Cataract Surgery and Myopia, Case Study Example

Introduction

A cataract is best described as the opacity or clouding of the eye lens that eventually results in a loss of vision in the affected eye (Part 1 Cataract, n. d). Cataract can occur in three primary forms: nuclear cataract, cortical cataract, and posterior subocular cataract. All these forms have their distinct pathologies, and they appear in different parts of the lens, have various risk factors, and have varying onset age (Part 1 Cataract, n. d). Each of the different cataract forms can occur in isolation or combination with the other states.

Cataract affects about 95 million people worldwide, with the condition almost always resulting in blindness in individuals from low- and middle-income countries (Liu et al., 2017). In Australia, cataract remains a crucial cause of blindness and visual impairments (Part 1 Cataract, n. d). Each year, about 120,000 cataract operations are done (Part 1 Cataract, n. d). It is worth noting that cataract incidence is associated with a set of risk factors that include age, smoking, sunlight exposure, and the use of corticosteroids (Becker et al., 2018).

The development of newer and better technology has resulted in the evolution of the cataract corrective procedure that enhances quick recovery and results in better visual outcomes (Liu et al., 2017). One subject area that has proven vital when looking at cataract surgery is patient education. Patient education, delivered in different forms, has been proven to be a critical factor in advancing the patient’s understanding of cataract surgery, further promoting adherence to pre-operative, operative, and post-operative bits of advice given by a healthcare provider during ophthalmic care. This paper will be focused on understanding cataract surgery guided by the facts of a case study. The case study that will be the centre of focus revolves around a 67-year-old male who presented to the hospital with his wife, who noted that her husband was gradually losing the visual acuity of his left eye. This report will tackle the patient’s history, assessment, diagnosis, management, and patient education.

Patient History

The patient is a 67-year-old male. The patient reported that he struggled with poor vision for the longest time since childhood, which was odd compared to the rest of his classmates. The patient said that reading the blackboard proved to be a challenge for him, and so he received a myopia diagnosis. Over the years, the patient reported that he has been wearing corrective lenses to rectify his myopia. For the past few years, the patient noted a deterioration in his eyesight, evidenced by the reduced vision and increased blurriness. As a result, the patient changed his prescription quite often. About three months ago, the patient noted heightened light sensitivity, mainly occurring during night driving because of glare. He reported this strained his eyes, resulting in frequent headaches. The patient is also diabetic and hypertensive, conditions he manages with medication. His family has a known history of diabetes. The patient does not smoke, and neither is he an alcohol partaker. The patient lacks any known allergies.

Regarding family life and career, the patient has been married to his wife for forty-two years and has two grown children. He was previously an engineer while his wife, a teacher.

Presenting Complaint, Description of Signs and Symptoms

The patient presented to the hospital because of deteriorating vision and loss of acuity in his left eye. The patient also presented to the hospital because of sensitivity to the eyes due to glare during night driving and headaches experienced afterward.

Assessment

The Ophthalmologist, working together with the ophthalmic nurse, performed different eye examinations. The eye assessments done included determination of visual acuity using the Pelli-Robson test, contrast sensitivity using the Spaeth/Richman Contrast Sensitivity tests, and detection of anomalies in the anterior and posterior eye chambers using the ophthalmoscope.

The Pelli-Robson test measures the patient’s visual acuity, damages in the visual field, and contrast sensitivity (Gupta et al., 2017). The PR is a chart containing letters of constant size and diminishing contrast (Gupta et al., 2017). The Spaeth/Richman Contrast Sensitivity test is a more reliable test of a patient’s contrast sensitivity, a critical indicator of cataract (Thakur et al., 2018). Because SPARCS uses contrast gratings as opposed to letters, it much more reliable to use on literate and non-literate patients (Gupta et al., 2017). Ophthalmoscopy is a technique deployed to determine the extent of eye damage by looking at the anterior and posterior chambers. The red reflex test is critical in ophthalmoscopy.

Diagnosis

The key findings that led to the diagnosis made were as follows:

1. Reduced PR was an indicator of visual impairment
2. The dim red reflex confirmed the existence of nuclear sclerosis.
3. White opacities were related to impaired vision.

