Refractive Errors

Pathophysiology and Etiology

 Emmetropia, or normal vision, means that light rays are bent to focus images precisely on
the macula of the retina.
 Ametropia is a term used to describe any refractive error
 Ametropia occurs when parallel light rays entering the eye are not refracted to focus on
the retina
 There are four common ametropic disorders: myopia,hyperopia, astigmatism, and
presbyopia
HYPEROPIA.

 caused by light rays focusing behind the retina

 People who are hyperopic see images that are far away more clearly than images that
are close
 corected with convex lenses
MYOPIA

 caused by light rays focusing in front of the retina

 Persons with myopia hold things close to their eyes to see them better.
 Distance vision is blurred.
 Myopia is corrected with concave lenses
ASTIGMATISM.

 Astigmatism results from unequal curvatures in the shape of the cornea

 When parallel light rays enter the eye, the irregular cornea causes the light rays to be
refracted to focus on two different points
 The person with astigmatism has blurred vision with distortion
PRESBYOPIA.

 condition in which the crystalline lenses lose their elasticity, resulting in a decrease inability
to focus on close objects
 The loss of elasticity causes light rays to focus beyond the retina, resulting in hyperopia.
 This condition usually is associated with aging and generally occurs after age 40
Signs and Symptoms

 Individuals with refractive errors often complain of difficulty reading or seeing objects.
 headache.
 Myopic individuals may hold reading materials close to the eyes.
 Hyperopic individuals hold reading materials farther away from their eyes
Diagnostic Tests

 Snellen’s chart
 retinoscopic examination
 The amount of focusing power needed in the trial lens to correct the visual defect
indicates the degree of refractive error
Medical and Surgical Treatment

 Refractive errors are commonly treated with corrective lenses, either eyeglasses or
contact lenses.
 Incisional radial keratotomy and photorefractive keratectomy (PRK) are surgical
procedures used to correct refractive error.
 PRK utilizes laser technology to accomplish the same goal of reshaping the cornea
 The cornea is made flatter for individuals with myopia and more cone shaped for those
with hyperopia.
Complications

 Complications of corrective lens use are primarily related to safety.

 Complications of contact lens use include corneal abrasions, infections, and keratitis.
Incisional
 radial keratotomy and PRK both have surgical risks and may not always be successful.
Nursing Process: The Patient
with Visual Impairment
ASSESSMENT.
NURSING DIAGNOSIS.

 Disturbed sensory perception: visual related to altered sensory reception

 Self-care deficit (specify area) related to visual impairment
 Risk for injury related to visual impairment
 Risk for impaired home maintenance related to lack of assistance,lack of rehabilitation, or other factors
 Interrupted family processes related to change in role secondary to visual impairment
 Ineffective role performance related to visual impairment, lack of rehabilitation
 Deficient knowledge related to disease process, prevention,and treatment due to lack of prior exposure
 Deficient diversional activity related to transition from sighted to visually impaired
 Fear related to blindness
 Anxiety related to sensory perception changes (visual)
PLANNING.

 If patients have minimal visual impairment or have attended rehabilitation, they may be
able to function independently
 If a patient has recently become visually impaired, he or she may be completely
dependent until learning alternative ways of coping with this impairment
 Planning focuses on meeting self-care needs, keeping the patient safe from injury,
supporting the grieving process, and helping the patient acquire knowledge of agencies,
services, and devices that allow maintenance of independence
 Families must be included in the planning phase because they need to understand and
be supportive of the self-image and role performance changes that may occur
cont
Cont
Ophthalmic Medications
Patient goals

 Maintains ability to complete activities of daily living with minimal assistance

 Remains free of injury
 Demonstrates ability to access agencies and services for visually impaired
 Maintains healthy relationships among family members
 Maintains positive self-esteem
 Verbalizes understanding of disease process, prevention,and treatment
 Participates in diversional activities
 Verbalizes lessened fear or anxiety about perceptual changes
NURSING INTERVENTIONS.

 Nursing care begins by understanding how to interact with the visually impaired patient
 Patient teaching is included in the plan of care.
 The goal of the teaching is to promote independence and safety for the patient while in
the hospital and in the home.
 Organizations exist whose mission is to enhance the independenceof visually impaired
persons.
 Referring patients to these resources enhances their ability to maintain independence.
Interacting with the Visually
Impaired Patient
cont
EVALUATION.

 Demonstrates ability to complete activities of daily living with increasing independence

 Remains free of injury
 Demonstrates ability to assess agencies and services for visually impaired
 Maintains healthy relationships among family members
 Maintains positive self-esteem
 Verbalizes understanding of disease process, prevention,and treatment
 Participates in diversional activities
 Verbalizes lessened fear or anxiety about perceptual changes