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Low Vision > Final > Flashcards

Final Flashcards

1
Q

what type of global delays can loss of vision cause?

A
  • cognition (object permanence- fairy phenomenon)
  • speech (learn by watching others)
  • motor (impedes exploring)
  • psychological (bonding)
  • self-care (social cues)
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2
Q

what is an important part of case history for pediatric low vision?

A

establish visual goals (school tasks, IEP or IPSP goals, community/vocational tasks, independent travel, avocational activities, reading, things they do for fun)

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3
Q

should you measure formal VA in a pediatric exam first?

A

not necessarily, more challenging than you think, maybe observe and do things like EOMs first for comfortability

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4
Q

what are some informal ways to measure visual acuity in peds?

A
  • observations made during assessment, use familiar objects to estimate VA
  • open hand thrust in front of face
  • objection to occlusion
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5
Q

formal acuity tests for birth-2 years

A
  • Teller Acuity cards

- Keeler cards

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6
Q

at what age do you use Cardiff cards?

A

3-5 years

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7
Q

at what age range do you usually use Lea symbols?

A

5-7 years

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8
Q

when do you use Feinbloom charts?

A

7 and above

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9
Q

does Teller Acuity over or underestimate VA?

A

over-estimates VA

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10
Q

what are some things you should take into consideration with presentation location of Teller Acuity cards

A
  • alternate between horizontal and vertical

- consider visual field findings (hemianopias? can they see in these gazes?)

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11
Q

what is the testing distance of Keeler and what is one con of it?

A

38cm

blank side of card has open circle that can distract patient

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12
Q

what VA test uses targets that are vanishing optotypes at 1m or 50cm where the child makes vertical eye movements and looks/points towards the picture

A

cardiff acuity tests

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13
Q

what test distance are lea symbols calibrated for?

A

10 feet

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14
Q

what does the “visual acuity package” mean?

A
  • no VA test in isolation can accurately and completely assess visual functioning, doctor must combine data from history, outside reports, observations, and formal and informal acuity
  • remember that resolution tests overestimate VA
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15
Q

what test do you want to obtain if possible when evaluating ocular alignment and binocularity?

A

sensory fusion status, RDS if possible

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16
Q

what are the “3 things you need to be able to walk” according to Heyman

A
  1. vision
  2. vestibular (ear)
  3. proprioception (feet)
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17
Q

increased head turning with horizontal tracking on ocular motilities may indicate:

A
  • homonymous VF loss

- neurological midline abnormalities

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18
Q

whats the best method for measuring accommodation?

A

MEM (objective) and patients with low vision have weird accommodation

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19
Q

do we evaluate contrast sensitivity on every low vision peds patient?

A
  • no, low data point because most have poor contrast
  • may test (Ex: Hiding Heidi) if child’s VA is better than low vision range but they aren’t performing well
  • always want to have high contrast accommodations for low vison kids
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20
Q

what cognitive level does a child have to be for color naming?

A

3-4 years

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21
Q

what is the most common type of adaptation used to manage low vision peds patients?

A

relative distance magnification

hold the material closer to the eye

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22
Q

what type of mag is using enlarged print ?

A

relative size magnification

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23
Q

what are some considerations to make when selective prescriptive low vision devices?

A
  • choose aids with a need/goal in mind

- consider cognitive ability, motor ability, visual ergonomics (like slant boards, classroom seating)

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24
Q

list management options for a Preschool/Early Elementary age kid with mild to moderate impairment

A
  • Srx, reading add
  • Paperweight- stand mag (go-to)
  • filters (ex: transitions)
  • classroom modifications (ex: slantboard)
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25
Q

list management options for a Preschool/Early Elementary age kid with moderate to severe impairment

A
  • Srx
  • CCTV/ video mag
  • filters
  • classroom modifications
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26
Q

list management options for a Older Elementary Age kid with mild to moderate impairment

A
  • hand held telescope (prerequisite to bioptic)

* in addition to early age stuff

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27
Q

list management options for a Older Elementary Age kid with moderate to severe impairment

A
  • portable video magnification

* in addition to early age stuff

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28
Q

list additional management options for a middle school to high school age kid with mild to moderate impairment

A
  • bioptic

- laptop

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29
Q

list additional management options for a middle school to high school age kid with moderate to severe impairment

A
  • portable video magnification

- laptop w/video magnification

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30
Q

what information do you include on a vision report

A
  • visual acuity
  • refractive status
  • sensory status
  • ocular health
  • recommendations/ classroom accommodations (slant board, large print, seating (null point considerations))
31
Q

which “team member” assesses student, writes individual education plan, and usually has daily contact with parents and patient?

A

classroom teacher

32
Q

what is part of an occupational therapy evaluation?