The above findings from the assessment and the patient’s history confirmed the cataract diagnosis.

Management

The Ophthalmologist advised the patient to undergo cataract surgery. Surgical management is often recommended to individuals confirmed to have a vision loss that makes them incapable of performing adequately in their everyday lives. In such cases, cataract surgery is deemed the only source of hope given its potential in restoring vision (Part 1 Cataract, n. d). Surgery is often recommended to individuals who drive a motor vehicle and whose Snellen visual acuity was 6/12 and below (Part 1 Cataract, n. d). Given that the patient suffered from glares during night driving, he was the best candidate for surgical cataract management.

Before performing the surgery, the Ophthalmologist and the Ophthalmic nurse need to explain the risks associated with cataract surgery and the best practices to advance patient understanding of the procedures to be experienced. For example, in line with Gerry (2019), there would be a need to tell the patient about pre-operative screening needed to rule out the risks of adverse events related to the cataract surgery. The Ophthalmologist and ophthalmic nurse would be required to shed light on the need to perform tests like electrocardiography, serum assessment, full blood count, and blood glucose levels, giving clues as to whether to cancel the cataract surgery. Additionally, the medical providers may also have to point out to the patient the complications that could arise from the operation. Some of the patient’s potential risks that may need to be enlightened include the risk of posterior capsule rupture in the surgery’s course, thereby increasing the risk of retinal detachment and endophthalmitis (Gerry, 2019). The patient may also need to be told about the risk assessments that are presently done to reduce the risk of operative/surgical complications. This would mean the patient is enlightened about the need to mitigate risks like obesity, poor mobility, and cognitive impairment associated with poor cataract surgery outcomes, as outlined by Gerry (2019). Additionally, the patient might need to receive information on the risks that exist if the surgery is not done and on time.

Knowledge of the risks associated with cataract surgery, including the risk of not having the surgery performed on time, and weighing these risks against the expected benefits of the cataract surgery is imperative to help the patient know if the surgery is something they would still want or not worthwhile (Ye, 2020). It is also worth noting that inadequate information about the risks associated with the surgery is in itself a risk factor for adverse psychological effects (Ye, 2020).

Additionally, as part of the management, there is a need to enlighten the patient about pre-operative, operative, and post-operative strategies that increase better outcomes.

Patient Education

The next step after the patient has decided to go through with the surgery is engaging in an in-depth patient education process. Patient education supports the patient’s effective transitioning in pre-operative, operative, and post-operative steps. Regarding pre-operative education, the healthcare provider can shed light on the procedure that would be done before the surgery. For example, considering the pre-operative procedures for cataract entails administration of 1% tropicamide, the healthcare provider can tell the patient role of administering these drops in supporting adequate intracameral dilation needs to be done before the surgery.

One information worth educating the patient on regarding post-operative care is the administration of drops. The healthcare provider can enlighten the patient that the drops are aimed at promoting healing and preventing infections. Other post-operative education topics worth covering include at-home care, such as why it would be essential to leave the plastic shields on upon discharge and using drops two hours after release from the hospital. It is also necessary to tell the patient that taking the shield off after two hours causes no harm and that the patient should wear the shields when sleeping. It is essential to educate the patient on not worrying about the eyes feeling scratchy, blurredness, and stuck eye-lids the next morning after waking up. The education should also cover follow-up appointments, use drops to aid recovery, instructions on new glasses after surgery, resume driving, exercise, and go outside and take precautions.

Covering the don’ts, the patient should consider post-operatively is worth considering in the patient education. The education should also cover the actions to take in case of an emergency.

Discussion

When looking at the doctor’s report on pre-op and post-op information shared with the patient, it is evident that the care received was up to par. The Ophthalmologist and ophthalmic nurse pointed began by pointing out to the patient the meaning of cataract, how it is recurrent in the aging population and how diabetes is a risk factor in ocular damage in line with the evidence by Kiziltoprak et al. (2019). This information was necessary to support the other deeper information that was covered regarding cataracts.

