instruct the client to lie on his back or on his unoperated side to reduce
intraocular pressure in the affected area.
References

Gabbey, A. (2017, March 31). Retinal Detachment: Types, Causes, and Symptoms.
Retrieved February 01, 2021, from
https://www.healthline.com/health/retinal-detachment#treatments

Nursing Care Plan for Retinal Detachment. (2018, March 17). Retrieved February 01,
2021, from
https://medicachemistry.blogspot.com/2012/12/nursing-care-plan-for-retinal-detachment.ht
ml

Retinal detachment. (2020, August 28). Retrieved February 01, 2021, from
https://www.mayoclinic.org/diseases-conditions/retinal-detachment/symptoms-causes/syc-
20351344

Retinal Detachment. (n.d.). Retrieved February 01, 2021, from

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinal-detach
ment
Retinal Vascular Disorders

Definition
Central Retinal Vein Occlusion (CRVO)
- Is a condition in which the main vein that drains blood from the retina closes off
partially or completely. This can cause blurred vision and other problems with the
eye
Branch Retinal Vein Occlusion (BRVO)
- Is a blockage of one or more branches of the central retinal vein, which runs
through the optic nerve
Central Retinal Artery Occlusion (CRAO)
- Is when one of the vessels that carry blood to your eye’s retina gets blocked, it
can cause you to lose your eyesight

Predisposing Factors
- Unknown

Precipitating Factors
- Diabetes
- Hypertension
- Atherosclerosis
- Blood clots
- Usage of birth control pills

Disease Process
Arteriosclerotic changes in the central retinal artery transform the artery into a rigid
structure. Changes in the artery affect the central retinal vein and results in endothelial damage,
hemodynamic disturbances, and thrombus formation. All these three factors contribute to the
occlusion of the central retinal vein. If the occlusion occurs in the branches of the central retinal
vein, then it is classified as Branch Retinal Vein Occlusion; however, if the occlusion occurs in
the central retinal vein, it is then classified as Central Retinal Vein Occlusion. Both of these
occlusions cause increased resistance to venous blood flow and stagnation of the blood.
Ischemia then occurs to damage the retina which then stimulates increased production of
vascular endothelial growth factor (VEGF). Increased VEGF stimulates neovascularization of
the posterior and anterior segment. Furthermore, damage to the central retinal artery also
causes obstruction of the same artery (CRAO). This leads to an inner layer edema and death of
the ganglion cell nuclei which then causes necrosis. The retina then loses transparency and a
homogenous scar replaces the inner layer of the retina. After a few weeks, opacification
resolves and the retina remains thin and atrophic.

Nursing Interventions

1. Disturbed sensory perception r/t vision loss

a. Nurses provides health education for patient

b. Assess patient’s ability to see

c. Provide sufficient lighting for the patient to carry out activities

d. Provide lighting that avoids glare on walls. Reading materials and etc.

e. Provide night light

f. Provide large print objects and visual aids

2. Risk for injury r/t decreased vision

a. Assess patient’s ability to see

b. Ensure the room is safe with adequate lighting and furniture and
moved to the walls. Remove every object that is hard to see and
potentially dangerous

c. Keep patient’s glasses and bell within easy reach

Signs and Symptoms

1. Central Retinal Vein Occlusion

a. Optic disc swelling

b. Venous dilation

c. Tortuousness

d. Tetinal hemorrhages

e. Cotton wool spots

 f. Bloody appearance of the retina

2. Branch Retinal Vein Occlusion

a. Usually has no symptoms

b. Sudden loss of vision

3. Central Retinal Artery Occlusion

a. Sudden loss of vision

b. Pale retina with cherry red spot at the fovea

c. Emboli in central retinal artery

Diagnostic Tests

1. Central Retinal Vein Occlusion

a. Fluorescein angiography

2. Branch Retinal Vein Occlusion

a. Fluorescein angiography

3. Central Retinal Vein Occlusion

a. Optical coherence tomography

Medical Management

1. Central Retinal Vein Occlusion

a. Laser pan retinal photocoagulation

2. Branch Retinal Vein Occlusion

a. Laser pan retinal photocoagulation

b. Intravitreal medications
 3. Central Retinal Vein Occlusion

a. Ocular massage

b. Anterior Chamber paracentesis

c. IV admin of hyperosmotic agents

d. High concentration of oxygen

Nursing Diagnosis

1. Disturbed sensory perception r/t vision loss

2. Risk for injury r/t decreased vision

Sources
https://www.asrs.org/patients/retinal-diseases/22/central-retinal-vein-
occlusion#:~:text=Central%20retinal%20vein%20occlusion%2C%20also,other%20probl
ems%20with%20the%20eye.

