Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service.

This report by a group of UK retina specialists and health professionals considers best practice recommendations for the management of sight-threatening neovascular age-related macular degeneration (nAMD), based on collective experience and expertise in routine clinical practice. The authors provide an update for ophthalmologists, allied healthcare professionals and commissioners on practice principles for optimal patient care and service provision standards. Refinement of care pathways for nAMD has improved access to intravitreal anti-vascular endothelial growth factor therapy but there are still variations in care and reported outcomes between clinic centres. Innovative organisational models of service provision allow providers to better match capacity with increasing demand. The authors review the recent NICE guideline for diagnosis and management of AMD, considerations for switching therapies and stopping treatment and need for regular monitoring of non-affected fellow eyes in patients with unilateral nAMD. Actions for delivery of high-quality care and to improve long-term patient outcomes are discussed. Local pathways need to detail nAMD target time to treat, maintenance of review intervals to ensure proactive treatment regimens are delivered on time and appropriate discharge for patients deemed low risk or no longer benefiting from treatment. Actual visual acuity outcomes achieved and maintenance of the level of vision when disease stability is achieved are considered good measures for judging the quality of care in the treatment of patients with nAMD. Robust community referral pathways must be in place for suspected reactivation of choroidal neovascularisation and rapid referral for second eye involvement. Practical considerations for intravitreal injection therapy are outlined.

Nursing actions that create a sense of good nursing care in patients with wet age-related macular degeneration.

AIMS AND OBJECTIVES: To identify and describe nursing actions performed by nurses that create a sense of good nursing care in patients with wet age-related macular degeneration. BACKGROUND: People who suffer from wet age-related macular degeneration risk central vision loss. Treatment with antivascular endothelial growth factor is the only available option at present that preserves vision and no definitive cure currently exists. Patients feel that they are compelled to accept this treatment because they might otherwise become blind. DESIGN: An explorative and descriptive design based on the critical incident technique was used. METHOD: Interviews with 16 Swedish patients who all had received intravitreal treatment for wet age-related macular degeneration. RESULTS: Two main areas of good nursing care were identified: 'Being perceived as an individual' and 'Being empowered'. The first area was divided into two categories: being respectful and being engaged. Being respectful was observed when nurses had a benevolent attitude towards their patients and answered questions kindly and politely. Patients saw themselves as individuals when nurses were available for conversation and focused on them. The second area was divided into two categories: encouraging participation and creating confidence. Encouraging participation refers to when nurses provided information continuously. Nurses instilled confidence and trust in their patients by keeping promises and by being honest. CONCLUSIONS: A respectful interaction between patients and caregivers is necessary for patients to obtain beneficial health care. RELEVANCE TO CLINICAL PRACTICE: Patient interviews revealed important information about nursing actions that created a sense of good nursing care in patients with wet age-related macular degeneration. Nurses acknowledged people as individuals and created trust by building partnerships and sharing decision-making. To address each patient's concerns, nurses need to prioritise each patient's narrative and participation by documenting agreements in their medical record.

Age-related macular degeneration.

Age-related macular degeneration (AMD) is a common and painless eye condition that is the leading cause of vision loss for people older than 50 years. Occupational and environmental health nurses can aid in slowing the progression of AMD by encouraging workers to have periodic eye examinations, maintain good health practices, and notify health care professionals if they notice blurred vision or blind spots in central vision.

Success in sight.

Staff working for a macular disease service in a London eye hospital have won an award for their work in providing a one-stop service.

Managing depression in older people with visual impairment.

The author describes the management of depression in older people with visual impairment. The concept of depression is defined, and the main classifications are outlined. The signs and symptoms of depression are presented and approaches to treatment are discussed. The role of the nurse in managing depression in older people with sight loss is discussed.

Home care as a complex experience: a chronological case study.

This case study of an older woman with macular degeneration describes her experience of dispensing daily medications over a 3-year period, during which a home care nurse began and continued visits. Using a phenomenological method, I analyzed data of 9 interviews, discerning the structure of her experience and depicting it in 7 diagrams. The home care experience can have unintended outcomes influenced by family and provider perceptions of clients' abilities, especially when family members and practitioners assume tasks that older women have managed alone. Minimizing intergenerational ambivalence about the need for home care and maximizing client agency should be preeminent foci of home care providers.

My father's experience with macular degeneration: implications for the home healthcare nurse.

Macular degeneration has become a problem of substantial proportions for older adults. This article can help the home health nurse gain a greater understanding of macular degeneration and therefore be more effective in the home setting. The addition of vision rehabilitation also can prolong older adults' independent years and enhance their satisfaction with life. Using Parse's human-becoming theory as a theoretical framework, the home health nurse can coparticipate in the older adult's experience of living and thus enhance the probability that the last years will be a rewarding time of life.

