Transcript Low Vision Clinic

Eye Care Center
at the Southern California College of
Optometry
MaryAnn Walls Low Vision
Center
Dr. Becky Kammer, Chief
714-449-7415
[email protected]
What is Low Vision?
Patients may be blind or just partially
sighted (visually impaired) 20/70 or worse
in better eye
Legally Blind is 20/200 or worse with best
correction on
What can Rehabilitative Optometry
do to help?
Help patients see to read
Help patients see to drive
Help patients meet specific vision goals
Main Rehabilitation Goal
Improve independence
and quality of life
How does the exam flow?
Patient’s come for at least 2-3 visits where
a full eye exam is given and then devices
are introduced to meet goals
First Visit: Team is introduced to patient
– Occupational therapist
– Student doctor
– Faculty professor
OT will schedule a home evaluation before
patient returns for second visit.
Second Visit
OT summarizes their home visit for Dr.
and the second optometric visit is planned
for the patient.
More visual goals are evaluated, devices
are ordered
Possibly more training visits with OT are
scheduled in the meantime
Dispensing Visit
Patient’s glasses or devices are given to
patient and basic training in office is
provided
OT schedules 2-4 more home visits to
make sure patient uses device correctly
and is using residual vision correctly
(eccentric viewing training if needed)
OT reports back to Dr. for follow up
EXAM COMPONENTS
Case history
Summarize to obtain basic goals
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Sustained Near: Reading continuous text
Spotting Near: Seeing bills, shopping
Sustained Distance: Watching TV
Spotting Distance: Driving, seeing signs
Illumination and Glare: often need
enhanced contrast indoor, need better
lighting indoor
EXAM COMPONENTS
Functional visual acuities
Distance Vision
– Feinbloom chart (Designs of Vision)
Near Vision
– Single digit chart (M notation – Lighthouse
charts)
– Continuous text chart (M notation Lighthouse)
EXAM COMPONENTS
Trial frame refraction
EXAM COMPONENTS
Functional visual fields
Several tests available to help determine
how much usable vision is present
Nystagmus patients usually have full
fields
– This is great for rehabilitation processes
EXAM COMPONENTS
Contrast sensitivity
Testing is critical for determining if
low contrast objects can be seen in
dim lighting
Poor contrast sensitivity may slow
down reading or cause problems
driving at night…
EXAM COMPONENTS
Binocularity
Functional considerations
– Depth perception up close (3D)
Many nystagmus patients have no
depth perception (or true
binocularity)
– Most Low Vision patients are
functionally monocular
EXAM COMPONENTS
Calculations to determine the
best type of magnification or
modifications
EXAM COMPONENTS
A Few Treatment options
Spectacle plane – high plus/microscope
Loupe – Hand magnifier, stand
magnifier, head mounted
Telescopes
Electronic devices
Filters/lighting
Glare Treatment
Various colored
filters (lens tints)
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NoIR
Corning
Plastic Photochromic
(Chadwick Optical)
Cocoon’s
Electronic Magnification: CCTV
Nonoptical aids
Relative Size Devices: Large Print
Books
Posture and Positioning Devices: Lap
boards
Writing Devices:Felt tip pens
Medical Devices: Talking glucometers
Mobility Devices: Cane, Dog guide
Sensory Substitution Devices: Talking
clocks
Referrals
Orientation and mobility
Visual impairment instructor –
independent living skills
Department of Rehabilitation
Support Groups/counseling
Braille Institute for ILS classes
What’s new in LV?
– Computer technology with adaptive software
– Volunteer at ECC provides one-on-one
computer appointments for low vision patients
What’s on the horizon for LV?
Blind Art Exhibit in September 05
Research
– SCCO is now part of a progressive group that is
attempting to initiate clinical trials in the U.S.
– Completion of a small multi-center study with
hemianopic patients