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To See or Not To See

To See or Not To See. Cataract Information Session through Role-Play. Scenario. Scene : takes place in the Opthalmologist’s office Characters : Mrs. Black: patient enquiring about her vision Opthalmologist:wearing a lab coat (optional) Set : table & 2 chairs.

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To See or Not To See

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  1. To See or Not To See Cataract Information Session through Role-Play CHSSN-NPI Seniors Health Promotion Session

  2. Scenario • Scene: • takes place in the Opthalmologist’s office • Characters: • Mrs. Black: patient enquiring about her vision • Opthalmologist:wearing a lab coat (optional) • Set: • table & 2 chairs CHSSN-NPI Seniors Health Promotion Session

  3. Patient arrives in Ophthalmologist's office Ophthalmologist: Mrs. Black, it is good to see you, what can I do for you? Mrs. Black: I am finding it more difficult to do my bills, read the newspaper & my vision just seems a little blurred…fuzzy. Things appear yellowish. CHSSN-NPI Seniors Health Promotion Session

  4. Ophthalmologist: Well…first things first…let me take a look at your eyes… it may show us what the problem is Ophthalmologist examines Mrs. Black’s eye with the ophthalmoscope Ophthalmologist: As I thought… your left eye shows a cataract. CHSSN-NPI Seniors Health Promotion Session

  5. Mrs. B. But I feel fine…how did I get a cataract? Ophthalmologist: Cataracts are a normal part of aging. It is a condition affecting the eye… not a disease. What happens is that the natural lens of the eye becomes cloudy (advance to next slide for pictures) CHSSN-NPI Seniors Health Promotion Session

  6. Cataracts CHSSN-NPI Seniors Health Promotion Session

  7. Because our lens becomes cloudy, light is not able to pass through as easily as it did when it was transparent. • Less light reaches the retina and therefore our vision becomes blurry & distorted. CHSSN-NPI Seniors Health Promotion Session

  8. Mrs. Black: Oh! I understand… now what happens. Ophthalmologist: I would recommend that you have your cataract removed. • The only treatment for cataracts is surgery. • The procedure involves the surgical removal of the cloudy lens & its replacement with a synthetic clear intraocular lens (IOL) CHSSN-NPI Seniors Health Promotion Session

  9. Intraocular Lens CHSSN-NPI Seniors Health Promotion Session

  10. Mrs. Black: I am 80 years old. Do you think it is worth it at my age? Ophthalmologist: Definitely… it is a simple & short procedure & your vision will be greatly improved. Mrs. B.: I am afraid… what is involved in the surgery? CHSSN-NPI Seniors Health Promotion Session

  11. Ophthalmologist: • Cataract surgery may be the oldest procedure in the world, it was introduced to Europe from India by Alexander the Great's army. • It is performed in Day Surgery • The whole procedure takes anywhere from 20 – 45 minutes under local & regional anaesthesia CHSSN-NPI Seniors Health Promotion Session

  12. Mrs. Black: How soon can I get it done? I have a wedding coming up & I would love it be able to see clearly! Ophthalmologist: Unfortunately we have a waiting list, but I could put your name down on my list. The waiting period differs from region to region Mrs. B.: Is there any preparation, like fasting that I should know about? CHSSN-NPI Seniors Health Promotion Session

  13. Ophthalmologist: Yes there is. • A few weeks before your surgery you will need to have a blood test, an electrocardiogram (ECG) & possibly an x-ray • You will have to see me again & I will take some measurements of your eye so that we can select the proper strength of your new artificial lens. CHSSN-NPI Seniors Health Promotion Session

  14. Mrs. Black: That does not seem too complicated. What will I have to do on the day of the surgery? Ophthalmologist: OK.. Let us talk about that. • First, you must be fasting the night before your surgery (after midnight) • When you arrive at the hospital… someone will take your temperature, blood pressure & pulse … these are called vital signs. CHSSN-NPI Seniors Health Promotion Session

  15. Then they will put some eye drops in your eyes. These drops : • Cause your pupil to dilate so I can see your cataract better. • The second type prevent infection & numb your eye. CHSSN-NPI Seniors Health Promotion Session

  16. Ophthalmologist Continued: • Because the operating room is a very sterile (that means clean) place… you will be asked to wear a hospital gown & hair bonnet. • You will also be asked to remove any jewellery. CHSSN-NPI Seniors Health Promotion Session

  17. Operating Room Monitoring • In the operating room itself.. monitors will be attached to your chest (sticky tapes) (Electrocardiogram) • A small light clip will be applied to your fingertip. (pulse oxymetry) CHSSN-NPI Seniors Health Promotion Session

