hey everyone it's sarah register nurse rn.com and in this video i'm going to talk about cataracts and as always whenever you get done watching this youtube video you can access the free quiz that will test you on this content so let's get started cataracts is an eye disorder where the eye lens loses its transparency so it's no longer clear instead it is cloudy and this actually affects the transmission of light onto the retina so normally light will enter into the eye it will go through the lens and the lens will help focus it on the retina so we get a nice clear image but whenever this lens is cloudy what happens is when light hits this cloudy lens it will actually break up and scatter so that light's not being focused clearly on to that retina so the person will have like cloudy murky vision perception and let's look at example here what you're going to see on the left is a cat this is normal vision of someone seeing a cat notice the cat is nice and clear and we can see the different types of colors but on the right we see a the same cat but the person has a cataract in their eye and notice that the cat is blurry it's a murky looking image and the colors are less vibrant now cataracts are a common eye disorder especially in older adults so if you're taking care of older adults you definitely want to evaluate them for this eye disease in fact according to the national eye institute more than half of all americans age 80 or older either have cataracts or have had surgery to remove the cataract so how do cataracts occur specifically the ones that affect older adults known as senile cataracts well let's talk about the pathophysiology here is an eye and the view of the eye is the side view cut in half and there are many structures in your eye that allow you to see images clearly and it really starts out with light so your eyes open up and they detect light and the light enters the eye and it will start going in through the front part of the eye specifically the cornea and the cornea if you look at the side profile of most people you can see the cornea because it's like this small outer bulge and it's going to go through the cornea it's going to bend then it's going to hit the iris and the pupil so the iris is the color part of the eye that gives you your unique eye color and the iris is a neat structure because it is made up of smooth muscle and it controls the diameter of the pupil and all the pupil is is a hole in your eye because that really allows light in it's like a little keyhole and um your iris knows that a certain amount of light has to enter your eye in order for you to see images so whenever too much light is detected that iris is going to use its smooth muscle to constrict the pupil make it smaller but if you need more light your iris is going to use its smooth muscle to dilate that pupil so more light gets into the eye so once light enters in through the pupil it's going to hit the lens and the lens is really where our problem is in cataracts and some specific things about the lens is that one thing attached to the lens on each side are called ciliary muscles and these muscles help with accommodation because they are going to bend the lens in a way where you can focus on objects depending on their distance now another thing about the lens is that it needs to be clear in order for light to go through it and be able to be transmitted to a specific part of the eye so what gives it that nice clear color are proteins called crystalline so once light goes through this nice clear lens it's going to be focused on or beamed in a sense on a specific part of the retina and where it's going is where there are special receptors called photoreceptors and we're particularly talking about cones and rods and it's going to take that light and it's going to turn it into an electrical signal and then it's going to transmit it to the optic nerve which is going to go to your brain and you'll be able to see the most clearest image possible now in an eye with a cataract what happens is that this lens is no longer clear so those nice clear crystalline proteins have started to stick together and this is typically what happens in the older adult because over time the eye has been damaged let's say by sunlight or something like that so these crystallines have started to just clump together and stick together and that causes that lens to become cloudy so when light enters in through the eye hits that cloudy lens instead of it being able to focus and go where it needs to go on the retina that light is going to break up and it's going to scatter so think of it as like a dirty window whenever you have a dirty window and lights trying to come in through that dirty window the light isn't able to go where it's supposed to it just sort of scatters instead if that window was nice and clear the light would beam in at a great direction and go where it needs to go so that's like the same concept what's happening with cataracts and what happens is that this process happens over time so gradually the vision is going to decrease now if this is not treated what can happen is that blindness can occur where you're not going to be able to see anymore in the eye that has the cataract now one eye can have a cataract or both eyes can so great news is that that blindness can be reversed because today we have surgical procedures where they can go in remove this cloudy lens and put in a new lens called an intraocular lens so now let's talk about the causes of cataracts and what can actually cause this lens to become cloudy well there are various causes and one cause i've already hit on is aging so advanced age can lead to cataracts in addition a person can be born with this so it could be a congenital cataract and this can happen if a mom was exposed or infected with rubella during that first trimester that increases the risk of that next is trauma followed by disease processes like diabetes where that