A
  • standardized testing and clinical assessment
  • identifies factors attributing to delays
  • sets up goals and treatment plan
33
Q

what is a key goal for occupational therapy?

A

sensory integration (tactile, touch, proprioception, vestibular, etc.)

34
Q

definition of physical therapist

A

therapeutic treatment designed to prevent or alleviate movement dysfunction through the use of exercise and physical agents

35
Q

what types of language concerns does a speech and language therapist work on?

A
  • language stimulation
  • auditory processing
  • augmentative and alternative communication
  • auditory training and total communication
36
Q

what does an audiologist do?

A
  • determines if hearing is normal (various testing strategies)
  • treats any loss (hearing aids, cochlear implants)
37
Q

list some goals of orientation training

A
  • develop confidence moving within classroom
  • sound sourcing and echolocation
  • develop body awareness including parts, laterality, and directionality
  • develop simple routes at school
  • eventually move into community
38
Q

list some goals of mobility training

A
  • develop curiosity to move in environment
  • teach protective skills
  • develop pre-cane skills such as trailing
  • introduction of aids such as white cane if appropriate
  • basic skill development
  • travel of routes at school and into community
39
Q

what does a “teacher of the visually impaired” do?

A
  • adapts education materials as needed snd works closely with optometrist
  • trains student on the use of low vision aids Rxed by OD
  • provides Braille and pre-Braille activities (visual stimulation)
  • technology help, with the school district
40
Q

what are some pre-braille and braille teaching techniques?

A
  • tactile information books
  • cupcake tin
  • swing cell (horizontal for typing and vertical for reading)
41
Q

what are the 3 types of Braille?

A

I- no contractions
II- over 200 contractions
III- no punctuation

42
Q

what type of Braille is used for math>

A

Nemeth code

43
Q

what adult low vision patients can benefit from occupational therapy?

A

-patients with poor ADL skills
-patients who need EV training
(need 20/70 or worse for Medicare billing)

44
Q

what is the department of rehab and how do you get services from them?

A
  • state agency that supports individuals with disabilities
  • must have goal of becoming a productive member of society (patient needs to have a plan), adults only
  • DOR will provide education and low vision services and each patient is assigned a counselor
45
Q

what does the Braille Institute do?

A

-nonprofit organization in So-cal offering free classes to eliminate barriers to a fulfilling life (cooking, assistive technology, Q&M, art, daily living skills, support services)

46
Q

what does the Dayle MacIntosh Resource center do>

A
  • nonprofit organization offering free services to persons with disabilities to help them live fully and independently (for senior citizens, don’t have to be blind)
  • services are advocacy, aging with vision loss, assistive tech, transition programs, deaf services, and disability awareness/ ADA training
47
Q

common causes of low vision from reduced acuity (blurred vision)

A
  • albinism
  • cataract
  • cortical visual impairment
  • congenital nystagmus
48
Q

management of patients with reduced acuity

A
  • determine mag for near, intermediate, and distance
  • determine most appropriate devices depending on ability to use devices to meet visual goal
  • use of CLs to dampen nystagmus
49
Q

common causes of low vision from central field loss

A
  • ARMD
  • diabetic retinopathy (CSME)
  • cone dystrophy
  • Stargardt
  • macular dystrophy
50
Q

management of patients with central field loss

A
  • determine best eccentric viewing location
  • train and make EV efficient and visual skills in relation to EV
  • determine mag needs and appropriate devices
  • respond well to magnification
51
Q

common causes of low vision from peripheral field loss

A
  • glaucoma
  • traumatic brain injury
  • retinitis pigmentosa
  • stroke
52
Q

management of patients with peripheral field loss

A
  • assess visual field loss and impact on safe independent travel
  • train visual skills (scanning, locating, searching)
  • manage night blindness (prolonged light/dark adaptation, normal light levels may appear dim) so use reverse TS, mirror, minus lens but limited response to magnification
53
Q

common causes of low vision with reduced contrast sensitivity and glare sensitivity

A
  • optic atrophy
  • corneal dystrophies/degenerations
  • cataract
  • pretty much any disease can cause it
54
Q

management of patients with reduced contrast sensitivity and glare sensitivity

A
  • evaluate filters (NOIR, tints, coatings, acetate sheets, lighting)
  • typscope, bold-lined paper, felt tip pens
  • provide magnification as needed
  • consider contrast enhancing magnifiers (like CCTV)
55
Q

define Albinism and its inheritance patterns and prevalence

A
  • congenital condition characterized by the lack of pigment (body’s inability to produce pigment) or reduced pigment
  • can be oculocutaneous (AR or AD 1:20,000), tyrosinase-negative (severe) and tyrosinase-positive (better acuity)
  • can be ocular albinism (X-linked 1:40,000)
56
Q

what is the expected acuity for the different types of Albinism

A
  • tyrosinase-neg: 20/200-20/400
  • tyrosinase-pos: 20/200 or better
  • ocular albinism: 20/40-20/100
57
Q

In Albinism, what is normal or abnormal for color vision, VF, and stereo?