https://www.willseye.org/branch-retinal-vein-occlusion-
brvo/#:~:text=Branch%20Retinal%20Vein%20Occlusion%20(BRVO)%20is%20a%20blo
ckage%20of%20one,Blurred%20or%20distorted%20central%20vision

https://www.hopkinsmedicine.org/health/conditions-and-diseases/central-retinal-artery-
occlusion#:~:text=Central%20retinal%20artery%20occlusion%20is%20the%20blockage
%20of%20blood%20to,pressure%2C%20glaucoma%2C%20or%20diabetes.

https://emedicine.medscape.com/article/1223746-overview#a5

https://emedicine.medscape.com/article/1223498-overview#a5

https://emedicine.medscape.com/article/1223625-overview#a5
 AGE-RELATED MACULAR DEGENERATION
I. Definition
• Age-related macular degeneration (AMD) is a degenerative process that
affects the macula and surrounding tissues, resulting in central visual
deficits. It is a problem in the retina which usually happens when a part
of the retina called macula is damaged. This is the most common cause
of visual loss in people older than 60 years of age in developed
countries. There are two types of AMD: nonexudative (dry) and
exudative (wet), both are usually bilateral and progressive.
II. Predisposing Factors
• Age over 50 years old
• Family History of AMD
• Overweight
• Caucasian
III. Precipitating Factors
• Diet high in saturated fat
• Cigarette smoking
• Hypertension
• Heart diseases, high cholesterol levels
IV. Disease Process
Age-related macular degeneration (AMD) is the most common cause of
visual loss in people of more than 60 years of age. AMD is characterized by tiny,
yellowish spots called drusen beneath the retina. These drusen are small clusters
of debris or waste material that lie deep within the RPE. When these drusen are
located in the macular area, they can affect vision. Patients with AMD have a wide
range of visual loss, but most do not experience total blindness. Central vision is
generally the most affected. There are two types of AMD, commonly known as the
dry type and wet type. Between 85% and 90% of people with AMD have the dry
type of the condition, in which the outer layers of the retina slowly break down. With
this breakdown comes the appearance of drusen. Patients do not have symptoms
when the drusen occur outside of the macular area. When the drusen occur within
the macula, there is a gradual blurring of vision that patients may notice when they
try to read. The wet type, may have an abrupt onset. There may be straight lines
that appear crooked and distorted or that letters in words appear broken. This effect
results from proliferation of abnormal blood vessels growing under the retina called
choroidal neovascularization. The affected vessels can leak fluid and blood,
elevating the retina. Some patients can be treated with the argon laser to stop the
leakage from these vessels. However, this vision may be affected by the laser
treatment and abnormal vessels often grow back after treatment
V. Signs and Symptoms
• Blurry area near the center of vision
• Blank spots in vision
• Things may seem less bright than before
 • Straight lines appear crooked and distorted
• Rarely, worse or different color perception
• Drusen, tiny yellow spots under retina or pigment clumping
VI. Diagnostic Tests
• Routine eye exam: Indirect ophthalmoscopy, I.V. fluorescein
angiography
• Amsler Grid – a pattern of straight lines that resembles a checkerboard
VII. Medical Management
• Anti-angiotensin Drugs – block the creation of blood vessels and leaking
from the vessels in the eye that causes exudative macular degeneration
• Laser Therapy – high laser therapy can destroy the abnormal blood
vessels growing in the eye
• Photodynamic Laser Therapy – the injection of light-sensitive drug
(verteporfin) into the bloodstream, it will then absorb the abnormal blood
vessels. The laser will then be used to trigger the medication and
damage those blood vessels
• Low Vision Aids – a device that have special lenses or electronic system.
It creates larger images of nearby objects to help those people who have
lost their vision due to macular degeneration.
VIII. Nursing Diagnosis
• Disturbed Sensory Perception: Visual
• Risk for Injury
IX. Nursing Interventions
• Encourage patient to see ophthalmologist at least yearly.
• Provide sufficient lighting for patient to carry out activities.
• Provide lighting that avoids glare on surfaces of walls, reading materials,
etc.
• Provide night light and ensure lighting is adequate for patient’s needs.
• Provide large print objects and visual aids for teaching.
• Provide information about laser surgery.
• Inform about special devices that can be used.
• Ensure room environment is safe with adequate lighting and furniture
moved toward the walls. Remove all rugs, and objects that could be
potentially hazardous.
• Keep patient’s glasses and call bell within easy reach.
• Instruct patient and/or family regarding need for maintain safe
environment and safe lighting.
• Patient should wear sunglasses to reduce glare. Advise family to use
contrasting bright colors in household furnishings.
 Age-Related Macular Degenration (AMD)

