Macular Degeneration Nursing Care Plan & Management


  • Macular degeneration is largely an age-related disease process whereby central vision gradually deteriorates.
Risk Factors
  • Increasing age
  • Smoking history
  • Hypertension
  • Overeight
  • Hyperopia
  • Familial incidence
  •  Wet AMD (more common in Caucasians than African Americans)
  • Use of thyroid hormones and hydrochlorthiazies
  • Arthritis


  • Age-related macular degeneration (AMD) is a painless disease where the macular gradually brakes down from the development of fatty, yellow, metabolic waste products, which accumulate in the retina. Drusen (yellowish spots associated with aging) appear in retina.


  1. “Dry” or nonneovascular AMD
    • Macular drusen may coalesce, causing gradual decrease in central vision. Missing letters in words, blank spots, geographic atrophy, and retinal pigment epithelial abnormalities may appear.
  2. “Wet” or neovascular AMD
    • Characterized by the development of an abnormal choroidal neovascular network beneath the macula. These vessels leak fluid and bleed, causing edema and the development of fibrosis. Visual changes can occur rapidly. Straight lines appear crooked and distorted. The resulting macular disciform scar causes a loss of central vision.
Assessment/Clinical Manifestations/Signs and Symptoms
  • Blurred vision
  • Blind spot in the middle of the visual field
  • Central vision can also be lost as small blind spot may also begin to develop
Laboratory and diagnostic study findings
  • Fluorescein angiography and indocyanine green angiography may be used to identify signs of macular degeneration.
Medical Management
Photodynamic therapy (PDT)
  • Has been developed in an attempt to ameliorate the choroid neovascularization (CNV) while causing minimal damage to the retina.
  • PDT is a two-step process. Verteporfin, a photosensitive dye is infused intravenously over 10 minutes. Fifteen minutes after the start of the infusion, a diode laser is used to treat the abnormal network of vessels.
Nursing Diagnosis
  • Disturbed sensory perception related to visual impairment
  • Ineffective health maintenance related to knowledge deficit
  • Risk for injury related to impaired vision
  • Self-care deficit related to impaired vision
Nursing Management
  • Nursing management is primarily educational. Verteporfin is a light-activated dye, and patient education is important preoperatively.
  • The patient should instructed to bring dark sunglasses, gloves, a wide-brimmed hat, long-sleeved shirt and slacks to the PDT setting.
  • The patient must be cautioned to avoid exposure to direct sunlight or bright light for 5 days after treatment. The dye within the blood vessels near the surface of the skin could become activated with exposure to strong light. This would include bright sunlight, tanning booths, halogen lights and the bright lights used in dental offices and operating rooms.
  • Gloves, shoes, socks, sunglasses and a wide-brimmed hat should also be worn if the patient has to go outdoors during daylight hours during this period. Inadvertent sunlight exposure can lead to severe blistering of the skin and sunburn that may require plastic surgery.


Nursing Care Plan

Nursing Diagnosis

Disturbed Sensory Perception: Visual

Related to
  • macular degeneration
  • presence of drusen
  • central vision loss
  • age-related ocular changes
Possibly evidenced by
  • distortion of central vision
  • Straight lines appear distorted
  • objects appearing smaller or larger than normal
  • Distortion of vision noted on grid
  • presence of drusen or yellow deposits under the retina, the light-sensitive tissue at the back of the eye
  • legal blindness
  • subretinal edema
  • retinal bleeding
Desired Outcomes
  • Patient will regain optimal vision possible and will adapt to permanent visual changes
  • Patient will be able to verbalize understanding of visual loss and diseases of eyes.
  • Patient will be able to regain vision to the maximum possible extent with surgical procedure.
  • Patient will be able to deal with potential for permanent visual loss.
  • Patient will maintain a safe environment with no injury noted.
  • Patient will be able to use adaptive devices to compensate for visual loss.
  • Patient will be compliant with instructions given, and will be able to notify physician for emergency symptoms.