Impact of visual impairment

Question 1

what is a system that can be used to define health and health related states

Answer 1

ICIDH (International Classification of Impairment, Disability and Handicap) (1980)

Question 2

what is an impairment

Answer 2

A loss or abnormality of physiological or anatomical structure or function

e.g. loss of leg or eye

Question 3

what is a disability

Answer 3

Any restriction or lack (resulting from impairment) of the ability to perform an activity in the manner or within the range considered normal for a human being

e.g. by losing your leg (the impairment) you have a disability as your unable to walk.
but you might have an impairment where you’ve lost an eye, but that doesn’t lead to a disability because you can still watch t.v. with one eye

Question 4

what is a handicap

Answer 4

A disadvantage for a given individual, resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal for that individual (in relation to age, sex, social and cultural factors)

Question 5

give an example of the impairment, disability and handicap of a person who has AMD

Answer 5

impairment:
at the level of the photoreceptors, so theres something wrong with the macula which results in a loss of VA and VF

disability:
difficult to recognise faces or read

handicap:
patient goes outside and is unable to recognise their neighbour, they feel this has put them in a disadvantage
or if you cannot read and you want to vote but you cannot see the voting form, this puts you in a social disadvantage

Question 6

what replaced the ICIDH (International Classification of Impairment, Disability and Handicap) (1980) which is the system that can be used to define health and health related states
and why was it replaced

Answer 6

The ICF (2001) replaced the ICIDH (International Classification of Impairment, Disability and Handicap) (1980)

Because:
- ICIDH can only describe ‘consequence of disease’
Whereas:
- ICF can describe conditions of both health and disease i.e. it can be used to describe any individual in the society, healthy or diseased.

WHO wanted a definition that looked at global health and was able to describe an individual regardless of whether they had a disease or whether they were normal

Question 7

explain how the ICF describes an individual and how this is categorised, give examples of this with a px who has AMD

Answer 7

The ICF describes the individual in terms of the:

• Body part thats affected
• The whole person
• The functioning at the level of the person
• The functioning in the society

e. g. with AMD
- The impairment is photoreceptor loss, which results in a loss of va and central vf loss
- What you can do for AMD depending on the type would be e.g. lucentis treatment
- If you then look at the whole person and look at the activity limitations i.e. what affects AMD will have on an individual e.g. px will be unable to read, so for that individual you will give a stronger pair of glasses or magnifier to help them read
- Next thing to look at is the individual interacting with society, an AMD px may not be able to participate in society as they cannot see well e.g. to vote
- So design the voting form to be accessible to everyone

So ICF tries to look at:
The body part, the individual on their own and the individual in society and different interventions at different stages which can help the individual

Question 8

what does the interaction between components of the ICF describe

Answer 8

How different components of the ICF interact with each other
Describes:
the limit in activities and participations depends on environmental and personal factors
e.g. px might live in a society with iPads, iPhones etc so not to read conventional print is not a big problem as they can enlarge the print or read out the text
this depends on the individual and their environment and also on personal factors e.g. what people accept as being normal differs between individuals

Question 9

list the:
impairment 
disability 
handcap 
of a person with AMD

Answer 9

• Impairment
  Loss of central vision and visual acuity
• Disability (difficulties)
  Reading
  Recognising faces
• Handicap
  Loss of independence
  as cannot read themselves, cannot recognise faces = have to depend on others

Question 10

list the:
impairment 
disability 
handcap 
of a person with cataract

Answer 10

• Impairment
  Loss of contrast
  Glare
  Poor acuity
• Disability
  Detail
  Low contrast targets
  Bright environments

Handicap
- Night time driving

You don’t see patients with just a cataract in the LV clinic, they may also have it with e.g. AMD, DM, glaucoma etc.
you can get a patient with a dense cataract and surgery for some reason may not be an option for them

Question 11

list the:
impairment 
disability 
handcap 
of a person with glaucoma

Answer 11

- Impairment
Contracted field (due to loss of nerve fibre layer) 

• Disability
  Mobility (from loss of visual field, bump into things)

- Handicap
Getting about (if have constricted vf)

Question 12

list 6 effects of the impact of vision loss on the individual

Answer 12

• Employment
• Independence
• Impact on QoL/leisure activities
• Psychological Impact
• Wellbeing
• Social Impact

Question 13

explain how the impact of vision loss can affect the individual’s employment

Answer 13

34% of individuals who have SI or SSI are in employment in comparison to 75% overall (Douglas et al. ,2008)

People with a visual impairment are less likely to be in work than those with other kinds of disability (McNeil, 2001) but are more likely than those with other disabilities to graduate from secondary school (Kaye, 1992)
So most VI people are educated, but can’t find a job because of their VI

