Post on 11-Jan-2015
description
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Visual Function and Low Vision Rehabilitation
Lissa V. Rivero, OD, FAAO
Sarasota Retina Institute
Sarasota, FL
Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday activities that have been affected by the loss of vision
• Specialized equipment and training
Typical Impairments from Macular Degeneration
Reading
Driving
Watching TV
Computer
Seeing faces
Writing checks
Additional Impairments from Vision Loss
Shopping price tags, labels
Hobbies crafts, playing cards
Activities of Daily Living (ADLs) food on plate, plugging in
appliances, setting appliances Using phone, cell phone
Trouble walking Increased risk of falls
Goals of Vision Rehabilitation
Adjustment to vision loss
Functional - Maximize remaining vision with devices and training
Emotional -LV patients are at 20x greater
risk of depression
Also inform patients
about community
resources available
Who pays for Low Vision Care?
Low vision exam is covered by Medicare and most Insurances, except for refraction fee.
OT training is covered by Medicare and most Insurances
Devices are not covered by insurance. Patients pay VA if patient qualifies DBS if patient qualifies Lions club
What can I expect in a Low Vision Exam?
Thorough history Measurements of functional
vision Acuity - Specialized charts
Contrast Visual Fields
Check eyeglasses - Refraction special technique for LV
Determine level of magnification
Trial of LV devices Develop a rehab plan
Central Field Loss and Eccentric Viewing (EV)
Train patients to move their eyes in a consistent way to look around their blind spot
Careful Refraction is First Step
Changes in prescription are often missed in ARMD patients
Use Special Charts Refract with a trial frame
Lighting
Special lamps
High intensity flashlights
OttLite -BetterVisionSeries
Ottlite.com
Glare Control
Macular degeneration patients benefits from Blue Blocker lenses:
Indoor glare control: Yellow or light amber
Outdoor glare control: Orange or Brown
Low Vision Devices for AMD Patients
Depends on: level of vision blind spots (scotoma) goals Patient’s motivation cost
Higher power reading glasses, require a closer viewing distance.
+10D(3.5X)=10 cm viewing distance
“I just need stronger glasses”
+20D(5X)= 5cm viewing distance
Telescopic Glasses
For distance activities like TV viewing, and enjoying the theater
For reading with a +3.00 reading cap
For Writing, Sewing, Computer Custom made
Prescribed magnification
Requires training and practice
Small field of view
$ 800 and up
• Standard• MaxDetail glasses• $180
What is an Occupational Therapist and what is their role in vision rehab?
An OT is a licensed health professional with expertise in rehabilitation
Some OT’s have special training in vision rehabilitation
Eccentric View training Device training Adaptive strategies Home visits and modifications, Fall prevention
Implantable Telescope Technology
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Scarred MaculaCentral Visual Field Projection (Natural Lens/IOL)
CAT
Telescope ImplantCentral Visual Field Projection
How It Works
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Field of View
3X External: 8°
3X Implant: 20°
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How It Works
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Telescope Eye = Central Vision
Distance: Faces, TV, signs
NO driving
Near: Reading, playing cards, dining
Other Eye = Peripheral VisionAllows orientation and mobility
How It Works
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• Not the solution to drive again
• Improves functional vision
• Care given by a team
• Patient participates in
rehabilitation!
Not ‘Cataract Surgery’
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Telescope Implant Program
Selection•Medical •Low Vision
Treatment•Surgical
Rehabilitation •Optometric•Occup. Therapy
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Pre-surgery assessment Informed decisionAgree to participate in visual rehab training
Low Vision Evaluation
Key Indications
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Post-Implantation
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• VisionCare’s Implantable Miniature Telescope (by Dr. Isaac Lipshitz) (intraocular telescope) is indicated for monocular implantation to improve vision in patients greater than or equal to 75 years of age with stable severe to profound vision impairment (best corrected distance visual acuity 20/160 to 20/800) caused by bilateral central scotomas associated with end-stage age-related macular degeneration.
Source: FDA Professional Use Information labeling
Indication For Use
Hand held mags
LED illuminated
Over the counter (+6 diopters or 2X) vs. Low Vision magnifiers (up to +56 diopters or 14X)
Magnifiers - The larger the magnifier the weaker it is.
Stand magnifiers
Traditional Magnifiers –
Makrolux (2.2x, 3.6X)Scribolux (2.8X)Menas Lux (3.0X)
Video MagnifiersClosed Circuit Television (CCTV)
Merlin by Enhanced Vision
Closed Circuit Television$2000 to $3000
Topaz by Freedom Scientific
Clearview by Optelec
Video magnifiers that read to you
DaVinci by Enhanced Vision
Clear View +Speech by Optelec
Prodigy Duo 2 in 1 byHumanware
Hand-held video magnifiers
$400 - $650
Pebble HD 4.3 by Enhanced Vision
Ruby by Freedom Scientific
Smartlux Digitalby Eschenbach
Mobilux Digital Magnifierby Eschenbach
Magnification range from3x to 6x
High Definition LED screen
Feels like a regular magnifier
Compact 7 HD
Continuous magnificationfrom 2X to 24 X
Computer Adaptations
Operating system accessibility options
Computer glasses Large Print Software
Zoom Text Jaws
Large print keyboard
Tablets and other eReaders
Apple iPad
Samsung Galaxy Note
Kindle Fire HD
Nook
BigMagnify Application
Available for smartphones free of charge!!
Adapted Communication
Large Print Phone Bold Line Paper, Felt Tip Pens
Adapted Leisure Activities
Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday activities that have been affected by the loss of vision
• Specialized equipment and training
• “Can do” attitude• Willingness to
learn “new tricks”