2 Macular Degeneration Nursing Care Plans

Macular degeneration is a progressive eye disease wherein the central portion of the retina gradually deteriorates. There are two types of age-related macular degeneration that occur. The dry or atrophic form is characterized by atrophic pigment epithelial changes and is most often associated with slow, progressive, and mild vision loss. The wet type is characterized by subretinal neovascularization that causes leakage, hemorrhage, and fibrovascular scar formation, which produce a significant loss of central vision.

Types of macular degeneration

The two types of macular degeneration are dry macular degeneration and wet macular degeneration.

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Dry macular degeneration is the most common form of this eye condition, affecting about 85 to 90 percent of people who have the macular degeneration. This form of the disease occurs due to small yellow deposits called druse developing under the macula. This causes retinal damage and vision loss.

Wet macular degeneration affects about 10 to 15 percent of people with the condition. This occurs when abnormal blood vessels develop under the retina and macula. If you have this form of macular degeneration, you may see a dark spot in the center of your vision due to blood vessels bleeding or leaking fluid.

Symptoms of macular degeneration

Macular degeneration is a progressive disease. This means that it will get worse over time. You may not notice vision problems in the early stages of the disease. You’re also less likely to notice vision changes when it affects both eyes at the same time.

The symptoms of dry macular degeneration include the following:

  • A distortion of straight lines in your field of vision
  • A reduction in central vision
  • The need for brighter lighting
  • Difficulty adapting to low lights
  • Blurriness
  • Trouble recognizing faces

Some symptoms of wet macular degeneration also resemble those of dry macular degeneration, such as visual distortions and reduced central vision. People with wet macular degeneration may also experience:

  • A blurry spot in your field of vision
  • Hazy vision
  • Rapidly worsening symptoms

Wet and dry macular don’t affect peripheral vision. While the disease can prevent you from seeing what’s directly in front of you, it doesn’t cause complete blindness.

Causes of macular degeneration

It isn’t known why some people develop macular degeneration while others don’t. However, certain factors can increase your risk of developing the disease. These risk factors include:

  • Being over the age of 65
  • Being Caucasian
  • Having a family history of macular degeneration
  • Smoking
  • Being overweight
  • Having cardiovascular disease

Diagnosing macular degeneration

It’s important to have annual eye exams even if your vision appears normal. You should also tell your doctor about any vision changes you experience. Your doctor can conduct a variety of tests to diagnose macular degeneration. For example, your doctor can use special eye drops to dilate your eyes and then check the back of your eyes for signs of fluid, blood, or yellow deposits.

During an eye exam, your doctor can also check your field of central vision by asking you to look at a grid. If some of the lines on the grid appear faded or broken, this can be a sign of macular degeneration. Other tests include the following:

Fluorescein angiography

Your doctor injects a colored dye into a vein in your arm to examine blood vessels in your eye. Then, they’ll use a special camera to take pictures of your eye. They’ll examine these pictures to look for problems and changes in your blood vessels and retina.

Indocyanine green angiography

Indocyanine green angiography is similar to fluorescein angiography. Your doctor injects indocyanine green dye. They can use this test to confirm the results of fluorescein angiography and to diagnose your type of macular degeneration.

Optical coherence tomography

This involves taking cross-sectional images of the retina and checking for swelling, thickening, or thinning. After you’re diagnosed with macular degeneration, your doctor may also use this type of test to see how your eyes respond to treatment.

Complications of macular degeneration

One of the complications of macular degeneration is being unable to perform certain tasks on your own. As the disease progresses, it becomes increasingly difficult to drive, read, or complete other activities. As a result of vision loss, about 30 percent of people with macular degeneration experience some form of anxiety or depression.

Speak with your doctor if you’re experiencing the symptoms of anxiety or depression. Your doctor can suggest treatments to improve your mental health, such as medication, counseling, or a support group for people with vision impairments.

It’s common for people with macular degeneration to be unable to drive a car. If your doctor diagnoses you with this condition, you may have to complete a vision test periodically to ensure you’re capable of operating a car.

Another complication is visual hallucinations. It’s estimated that 1 in 10 people with the disease experiences visual hallucinations due to low vision stimulation. As your vision decreases, your brain may compensate by creating false images or hallucinations. This isn’t a symptom of a mental health problem. You should discuss your hallucinations with your doctor or a support group. They can help you find ways to cope.

Treatment for macular degeneration

No cure is available for macular degeneration, but your doctor can recommend options to slow the progression of the disease.

