October 30, 2018 1

Age-Related Macular

Degeneration:

A Nursing Engineering Project

Presented by: Sherry Dong, RN, BSN, CCRN

Pathophysiology of Age-Related

Macular Degeneration (AMD)

Photo by: http://www.bva20-20.com/macular

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Macula: Holds photoreceptors responsible for high-resolution central visual acuity9

Retinal Pigment Epithelium and Bruch’s Membrane: supply nutrients, filter out

waste, secrete immune responders9

Photo by: https://www.youtube.com/watch?v=bCZCn9bt9fw

Drusen: Accumulation of debris that directly results in central vision loss9

Photo by: http://imagebank.asrs.org/file/3541/normal-fundus-photoPhoto by: https://www.snec.com.sg/eye-conditions-and-treatments/common-eye-conditionazs-

and-procedures/Pages/age-related-macular-degeneration.aspx

AMD’s Effect on Vision

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Photo by: http://www.gifak.net/2013/05/baby-duck-cant-stay-awake.html

Current Assistive Devices for AMD

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Photo by: https://nelowvision.com/pebble-hd-one-low-vision-product-you-need/

Photo by: https://nelowvision.com/wp-content/uploads/2014/12/merlin_elite-video-magnifier-with-text-to-speech-635x462.jpg Photo by: https://nelowvision.com/wp-content/uploads/2018/03/Patriot-ViewPoint-Lady-reading-a-book-on-a-couch.jpg

Review of Literature (ROL)

• Databases: – PubMed

– World of Science

– CINAHL

• Key terms– Age-related macular degeneration

– Central vision loss

– Older adults

– Mobility

– Low vision

– Quality of life

– Mental health

– Visual acuity

– Activities of daily living (ADLs)

– Instrumental activities of daily living

(IADLs) From 33 studies, a total of 6 full texts

were included for the final synthesis.

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How does AMD effect everyday life function for community-dwelling older adults?

ROL: Physical Effects of AMD

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• Decreased visual acuity and contrast sensitivity

– Exacerbates age-related cognitive decline8

– Makes it harder and longer to do everyday tasks8

• Highest frequency of disability: heavy housework (18.9%), traveling

beyond walking distance (14.7%), and grocery shopping (13.6%)2

• Limited life-space

– Causes a decreased ability to perform basic IADLs especially housework,

walking, and grocery shopping2

– ADL limitations increased continuously as their frequency of leaving the

house declined11

– Associated with worse nutrition and frailness10

• Poor health outcomes

– Increased risk of fractures and falls11

– Take fewer steps and engage in less physical activity10

ROL: Social Effects of AMD

• Limited life-space

– 20% higher mortality rate in subjects with home confinement and

constricted life space10

• Decreased ability to read

– Lose ability to manage money2

– Less likely to talk on the phone2

• Social support

– One study reports that the elderly with vision loss have a higher instance of

social support in problem situations6

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ROL: Psychological Effects of AMD

• Depression

– Loss of sight

– Home-bound

– Dependent on others

• Fear of falling

– Caused by decreased visual acuity and contrast sensitivity

– correlates strongly with balance, falls, injuries, and other functional

outcomes

• Anxiety

– Previous fall or knowing someone who fell

• Fear of performing risky housework

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Client

• Lived alone for 15 years

• Now lives in assisted living facility

• Long Island, NY Western MA

• Gerontological considerations

– Peripheral Vision Loss

– Decreased Senses

– Decreased Reactivity

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Our Project

• Team: – One nurse

– Four mechanical engineers

• Purpose: – To create an assistive device

that aids and improves life function for a community dwelling older adult

• Budget: $1000

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Nurse’s Role

• Focus on human factors of the patient

• Talk to client about current health status

and difficulties in life function

• Conduct comprehensive nursing

assessment

– Focused vision assessment emphasizing the

confrontation test

• Evaluated functional needs

• Assess environmental risk factors and

safety hazards

• Schedule visits in coordination with the

engineers

• Assess safety, reliance, and user

compatibility of the device11

Engineering process

• Objective: Develop an obstacle-

detecting attachment to our client’s

walker with an effective non-visual

alert mechanism to prevent the client

from tripping over unseen objects in

her path

• Improve safety and independence of

client’s mobility as vision decreases

• User compatibility and convenience

• Work ergonomically well with user

– Ease of operating the device

– Communication

– Reliability

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December 4, 2017 14

Proof of concept and performance

• Prototype is able to detect objects

within specified range

• Weight, low battery communication,

and battery life are within margin

• Communicates direction of obstacle

through vibration

• Remaining issues

– Slight delay between communication and

object detection systems

– Reflectivity Test: LIDAR sensor cannot

detect matte black objects

– Too close to client’s feet when walking

– Exposed wires

– Expand peripheral range

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December 4, 2017 16

Works Cited

1. Carpenito, L. J. (2012). Handbook of nursing diagnosis. Lippincott Williams & Wilkins.

2. Hochberg, C., Maul, E., Chan, E. S., Van Landingham, S., Ferrucci, L., Friedman, D. S., and Ramulu, P. Y. (2012).

Association of Vision Loss in Glaucoma and Age-Related Macular Degeneration with IADL Disability, IADL

Disability in Glaucoma and AMD. Investigative ophthalmology & visual science, 53(6), 3201-3206.

3. Jager, R. D., Mieler, W. F., and Miller, J. W. (2008). Age-related macular degeneration. New England Journal of

Medicine, 358(24), 2606-2617.

4. Jarvis, Carolyn. Physical Examination and Health Assessment, 7th Edition. Saunders, 022015.

5. Katz, S., Down, T. D., & Cash, H. R. (1970). Progress in the development of the index of ADL. Gerontologist, 10,

20-30.

6. Kempen, G. I., Ballemans, J., Ranchor, A. V., van Rens, G. H., & Zijlstra, G. R. (2012). The impact of low vision on

activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older

adults seeking vision rehabilitation services. Quality of Life Research, 21(8), 1405-1411.

7. Lawton, M. P. (1971). The functional assessment of elderly people. Journal of the American Geriatrics Society,

19(6). 465-481.

8. Owsley, C., McGwin, G. E. R. A. L. D., Sloane, M. E., Stalvey, B. T., and Wells, J. (2001). Timed instrumental

activities of daily living tasks: relationship to visual function in older adults. Optometry & Vision Science, 78(5), 350-

359.

9. Porter, R. S., Kaplan, J. L., Homeier, B., and Beers, M. (2011). The Merck Manual for health care professionals.

Merck and Co.

10. Sengupta, S., Nguyen, A. M., van Landingham, S. W., Solomon, S. D., Do, D. V., Ferrucci, L., Friedman, D. S., and

Ramulu, P. Y. (2015). Evaluation of real-world mobility in age-related macular degeneration. BMC

ophthalmology, 15(1), 1.

11. Shimada, H., Ishizaki, T., Kato, M., Morimoto, A., Tamate, A., Uchiyama, Y., and Yasumura, S. (2010). How often

and how far do frail elderly people need to go outdoors to maintain functional capacity?. Archives of gerontology

and geriatrics, 50(2), 140-146.

12. van Landingham, S. W., Massof, R. W., Chan, E., Friedman, D. S., and Ramulu, P. Y. (2014). Fear of falling in age-

related macular degeneration. BMC ophthalmology, 14(1), 1.17