By looking for early signs of cataracts when conducting holistic patient assessments, nurses can help affected patients manage any loss of vision until surgery is appropriate.
Cataracts have a significant impact on NHS resources and patients’ independence and quality of life. Despite their high incidence, however, their impact is rarely considered outside ophthalmology.
Minassian et al (2000) stated that in the UK adult population there were 225,000 new cases of visually impairing cataracts per year. The NHS performed 345,038 procedures to treat cataracts in 2012-13 (Health and Social Care Information Centre, 2014), with a further 20,800 performed in the independent sector (HSCIC, 2012); the number of procedures rose the following year to 371,240 (HSCIC, 2015). Worldwide it is estimated that 18 million people are “cataract blind”, representing half of all cases of blindness (Lansingh, 2011). This article focuses on age-related cataracts and nurses’ role in their early detection.

Pathophysiology of cataracts

The lens is an asymmetric spheroid located behind the iris in the anterior segment of the eye that possesses no nerves, blood vessels or connective tissue. It has three parts:

  • An elastic capsule, made up of collagen fibrils that envelop the whole lens;
  • Lens epithelium, which is confined to the anterior surface;
  • Lens fibres, which make up the main mass of the lens.

Over time, some lens fibres lose their nucli and start to produce crystallins; these water-soluble proteins are thought to increase the refractive index and transparency of the lens (Yanoff and Duker, 2008). These crystallins concentrate over time in the central portion of the lens, increasing its density, making it less pliable.

Impact of cataracts

There are several cataract types (Table 1, attached); with some, patients may have “normal” vision in certain light conditions despite having cataracts. However, visual impairment due to cataracts can reduce functional status and wellbeing to a degree comparable to those with a major medical condition (Chia et al, 2004). The decline in visual acuity is insidious and patients may not notice for some time; although it is likely to have been deteriorating for several years, they often report a sudden loss in visual acuity.
Diminishing visual function can cause a range of problems. Patients may find it difficult to:

  • Recognise faces;
  • Watch television;
  • Read;
  • Drive.

As a result, leisure, employment, activities of daily living, socialisation and safety can be negatively affected. A diminishing appreciation of colours may also hinder contrast and affect employment.
Patients’ safety can be compromised if they cannot see to avoid potential hazards, even in familiar environments. Davey et al (2011) noted that patients with cataracts who have had a procedure experienced fewer falls at home (18% compared with 25% of those who have not had a procedure), and fewer bone fractures (3% compared with 12%); this clearly shows that rehabilitation of vision from cataract surgery has wider benefits for patients.
Some cataracts are associated with visual glare at dusk or dawn; this can make driving difficult or dangerous, putting patients at risk of committing an offence if they are unable to comply with the eyesight requirements of the Road Traffic Act 1988. They may lose mobility and independence by giving up driving…..
Read more:
Source: Nursing Times