Nurses’ Notes 2013 SUMMER

RISD

One of the most important parts of your eye is the cornea. It helps focus light to create an im-age on the retina on the back of the eye and then is sent and interpreted by the brain. The cornea works like a lens on a camera, bending and focus-ing light to make a clear image. The cornea is not always perfectly shaped. When the cornea is misshapen, or has “refractive errors,” the image will appear blurry or out-of-focus. There are three types of refractive errors: 1. Myopia or near-sightedness in which distant

objects are more out of focus than near objects 2. Hyperopia or far-sightedness, in which near

objects are more out of focus than distant ob-jects

3. Astigmatism refers to any other distortion of the cornea which causes imperfect vision

(view these images at the bottom of page 5)

Laser Eye Surgery can help correct these problems by using a laser to reshape the cornea, cor-recting its “refractive” im-perfections, thereby im-proving vision. Lasik is the most familiar and popular form of laser eye surgery, but there are actually several different procedures that a doctor can perform when it comes to using a laser to correct your vision. Lasik “Laser-assisted in-situ keratomileusis” uses a laser to remove corneal tissue to reshape the cornea and improve vision. It is the most popular

form of laser corrective eye surgery, used to correct astigmatism, myopia and hyperopia. During Lasik the doctor makes a cut called a “hinged flap” in the cornea, lifting it away from the eye. Then a laser is used to reshape the cornea, flattening or curving it according to where it needs to be corrected. The flap is then folded back into place and heals with a little bit of time. Lasek Lasek is very similar to Lasik, but a much thinner piece of the cornea is lifted away. People who have very thin corneas sometimes opt for Lasek. PRK PRK was an earlier version of laser eye sur-gery than Lasik. A thin layer on the surface of the cornea is removed and unlike Lasek or Lasik it is never replaced. The exposed surface of the cornea repairs itself over a period of a few days while cov-ered with a special contact lens. People who have PRK generally have one eye done at a time, due to the length and nature of the healing process. ALK ALK is used in some cases to treat high lev-els of nearsightedness and mild to moderate far-sightedness. Like Lasik or Lasek, a small flap is cut in the cornea. The doctor uses microkeratome to remove material under the flap. LTK Laser thermokeratoplasty is a relatively new procedure used to treat farsightedness and astigma-tism. The heat of a laser beam is used to shrink and reshape the cornea. The improvements of LTK do not last as long as those attained with other proce-

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Eyes On Eye Health this issue

Types of Eye Surgery P.2

What are Those Pesky Floaters in my Line of Sight? P.2

The Risks of Non-Prescriptive Cosmetic Lenses P.3

Vision Quiz 1.0 P.4

Guide to Instilling Eye Drops P.4

Retinal Detachments P.5

“The Eyes Have It” Crossword Puzzle P.6

Cataracts: Not Just for Senior Citizens P.7

My Doctor Says I Have Astigmatism P.8

Types of Eye Surgery

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dures as about half of the corrective effect will be lost two years post-surgery. Crystalens Natural Lens Replacement This is an FDA procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately. Crys-talens works like the eye’s natural lens to allow patients to see images that are near (inside 16 inches), interme-diate (between 16 and 36 inches) and distant (36 inches and beyond) without glasses. Usually, the eye is ad-justed to see more clearly at distance, though the eye can be adjusted to see at near, if desired. Each of these lenses has limitations, including halos and limited near or midrange vision. Crystalens surgery is much like cataract surgery, except that an accommodating lens is implanted. Patients who choose to have Crystalens will have the added benefit of avoiding cataracts in the future since the lens is removed and replaced. Another advantage of Crys-talens is that it can reduce or eliminate the need for reading glasses. This is a good choice for patients over age 40 and who are too farsighted for LASIK. Cataract Surgery This is recommended for those individuals who have vision loss that is affecting their daily life. Cataract surgery is performed with minimal sedation and gener-ally takes less than 30 minutes. During surgery, an artifi-cial lens is put in place of the original to restore vision. Over time, the lens replacement may begin to cloud.

