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01.03 Macular Degeneration

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Overview

Macular degeneration is the loss of central vision caused by damage to the center of the retina, also known as the macula.

Nursing Points

General

  1. A&P
    1. Retina
      1. Innermost layer
      2. Made up of photoreceptors
      3. Transmits impulses to optic nerve
    2. Macula
      1. Center portion of retina
      2. Focuses central vision in the eye
      3. Controls ability to read, drive, recognize faces and colors
      4. Allows eye to see objects in fine detail
  2. Macular degeneration
    1. Leading cause of vision loss
    2. No cure
    3. Two types
      1. Atrophic → age related/ dry
        1. More common
        2. Gradual decrease in vision
        3. Gradual blocking of retinal capillaries
        4. Retinal cells in macula become ischemic and necrotic
        5. Rod and cone photoreceptors die
      2. Exudative →  wet
        1. Sudden decrease in vision
        2. Can occur at any age
        3. Happens after serous detachment of pigment epithelium in macula
        4. New blood vessels invade injured area
        5. Results in scar formation and visual distortion
        6. Drusen (yellow deposits under retina)
    4. Risk factors
      1. Hypertension
      2. Family history
      3. Female Gender

Assessment

  1. Dry macular degeneration
    1. Central vision declines
    2. Starts with mild blurring and distortion
    3. Leads to loss of all central vision
  2. Wet macular degeneration
    1. Sudden, acute decrease in central  vision
  3. Loss of vision leads to issues with
    1. Reading
    2. Writing
    3. Recognizing  safety hazards
    4. Driving

Therapeutic Management

  1. Diagnosis
    1. Fluorescein angiography
      1. Dye given
      2. Shows problems with retinal circulation
  2. Treatment
    1. Dry macular degeneration
      1. No cure
      2. Focused on slowing progression of vision loss
      3. Help patient maximize remaining vision
    2. Wet macular degeneration
      1. Slowing process
      2. Identifying further changes in visual perception
      3. Fluid and blood may resorb
      4. Laser therapy
        1. Seal leaking blood vessels
    3. Eye drops
      1. Ranibizumab (Lucentis)
  3. Management
    1. Maximize remaining vision
    2. Lifestyle modifications

Nursing Concepts

  1. Functional ability
  2. Sensory perception
  3. Safety

Patient Education

  1. Eye drops
    1. Administration
    2. Side effects
  2. Maximize remaining vision
  3. Lifestyle modifications
Study Tools

Video Transcript

Hey guys! Today we’re going to learn about macular degeneration. By the end of this lesson, you’ll have a better understanding of what macular degeneration is, the types of macular degeneration, assessment findings, treatment options, and nursing considerations when taking care of patients with this condition.

0k, So two things I want to make sure we understand before going further: the retina and the macula of the eye. So the retina is this innermost layer here. It is made up of photoreceptors and transmits impulses to the optic nerve which is right about here. The optic nerve is important because it transmits visual information from the retina to the brain. The macula is located right here. It is the central portion of the retina. It helps focus central vision in the eye. So the macula also controls our ability to do things like read, drive, recognize faces and colors, etc. It also allows our eyes to see things in fine detail. So alterations in these structures directly impact vision.

So macular degeneration in general is the loss of central vision caused by damage to the center of the retina, which is also known as the macula. Macular degeneration is the leading cause of vision loss and it has no cure.

So there are two types of macular degeneration. One is atrophic or age related or dry macular degeneration. This is more common and is a gradual decrease in vision. It is caused by the gradual blocking of the retinal capillaries in the eye. This leads to the retinal cells in the macula becoming ischemic and necrotic, which then causes the rod and cone photoreceptors to die. On the other hand, exudative or wet macular degeneration is a little different. This is characterized by a sudden decrease in vision and can happen at any age. It is caused by serous detachment of pigment epithelium in the macula. New blood vessels then invade the injured area and leak. This causes fluid and blood to collect under the macula kind of like a blister, which results in scar formation, visual distortion, and permanent injury. The deposits under the retina are called drusen or drusen bodies. So an easy way that I keep these apart is I think age related as old. Old people can be dry and their bodies atrophy as they age. Atrophic equals age related. And with exudative I think of the definition of exudate – drainage, right? So exudative is wet because there’s literally leaking blood vessels that cause the vision loss.

These pictures to the right do an excellent job showing macular degeneration. This top picture is what normal vision looks like and this bottom picture is what a person with macular degeneration sees. So in dry macular degeneration it is a gradual loss of central vision. It starts with mild blurring and distortion and leads to loss of all central vision. With wet macular degeneration, it is a sudden, acute decrease in central vision. With both dry and acute macular degeneration, patient’s will have problems with simple day to day tasks like reading, writing, recognizing safety hazards, and driving due to blurred and decreased central vision.

One of the diagnostic tests that can be done is called fluorescein angiography, which is when a patient is given dye which helps the provider see problems with retinal circulation. So there really is no cure to dry macular degeneration. Treatment is focused on slowing the progression of vision loss and helping patients maximize remaining vision. Wet macular degeneration is similar, as treatment is aimed at slowing the process, but there is an intervention called laser therapy that can be implemented to help seal the leaking blood vessels, which helps limit the extent of the damage.Eye drops such as Lucentis can be administered, which helps prevent the growth of new blood vessels in the retina. Sometimes with wet macular degeneration the fluid and blood can be resorbed. We will also be monitoring for further changes to the patient’s vision and assessing to see if there is further bleeding. Management for both kinds of macular degeneration is aimed at maximizing the patient’s remaining vision and implementing lifestyle modifications like providing large print education materials and encouraging public transportation.

If your patient is on eye drops for macular degeneration, you’ll want to educate on how to administer the drops and side effects to monitor for such as corneal edema and increased intraocular pressure. These are two things that should be reported to the provider. We want to maximize the patient’s remaining vision as there is no “cure” for macular degeneration. This vision loss affects the patient’s independence, well-being, and quality of life. Finally, you’ll want to educate about different lifestyle modifications the patient can implement, such as using large print books, public transportation vs driving, and considering a meal delivery service depending on the degree of visual impairment.

One of the nursing concepts relating to macular degeneration is alterations in functional ability. These patients have alterations in vision which directly impacts their ADLs. Another nursing concept is sensory perception, as the patient’s vision is directly impacted. These patients have blurred vision that can lead to blindness, which absolutely impacts their sensory perception.
Alright guys so I want you to take away from this lesson the differences between wet and dry macular degeneration. Wet = exudative or leaking vessels. And dry is age related or atrophic – old people can be dry and atrophy as they age. Although there is no cure, there are eye drops and laser therapy that can be implemented to help slow the progression of wet macular degeneration. Finally, management is centered around maximizing vision and helping the patient identify and implement lifestyle modifications as their vision suffers from this disease.

Alright guys, that’s it for our lesson on macular degeneration. Make sure to check out the other resources attached to this lesson. Now, go out and be your best self today. And, as always, Happy Nursing!

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