227. CCA Study Notes: Eye Disorders, Vision Impairment, and Supporting Clients

The Big Picture

Vision impairment affects people of any age. A person might have some useful vision, see light without seeing details, or have no vision at all. Vision loss sometimes develops slowly and sometimes happens suddenly. Health conditions, accidents, and eye diseases are among its causes.

Different eye disorders affect vision in different ways. Some affect central vision. Others affect the retina, lens, or optic nerve. Supporting a client with vision impairment also means protecting safety, respecting independence, following the client’s choices, and communicating clearly.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Understanding Vision Impairment

Vision impairment ranges from mild difficulty seeing to complete loss of vision. Some people have no ability to sense light. Others sense light but do not see details. Some retain useful vision but do not see well.

A person described as legally blind sees objects at 6 m (20 ft.) that a person with normal vision sees at 60 m (200 ft.).

Vision impairment sometimes develops gradually and sometimes occurs suddenly. Surgery, eyeglasses, or contact lenses are among the corrective measures described for different vision problems.

Conjunctivitis

Conjunctivitis is inflammation of the clear membrane covering the white part of the eye and lining the inside of the eyelids.

The everyday term for conjunctivitis is pink eye.

Age-Related Macular Degeneration

Age-related macular degeneration (AMD; ARMD) is degeneration of the macula.

The retina is the inner layer of the eye that senses light and colour. The macula is a small part of the retina where vision is sharpest. It also contains the highest concentration of cones used for colour vision.

AMD is associated with aging. It is the most common cause of vision impairment in people over age 50. For adults over age 55, it is the leading cause of blindness in North America.

AMD starts with gradual or sudden partial vision loss. It is not painful. Central vision becomes fuzzy or shadowy and worsens over time.

The amount of remaining vision differs from person to person. Some people lose all sight. Some retain some sight. Others lose central vision while keeping some peripheral vision, meaning vision at the sides, top, and bottom.

There is no cure for AMD. Macular degeneration also affects some younger adults and children.

Wet AMD and Dry AMD

Wet AMD	Dry AMD
Blood vessels grow behind the retina and under the macula.	Light-sensitive cells in the macula slowly break down.
The blood vessels leak blood and fluid.	Central vision gradually becomes blurry.
Central vision is lost quickly.	Central vision is lost gradually.
An early symptom is straight lines looking wavy.	A blurred spot develops in the centre of vision as the condition worsens.
It is considered advanced and more severe than dry AMD.	It usually affects both eyes.
Less common than dry AMD.	More common than wet AMD.

Retinal Detachment

Retinal detachment is separation of the retina from the tissue supporting it.

The vitreous is the gel-like material inside the eyeball. As a person ages, the vitreous thickens. Shrinking or contracting vitreous sometimes pulls on the retina and leads to a retinal tear.

A detached retina does not function properly. Permanent vision loss in the affected eye might result.

Supported causes include:

• eye injury
• head injury
• a fall
• eye disease
• a condition such as diabetes
• excessive nearsightedness
• congenital thinning of the retina

Possible symptoms include flashing lights in the corner of the affected eye and seeing “floaters.”

Surgically reattaching the retina sometimes saves vision. The client needs assessment by an ophthalmologist, a specialized eye doctor, as soon as possible.

Diabetic Retinopathy

Diabetic retinopathy is a disorder in which diabetes damages blood vessels in the retina. The condition described is caused primarily by type 1 diabetes.

Blood might leak from damaged vessels. New vessels grow over the retina and create scar tissue. This scar tissue pulls the retina away from the back of the eye.

Retinal detachment and vision impairment might result. Routine vision examinations are urged for people with diabetes.

Cataracts

A cataract is clouding of the eye’s lens. The clouding prevents light from entering the eye.

Cataracts occur most often in older people, although younger people also receive this diagnosis.

Signs and effects include:

• gradual blurring
• dimmer vision
• sensitivity to light and glare
• eventual loss of vision

A cataract affects one eye or both eyes.

Surgery is the only treatment described. During surgery, the cloudy lens is removed through a small incision and replaced with a plastic lens. Vision returns to near-normal after surgery.

Glaucoma

Glaucoma is an eye disease that creates pressure inside the eye and damages the optic nerve.

Without treatment, blindness eventually results. Glaucoma is usually associated with aging. Its onset is either gradual or sudden.

Signs and symptoms include:

• tunnel vision, where the field of vision narrows until the person sees only straight ahead
• blurred vision
• multicoloured halos around lights

Treatment includes medication and sometimes surgery. The goal is to prevent more damage to the optic nerve. Damage that has already occurred does not reverse.

