Age-Related Macular Degeneration (AMD)

• Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults

Risk Factors

• Advanced age is the primary risk factor
• Smoking significantly increases the risk
• Family history and genetics play a role
• Caucasian ethnicity is associated with higher risk
• Cardiovascular disease and hypertension may contribute

Types of AMD

• Dry AMD (non-neovascular) is more common
  • Characterized by drusen (yellow deposits under the retina)
  • Gradual vision loss
• Wet AMD (neovascular) is less common but more severe
  • Characterized by abnormal blood vessel growth under the retina (choroidal neovascularization)
  • Rapid and severe vision loss

Symptoms

• Blurred vision is a common initial symptom
• Difficulty reading or seeing details
• Metamorphopsia (straight lines appear wavy or distorted) in wet AMD
• Scotomas (blind spots) in the central visual field
• Difficulty adapting to low light levels
• Decreased color vision

Diagnosis

• Dilated eye exam to visualize the retina and macula
• Visual acuity testing to assess sharpness of vision
• Amsler grid to detect metamorphopsia
• Fluorescein angiography to visualize blood vessels in the retina
• Optical coherence tomography (OCT) to image retinal layers

Treatment

• Dry AMD:
  • No specific treatment to reverse vision loss
  • AREDS (Age-Related Eye Disease Study) formulation of vitamins and minerals (vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper) may slow progression
  • Lifestyle modifications: smoking cessation, healthy diet
• Wet AMD:
  • Anti-VEGF (vascular endothelial growth factor) injections (e.g., ranibizumab, bevacizumab, aflibercept) to inhibit abnormal blood vessel growth
  • Laser photocoagulation to destroy abnormal blood vessels (less common now due to side effects)
  • Photodynamic therapy (PDT) to damage abnormal blood vessels

Nursing Interventions

• Assessment:
  • Assess visual acuity and visual field
  • Monitor for changes in vision
  • Assess patient's ability to perform activities of daily living (ADLs)
  • Assess psychosocial impact of vision loss (depression, anxiety)
• Education:
  • Explain the disease process and treatment options
  • Teach patient how to use the Amsler grid to monitor for changes
  • Educate on the importance of taking AREDS vitamins for dry AMD
  • Explain the injection procedure and potential side effects for anti-VEGF treatment
  • Encourage smoking cessation
  • Provide information on low vision aids (magnifiers, large-print materials)
  • Refer to support groups and resources for visually impaired individuals
• Safety:
  • Ensure adequate lighting in the home
  • Remove tripping hazards
  • Encourage use of assistive devices (canes, walkers)
  • Provide transportation assistance if needed
• Medication Administration:
  • Administer eye drops as prescribed
  • Assist with anti-VEGF injections as needed
• Emotional Support:
  • Provide emotional support and encouragement
  • Listen to patient's concerns and fears
  • Encourage patient to maintain social connections

Potential Complications

• Severe vision loss or blindness
• Depression and anxiety
• Social isolation
• Increased risk of falls and injuries

NCLEX-Style Questions Considerations

• Focus on assessing risk factors, recognizing symptoms, and understanding treatment options
• Prioritize nursing interventions related to safety, education, and emotional support
• Be familiar with the medications used to treat AMD and their side effects
• Understand the importance of early detection and treatment to prevent further vision loss
• Questions may involve prioritization, delegation, and patient teaching scenarios

Key Nursing Concepts

• Patient education regarding disease process, self-monitoring, and treatment adherence
• Safety measures to prevent falls and injuries
• Psychosocial support to address emotional distress related to vision loss
• Collaboration with ophthalmologists and other healthcare providers

Important Medications

• Anti-VEGF drugs (ranibizumab, bevacizumab, aflibercept)
  • Inhibit the growth of new blood vessels in wet AMD
  • Administered by intravitreal injection
  • Potential side effects: eye pain, redness, blurred vision, endophthalmitis
• AREDS vitamins (vitamin C, vitamin E, lutein, zeaxanthin, zinc, copper)
  • Shown to slow the progression of intermediate to advanced dry AMD
  • No significant side effects at recommended doses

Amsler Grid

• Used to monitor for metamorphopsia (distortion of straight lines)
• Patient should look at the central dot on the grid with one eye at a time
• Report any areas of distortion, blurriness, or missing lines to the ophthalmologist