  18. Mrs. Black: I have heard my friends talking about something that costs $200. What is that about all about? Ophthalmologist: Your friends are correct. There is a new intraocular lens (IOL) available that is foldable. The major advantage of this lens over the regular lens is that it requires a smaller incision… & with a smaller incision there are the following advantages: 1) quicker healing 2) less trauma CHSSN-NPI Seniors Health Promotion Session

  19. Mrs. Black: If this new lens is so good… why do we have to pay for it? Why is it not covered by health care? Ophthalmologist: The government does not cover this expense because they have not found any difference in the post-surgery quality of vision between this lens & the regular one. CHSSN-NPI Seniors Health Promotion Session

  20. The only exception to this rule is for diabetic patients & those individuals on blood thinning medications. These patients have difficulty healing & in these cases the smaller lens may be covered by Medicare Mrs. Black: I remember my friend had to have (x2) operations for the same cataract… can they “grow” back? CHSSN-NPI Seniors Health Promotion Session

  21. Ophthalmologist: Your friend had (x1) operation to remove the cataract & a laser treatment to correct a secondary cataract. • In cataract surgery, the cloudy lens is broken up by ultrasound.. then the tiny pieces are removed. (phacoemulsification) CHSSN-NPI Seniors Health Promotion Session

  22. Secondary Cataracts • The sac (capsule) that the lens was contained in, remains. This sac is sometimes opaque & the light cannot pass through. This is called a secondary cataract CHSSN-NPI Seniors Health Promotion Session

  23. Ophthalmologist continued: • This problem is corrected with laser treatment • 40-45% of patients will develop a secondary cataract within about (x2) years. Mrs. Black: What can I expect when I return home after my cataract surgery? CHSSN-NPI Seniors Health Promotion Session

  24. Post Cataract Surgery Ophthalmologist: • First of all.. we recommend that someone else bring you home since you will perhaps return home with a patch over your operated eye. • Secondly.. You will have to come back & see me the next morning where I will (remove the patch-if needed) & take a look at your eye & see how it is healing. CHSSN-NPI Seniors Health Promotion Session

  25. Ophthalmologist: Here are some additional tips for you for after your surgery. • For the 1st month it is best if you DONOT strain or lift objects over 15lbs. • You will most likely have drops & or ointment to apply for approx. (x3) weeks following the surgery CHSSN-NPI Seniors Health Promotion Session

  26. Always remember to apply your drops before the ointment (d comes before o in the alphabet) • Your glasses may have to be adjusted anywhere from 4-15 weeks after the surgery CHSSN-NPI Seniors Health Promotion Session

  27. Mrs. Black: What kind of results can I expect following the surgery? Ophthalmologist: Here are some of the benefits of having your cataract removed. CHSSN-NPI Seniors Health Promotion Session

  28. Benefits of cataract surgery • Improved color vision… colors will be more vivid & brighter • Clearer vision. Your vision will be sharper • Improved quality of life… your favourite activities ex: reading , sewing, carpentry, baking & using the computer are generally easier. CHSSN-NPI Seniors Health Promotion Session

  29. Mrs. Black: Are there any complications to the surgery? Ophthalmologist: Any surgery carries a certain risk.. But of all surgeries…this type carries very low incidence. Here are some stats for you: • 1:1000 for bleeding • 1:10,000 for infections These complications can be easily treated during surgery or afterwards. • Do you have any questions Mrs. Black? Mrs. B.: No Doctor.. I think you have covered all my concerns CHSSN-NPI Seniors Health Promotion Session

  30. Eye Drops Information Sheet Eye Drop Instillation 1. Wash your hands. 2. Tilt your head back and look at the ceiling. 3. Using your index finger, gently pull down your lower eyelid to form a pocket. CHSSN-NPI Seniors Health Promotion Session

  31. Eye Drops Information Sheet 4. Gently squeeze 1 drop into the pocket. Do not let the bottle tip touch your eye, your fingers or any other surface. 5. Gently close your eye for about 2 minutes. This helps keep your medication in contact with your eye and prevents absorption into the blood stream. REMEMBER: Follow directions carefully Do not miss doses. Use the exact number of drops recommended CHSSN-NPI Seniors Health Promotion Session

  32. Applying Eye Ointment • Open eye and tilt head backward and look toward ceiling.  It is easier to put ointment in the eye while lying down. • Gently pull down the lower lid to form a pouch. • Squeeze the ointment from the tube along the pouch, but do not touch the eye or eyelid with the tube. CHSSN-NPI Seniors Health Promotion Session

  33. Applying Eye Ointment • Close the eyes gently for one minute (do not rub eyes.) • Vision may be blurred for a time after applying this medication. • If possible, have another person administer they eye ointment for you. CHSSN-NPI Seniors Health Promotion Session

  34. Thank you CHSSN-NPI Seniors Health Promotion Session

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