(Continued from page 1) This is easily corrected with an additional laser treatment. Glaucoma Surgery Glaucoma results in raised intraocular pressure and vision loss over time. Unfortunately, surgery for glau-coma cannot reverse this vision loss. Surgery can reduce the intraocular pressure when medication is not a suffi-cient solution. Lid Repair Surgery This may be indicated for both cosmetic and func-tional reasons. Lid repair is most commonly used to treat ptosis, also known as droopy eyelids. This has become a very popular surgery as ptosis can cosmetically age the patient and obstruct vision. Orbital Surgery Orbital eye surgery is indicated for individuals with congenital defects resulting in absent eyes, large eye tu-mors, or when the eye cannot be preserved due to trauma. Surgical approaches include introducing an orbital implant such as the Orbital Tissue Expander, and bioce-ramic or silicone orbital implants.

Christy Hamilton, BSN RN Stults Elementary Donna Anderson, BSN RN Skyview Elementary www.allaboutvision.com/visionsurgery/ www.allaboutvision.com/visionsurgery/other.htm LASIK eye surgery - MayoClinic.com www.webmd.com/eye-health/overview-refractive-laser-eye-surgery

Types of Eye Surgery

I have two friends, I call them Jack and Jill. I can’t always see them, but they are there, and whenever I try to corner them, they run away. I can never quite catch them in my line of sight.

Jack and Jill are “floaters” in my left eye. They look like little short curly wires. They first came to see me about 5 years ago when I was 38. They usually show up if I am tired or stressed. My doctor said they are com-pletely normal, and unless they are impeding my vision or I’m experiencing any other symptoms along with them, I shouldn’t worry about them. He did say I should call him if a large amount of floaters show up suddenly, since that is not normal.

My doctor also told me that floaters can be differ-ent for everyone. They can look like little circles or even “cobwebs” to some people. They can be darker or lighter, black or gray. Usually you can see floaters better if you are looking at something bright or white. I just saw Jill as I was typing this article!

Floaters are usually present when the liquid part

of the eye (which helps the eye keep its shape) gets smaller as we get older and becomes stringy and makes shadows on the retina. Generally there is no treatment for floaters and we just learn to live with them. .

Sometimes you can move the floater from your field of vision by looking up and down or side to side since this movement will shift the fluid in your eye. Rarely are floaters caused by something more serious but if you have changes in your vision or eye pain you should al-ways inform your eye doctor. If there are too many float-ers causing interference with seeing well, an eye surgeon can perform surgery and remove the liquid part of the eye and replace it; however it can be a dangerous surgery and possibly cause other problems.

Leah Angel, BSN RN Hamilton Park Pacesetter Magnet SOURCE http://www.nei.nih.gov/health/floaters/index.asp

“What are Those Pesky Floaters in my Line of Sight?”

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We’ve all seen them, the contact lenses that change a person’s eye color, or give the illusion that the person has snake eyes. While entertaining, these cosmetic contacts can pose severe risks, even blindness. All contacts, pre-scription or cosmetic, are regulated by the FDA and should only be distributed by licensed eye care professionals. Although it is illegal to sell cosmetic contacts without a prescription, these lenses are readily found at Halloween stores, flea markets, beauty supply stores, and street vendors. There are many risks of wearing contacts that are purchased from a resource other than a licensed eye care provider. Some cosmetic lenses, like circle lenses, cover a large area of the eye which prohibits the delivery of oxygen to the eye. This can lead to irritation and infection. Some of these contacts are made from materials that are not FDA approved. This material can also inhibit the delivery of oxygen to the eye. To decrease the risk of in-fection, an optometrist will measure the diameter and curvature of the eye to ensure the contact fits properly. If a contact is too big it may scratch the cor-nea (the outer layer of the eye) which puts the eye at risk for infection, scar-ring, decreased vision, and blindness in the most extreme cases. Lenses that are too small may adhere to the cornea causing Tight Lens Syndrome. If this occurs the cornea swells and may become infected. Contacts should be cleaned and stored in sterile solution. Unfor-tunately, people that buy contacts without a prescription are not aware of the proper care of their lenses and may de-velop infections because of improper care. Signs of an eye infection include redness, drainage, pain that is not resolved after several days, and de-creased vision. If you experience these symptoms, you should remove the contacts and discard them, then contact a health care professional as soon as possible. The sooner the infection is treated, the less at risk you are for develop-ing long-lasting complications. A few simple DO’s and DON’Ts in regards to contact lenses, cosmetic or prescription:

