Analysis of Case Study on Cataracts. Essay Example

A 78-year-old woman complained of having problems regarding seeing and driving at night for the past 2years. She further complained of having difficulties understanding in direct sunlight. Warren Jones has a concurrent medical history of hypertension and is on ramipril medication. Her family history also indicated that her mother suffered from cataracts. Based on the patient's medical history, the use of ramipril is evidence of hypertension, which is a contributing factor to the development of senile cataracts. Furthermore, based on family history, the patient's mother previously suffered from cataracts. For senile cataracts, a patient often presents with gradual deterioration of visions and other forms of lens opacity exhibited.

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Assessment of the Condition

The doctor will perform examination and record-keeping through differential diagnosis regarding the reduced Vision of Warren Jones. The therapy will assess the common cases with low visual acuity and hypersensitivity to light. The whole procedure will examine the level of cataracts, diabetic retinopathy, and glaucoma. Regarding the blurring of images, the test will focus on corneal dystrophy, corneal scarring, retinal detachment, and age-related macular degeneration. Due to the underlying conditions based on the information provided in the patient’s record, the evaluation will focus on cataracts.

Relevant Examination Procedures for Cataracts

The process will begin with the anterior eye exam. Inspection for cataracts will occur in the cornea, iris, lens as well as the anterior part of the eye. In the anterior chamber, peripheral light will focus on the cornea and check whether the entire iris will be visible under the light without showing a shadow. Normality and absence of cataracts will be more apparent when the cornea is smooth, avascular, and translucent (Berry et al. 2020, p.173). Besides, flatness in the iris alongside color variance with pupil location in the upper chamber will appear bright with corresponding uniformity in density and transparency of the lens. The problem will be evident if the shadow is absent when peripheral light focuses on the cornea.

Another test for the condition entails a visual acuity test. The process will test the patient singly when the other eye is closed. The optician then applies a viewing device, or a chart is while reducing small letters as the doctor finds out if the patient has 20/20 vision or evidence of visual impairment.

Also, the Pearls and Pitfalls test will follow by examining the Red reflex condition of the patient via dilated pupil by use of an ophthalmoscope at a distance of about 30cm away. It will help in the identification of early development of cataracts if a slit lamp is unavailable.

The doctor will also conduct a slit-lamp examination whereby the patient sits on a chair with their forehead placed on a support to enable the doctor to check for any abnormalities and discuss the findings with the patient. The slit-lamp examination will assess defects in the eye under a microscope. Parts of the eye that will be under slit lamp include the lens, pupil, sclera, conjunctiva, retina, iris, eyelids and cornea. After the examination, the diagnosis of a wide range of abnormalities will occur. For instance, the opacity of the lens is an indication of cataracts. Also, the presence of foreign substances in the eye, along with inflammation of the middle layer of the eye indicates muscular degeneration and damage to the retina (Camacho et al. 2019, p.16).

Similarly, a Fundus examination will follow if the previous tests fail to provide valid results. During the procedure, an ophthalmoscope will examine the patient’s eye. An indirect ophthalmoscope will be better than a direct ophthalmoscope because it will give a full field of view on the eye for an accurate diagnosis.

Relevant Presenting Signs for Cataracts

A blurring of vision will symbolize cataracts in the patient’s eye. In such a case, there will be a notable film in the patient’s daily view. The proof will be evident as images that appear black and white begin to look grey (Nguyen et al. 2020, p.64). Furthermore, there will be noticeable problems with watching television as well as reading. The entire factors will result from the action of the lens channeling light into the retina, which further conveys the images to the optic nerve for interpretation and localization. Blurry vision is a result of the cloudiness of the lens due to cataracts (Hess & Woo, 2020 p. 199). However, other conditions such as myopia also cause blurred vision, but cataracts show more unique signs and symptoms. The state at a distance is also a symptom of developing cataracts because of the diminishing amount of light reaching the retina thus making the patient’s view foggy or cloudy which in turn complicates night driving by the patient. The following are some signs of the condition.

Relevant Signs

Hypersensitivity to Light

At the initial stages of cataracts, problems in perceiving bright sunlight or standard indoor lights begin as a person feels that the sun is more glorious than average (Wortman et al. 2020 p.260). As the abnormality progresses, the person loses the ability to drive at night because the glare caused by the oncoming vehicle headlights or streetlights becomes unbearable for the eye of the driver. There should be a change in the strength of the lens resulting from the condensation of the proteins inside the glass. It will cause a considerable difference in the prescription of spectacles regularly in an attempt to improve Vision. Scenes will provide short-term solutions as cataracts progress because cataracts are often progressive and worsen with time (Camacho-Barcia et al. 2019 p 621). Therefore frequency in a change of spectacles in an attempt to improve Vision is a sign of cataracts.

