A Critical Analysis and Evidence Based Case Study of a Visual Impaired Patient, Exploring the Pathology or Pathologies Causing the Impairment, and Reflecting on the Lived Experience for That Individual.

Hina Jadavji
ABDO membership no. 309971
Word Count: 1639
Submission Date: 08 December 2014

The purpose of this essay is to critically discuss the pathology of a visually impaired (Appendix 3) patient described in the pre-qualification portfolio (PQP) dispensing case (Appendix 1). The patient described in the PQP has been diagnosed with the wet form of Age-Related Macular Degeneration (ARMD). Initially this paper will explore and analyse the pathology involved in the PQP. The possible causes and risk factors for ARMD will be outlined. This paper will also discuss about the visual assessment for a low vision patient. The patient journey when diagnosed with AMRD will be considered. The patient’s life experience after diagnosing ARMD will be also described. The management strategies used for patients diagnosed with ARMD will be discussed. Systematic reviews on existing publications, abstracts and relevant articles will be analyzed from online science databases to research about the topic of ARMD.

According to Owen et al. (2003) ARMD is the major cause of visual impairment in United Kingdom (UK). ARMD is an eye condition that affects the macula (Appendix 3) in elderly subjects as explained by Kanski (2003). This condition is associated with extensive drusen (Appendix 3) and abnormal pigmentation. Subjects with small account of drusen are less likely to develop ARMD. However Sarks et al. (1999) explains that an increased number of drusen represents a risk factor for ARMD to develop resulting in a visual loss. According to Pipe and Rapley (1984) ARMD produces a progressive loss of central vision (CV), whilst retaining the peripheral vision. There are two types of ARMD, the wet and dry. Dry ARMD is more common in UK; however Lotery et al. (2007) showed that the wet form of ARMD is more sight-threatening. Wet form of ARMD is the second type of ARMD. In wet ARMD there is an abnormal increase of new blood vessels (Appendix 3) resulting in vision distortion and scarring causing a rapid vision loss as explained by Mousa and Mousa (2010). At present, research suggests there is no form of effective treatment to regain vision loss caused by ARMD. According to Evans (2001) the risk factors associated to ARMD prevalence in the UK are due to age, smoking and diet. However Owen et al. (2003) identified the causes for ARMD are due to “genetic and/or environmental exposure”. Williams et al. (1998) explain that ARMD is predominant in elderly people and significantly impair their quality of life and independence. The risk of developing ARMD increases when age increases. Owens et al. (2011) study shows the prevalence of ARMD in subjects with fifty or more years. The data of this meta-analysis, collected between 2007 and 2009, resulted in two point four percent of developing late ARMD. From these results approximately five percent of subjects are sixty-five or more years and approximately twelve percent in subjects with age of eighty years and more. They also predicted that in 2020 will increase the number of population with ARMD. This study confirms that age is one of the risk factors of ARMD; however the data collection was sort by population with the age of fifty or more and would be more accurate if there would be follow-ups in all group ages. Several studies suggests no prevalence in ARMD between male or female, however Evans (2001) contradicts by explaining that women are at a greater risk to develop ARMD due to their increased life span compared to men.
Smoking is more likely to increase the risk of developing ARMD contributing to the damage of cells in the macula. According to Thornton et al. (2005) smoking contains toxins which can also have detrimental effects on the retina (Appendix 3). The risk of developing ARMD is two or four