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LET’S TALK LOW VISION Suleiman Alibhai, O. D. Retina Group of Washington Krista M. LET’S TALK LOW VISION Suleiman Alibhai, O. D. Retina Group of Washington Krista M. Davis, O. D. , F. A. A. O. Columbia Lighthouse for the Blind

Eye Anatomy Eye Anatomy

Definitions ¬Legal Blindness – Best corrected distance visual acuity of 20/200 or worse in Definitions ¬Legal Blindness – Best corrected distance visual acuity of 20/200 or worse in better eye – Horizontal visual field of 20 degrees or less at widest point in the better eye ¬Low Vision – Worse than 20/60 in the better eye – Significant field loss – Impaired function

Goals of Low Vision Management ¬Increase functionality – Make the most of the remaining Goals of Low Vision Management ¬Increase functionality – Make the most of the remaining vision ¬Provide link to community resources and support services ¬Education

Common Conditions ¬ Macular Degeneration ¬ Glaucoma ¬ Diabetic Retinopathy ¬ Stroke/ brain injury Common Conditions ¬ Macular Degeneration ¬ Glaucoma ¬ Diabetic Retinopathy ¬ Stroke/ brain injury ¬ Retinitis pigmentosa ¬ Optic Nerve disease ¬ Albinism ¬ Nystagmus ¬ Cortical Visual Impairment

Functional Effects of Low Vision ¬Loss of central vision (visual acuity) ¬Loss of peripheral Functional Effects of Low Vision ¬Loss of central vision (visual acuity) ¬Loss of peripheral vision (visual field) ¬Glare and contrast

Issues Related to Decreased Acuity ¬Difficulty reading ¬Problems writing/ completing paperwork ¬Inability to recognize Issues Related to Decreased Acuity ¬Difficulty reading ¬Problems writing/ completing paperwork ¬Inability to recognize distance objects and faces

Issues Related to Visual Field Loss ¬Location of scotoma important! ¬Generalized loss of visual Issues Related to Visual Field Loss ¬Location of scotoma important! ¬Generalized loss of visual field difficult to compensate for ¬Mobility and independent travel ¬Reading may require adaptations

Issues Related to Contrast ¬Need for additional lighting ¬Problems with glare ¬Increased adjustment to Issues Related to Contrast ¬Need for additional lighting ¬Problems with glare ¬Increased adjustment to changes in illumination ¬Visual discomfort and fatigue

Exam Sequence ¬ History/ intake ¬ Visual acuity ¬ Visual field testing ¬ Pupils Exam Sequence ¬ History/ intake ¬ Visual acuity ¬ Visual field testing ¬ Pupils ¬ Extraocular muscle testing ¬ Refraction ¬ Color vision and Contrast Testing ¬ Ocular Health

Types of Acuity Charts ¬Distance – Snellen (projection) – Feinbloom/ SOSH – ETDRS – Types of Acuity Charts ¬Distance – Snellen (projection) – Feinbloom/ SOSH – ETDRS – Lea Symbols ¬Near – Single letter – Continuous text

Distance Charts Distance Charts

Near Charts Near Charts

Interpreting Near Acuity ¬Threshold acuity – Difference between single letter and continuous text ¬ Interpreting Near Acuity ¬Threshold acuity – Difference between single letter and continuous text ¬ 1. 0 M = 20/50 = 8 -10 point font – Need to look at working distance – Jaeger charts nonstandard ¬Typical sizes – – Newspaper = 1. 0 M Children’s books = 1. 2 – 1. 6 M Large print = 1. 6 – 2. 0 M Newspaper headlines = 4. 0 – 5. 0 M

Visual Field Testing ¬Confrontation ¬Arc perimeter ¬Vision Disc ¬Automated perimetry ¬Goldmann perimetry Visual Field Testing ¬Confrontation ¬Arc perimeter ¬Vision Disc ¬Automated perimetry ¬Goldmann perimetry

Color and Contrast Tests ¬Ishihara ¬Color Vision Testing Made Easy ¬D-15 ¬Pelli-Robson ¬Vistech Contrast Color and Contrast Tests ¬Ishihara ¬Color Vision Testing Made Easy ¬D-15 ¬Pelli-Robson ¬Vistech Contrast System ¬Mr. Happy ¬Hiding Heidi

Color Vision Tests Color Vision Tests

Contrast Tests Contrast Tests

Magnification ¬Enlarges image on retina to stimulate more retinal cells ¬Can be achieved in Magnification ¬Enlarges image on retina to stimulate more retinal cells ¬Can be achieved in many ways – Relative Distance – Relative Size – Optical / Angular – Electronic

Low Vision Devices ¬Distance ¬Near ¬Field enhancement ¬Non-optical Low Vision Devices ¬Distance ¬Near ¬Field enhancement ¬Non-optical

Distance Devices ¬Hand held telescopes ¬Mounted telescopes ¬Electronic systems Distance Devices ¬Hand held telescopes ¬Mounted telescopes ¬Electronic systems

Telescopes Telescopes

Electronic Distance Systems Electronic Distance Systems

Near Devices ¬Spectacles – Prismatic ½ eyes – Full-field microscopes ¬Magnifiers – Hand held Near Devices ¬Spectacles – Prismatic ½ eyes – Full-field microscopes ¬Magnifiers – Hand held vs. stand – Illuminated vs. non-illuminated ¬Telemicroscopes ¬Electronic Devices

Spectacle Microscope Spectacle Microscope

Near Loupe Near Loupe

Hand Held Magnifiers Hand Held Magnifiers

Stand Magnifiers Stand Magnifiers

Electronic Magnifiers Electronic Magnifiers

Non-optical Devices ¬Glare reduction devices ¬Contrast enhancement devices ¬Computer software ¬Accessory devices – Talking Non-optical Devices ¬Glare reduction devices ¬Contrast enhancement devices ¬Computer software ¬Accessory devices – Talking watches, clocks, etc – Writing guides – Tactile markers

Glare and Contrast Glare and Contrast

Lighting Lighting

Other Non-optical Devices Other Non-optical Devices

Adaptive Computer Equipment Adaptive Computer Equipment

Additional Services ¬Orientation and mobility training ¬Independent living skills training ¬Support groups ¬Braille instruction Additional Services ¬Orientation and mobility training ¬Independent living skills training ¬Support groups ¬Braille instruction ¬Computer training ¬Genetic counseling

Community Resources ¬Support groups ¬Paratransit Services ¬Books on tape ¬Audio described performances ¬Tactile tours Community Resources ¬Support groups ¬Paratransit Services ¬Books on tape ¬Audio described performances ¬Tactile tours ¬Large print publications ¬Educational services

Communication Goals ¬ Educate patient on eye condition ¬ Help them to understand what Communication Goals ¬ Educate patient on eye condition ¬ Help them to understand what options are available and how to use/ care for tools – – Glasses Low vision devices Technology Community resources ¬ Educate parents and teachers/ professionals on functional implications

Functional Implications ¬Print size ¬Visual efficiency and fatigue ¬Mobility issues ¬Positioning/ classroom placement ¬Lighting/ Functional Implications ¬Print size ¬Visual efficiency and fatigue ¬Mobility issues ¬Positioning/ classroom placement ¬Lighting/ glare reduction needs