Treatment for dry macular degeneration

If you have dry macular degeneration, your doctor may suggest that you work with a low vision rehabilitation specialist. The specialist can teach you how to adjust and cope with vision loss.

Your doctor may also recommend surgery to help improve your vision. During the surgery, they’ll implant a telescopic lens on your eye, which magnifies your field of vision.

Treatment for wet macular degeneration

If you have wet macular degeneration, you’ll also benefit from working with a low vision rehabilitation specialist. Also, your doctor may administer a medication directly into your eye to stop the growth of new blood vessels. It can take several weeks of treatment before you notice a difference.

Another treatment option is photodynamic therapy. Your doctor injects a medication into a vein in one of your arms and then uses a special laser to close up leaking blood vessels. This type of therapy can improve your vision, but you may need multiple treatments.

Photocoagulation is another therapy for wet macular degeneration. This involves the use of high-energy laser beams to destroy abnormal blood vessels. The purpose of this therapy is to stop bleeding and reduce further damage to your macula. However, the laser can cause scarring and leave a blind spot on your eye. Even if this treatment is successful, abnormal blood vessels can regrow, and you’ll have to return for another treatment.

Tips for prevention

Experts haven’t determined a way to prevent macular degeneration. However, you can reduce your risk of the disease by maintaining a healthy lifestyle. This includes:

  • Quitting smoking if you smoke
  • Eating a healthy diet
  • Maintaining a healthy weight
  • Getting plenty of exercise

Macular degeneration isn’t preventable, but it’s possible to diagnose the condition early with regular dilated eye exams. Early treatment can slow the progression of the disease and minimize vision loss.

Nursing Care Plans

Nursing management of macular degeneration involves supportive lifestyle changes to adapt to the decrease in vision, unless the degeneration is new and caused by abnormal blood vasculature, then laser surgery can sometimes slow or halt the deterioration by sealing off the leaking vessels. Reversal of damage that has already occurred is not possible.

Here are two nursing care plans (NCP) and nursing diagnosis for Macular Degeneration: 

  1. Disturbed Sensory Perception: Visual
  2. Risk for Injury

Disturbed Sensory Perception: Visual

Nursing Diagnosis

  • Disturbed Sensory Perception

May be related to

  • macular degeneration
  • presence of drusen
  • central vision loss
  • age-related ocular changes

Possibly evidenced by

  • distortion of central vision
  • Straight lines appear distorted
  • objects appearing smaller or larger than normal
  • Distortion of vision noted on the grid
  • presence of drusen or yellow deposits under the retina, the light-sensitive tissue at the back of the eye
  • legal blindness
  • subretinal edema
  • retinal bleeding

Desired Outcomes

  • Patient will regain optimal vision possible and will adapt to permanent visual changes
  • Patient will be able to verbalize understanding of visual loss and diseases of eyes.
  • Patient will be able to regain vision to the maximum possible extent with surgical procedure.
  • Patient will be able to deal with potential for permanent visual loss.
  • Patient will maintain a safe environment with no injury noted.
  • Patient will be able to use adaptive devices to compensate for visual loss.
  • Patient will be compliant with instructions given, and will be able to notify physician for emergency symptoms.
Nursing Interventions Rationale
Assess the patient’s ability to see and perform activities. Provides a baseline for determination of changes affecting the patient’s visual acuity.
Assist in diagnostic procedures and provide appropriate information:
  • Indirect ophthalmoscopy
Fundus examination through a dilated pupil that may reveal gross macular changes.
  • Amsler’s grid
Used to monitor visual field loss.
  • I.V. fluorescein angiography
Sequential photographs that may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.
Encourage patient to see an ophthalmologist at least yearly. Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient.
Provide sufficient lighting for the patient to carry out activities. Elderly patients need twice as much light as younger people.
Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth. Elderly patient’s eyes are more sensitive to glare and cataracts diffuse and glare so that the patient has more difficulty with vision.
Provide night light for the patient’s room and ensure lighting is adequate for the patient’s needs. Patient’s eyes may require longer accommodation time to changes in lighting levels. Provision of adequate lighting helps to prevent injury.
Provide large print objects and visual aids for teaching. Assists patient to see larger print and promotes a sense of independence.
Provide information about laser surgery. Laser surgery may be helpful for the wet type of macular degeneration if done early. An approximate of only 20% of patients will have any improvement in visual function if done later.