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Elizabeth Varona-Martin

Module 6

We should ask the patient if he has difficulties  reading road signs or fine print or driving at night due to glare from approaching headlights . We need to figure out if he has any risk factors, such as diabetes or steroid use, or any significant eye trauma in the past, or if he noticed any difficulties with dark adaptation, fluctuating vision, presence of floaters, flashes of light (photopsia), defects in the field of vision. (Jacobs, 2022). 

Determine if he has any pain, differentiate between ocular and head pain, any related ocular symptoms like red-eye, discharge, atypical appearances,  or systemic issues, for example,  headache, other neurological problems, generalized malaise.

During a non-dilated fundus examination with a direct ophthalmoscope, check for lens opacity, opacities within the red reflex, or obscuration of ocular fundus detail. Look for the presence of cupping in the fundus examination. Cupping is called a hollowed-out look of the optic nerve. Glaucoma is indicated by a cup with a diameter of more than 50% of the vertical disc diameter (Jacobs, 2020). Thinning or notching of the disc rim, progressive change in the size or form of the cup, and asymmetry of the cup-to-disc ratio between the eyes are all signs of glaucoma on fundus examination.

Macular degeneration, glaucoma, diabetic retinopathy, and cataracts are the most common causes of vision loss in older people.

Macular degeneration is the most prevalent cause of significant vision loss in adults aged 50 or older. This condition affects the center of the vision. It’s crucial to note that it’s rare for people to go blind (Seltman , 2021).

Glaucoma is a collection of ocular disorders that damage the optic nerve over time, resulting in visual field loss and eventual blindness.  The most frequent types are primary open-angle glaucoma and primary angle-closure glaucoma. Ocular hypertension, or high intraocular pressure, is common in glaucoma patients, although optic nerve injury can also occur with normal intraocular pressure. 

Diabetic retinopathy is a complicated condition caused by several interconnected variables that result in two fundamental abnormalities in the retinal vessels: inadequate permeability and vascular occlusion with ischemia and consequent neovascularization. Nonproliferative and proliferative diabetic retinopathy are distinguished by the lack or presence of aberrant new blood vessels emerging from the retina (Fraser & D’Amico, 2020).

Cataract is a clouding of the eye’s lens that can result in impaired or distorted vision, glare issues, or, in the most severe cases, blindness (Jacobs, 2022).

Laboratory tests ordered CMP, HbA1c, CBC.

The visual field exam can help a provider detect early signs of disorders like glaucoma, which gradually deteriorate vision. There are two types of visual field tests, the Amsler grid and the confrontation visual field.

A CT scan is frequently used in eye care to image the bony orbit and determine the anatomic position of the extraocular muscles . Whenever a patient appears with orbital injuries, a non-contrast CT scan of the orbit can be helpful (Suhr & DelGiodice, 2015).

The orbital soft tissues and the brain can also be imaged with MRI. The benefit of MRI is that it provides better clarity between different soft tissues, making it the procedure of choice for imaging the brain and orbital soft tissue (Suhr & DelGiodice, 2015).

Surgery is recommended if the symptoms of a cataract make it difficult for the patient to meet their daily demands. Outpatient surgery is usually performed under a local anesthetic with closely monitored sedation (Jacobs, 2022).

Surgery is usually well-tolerated; uncommon complications include endophthalmitis, lens malposition or dislocation, cystoid macular edema, and retinal detachment (Jacobs, 2022).

Patients are seen on the first postoperative day, one week after surgery, and one month after surgery. Most providers recommend limiting physical activity for a few days to weeks.

Smoking and ultraviolet light exposure have both been linked to increased cataract formation. It is fair to advise older patients to limit their exposure to ultraviolet radiation and to quit smoking whenever possible. Smoking has also been connected to a significant risk of vision loss due to age-related macular degeneration.

A history and examination can disclose multiple causes in the primary care context, but an ophthalmologist may be required for confirmation, diagnosis, and therapy of the disease.

References

Fraser, C. E., & D’Amico, D. J. (2020, October 26). Diabetic retinopathy: Classification and clinical features. UpToDate. Retrieved April 19, 2022, from https://www.uptodate.com/contents/diabetic-retinop… 

Jacobs, D. S. (2020, August 4). Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis. UpToDate. Retrieved April 19, 2022, from https://www.uptodate.com/contents/open-angle-glauc… 

Jacobs, D. S. (2022, April 12). Cataract in adults. UpToDate. Retrieved April 18, 2022, from https://www.uptodate.com/contents/cataract-in-adul… 

Seltman , W. (2021, November 22). Macular degeneration (AMD): Symptoms, causes, treatment, prevention. WebMD. Retrieved April 19, 2022, from https://www.webmd.com/eye-health/macular-degenerat… 

Suhr, C. L., & DelGiodice, M. (2015, October 1). Neuroimaging 101 for the Optometrist. Review of Optometry. Retrieved April 19, 2022, from https://www.reviewofoptometry.com/article/neuroima…