glucose level is not controlled also unprotected exposure to sunlight can cause this it affects your eyes and medications can cause this like corticosteroid use and then lifestyle so if a person is a heavy smoker uses high volumes of alcohol or they have a family history of cataracts that can develop them so how do you know if your patient has a cataract what are those signs and symptoms well let's think back to that image i showed you at the beginning of this review it was of the cat one side it was normal vision the other side was vision associated with the cataract in the eye so to help you remember those signs and symptoms let's remember the mnemonic cats so c is for cloudy blurry vision and the patient can also have double vision in the affected eye and remember cataracts can occur in both eyes and it typically is not painful and it happens gradually and very subtly a is for acquiring frequent eye glass prescriptions to help their vision they may notice that they're having to do that to get good vision t is for toned down colors so colors that they see will be washed out and faded s is for sensitivity to glare and light so light seems to be too bright there's a glare and there can be halos around the light and it tends to be worse at night so many patients may report to you you know i'm having trouble driving at night like the light is really just hurting my eyes i can't see and again this is due to that lie entering the eye and it's scattering onto that retina instead of focusing on that one specific area now how are cataracts diagnosed how can you tell a patient actually has a cataract well in severe cases where that cataract has really advanced you can actually see it in the eye like in this picture here if you look at the pupil you can notice in that area that there is this cloudy part covering the eye but the ophthalmologist can do some tests that can determine you know we have cataracts present so what they will do is they'll first do a visual acuity test with a snelling chart so have the patient look at certain letters read them back also they will use a slit lamp to assess the eyes and what this will do is it will help enlarge the front area of the eye to allow the doctor to see the structures of the eye for evaluation like the cornea the iris the lens etc furthermore they will dilate the eye so dilate those pupils put in some eye drops that will assist with that whenever they do that they can use an ophthalmoscope and they can look and assess the eye specifically look at that optic nerve now when a patient does develop a cataract what are their treatment options well typically the first option is just to monitor that cataract until it progresses to a point where that person can't really do their activities of daily living it just really interferes with their vision so during the monitoring part what the patient needs to do is that they need to get regular eye exams so they can monitor that cataract and change their eye glass prescriptions as needed to help with the vision along with wearing anti-glare glasses because remember the signs and symptoms part we talked about that they have a sensitivity to glare so that can help some patients and you want to educate the patient that daily they want to protect their eyes from the sun so wear sunglasses with uva and uvb protection along with using magnification whenever they're reading to help them see better and if they need more light while they're reading to add more light to whenever they're looking at certain things however whenever these things are no longer helping and this cataract or cataracts have advanced so much where they can't really function like they used to surgery is an option and the most common type of surgery that is performed today is called a fat co-emulsification and this is a type of extra capsular extraction and what they do is they remove the cloudy lens from the eye by breaking it up with sound waves and they in a sense just suck it out and then they put in a new lens called an intraocular lens and this will permanently stay in the eye and this will be the patient's new eye lens now um what's really good about this type of surgery is that the incision that is made in the eye is typically small and they usually don't need sutures or stitches so now let's wrap up this lecture and let's talk about our role as a nurse for a patient who has cataracts so the first thing we can do as the nurse is we can look at those patients who are at risk for cataracts and we can give them some education on how to prevent cataracts so what are some measures that a patient can take in helping hopefully delay or maybe stop the development of cataracts well to help us remember those points let's remember the word lens l is for layers of protection so you can educate your patient about the importance again of wearing sunglasses that provide uva and uvb protection and to wear large brim hats that help shade the eyes from the sunlight e is for eating fruits and vegetables in their diet because they provide nutrients like vitamin c e lutein and zeaxanthin which are all things that are very important for eye health and if your patient is diabetic this is a time that you can talk to them about the importance of managing their glucose levels because again that's a risk factor for cataracts n is for no smoking and to reduce their alcohol consumption and then s is for schedule regular eye exams to monitor the health of the eyes now let's talk about the nurse's role whenever the patient is having surgery so before the surgery the patient needs to be educated about what to expect and typically the surgery for cataracts will be an outpatient procedure they won't require hospitalization and the procedure itself where they do the surgery remove the lens put in a new lens is usually really quick lasting about 15 to 20 minutes and then afterwards the nurse will monitor the patient and one eye is treated at a time