Download Eye and Ear Disorders Related to the Geriatric Population

SENSIONEURAL FUNCTION
DISORDERS
NS 202A
Debra Dickinson
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Impaired Vision
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Refractive errors
Vision Impairment & blindness
Promoting coping efforts
Occupational therapy for spatial
orientation and mobility
• Braille, Print magnification, computerassisted speech output
• Service animals
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Cataracts
• Part of the aging process
• Clouding of the eye’s naturally clear lens
• Effects approximately 1/2 of Americans ages
65-75
• Normal vision
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lights passes through cornea
pupil
lens
– lens focuses light rays on the retina (the layer of lightsensing cells lining the back of the eye) to produce a
sharp image of what we see
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Cataracts
• Lens becomes cloudy, light rays cannot pass
through it easily
• Risk factors
– age, diabetes, family history, previous eye injury,
medications (corticosteroids), excessive alcohol,
excessive sunlight exposure, smoking
• some evidence that antioxidant vitamin supplements
including vitamin C and E may play role in reducing
risk of cataract
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Cataracts
• can develop in one or both eyes and may
or may not affect an entire lens
– symptoms
• Blurred (cloudy) or dimmed vision, poor night
vision, sensitivity to light and glare, reduced
distance vision, need brighter lighting for reading
and other activities, double vision
• blinking
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Treatment of Cataracts
• Treatment
– Glasses, stronger bifocals, use of magnifying glass,
surgery
• Surgery allows lens implant brings light rays into
proper focus upon the retina
– usually outpatient procedure
• local anesthesia typical
• microsurgery (takes out the cataract but leaves much of
eye’s natural lens capsule in place (the capsule helps
support an artificial replacement lens that’s inserted)
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Cataract Surgery
• A small opening is
made in the front of
the capsule that holds
the natural lens
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Cataract Surgery
• Ultrasound procedure
(phacoemulsification) 3mm
incision
– the probe dissolves the
cataract, allowing it to be
gently vacuumed from the
eye.
• FDA approved use of laser
(instead of ultrasound) to
dissolve cataract along with
the 1/8 inch incision to insert
the folded implant.
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Cataract Surgery
• By using soft material
that can be folded,
the artificial lens
(intraocular lens
made of inert
materials) can be
inserted inside the
eye through the
original surgical
incision.
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Cataract Surgery
• The lens unfolds to fill
the capsule much as
the natural lens of the
eye had done prior to
cataract surgery.
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Cataracts
• Post-op
– eye mildly inflamed
– feel a little scratchy and irritated for a few
days
– patient wears a patch for first 24 hours
– return visit day after surgery
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Treatment of Cataracts
• Post-op
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patch removed at first visit
several more return visits over next 4-6 weeks
wear sunglasses outside
do not rub eye
improvement in vision gradual
• Post-op complications
– bleeding, swelling, inflammation, infection or retinal
detachment
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Treatment of Cataracts
• Post-op
– call MD for any of following:
• loss of vision, pain not relieved by OTC
medication, marked increase in eye redness, light
flashes or multiple new spots before your eye,
nausea, vomiting or excessive coughing
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Eye
• Optic nerve cells (made up of many nerve
fibers) transform the light entering the eye
into electrical impulses that are understood
by the brain
• Glaucoma
– Group of eye diseases all which involve
progressive damage to the optic nerve
– Leading cause of blindness in world
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Glaucoma
• Clear liquid (aqueous humor) circulates inside front portion of eye.
– Small amount of aqueous humor is produced constantly
– Equal amount flows out of eye through a microscopic drainage system
(maintains a constant level of pressure in the eye)
– Aqueous humor is not part of tears on outer surface of eye
– Eye is a closed structure
– If drainage area (drainage angle) blocked, excess fluid cannot flow out
of eye and fluid pressure within eye increases (pushes against optic
nerve potentially causing damage
• Note: Many people develop glaucoma with “normal” eye pressure
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Glaucoma
• If enough of these cells die, then some vision
may be lost
• Measuring only the intraocular pressure to
diagnose glaucoma has been proven to be
wrong
• Diagnosis is made by detecting the presence of
ocular tissue damage related to intraocular
pressure or decrease blood flow to optic nerve
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Glaucoma
• The size of the optic cup is related to the
presence or absence of glaucoma
• Treatment usually designed to lower intraocular
pressure to a level that will no longer damage
the optic nerve
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Most important risk factors of glaucoma
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Age over 60 years
Diabetes
African ancestry
Asian or Eskimo ancestry higher risk for angle-closure
glaucoma
Family history
Increased intraocular pressure
Previous eye injuries
Nearsightedness
Extensive steroid use
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Glaucoma
• Ophthalmologist evaluation
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Tonometry-measures intraocular pressure
Gonioscopy-inspects drainage area of eye; determines type
Opthalmoscopy-examines optic nerve
Optical coherence tomography-imaging technique which shows
cross sectional images of retina
– Visual field test-tests the peripheral vision of eyes
– variety of possible symptoms such as decreased peripheral
vision, decreased ability to perceive motion and recognize color,
etc
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Types of glaucoma
• Chronic open-angle glaucoma
– The Canal of Schlemm is somehow clogged,
fluid does not drain and pressure builds up
– Result is build up of IOP which can damage
the optic nerve and lead to vision loss
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Types of glaucoma
• Open-angle glaucoma
– most people who develop this form notice no
symptoms until vision is impaired
– peripheral vision loss
– Usually responds well to medications
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Types of glaucoma
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Angle-closure glaucoma
– Drainage angle of eye becomes completely blocked.