Older men's experiences of living with severe visual impairment.

BACKGROUND: Little is known about how men react to their health and illness experiences. Lack of information about the lives of older men is unfortunate considering the anticipated growth of the older male sector of society and the fact that older men age differently than older women. One health-related experience common to many older men is severe visual impairment caused by macular degeneration, a chronic eye disease that affects central vision. Understanding the health experiences of older men is imperative if nurses are to provide quality care to this growing segment of society. AIM: The purpose of this study was to gain an understanding of the experience of severe visual impairment from the perspective of older men with macular degeneration. METHOD: A phenomenological approach was used to investigate the experience of severe visual impairment in eight older men with macular degeneration. Data were gathered through audiotaped interviews and analysed using a modified Giorgi method. FINDINGS: The resultant general structural description revealed six central themes: (1) older men's lives were circumscribed by what they could and could not see and could and could not do, (2) cherishing of independence, (3) creation of strategies, (4) acknowledgment of the progression of visual impairment, (5) confrontation of uncertainties, skepticism, and fears about their diagnosis and treatment, and (6) persistence with hope and optimism. CONCLUSIONS: A thorough nursing history and assessment must be completed, including information about the progression of the visual impairment, strategies used for living with visual loss, and presence of other health problems that may complicate life with visual impairment. Nurses must be aware that older men with macular degeneration are often sceptical about their diagnosis and treatment. Therefore, careful education and clear communication are essential.

The nurse's role in helping patients cope with sight loss.

Patients with sight loss often have additional nursing and care needs. Nursing staff should be familiar with the common causes of sight loss and their treatment. To help patients come to terms with the distress of losing their eyesight, nursing staff should be aware of the implications of sight loss for patients and, where appropriate, refer them to the relevant support worker, such as an eye clinic liaison officer.

Macular translocation--what our patients need to know.

Age-related macular degeneration is the most common cause of rapid and irreversible central vision loss among persons older than 60 years in the United States. Vision loss occurs as a result of choroidal neovascularization in which abnormal blood vessels in the choroid bleed and scar beneath the fovea. If this is caught early, a new approach called macular translocation surgery can be considered. In this procedure, the surgeon moves (translocates) the macula to a healthy area of the retina where it may recover and maintain its function. Moving the fovea allows the surgeon to use laser to destroy the abnormal blood vessels and spare the fovea. As with any procedure, it is important for the patient to have a positive perioperative experience, to be able to report and prevent postoperative complications, arrange follow-up care and transportation, and have realistic expectations of visual outcomes. To this end, a patient education brochure has been developed to ensure a more informed, involved, and satisfied patient. Our topics include: (1) a brief description of macular degeneration, (b) perioperative examinations and procedures, (3) the procedure itself, surgical risks, and postoperative care, (4) appointments for follow-up and laser procedures a few days after surgery, and (5) possible improvements in visual outcomes. Our objectives are to describe macular translocation surgery as it pertains to the management of choroidal neovascularization in age-related macular degeneration and to identify the essential perioperative elements that patients need to know about macular translocation surgery.

Macular degeneration in older adults.

Macular degeneration, a chronic, progressive eye disease, is the leading cause of blindness in older Americans. As the aging segment of society grows, the number of seniors diagnosed with macular degeneration will increase. Caring for individuals with this disease is a task that will be increasingly allotted to nurses. This article presents information on the disease process, risk factors, medical therapies, and nursing implications involved in caring for individuals with this condition. When nurses gain a thorough understanding of macular degeneration and the implications of living with this disease, quality care can be provided to an expanding segment of society.

The nursing process in photodynamic therapy.

The results from the TAP Study have been found to be significant, but remember this is not a cure. There are no quick and easy solutions to this devastating disease, which can creep up so suddenly and without warning. Ophthalmologists may be able to stabilize the vision without allowing it to become worse, but the key words are "without allowing it to become worse." Unfortunately, to most patients, it is already worse. Nurses must address the patients' feelings and concerns first, before offering a physical solution that is only a temporary "band aid." After 10 years of working in the area of ophthalmology, specifically low vision, it has come to the authors' attention that a large percentage of patients suffering from AMD display depressive symptoms such as feelings of sadness, worthlessness, and hopelessness, and low self-esteem. Many appear to go through a grieving process. Keeping this is mind, the overall goal in nursing care should be to help patients with AMD use available resources so they have the potential to maintain a satisfying quality of life, physically and emotionally.