Download Cataracts

By: Ashley Medrano, Theresa Polly, Ashley Alvarado, Ruben Olmsted
Cataracts are cloudy areas in the lens of the
eye that can cause changes in vision.
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Nuclear – tends to have a substantial genetic component
that causes a central opacity in the lends. It is associated
with myopia (i.e. nearsightedness), which worsens when the
cataract progresses.
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Cortical – involves the anterior, posterior, or equatorial
cortex of the lens. Cortical cataracts progress at a high
variable rate. Vision is worse in very bright light.
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Posterior Subcapsular – occurs in front of the posterior
capsule. Near vision id diminished, and the eye is
increasingly sensitive to glare from bright lights.
Visual Acuity Test:
A visual acuity test uses an eye chart to measure how well you can read a series of
letters (e.g. Snellen Chart.) Your eyes are tested one at a time, while the other eye is
covered.
Retinal Examination:
The eye doctor puts dilating drops in your eyes to open your pupils wide. Making it
easier to examine the back of your eyes (retina).
Slit-lamp Examination:
A slit lamp allows your eye doctor to see the structures at the front of your eye under
magnification. The microscope is called a slit lamp because it uses an intense line of
light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and
cornea. The slit allows your doctor to view these structures in small sections, which
makes it easier to detect any signs of cataracts or tiny abnormalities.
Ophthalmoscopy:
A test that allows a health professional to see inside the fundus of the eye and other
structures
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Increasing age
Diabetes
Drinking excessive amounts of alcohol
Excessive exposure to sunlight
Exposure to ionizing radiation, such as that used in Xrays and cancer radiation therapy
Family history of cataracts
High blood pressure
Obesity
Previous eye injury or inflammation
Previous eye surgery
Prolonged use of corticosteroid medications
Smoking
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Clouded, blurred or dim vision.
Increasing difficulty with vision at night.
Sensitivity to light and glare.
Seeing "halos" around lights.
Frequent changes in eyeglass or contact lens prescription.
Fading or yellowing of colors.
Double vision in a single eye.
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Eye protection – wearing sunglasses
outdoors to protect eyes.
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New Research: researchers from the
University of California, San Diego have
discovered eye drops containing lanosterol
can improve vision by dissolving the clumped
proteins that form cataracts.
Phacoemulsification:
a portion of the anterior capsule is removed,
allowing extraction of the lens nucleus and
cortex while the posterior capsule and zonular
support are left intact. An ultrasonic device is
used to liquefy the nucleus and cortex, which
are then suctioned through a tube.
Lens Replacement:
After removal of the crystalline lens. The lens which focuses
light on the retina must be replaced for the patient to see
clearly. These are the 3 types of lens replacement options:
aphakic eyeglasses, contact lenses, and IOL implants.
Patients should Wash hair before surgery for hygiene.
It won’t need washing the first day or two
postoperatively.
 Educate patient to not rub their eyes, do not wear
makeup around eyes
 Educate patient food or milk 6 hours prior to surgery
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Three days before surgery patient should
Begin using your pre-op eye drops four times a day in
your operative eye, at mealtimes and at bedtime.
 Use your eye-drops on the day of surgery as well,
before and after.
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(If you are INSULIN-DEPENDENT your surgery will be scheduled early. DO NOT TAKE YOUR MORNING
INSULIN; instead, bring your insulin to surgery for administration after surgery)
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Educate patient regarding eye protection, recognition of
complications, activities to avoid, and obtaining emergency
care.
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Educate the patient administration of medications. Such as
mild analgesic agents, acetaminophen, antibiotic, antiinflammatory, and corticosteroid eye drops or ointments
prescribed.
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Inform that there should be minimal discomfort after
surgery.
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Eye is unpatched, discharge usually occurs within 1
hour
Dark glasses required
Mild itching normal
Pain indicates complications
Reduce IOP
Prevent infection
Assess for bleeding
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*Cloudy vision *Foggy vision *Vision Loss
Cataract is a clouding of the eye's lens It
gradually occurs and isn't noticeable until you
have trouble driving at night or difficulty reading
and it never goes away on its own.
Cataract surgery - a standard procedure that
cataract is very successfully removed.
Cataract stops progressing on it own and is
never reversible.
Drugs and illness are promoting factors for
cataracts .
Potential Early Postoperative Complications
Complication
Effects
Acute bacterial endophthalmitis — the most visual loss, pain, lid edema, hypopyon,
common causative organisms are
corneal haze, and chemosis
Staphylococcus epidermidis, Staphylococcus
aureus, Pseudomonas & Proteus species
Toxic anterior segment syndrome —
noninfectious inflammation that is a
complication of anterior chamber surgery;
caused by a toxic agent such as an agent
used to sterilize surgical instruments
Corneal edema occurs >24 hours after
surgery; symptoms include reduced visual
acuity and pain.
Potential Late Postoperative Complications:
Complication
Effects
Suture related problems
Toxic reactions or mechanical injury from broken or
loose sutures.
Malposition of the IOL
Results in astigmatism, sensitivity to glare, or
appearance of halos.
Chronic Endophthalmitis
Persistent, low –grade inflammation and granuloma.
Opacification of the posterior
Visual acuity is diminished
capsule – the most common late
complication of extracapsular
cataract extraction.
Actual:
Disturbed sensory perception r/t lens protein denaturation
AMB clouded, blurred or dim vision secondary to cataracts.
Goal:
Improving visual acuity within the limits of individual situations,
recognize sensory disturbances and compensate for changes.
Interventions:
 Determine visual acuity, note whether one or two eyes involved.
 Orient clients to the environment
 Observation signs of disorientation.
 Approach from the side that was operated on, talk to touch.
 Remind clients use of cataract glasses whose purpose enlarge
approximately 25 percent, loss of peripheral vision and blind spot
may exist.
 Put the items required / position call bell within reach.
Risk:
Risk for injury related to blurred vision
Goal:
Prevention of injury.
Interventions:
 Help the patient when able to do until postoperative
ambulation and achieve stable vision and adequate
coping skills, using techniques of vision guidance.
 Do not put pressure on the affected eye trauma.
 Use proper procedures when providing eye drugs.
 Discuss the need for the use of metal shields or
goggles when instructed
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African Americans experience impaired vision
from both cataracts and glaucoma at twice
the rate of Caucasian Americans, primarily
due to lack of treatment.
In 2010, white Americans age 40 and older
had the highest prevalence rate of cataract
(18 percent) followed by black Americans (13
percent). Hispanic Americans had the lowest
rates of cataract (12 percent).
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