Double Vision

There is double Vision when a person is viewing with just one eye because light passes through the many transparent portions of the lens to the retina, although the images do not line up well. It will majorly revolve around the client regarding the issues to do with form. Change in the perception of colors. Mostly, in cataracts, bright colors appear to be faded; for instance, a person may perceive yellowish color to be brownish, and as the damage progresses, they become unable to distinguish between blue and purple colors (Hess & Woo, 2020 p. 200). Occasionally, cataracts make individuals believe that they have a good vision because it makes them read close-up texts, thus no need of reading aids. However, as the cataract develops, the Vision worsens again to a point where reading aids are needed.

Changes in Perception of Colors

Colors perception is equally affected by cataracts just like other aspects of Vision. Mostly, in cataracts bright colors appear to be faded, for instance, a person may perceive yellowish color to be brownish and as the damage progresses, they become unable to distinguish between blue and purple colors (Camacho-Barcia et al. 2019 p 621). Occasionally, cataracts make individuals believe that they have a good vision because it makes them read close-up texts thus no need of reading aids. However, as the cataract develops, the Vision worsens again to a point where reading aids are needed.

A list of all possible differential diagnoses

Suspected Cases revolve around reduced visual acuity, hypersensitivity to light, and blurring of images include cataracts, diabetic retinopathy, glaucoma, corneal dystrophy, corneal scarring, retinal detachment, and age-related macular degeneration (Berry et al. 2020 p. 188). It is because the patient's complaints were noted on the left eye with difficulty in driving at night, increased glare, blurriness, and age, which makes the condition age-related cataracts.

Thyroid-related orbital disease could also be the case since most common instances of corneal dystrophy are with the patient’s age range. Besides, the assessment lacks signs of nerve involvement or diplopia (Berry et al. 2020 p. 178).

Diabetic Retinopathy would be possible since there were no meibomian gland problems (Berry et al. 2020 p. 191).

Retinal Detachment would be possible since there was no optic nerve involvement.

Most Likely Diagnosis for Cataracts

The surgical treatment of cataracts is dependent on the risk factors and the patient's functional and visual demands. Some conditions that the patient has to meet for cataract surgery include patients' informed consent and the presence of comorbid conditions that can be treated by the operation. , the magnitude of the effect the cataract imposes on the patient, diseases affecting the posterior part of the eye that medicine can help in managing (retinopathy), and when the cataract is likely to cause uveitis or secondary glaucoma(Li et al. 2020 p.107). The surgical procedure to remove cataracts can is applicable irrespective of the stage of cataracts. The cataract removal surgery requires local anesthesia facilitation. In developed countries, phacoemulsification is useful when aided by ultrasonic energy that blends the eye lens. The phacoemulsification procedure will take six steps; first, subtenon injection or typical eye drops are used as anesthesia to numb the eye (Camacho-Barcia et al. 2019 p 623). Two incisions are made at the cornea's margin for easy insertion of the instrument in the eye. It is advisable to give an antibiotic injection into the eye to lower the threat of infections. To sum up the process, the salt solution is injected in the corneal wounds to bring about inflammation to cover the incision.

An extracapsular cataract is done by manual removal of the lens, while most of the capsule is left undamaged. Surgically, a disabled lens is removed and replaced with an intraocular lens. This surgical method is advisable only in cases where there is significant vision loss by the patient, and he or she is willing to undergo surgery to correct the abnormality (Narendra et al. 2020 p.944)

Non-surgical methods that are used in the management of cataracts include advising the patient on the need to minimize interaction with aggravating factors such as smoking, managing diabetes, alternative medications for patients on oral corticosteroid medications, use of contact lenses to boost Vision, use of spectacles, putting on sunglasses to reduce hypersensitivity to light, dilation of the pupil to treat minor centrally located cataract and counseling the patient how to effectively manage cataracts in their day to day life (Wortman et al. 2020 p.258).

Advice to the Patient

The patient should avoid smoking or exposure to smoke which in turn avoids high-intensity light to reduce incidences of hypersensitivity, not abuse ramipril to reduce the effect of corticosteroids on Vision. The patient would need to adhere strictly to the medication of comorbid conditions such as diabetes, and hypertension. It will reduce the rate of progression of cataracts; go for regular medical checkups so that emerging medical conditions related to cataracts such as uveitis (Zhang et al. 2020 p.150).

Conclusion

On balance, the study measures the intended elements that are supposed to be measured in the study. The intended data were in line with the questions in the questionnaires and interviews, thus making the study valid and fit for its intended purpose. The surveys and interviews assisted in providing data-driven information regarding a systematic approach toward the disciplines of collection, analysis, and interpretation of data. It has therefore facilitated candid comparison groups that help in assessing the resulting observations.