Presbyopia

Presbyopia is the gradual loss of the ability to focus on objects that are close.

It is associated with aging. Most people experience this normal decline in vision after age 40.

Corrective lenses, contact lenses, and good lighting help with presbyopia.

How Severe Vision Impairment Affects a Person

Severe vision impairment affects physical, emotional, social, intellectual, and spiritual health.

Severe vision impairment can affect independence and self-esteem. For example, dressing may take much longer, reading the newspaper may no longer be possible, and fear of falling or getting lost may stop a person from going out alone or attending a place of worship.

Resources include talking books, aids for activities of daily living, technology, support for clients and families, entertainment devices, medical devices, computers, and computer software. The Canadian National Institute for the Blind, CNIB, provides resources for people with vision impairment.

Many people with severe vision impairment learn different ways to move around, perform activities of daily living, read, and live independently.

Guide Dogs and White Canes

Some people use a guide dog or a special white cane with a red tip to move around independently. Both are recognized worldwide as signs of vision impairment.

A guide dog recognizes danger and guides the person through traffic.

A professional trains clients to use a white cane. People suited to using a guide dog attend special training sessions.

Eyeglasses

Eyeglasses correct vision impairment for reading, seeing objects at a distance, or both. Some clients wear them throughout their waking hours.

Protect eyeglasses from damage. Store them in their case when they are not being worn. Label the glasses with the client’s name.

Lenses consist of hardened glass or plastic to reduce breakage.

Cleaning Eyeglasses

Glass lenses are washed with warm water and dried with soft tissue.

Plastic lenses scratch easily. Use the special cleaning solutions, tissues, and cloths intended for cleaning and drying them.

Removing Eyeglasses

Hold the frames at the parts resting on both ears.

Lift the frames off the ears. Bring the glasses down and away from the client’s face.

Avoid touching the lenses. Do not place the glasses down on their lenses.

Contact Lenses

Contact lenses are hard or soft lenses that fit directly on the eye.

Some people prefer contacts because they are not visible, do not break easily, and work during sports. One disadvantage is that they are easily lost.

Depending on the type, contacts can be worn continuously for 12 to 24 hours or even for 1 week. They are usually removed for swimming and sleeping.

CCA action: Remove and clean the client’s contacts according to the manufacturer’s instructions and employer policy.

Report: Report eye redness or drainage to your supervisor. Also report complaints of eye pain or blurred vision.

Safety: Wear gloves to decrease the risk of spreading pathogens.

Laser Surgery for Vision Correction

Laser surgery corrects a number of vision conditions.

Laser correction does not suit every person. An eye surgeon who specializes in the procedure determines whether the person is suited for it.

Intra-Ocular Lens Implants

Cataract surgery replaces the natural lens with an artificial lens.

An intra-ocular lens implant is a clear hard plastic, soft plastic, or silicone disc. It is about the size of a small button and is usually placed behind the iris.

Soft lenses fit through a small incision, which shortens recovery time after surgery. The artificial lens restores the focusing ability lost because of the cataract.

After cataract surgery, clients receive instructions for a special eye-drop regimen ⓘ and special sunglasses that block the sun’s rays more effectively than regular sunglasses.

Some clients experience temporary dry eyes. Drops treat this problem. Follow-up care and appointments remain important.

Braille and Reading Aids

Braille is a writing system that uses patterns of raised dots to represent letters.

A person feels the dots with their fingers to identify each letter. The first 10 letters also represent the numbers 0 through 9.

Braille appears in books, magazines, newspapers, computer keyboards, elevators, subways, bus stops, and other transportation settings.

Learning Braille is difficult for some people, especially older adults. Some people with vision impairment do not learn it.

Other reading aids include:

• large-print books
• audiobooks
• magnifiers
• magnifiers with reading lamps

Communication Aids

Communication aids include:

• Braille calendars
• large-print clocks that speak the time
• telephones with Braille keypads
• telephones with extra-large numbers
• cheque-writing guides
• envelope-writing guides
• computer software designed to assist people with vision impairment

Entertainment Devices

Entertainment devices include televisions with descriptive captions for movies and shows, as well as playing cards and bingo cards with large numbers or Braille.

Medical Devices

Examples of medical devices include pillboxes marked with days or times in Braille. The person feels whether a pill has been taken.

“Talking prescription devices” provide spoken messages explaining how to take medication.

Artificial Eyes

Removal of an eye is sometimes necessary because of injury or disease.

An ocular prosthesis is an artificial eye made from glass or plastic. It matches the other eye in colour and shape.

