Acute Macular Degeneration & Hearing Deficits 

NSG 409 Spring 2023 

A largely age-related disease process, known as Acute Macular Degeneration (AMD), is an eye disease that causes vision loss. Specifically, this eye disease causes the loss in the center of the field of vision, which is a gradual deteriorating process. Moreover, sight details when looking straight ahead are blurry or wavy. Individuals are unable to see finer details in the center of their vision. In other words, there is a blind spot in the middle of their vision field. When treating someone with AMD, a nurse faces challenges with the patient coping with the diagnosis and lifestyle management. The patient will likely be frightened when they receive the diagnosis of AMD and then challenged with adjusting their lifestyle while they adapt to the changes in their eyesight. Overall, the opportunity to see the world through Alfred’s eyes, the 74-year-old man with suspected mild cognitive impairment (MCI) as well as age-related vision and hearing loss for this virtual reality assignment was a wonderful opportunity to understand how individuals with this condition see and feel throughout their daily lives.  

As a future nurse, if I were to encounter a patient who was experiencing these symptoms, there are some diagnostic assessments and exams a nurse is able to assist with include bothFluorescein angiography and indocyanine green angiography, which are tests used to determine signs of macular degeneration. Nursing management in regard to these exams primarily depend on patient education preoperatively and postoperatively. For instance, to name a few, the nurse can counsel the patient to wear dark sunglasses in the daylight as well as to avoid direct sunlight exposure for five days after treatment. The patient should be warned that bright lights should be avoided such as tanning booths, intense room lights as well as halogen lights. Notably, as a nurse, I can assist the patient with a variety of testing that may be needed, such as the Montreal Cognitive Assessment, which was an assessment conducted with Alfred. 

Not only can a nurse be of assistance with diagnostics and treatments, but a nurse also offers interventions to help a patient manage AMD during their daily life. A nurse is part of a patient’s support system, so to provide someone suffering from AMD with resources and tools as part of their lifestyle management is important. I can only imagine how greatly this disease impacts a person’s mental and emotional well-being as well as their connection with others and the outside world. An individual losing their central vision causes it to be more difficult for them to see people’s faces, read newspapers or books, drive, cooking, or housework. For instance, experiencing the virtual reality simulation through Alfred’s eyes, I was able to witness first-hand what these patients see and how their vision is affected. Alfred was unable to see his surroundings clearly, faces across the table as well as faces at his doctor appointments. For these individuals it can be emotionally, physically, and mentally debilitating and it is of utmost importance for a nurse to assess how this condition impacts them in order to help implement strategies that will assist them with daily life activities and to help them cope with the changes in their vision loss.

This experience will impact how I assist my future patients suffering from AMD and I will be empathetic and supportive so that these patients receive the best care possible. For instance, I will offer recommendations for supportive lifestyle changes to help compensate for the patient’s AMD and ask the patient how they already perform daily activities and make recommendations for ways that the patient can maintain an independent lifestyle. I will educate the patient to ensure that they keep the floors clutter free, avoid moveable and slippery rugs, avoid cords on the floors and offer any other recommendations to reduce the patient’s risk of falling at home. I will also counsel the patient about the use of proper lighting to improve their vision in darkness by using such tools as night lights and having lamps or lighting adequately placed throughout the house. In this way, lighting can help enhance their ability to see and tackle daily life activities. If reading is a challenge for these patients, I can assist them with lenses or other seeing devices that will enlarge images or words to allow them to see more effectively. I will recommend the use of handrails in risky areas in the patient’s home such as in the bathroom or for unlevel areas. Tools such as a cane can assist with walking and enlarging the fonts on all electronics, such as the patient’s phone and computer, can assist as well.

In the hospital, if I were a nurse caring for a client with visual impairment, I would also ensure to orient the individual to their room and the hospital by demonstrating where the call light is if they were to need assistance, where their belongings are located, where the hospital equipment is located, where the tv and tv remote are located, and where the bathroom is located to name a few. I would also ensure to keep the room as clutter free as possible in order to avoid patient falls as well as ensure the room has proper lighting. And, most importantly, I would discuss with the individual how to best accommodate them with their visual impairment. I will make sure the patient is aware of all resources and tools to best ensure that they can maintain their independence and their normal routine.

As a future nurse, I perceive my nursing practice will be affected in various ways when caring for patients with AMD. I will need to be aware that such patients will have limitations such as with navigating their surroundings during appointments or in a hospital setting, and I will be aware that patients with AMD will unlikely see me or others well and that accommodations will be needed such as with assistance walking and showing them where to sit.  I will read any instructions and correspondence that are provided to ensure they have a full understanding of their diagnosis and treatment plan and will do so with any other information they may need to know. Being a nurse, I realize I have a critical role in providing quality and safe care for those with age-related conditions such as AMD, so I will be conscientious of any needs that the patient may have so that they have a successful caregiving experience.