– Iris may drop over and completely close off the drainage
angle
– Treated with laser or conventional surgery to remove a small
portion of the bunched up outer edge of iris.
– acute closed angle-closure glaucoma
• sudden IOP build up
• an emergency because optic nerve damage and vision loss
occurs very quickly
• nausea, vomiting, rainbow-colored haloes around lights,
sudden eye pain, blurred vision, headache
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Types of Glaucoma
– Chronic angle-closure glaucoma
• may cause vision damage without symptoms
• Both angle-closure and open-angle
glaucoma can be primary or secondary.
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Treatment choices for glaucoma
• Medications (eye drops) that decrease aqueous
humor production
– Prostaglandins-increases outflow of aqueous fluid through
uveoscleral route
• Xalatan
– Beta-blockers-reduces production of aqueous humor
• Betoptic, betagan, timopotic
– Alpha-2 adrenergic agonists- activates receptors in ciliary
body, inhibiting aqueous secretion and increasing uveoscleral
aqueous outflow.
• Alphagan
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Treatment choices for glaucoma
• Medications (eye drops) that decrease aqueous humor production
– Carbonic anhydrase inhibitors (drop form; pill form seldom used)-reduces
fluid flow into the eye by inhibiting enzyme carbonic anhydrase
• Medications (eye drops) that increase outflow of aqueous humor
– Miotics-stimulates ciliary muscles, leading to increases in contraction of the iris
sphincter muscle (constricts pupil)-seldom used anymore
• Pilocarpine
– Sympathomimetics-increases rate of fluid flow out of eye and
decreases rate of aqueous humor production
• Epinephrine
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Treatment of choices for
glaucoma
• Surgery
– Open-angle (when meds no longer work)
• selective laser trabeculoplasty-modifies the drain thus
controlling IOP
– Very small burn (opening) made at opening of fluid channel
(Schlemm’s canal)
– not a cure but helps
– Closed-angle
• Iridectomy-laser creates hole in iris to improve flow of
aqueous fluid to the drainage area
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Treatment Choices for
glaucoma
• If trabeculectomy and medications fail,
an aqueous shunt may be required.
– Glaucoma drainage device (an implant)
creates an alternate aqueous pathway
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Hearing loss in the geriatric
population
• 1/3 of U. S. adults over 65 (nearly 10
million people) are hearing impaired
• Noise-induced hearing loss
• Conductive hearing loss
• Sensorineural loss is mostly age-related
hearing loss results from damage to
cochlea or vestibulocochlear nerve
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Hearing loss
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Speech deterioration
Fatigue, Indifference
Social withdrawal, Insecurity
Indecision and procrastination
Suspiciousness, False pride
Loneliness and unhappiness
Tendency to dominate conversations
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Communication
• Chart 64-4
• Hearing impaired with speech difficulty
• Hearing impaired and reads speech
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Aural Rehabilitation
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Speech (lip) reading
Listening skills
Speech training
Implanted Hearing Devices
Hearing Guide Dogs
Hearing Aids
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Hearing Aids
• Basic styles of hearing aids
– behind-the –ear
– in-the-ear
– in-the canal
– completely-in-the-canal
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Hearing Aids
• The digital age
– can reprogram hearing aids from distance
– requires that hearing aid is interfaced through
patient’s home computer attached to modem
– software packages temporarily takes control
of the modem (costly)
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Future of hearing aids
• Studies looking at regenerating tiny hair
cells in the ear
• Advanced Electron microscopy and
Imagery Center (AEMI) at House Ear
Institute doing a lot of research as well as
other major centers
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