and the other eye if it has a cataract will be treated at another time not the same day the patient will be mpo so nothing by mouth before the surgery they'll need a driver to drive them home and they'll be responsible for instilling eye drops in their eye before the surgery some surgeons require the patient start instilling the eye drops about three days before the procedure and this includes medications like anti-inflammatories and antibiotics some examples of this include a corticosteroid known as difluoprenate also an insect can be used like napafanak or an antibiotic like moxifluxin so since the patient will be responsible for instilling whatever is ordered for them at home you want to go over some key points about how they should do this so they want to instill the drops in the eye that is having surgery and they want to wait three to five minutes in between each medication before instilling the next medication to allow the eye enough time to absorb that particular medication also show how to instill the eye drops in the conjunctival sac of the eye and how to perform punctal occlusion for two to three minutes to prevent the medication from being absorbed into the systemic circulation and i have a whole video that demonstrates how to perform this if you need to refresh on this technique another thing you want to remember is where the patient will have their eyes dilated right before surgery and the nurse may be administering these drops so the pupils why are they dilated well the surgeon needs them dilated so they can obtain the best view of the eye when replacing the lens so some things to remember is that patients who have darker eye colors like dark brown may need higher doses of the dilation medications to achieve the same effects compared to someone with like blue or green eyes and the reason for this is because dark eyes have more pigment melanin in them and the pigment binds or bounds the drops so people with a lot of pigment in their eyes like with dark brown the eyes need higher doses and it takes a little bit longer for them to dilate compared to those lighter eye colors also because the eyes are going to be dilated you want to make sure your patient's comfortable and dim those lights down because it makes eyes more sensitive to light and they will have blurry vision so they're definitely going to be at risk for falls and they'll need assistance when getting up another thing to remember is that you have taken the time to thoroughly look through the patient's medication list and particularly in the male patient if they have a large prostate see if they are taking a medication called tamsilosin like flomax or any other type of alpha blocker because these medications what they do is they relax the smooth muscle and remember at the beginning of the lecture i talked about the iris be made up of smooth muscle and because it is made up of that it can constrict or dilate the pupil well with cataract surgery we need a nice dilated pupil and these type of medications can make that iris floppy or we won't get that good response so this can prevent the pupil from dilating properly and lead to complications like intraoperative floppy iris syndrome so if your patient is taking this let the eye doctor know now what are some medications that can be used to help achieve this pupil dilation prior to surgery well madriatics can be used such as phenylephrine and this works on the alpha-adenergic receptors of the eye and cause the iris dilator muscle to contract and when this happens the pupil hence dilates increases in size also cycloplegics can be used and how they work is they paralyze those ciliary muscles that attach to the lens so they are circular smooth muscles of the eye which results in the loss of accommodation and to help you remember their action just break this word apart cyclo means circular and we're talking about circular smooth muscle and then plegic means paralyzed so they paralyze that structure now some key points you want to remember after surgery is that the patient is positioned on their non-surgical side also that they wear their eyes shield after surgery and while sleeping now these guidelines vary depending on what the surgeon wants for the patient but typically they may have an eye shield after surgery and they'll want to wear that while they're sleeping or even napping because it prevents the patient from accidentally rubbing the eye or hitting the eye while they're sleeping and then during the day if they aren't wearing an ice shield they can wear glasses to protect the eye and they will need eye drops after surgery so it's very important they take time to instill those and use clean hands and typically this is like antibiotics and anti-inflammatories they want to avoid any heavy lifting running coughing bending swimming etc that increases the intraocular eye pressure in the eye they just want to take it easy for several days and the pain that they should have with this should be minimal so acetaminophen tylenol is usually helpful with this if they do have really bad pain severe pain this is not normal they need to report this this could indicate a complication and it's normal to experience some itching of the eye and they don't need to rub it and blurriness for the next few days it's not normal again to have a severe pain or a further decrease in their vision and seeing light flashes or floaters that could indicate retinal detachment or any type of purulent drainage or excessive redness and the importance of them always keeping their appointments because during these appointments the doctor is going to be looking making sure the eye is healing properly and pressures are increasing in the eye there's no infection and some patients may need new eye glass prescription once the healing process is over okay so that wraps up this review over cataracts and don't forget to access the free quiz that will test you over this content i just covered