- Diet high in saturated fat

·Age over 50 years old - Cigarette smoking
·Family History of AMD - Hypertension
·Overweight - Heart diseases, high
·Caucasian cholesterol levels

Low perfusion leading

Inflammatory processes
to photoreceptor retinal Primary senescence of
leading to RPE
pigment epithelium RPE cells
apoptosis
(RPE) ischemia

Photoreceptor athropy

Extracellular debris (drusen) Nutrients cannot reach retina

from RPE athropy/metabolism Drusen above Bruch's from choroid and waste
deposits between Bruch's membrane reduces blood flow products from retina cannot
membrane and RPE from choroid to retina pass itno the choroid bed

Blood vessels grow from the

Break occurs in Bruch's Ischemia of RPE and
choroidal circulation into the
membrane photoreceptors
reina

Exudative (wet) AMD Nonexudative (dry) AMD

New abdnormal blood vessels

leak serous fluid and blood Loss of photo receptors
under the retina

- Routine Eye exam - Routine Eye exam

- Fundoscopy - Fundoscopy
- Amsler Grid - Amsler Grid Asymptomatic
(early stages)

- Distorted central vision - Faded/blind spots in central

- Macular edema vision
- Distortion of lines when - Straight but faded lines when
lookng at a grid of straight looking at a grid of straight
lines lines

Disturbed Sensory Perception:

Risk for Injury
Visual

- Encourage patient to see ophthalmologist at least yearly.

- Anti-angiotensin Drugs Predisposing Factors Diagnostic Test/Finding
- Provide sufficient lighting for patient to carry out activities.
- Provide lighting that avoids glare on surfaces of walls, - Laser Therapy
reading materials, etc. - Photodynamic Laser Therapy
- Low Vision Aids Precipitating Factors Nursing Diagnosis
- Provide night light and ensure lighting is adequate for
patient?s needs.
- Provide large print objects and visual aids for teaching. Disease Process Nursing Management
- Provide information about laser surgery. - Laser Photocoagulation
- Inform about special devices that can be used.
- Ensure room environment is safe with adequate lighting and Clinical Manifestations Medical Management
furniture moved toward the walls. Remove all rugs, and objects
that could be potentially hazardous.
- Keep patient?s glasses and call bell within easy reach. Disease Surgical Management
- Instruct patient and/or family regarding need for maintain
safe environment and safe lighting.
- Patient should wear sunglasses to reduce glare. Advise
family to use contrasting bright colors in household furnishings.
REFERENCES

Age-Related Macular Degeneration. (n.d.). WebMD. Retrieved January 30, 2021,

from https://www.webmd.com/eye-health/macular-degeneration/age-related-
macular-degeneration-overview#3

Boyd, K. (2021, January 28). What Is Macular Degeneration? American Academy of

Ophthalmology. https://www.aao.org/eye-health/diseases/amd-macular-
degeneration

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