Amy Smith, BSN RN

Lake Highlands HS

http://www.fda.gov/forconsumers/consumerupdates/ucm048902.htm http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ContactLenses/ucm270953.htm http://abcnews.go.com/Health/EyeHealthContactLenses/14-year-girl-cornea-transplant-wearing-colored-contact/story?id=13969384#.UXFXT6JJOOI http://www.news-gazette.com/news/local/2012-10-18/state-warns-against-cosmetic-contact-lenses.html http://www.sfgate.com/default/article/Cosmetic-contact-lenses-called-risky-Teen-s-2778036.php Google Images

I Can See Clearly Now: The Risks of Using Non-Prescription Cosmetic Lenses

DO

Purchase contacts from a licensed eye care profes-sional Get regular eye exams to ensure your contacts fit properly Use sterile solution to clean and store contacts Wash hands before handling your contacts See a doctor immediately if you develop signs of in-fection

DON’T

Purchase contacts without a prescription Ever share contact lenses with a friend Continue to wear contacts if you are experiencing signs of infection Sleep in your contacts Buy contacts that are not FDA approved

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Vision Quiz 1.0

Guide to Instilling Eye Drops

Eye drops are commonly prescribed to treat con-ditions such as allergies, dry eyes, conjunctivitis, iritis and glaucoma. Eye drops and eye ointments deliver medica-tion directly to the eye. Become familiar with the proper technique by following these simple steps:

Read all instructions before using eye drops. Do not use cloudy solution or eye drops containing particles. Check the expiration date before using medication. Use only the recommended number of drops in each eye. Avoid touching the tip of the bottle to your eye, eyelid or eye lashes to prevent contamination. Wash hands before using eye drops or ointment. Tilt head backwards and gently pull down the lower lid with index finger to create a pouch. Squeeze the bottle and drop the correct number of drops into the pouch. Wait 1-2 minutes between each drop to allow absorption of the medicine. Close eyes and press the inside corner of the eye for 1 minute after instilling drops. Avoid rubbing eyes after medicine is given. Replace cap and wash hands.

For eye ointment, create a pouch with the lower lid and apply a thin line of ointment in the pouch. Eyes should remain closed for one minute to allow medicine to absorb. Blurry vision may occur for a few minutes after applying eye ointment.

Occasionally, burning or stinging of the eyes may occur when eye drops are given, but should only last a few minutes. Notify your doctor immediately if you experi-ence severe eye pain, allergic reaction or changes in vi-sion. In young children, instill the eye drop with the eyes closed. Simply place the drop in the inner corner of the eye and have the child open the eye. The drop will run in. The child should avoid squeezing or rubbing the eye after drops are given. Close eyes again and wait 1-2 minutes. Barbara Smith, BSN RN Aikin Elementary References: http://www.webmd.com/default.htm Lippincott, Williams, & Wilkins (2009). Lippincott’s nursing proce-

dures (5th Ed.). Philadelphia, PA: J. B. Lippincott Company

Since it’s invention, generations of parents have cautioned their children from sitting too close to the television set with comments such as “don’t sit so close, it will ruin your eye sight”. Parents have also encouraged us to eat our carrots; those beta-carotene filled veggies are almost considered to be a precious metal at some dinner tables since no parent has actually seen a rabbit with corrective lenses. The final straw is around age 40 when you realize that you need reading glasses and begin to wonder if you sat too close to the television or maybe should have eaten more car-rots. Take this quick quiz and find out what’s really true about vision and if mom was right all along! Fact or Fiction: 1. Eating carrots will improve your eye sight. Depending on your source, this can be fact or fiction. According to WebMD, carrots are high in vitamin A which is im-portant for good vision. However, it’s not all about carrots. A well rounded diet including milk, cheese, egg yolk and liver are great resources of vitamin A. A deficiency of vitamin A may lead to poor vision but eating an entire truck load of carrots does not improve your vision. 2. Sitting too close to the television will ruin your eye sight. This is fiction; permanent vision problems are not caused by sitting too close to your screen. According to MedicineNet, sitting too close to any screen including your computer or your television may cause a head-ache at best. ABCnews reports that when we watch television for a long time we tend to blink less frequently and our eyes become dry. This can lead to a decreased quality of vision but it is only temporary. In order to avoid eye strain, you should take frequent breaks from the computer or television. 3. Sometime after age 40, you will begin to notice that your close vision is becoming blurred. This is fact. As we age, the lenses of our eyes begin to thicken and become less flexible which is causes presbyopia or “long-arm syndrome.” In order for print, like a menu or newspaper, to come into focus, we must extend our arms out from our body. It may seem that it happens overnight but in reality this happens over time and can be easily corrected. Kelly Wicker-Wilson, BSN RN Forest Lane Academy

