Chapter 17: Vision

Overview of Vision and the Older Adult• Visual function and performance of ADLs• Safety considerations• Quality of life• Gradual age-related changes• Compensatory mechanisms• Effect of disease processes

Age-Related Changes That Affect Vision• Eye Appearance and Tear Ducts

– Minimal effect on actual vision– Arcus senilis– Enophthalmos– Blepharochalasis– Ectropion/Entropion– Dry eyes

Age-Related Changes That Affect Vision (cont’d) • Changes in the Eye

– Cornea– Lens– Iris– Pupil– Ciliary body– Vitreous– Retinal-neural pathway

Question

Which of the following statements about age-related changes that affect vision is true?

A. Gradual age-related changes in vision have an immense impact on the older adult’s quality of life.B. Age-related changes affect all the structures involved in visual function.C. The size of the pupil enlarges, which causes more light to reach the retina.D. Arcus senilis is a rare age-related change associated with protein accumulation.

Answer

Answer: B. Age-related changes affect all the structures involved in visual function.

Rationale: Age-related changes affect all the structures involved in visual function and alter visual perception for the older adult. In the absence of disease processes, these gradual changes have only a subtle impact on the daily activities of the older person.

Effects of Age-Related Changes on Vision

• Age-related changes in vision as a biomarker of aging

• Age-related visual changes are universal.• Visual impairment• Compensatory mechanisms

Effects of Age-Related Changes on Vision (cont’d)

• Presbyopia: loss of accommodation• Diminished visual acuity• Delayed dark and light adaptation• Increased sensitivity to glare• Reduced visual field

Effects of Age-Related Changes on Vision (cont’d)

• Diminished depth perception• Altered color vision• Diminished critical flicker fusion• Slower visual information processing

Question

Presbyopia is best described as:

A. The loss of accommodationB. Diminished visual acuityC. Delayed reaction to changes in lightD. A reduction in the visual field

Answer

Answer: A. The loss of accommodation

Rationale: Presbyopia is the loss of accommodation, which is the ability to focus clearly on objects at various distances. Presbyopia is an initial and universal age-related vision change, which begins in early adulthood and affects all humans to some degree by their mid-50s.

Question

Opacification and yellowing of the lens cause an altered perception of which colors?

A. Red and orangeB. Blue and greenC. Brown and blackD. Yellow and white

Answer

Answer: B. Blue and green

Rationale: Age-related changes that interfere with retinal illumination − including opacification of the lens, pupillary miosis, and retinal or retinal-neural changes − can interfere with accurate color perception. Opacification and yellowing of the lens interfere most directly with shorter wavelengths, causing an altered perception of blues, greens, and violets.

Risk Factors That Affect Visual Wellness

• Environmental factors• Smoking• Chronic conditions• Medications

Cataracts• Leading cause of visual impairment in older

adults• Cataract formation• Risk factors• Actual changes in vision• Treatment

Age-Related Macular Degeneration• Leading cause of severe vision loss in older

adults• Risk factors• Types• Signs and symptoms• Effects on vision• Treatment

Glaucoma• Second leading cause of blindness in the

United States• Role of aqueous humor and damage to the

optic nerve• Types• Signs and symptoms• Treatment

Question

Mrs. W. complains of a loss of peripheral vision. Which of the following should she be evaluated for?

A. Cortical cataractsB. Nuclear cataractsC. Macular degenerationD. Glaucoma

Answer

Answer: D. Glaucoma

Rationale: The term glaucoma refers to a group of eye diseases in which the ganglion cells of the optic nerve are damaged by an abnormal build-up of aqueous humor in the eye. Damage to the optic nerve then causes a loss of peripheral vision.

Functional Consequences Affecting Visual Wellness

• Effects on Safety and Function– ADLs – IADLs – Changes in gait, balance, and postural

stability– Increased risk of falls and injury

Functional Consequences Affecting Visual Wellness (cont’d)• Effects on Quality of Life

– Withdrawal from normal activities– Decreased psychological well-being– Fear– Negative attitudes– Hopelessness

Functional Consequences Affecting Visual Wellness (cont’d)

• Effects on Driving– Safety– Independence– Consequences while driving for the older

adult with vision impairment

Question

Consequences of visual impairment while driving include all the following except:

A. Slower dark and light adaptation B. Interference with peripheral vision C. Increased illumination with tinted windowsD. Difficulty with perception of the colors of traffic lights

Answer

Answer: C. Increased illumination with tinted windows

Rationale: Consequences of visual impairment while driving include slower dark and light adaptation, a decrease in peripheral vision, and interference with the perception of red and green traffic lights in bright sunlight. There is actually a diminished illumination in cars with tinted windows.

Nursing Assessment of Vision• Goals of assessment• Interviewing about vision changes• Assessment of usual eye care practices• Early detection of disease• Identification of risk factors• Observing cues to visual function• Utilization of vision tests

Nursing Diagnoses• Disturbed Sensory Perception: Visual• Anxiety• Ineffective Coping• Self-Care Deficit• Risk for Injury• Impaired Social Interaction• Readiness for Enhanced Coping• Readiness for Enhanced Self-Care

Planning for Wellness Outcomes

• Vision compensation behavior • Sensory function: vision• Coping• Adaptation to physical disability• Self-care: ADLs

Planning for Wellness Outcomes (cont’d)

• Stress level• Knowledge: personal safety• Fall prevention behavior• Risk control: visual impairment

Nursing Interventions for Visual Wellness

• Health Promotion for Visual Wellness– Elimination or reduction of risk factors– Smoking cessation– Visual examinations– Use of educational materials for teaching

Nursing Interventions for Visual Wellness (cont’d)• Comfort Measures for Dry Eyes

– Over-the-counter remedies– Cold compresses – Wraparound glasses– Humidification– Avoidance of irritants

Nursing Interventions forVisual Wellness (cont’d)

• Environmental Modifications– Proper lighting – Color contrast– Reduction of glare

Nursing Interventions forVisual Wellness (cont’d)• Low-Vision Aids

– Best when used to improve focus, contrast, magnification, or illumination

– Used in conjunction with environmental modifications

– Specific examples of low-vision aids

Nursing Interventions forVisual Wellness (cont’d)

• Maintaining and Improving Quality of Life– Interventions that allow compensation for

visual changes– Increased ability to perform activities that

enhance function– Support groups

Evaluating Effectiveness of Nursing Interventions• Observation of compensatory behaviors • Assessment for improvement of

independence• Evaluation of quality of life and ability to

participate in activities• Referrals for vision services

Chapter 17: Vision

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