An artificial eye is either a permanent implant or removable. A person with a removable prosthesis learns how to remove, clean, reinsert, and routinely care for it.

The artificial eye belongs to the client. Protect it from loss and damage. Provide care in a safe place. Do not hold the artificial eye over a sink because it might fall down the drain.

A CCA may assist the client in caring for the artificial eye and the eye socket where it is placed.

When the Artificial Eye Will Stay Out

When the artificial eye is removed and will not be reinserted right away, follow this order:

1. Wash the artificial eye with mild soap and warm water. Rinse it well.
2. Line a container with a soft cloth or a 4 × 4 gauze square to protect the artificial eye.
3. Fill the container with water or saline solution ⓘ.
4. Place the artificial eye in the container and close it.
5. Label the container with the client’s name. In a facility, include the room number.
6. Put the container in the bedside-stand drawer or another safe place directed by the client.
7. Wash the eye socket with warm water or saline. Use a washcloth or gauze square. Remove excess moisture with gauze.
8. Wash the eyelid with mild soap and warm water. Clean from the inner part of the eye toward the outer part. Dry the eyelid.

A client has vision loss on the side with the artificial eye. Vision in the other eye might be normal or have slight to moderate impairment.

Communicating With a Client With Vision Impairment

People with vision impairment often have highly developed senses of hearing, touch, smell, and taste. They are sensitive to the tone of another person’s voice.

Your voice carries information that body language usually provides. Speak with warmth and respect.

Protect Dignity

Clients with vision impairment need patience and respect, not pity.

Speak clearly in a normal tone. Do not shout, mumble, use slang, or speak to the client like a child.

Include the client in conversations. Do not ask another person to speak for the client.

Use respectful wording that describes the person as having an impairment rather than defining the person by the impairment.

Support Independence

A person with vision impairment is not automatically impaired in other areas. Do not assume what the client is or is not able to do.

Allow the client to do as much as possible independently.

Tell the client what you are doing step by step. Tell the client when a procedure has ended.

When the client uses assistive devices to maintain independence, keep those devices accessible.

Give Individualized Care

Client-centred care fits the client’s:

• choices
• physical strengths and limitations
• cognitive ⓘ strengths and limitations
• personality
• care plan

Clients with vision challenges sometimes feel isolated or lonely. Plan activities suited to the client’s strengths.

Respect the Client’s Preferences

Follow the client’s choices and directions.

Ask how you should help. Assist only when the client wants your help.

Protect Privacy

Always let a client with vision impairment know when you are in the room.

Announce your arrival clearly. Tell the client when another person joins you.

Keep the Environment Safe

Clients with vision impairment do not see obstacles in their path and face a high risk of falls.

Follow the care plan for safety measures specific to the client.

In a facility, keep the call bell within easy reach.

Keep Paths and Rooms Clear

Outdoor walks and stairs must be clear of ice and snow. Tell your supervisor if they are not.

Hallways and rooms must stay free of clutter.

Keep doors fully open or fully closed. Never leave a door partly open where the client might walk into it.

Furniture and other objects are arranged to meet the client’s needs. Put items back where you found them. Avoid rearranging furniture.

When the client enters a new setting, explain the layout and identify the location and purpose of furniture or equipment. Let the client move around and touch or locate furniture when possible.

In a facility, keep the call bell within the client’s reach.

Adjust Lighting

Ask what type of lighting the client prefers.

Adjust blinds and shades to reduce glare. Glare is usually worse on bright or snowy days.

Stand or sit where the lighting is good.

Let the Client Know You Are There

Identify yourself when you enter the room.

Give your name, title, and reason for being there. Do not touch the client before making your presence known.

Address the client by name. Tell the client when you leave the room.

Assist With Walking

When escorting a client with severe vision impairment:

1. Walk slightly ahead at a normal pace.
2. Offer your right or left arm and tell the client which arm you are offering.
3. Let the client take your arm.
4. Never push, pull, or guide the client in front of you.
5. Tell the client when you approach a curb or steps.
6. Say whether you are stepping up or down.
7. Tell the client about doors, turns, furniture, and other obstacles.
8. Give specific directions such as “on your left,” “in front of you,” or “right behind you.”
9. Avoid vague directions such as “over here” or “over there.”

The client holds you. You do not hold and steer the client.

Assist With Eating

Read menus to the client when needed.

Use solid-coloured dishes and table linens rather than patterns or designs. Create contrast between items, such as a white plate on a dark placemat.

Explain where food and drinks sit on the tray. Use the face of a clock to describe their locations, or guide the client’s hand to each item.

Help with tasks such as cutting meat, opening containers, and buttering bread as needed.