References: http://abcnews.go.com/ http://www.medicinenet.com/script/main/hp.asp http://www.webmd.com/default.htm

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Retinal Detachments

A retinal detachment occurs when there is a tear or break in the retina, which is the light-sensitive tissue lining the back of the eye. When this occurs, it is considered a medical emergency and surgery is needed to repair the ret-ina.

Vision is created in the healthy eye when rays of light pass through the pupil, cornea and lens through the vit-reous gel in the center of the eye and on to the retina. The retina creates impulses that travel through the optic nerve to the brain, and the brain creates the images we see. A retina that is damaged will cause blurry vision or blindness if not surgically repaired. The retina becomes damaged if a tear or break occurs that causes it to pull away from the back wall of the eye. The tear is especially damaging to vision if the macula, the central region of vision within the ret-ina, is detached.

Those people who are at most risk for detachment usually have one of the following conditions: Extreme nearsightedness Previous cataract surgery Glaucoma Trauma to the eye A previous retinal detachment in other eye Family history of retinal detachment Weak area in retina that can be seen by the eye doctor on exam

Warning signs that a tear or break in the retina has occurred are: Sudden increase in number or size of floaters (which look like specks floating in the field of vision) Sudden bright flashes of light A shadow in peripheral (side) vision A sudden decrease in vision Appearance of curtain over the field of vision

Those who are at risk for detachment and experience any of the symptoms should see their ophthalmologist (a medical doctor who specializes in eyes) immediately. Laser surgery or a freezing treatment can be performed to repair the tear. With these procedures, 90% of those with a detachment will have a successful treatment.

If you are at risk for a retinal detachment, be familiar with the warning signs. Be sure to get regular, complete ex-ams with your eye doctor that includes dilation of the eyes. Protect your eyes with protective eyewear when playing sports or doing hazardous work and seek immediate medical attention if you have any of the warning signs.

Melanie Cowlishaw, MSN RN Northlake Elementary References www.geteyesmart.org/eyesmart/diseases/detached-torn-retina-risk.cfm www.nei.nih.gov/health/retinaldetach/retinaldetach.asp http://jama.jamanetwork.com/article.aspx?articleid=1148332

What Do You See When….

Images from the article “Types of Eye Surgery” from page 1

You are farsighted, or have hyperopia: You have astigmatism, which causes distorted vision, as in the lower photo:

You are nearsighted, or have myopia:

The Eyes Have It Crossword Puzzle

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Nancy Cripe, BSN RN Lake Highlands Freshman Center http://www.puzzlefast.com/

Answers to puzzle at bottom of page 7

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Cataracts: Not Just for Senior Citizens

Most of us associate cataracts only with the elderly. While it’s true that the incidence of developing a cataract increases with age, it is important to know that there are other causes for cataracts besides age. A cataract occurs when the lens of the eye becomes cloudy and affects vision. The eye lens functions similar to a camera lens by focusing light to the retina where images are received. The lens must be clear, or the image seen will be blurry. With increased age, the lens of the eye gets thicker, less flexible, and less transparent. The tissues in

the lens begin to breakdown and clump together, and the result is clouding of the lens. Eventually the cloudiness covers more and more of the lens and interferes with vision. The process is slow, and often a person is not even aware of vision loss in the early stages. Besides age, other factors that increase an adult’s risk of developing cataracts are: smoking, dia-betes, obesity, family history of cataracts, high blood pressure, previous eye surgery or injury, excessive alcohol use, prolonged exposure to sunlight, and long-term use of steroid medication, especially combined use of oral and inhaled steroids. Symptoms of a cataract include: clouded or blurred vision, sen-sitivity to light and glare, seeing “halos” around lights, increasing diffi-culty with vision at night, and fading or yellowing of colors. If you notice