The healthcare providers then pointed out the risks and benefits of cataract surgery, giving the patient all the necessary information needed to make an informed decision. The patient later consented to the information provided to him on the risks and benefits of cataract surgery, thusly agreeing to go through with the procedure. The patient requiring convincing to consent to surgery pointed to the psychological underpinnings of disease, patient-care, disease management, and wellness. In this case, it became clear that psychology was imperative to improve patient care.

In this regard, it makes sense to study the Safety stage of Maslow’s Hierarchy of needs to understand the patient’s initial disagreement with surgery until he was told about the risks and benefits of cataract surgery. Under the safety stage, concerning patient care, patients are most concerned about their emotional wholesomeness, especially in the context of constant worries and wondering if the cataract surgery team members could prevent their conditions from worsening. While these are valid patient concerns, the fact that the Ophthalmologist and ophthalmic nurse engaged the patient in a discussion that transformed the patient’s mind is impressive. These providers likely used an intervention that pointed out the reality of the patient’s medical condition while offering active emotional support that transformed the patient’s cognitive distortions. The patient’s cognitive distortion transformation and further consenting to go through with the surgery displayed a higher level of patient education.

Additionally, the pre-op and post-op guidance offered by the Ophthalmologist and the ophthalmic nurse was impressive and detailed, providing step by step guide on the events before, during, and after the operation. The pre-op and post-op activities were likely to result in positive patient outcomes in line with Gül?en and Alkansen (2020). The authors established in this study that by deploying a Model of living in the discharge instruction, a wide array of surgical patient cohorts would enhance their patient outcomes following discharge.

Conclusion

The above study confirmed that cataract is a medical condition that results in ocular impairment. Millions of people struggle with this disease around the globe, Australia included. This condition accounts for blindness in the country, and the burden attributed to it is unimaginable, given the costs incurred to correct the disease. The case study analysed in this paper followed a 67-year-old male whose presenting conditions confirmed a cataract in the left eye. The paper outlined a critical evaluation of the patient’s care, which confirmed up to par care offered by the Ophthalmologist and the ophthalmic nurse.

References

Becker, C., Schneider, C., Aballéa, S., Bailey, C., Bourne, R., Jick, S. and Meier, C., 2018. Cataract in patients with diabetes mellitus—incidence rates in the UK and risk factors. Eye, 32(6), pp.1028-1035.

Clare, G., 2019. Cochrane corner: patient safety in cataract surgery.

Gül?en, M. and Akansel, N., 2020. Effects of Discharge Education and Telephone Follow-up on Cataract Patients’ Activities According to the Model of Living. Journal of PeriAnesthesia Nursing, 35(1), pp.67-74.

Gupta, L., Cvintal, V., Delvadia, R., Sun, Y., Erdem, E.L.?.F., Zangalli, C., Lu, L., Wizov, S.S.,

Kiziltoprak, H., Tekin, K., Inanc, M. and Goker, Y.S., 2019. Cataract in diabetes mellitus. World journal of diabetes, 10(3), p.140.

Richman, J., Spaeth, E., and Spaeth, G.L., 2017. SPARCS and Pelli–Robson contrast sensitivity testing in normal controls and patients with cataracts. Eye, 31(5), pp.753-761.

Liu, Y.C., Wilkins, M., Kim, T., Malyugin, B. and Mehta, J.S., 2017. Cataracts. The Lancet, 390(10094), pp.600-612.

Part 1 Cataract, n. d. Cataract. [Accessed 17 April. 2021].

Thakur, S., Ichhpujani, P., Kumar, S., Kaur, R. and Sood, S., 2018. Assessment of contrast sensitivity by Spaeth Richman Contrast Sensitivity Test and Pelli Robson Chart Test in patients with varying severity of glaucoma. Eye, 32(8), pp.1392-1400.

Ye, G., Qu, B., Shi, W., Chen, X., Ma, P., Zhong, Y., Chen, S., Lamoureux, E. and Zheng, Y., 2020. Knowledge about benefits and risks of undergoing cataract surgery among cataract patients in Southern China. International Ophthalmology, 40(11), pp.2889-2899.