A
  • color vision normal
  • visual fields full
  • lack of stereo (b/c optic nerve fibers do not cross at optic chiasm)
58
Q

what are other ocular signs in albinism?

A
  • white eyebrows and eyelashes
  • irides light blue with transillumination causing photophobia
  • lack of foveal pigment with macular hypoplasia
  • nystagmus
  • high hyperope, myope, or with-the-rule astigmatism
  • strabismus
59
Q

what are 2 other associated sydromes with Albinism and what questions should you add to your case history for them?

A
  1. Hermansky-Pudlak: Puerto Rican that easily bruises, epistaxis, profuse bleeding with injury due to serum platlet defect (Bleed a lot?)
  2. Chediak-Higaski: rare, increased susceptibility to infection (get sick a lot?)
60
Q

low vision management for Albinism patient

A
  • correct refractive error with glasses or contacts, which may improve acuity and reduce the nystagmus
  • control illumination with tints, aperture control contacts, UV, visors, hats, etc.
  • magnification at distance and near, will usually respond as predicted
  • ideal low vision patient without central or peripheral defect
  • telescopes (monocular or bioptic for driving)
  • prism, if null point causes head turn/tilt
  • genetic counseling
  • support groups (NOAH)
61
Q

Stargardt macular dystrophy: what is it and what is the inheritance pattern?

A

“fundus flavimacultus” characterized by a “beaten bronze appearance to the fovea with parafoveal flecks (fish shaped)

  • Juvenile Macular Degeneration
  • autosomal recessive
62
Q

low vision management of Stargardt macular dystrophy patients:

A
  • vocational rehab and counseling (b/c young patients)
  • refractive error correction
  • eccentric viewing techniques
  • mag and distance and near
  • direct illumination
  • filters, sun lenses, non-optical
  • support groups
63
Q

what are some special considerations for low vision devices with a diabetic patient

A
  • opt for flexible easy modified or adaptable systems
  • avoid expensive custom made systems that are fixed-focused or unadaptable
  • realize several different powers may be needed by diabetic patient due to changing visual status
64
Q

special low vision considerations for myopic degeneration patients

A
  • best Rx, note vertex (soft or rigid contacts best option is not contraindicated)
  • spectacle design (poly, 1.66 or 1.74, myodisc or blended myodisc, rolls and polish, A/R coating (front and back)
  • magnification devices (distance and near)
  • simply removing Rx provides built in microscope
  • clip on telescope system may not work due to edge thickness of Srx
  • can use handheld telecscope w/Srx
  • O&M referral if extensive PRP, cyro or scleral buckle
65
Q

define retinitis pigmentosa

A

a group of retinal hereditary dystrophies characterized by progressive visual field loss, night blindness, and abnormal ERG

66
Q

what are the different inheritance patterns for RP and % affected in each

A
  • AR (60-80%)
  • AD (10-25%) milder and later onset
  • X-linked (5-18%) severe and earlier onset

odds 1 in 2,000 to 1 in 7,000 (males>females)

67
Q

ocular signs and symptoms of RP

A
  • bone spicule pigment formation, loss of pigment, motheaten, prominent choroidal vasculature, attenuated retinal arterioles, waxy pallor, smaller c/d ratio, ONH drusen
  • CME, PSC
  • night blindness
  • delayed dark and light adaptation speed
  • decreased color sensitivity, photophobia
68
Q

constricted visual field symptoms

A
  • prolonged light/dark adaptation
  • normal light levels may appear dim
  • use reverse TS, mirror, minus lens
  • limited response to magnification
69
Q

strategy for constructed visual field

A
  • assess visual field loss and impact on safe independent travel
  • train visual skills (scanning, locating, searching)
  • night blindness
  • consider other technologies in rehab plan
70
Q

what magnification on a telescope is ideal in an end stage glaucoma patient

A

2.5x or 2.8x hand held galilean for both magnification and minification (easy to use)

71
Q

what is rod monochromatism and what inheritance pattern

A

true color blindness

AD

72
Q

what is blue cone monochromatism and what inheritance pattern

A

loss of red/green cones

X-linked

73
Q

ocular signs and symptoms of achromatopsia

A
  • VA 20/60-20/200, better in dim
  • reduced central acuity in bright light
  • decreased color perception
  • photophobia (extreme)
  • nystagmus
  • blonde fundi and RPE disturbances in macula
74
Q

low vision management in achromatopsia

A
  • reduce illumination with filters, tints, and sideshields
  • red tinted or dark tinted lenses and sunglasses
  • magnification devices for distance and near
  • genetic counseling
  • support groups

Low Vision (4 decks)

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