any problems or changes in your vision, you should make an appointment with your eye doctor right away. The only effective treatment for cataracts is surgery to remove the damaged lens and replace it with a plastic implant. This has proven to be a very common and safe procedure, and is usually done on an outpatient basis. After surgery, it is nor-mal to have some discomfort and itching, fluid discharge from the eye, and sensitivity to light. Eye drops are normally prescribed to decrease risk of infection and to promote healing. Even an infant or child can develop a cataract, and the reason is most often because of abnormal develop-ment of the lens during pregnancy. If a cataract is present at birth, it can interfere with normal development of the parts of the brain related to vision. In children, cataracts that affect vision should be removed as soon as it is safe to do so. Doctors think we can at least reduce risk factors by wearing sunglasses that block ultraviolet rays, maintaining a healthy weight, making sure to include lots of fruits and vegetables so as to benefit from the many vitamins and nu-trients. It would also be important to follow any treatment plan for diabetes to keep it well controlled. Angela Watkins, BSN RN Merriman Park Elementary Marlys Woodard, BSN RN White Rock Elementary

Answers to “The Eyes Have It” crossword on page 6 Across 1. Conjunctivitis 5. Myopia 8. Astigmatism 9. Sclera 12. Hyperopia 13. Optometrist 15. Glaucoma

Down 2. Optician 3. Chalazion 4. Ophthalmologist 6. Amblyopia 7. Cataract 10. Sty 11. Iris 14. Pupil www.webmd.com/eye-health/eye-glossary www.allaboutvision.com/resources/glossary.htm

Sources: American Academy of Ophthalmology, http://www.aao.org/ American Association for Pediatric Ophthalmology and Strabismus, www.aapos.org Google Images www.nei.nih.gov www.mayoclinic.com

Disclaimer: The Richardson ISD and its offices, and employees make no warranty as to the accuracy, reliability, completeness or timeliness of any informa-

tion included in the contents and are not responsible for any errors or omissions or for results obtained from the use or misuse of this information.

Gloria Canham, MSN, RN Director of Health Services

Health Services thanks the Lake Highlands area nurses for this issue’s articles.

“Nurses’ Notes” compiled by Caroline Lewis, BSN RN, sub for Becky Geise, BSN, RN, NCSN Health Services Lead Nurse

“Nurses’ Notes” can be accessed anytime on the Health Services page of the RISD Intranet on Edline

My Doctor Says I have Astigmatism: What does that mean?

An individual’s eyes are shaped like a sphere. When light enters the eye, it refracts (bends) creating a clear view of an object. Light entering the eye will not extend past the retina or back of the eye. A person with astigmatism has an eye that is not completely round and is shaped more like a football. Because of this different shape, when light enters the eye, it will be refracted more in one direction than the other, allowing only part of the object to be in focus at one time or causes objects, near or far, to appear blurry or wavy. It is like looking into a fun house mirror in which you appear too tall, too wide or too thin. Light entering the eye will extend beyond the retina (see illustration).

Symptoms of astigmatism may include the following: fatigue eyestrain blurry or distorted vision headaches squinting eye discomfort

An optometrist or ophthalmologist can do a comprehensive eye exam to determine if you have astigmatism.

This is done by using various instruments to measure how your eye focuses light. Astigmatism can occur with other vision problems such as nearsightedness or farsightedness.

Most degrees of astigmatism can be treated with properly prescribed eyeglasses or contact lenses. If an indi-vidual has only a slight degree of astigmatism, eyeglasses or corrective lenses may not be needed at all as long as there are no other conditions such as nearsightedness or farsightedness. Corrective lenses will most likely always be needed if the astigmatism is moderate to high.

Refractive Surgery is another method for correcting astigmatism. This is done by changing the shape of the cornea through laser eye surgery. While there is more than one type of refractive or laser eye surgery, specific treat-ments are recommended on an individual basis.

If you do have astigmatism, and need corrective lenses (eyeglasses or contact lenses) make sure you have your eyes checked at least once a year by your optometrist or ophthalmologist.

Donna Morrissey, BSN RN

Lake Highlands Elementary

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Sources: http://www.webmd.com/ American Academy of Ophthalmology, http://www.aao.org/ Medline Plus Medical Encyclopedia, http://www.nlm.nih.gov/medlineplus/mplusdictionary.html