Question 14

explain how the impact of vision loss can affect the individual’s independence

Answer 14

• Loss of independence (Mitchell et al., 2005)
• No longer able to drive, mobility problems, problems while cooking and managing money (Sloan et al., 2005)
• Correlation between distance visual acuity and independent living for individuals between the ages of 70 and 95 years of age (Bergman & Sjöstrand, 2002)
  As distance VA declines, more likely to end up in care home, as px has not much independence

Question 15

explain how the impact of vision loss can have an impact on QoL/leisure activities

Answer 15

• Rovner and Casten (2002) found that over half VIP had lost valued activities: most common being reading and driving
• Rees et al. (2007) found that 79% of VIP had problems with reading, 46% had difficulties with household tasks and 31% had problems with personal care

Question 16

explain how the impact of vision loss can have a psychological impact

Answer 16

• VIP are prone to depressive symptoms (e.g. Burmedis et al., 2003) so need to ask about depressive symptoms to pick them up
• Rate of depressive disorder is twice that among the elderly VIP than among the overall elderly population (Brody et al., 2001)
• Visual impairment in the elderly has been shown to lead to an increased risk of committing suicide (Waern et al., 2002)
• Poor sleep quality has also been frequently reported among VIP (Asplund, 2000)

Question 17

explain how the impact of vision loss can affect the individual’s wellbeing

Answer 17

• Visual impairment can increase the number of injuries resulting from falls (Vu et al., 2005) compared to non VIP
• VIPs more likely to visit GPs( Branch et al., 1989)
• Visual impairment can increase the risk of death from injuries (Lee et al., 2002)

Question 18

explain how the impact of vision loss can have a social impact

Answer 18

• Reduced participation in social activities because the individual has mobility problems and is worried about having problems recognising faces (Dickinson 1998)
• VIP are more likely to be single/have never married than those in the general population (Clements & Douglas, 2009)

Loss of vision is one of the most feared results of aging

Question 19

explain how large the economic impact is on vision loss

Answer 19

Future Sight Loss UK (2009)

• Cost of visual impairment in 2008 was approximately £6.5 billion.
• £2.2 billion were direct costs, such as hospital and social care
• £4.3 billion was indirect costs, such as costs associated with lower employment, informal carers, LVAs and home modifications etc.

Costs associated with loss of healthy life and loss of life due to premature death associated with visual impairment is estimated at a further £15.51 billion

Question 20

list 3 impacts that vision loss can have on the VIP’s carer and family

Answer 20

• Depressive symptoms
• Economic impact (if cannot work and support family)
• Psychological impact

Question 21

list the 5 stages of response to a visual loss that a VIP may have (seen in clinic)

Answer 21

• Denial
• Anger
• Bargaining (e.g. religious person may bargain with god)
• Depression
• Acceptance

Question 22

list 7 factors affecting the adjustment to visual impairment (i.e. how well someone will adjust to visual impairment)

Answer 22

• Type of loss
• Cultural and Family reaction
• Life stage
• Significant life event
• Patient expectations
• Self concept
• Personality

Question 23

what 5 types of visual loss are there, that can affect the adjustment to visual impairment

Answer 23

• Congenital: VI for long time = better adjusted as may have not known what good sight is
• Adventitious and long standing
• Adventitious and recent onset
• Blind
• Low Vision

Question 24

how can a congenital type of visual loss affect an individual’s adjustment to visual impairment

Answer 24

better adjusted as may have not known what good sight is

Question 25

how can a adventitious and long standing and adventitious and recent onset type of visual loss affect an individual’s adjustment to visual impairment

Answer 25

It depends on how fast the visual loss is e.g. if its gradual in dry AMD, you tend to adjust better to the visual loss than something sudden like wet AMD

Question 26

what is the debate about how a low vision type of vision loss can affect an individual’s adjustment to visual impairment

Answer 26

some debate that it is better to be blind and have LV, as it can be more disturbing if a patient can see some light as things appear distorted and may take them longer to adjust than being completely blind

Question 27

list 3 different reactions describing how cultural and family can affect an individual’s adjustment to visual impairment

Answer 27

• Vision loss - roll changes within the household (partner may have to go out and work and VIP stays at home), anger and resentment
• Social stigma in some cultures
• Pity & over protection (can’t do things VIP used to)

Question 28

list 3 different life stages that a person can become visually impaired and depends on how well they adjust to it

Answer 28

• School going
• Working life
• Retired

Question 29

list 2 significant life events that can have an impact on how a visually impaired person adjusts to their visual loss

Answer 29

• Illness
  e. g. if also have cancer, then won’t have time to think about the VI, but once treatment for the cancer is sorted, it then can sink into the patient that they’re VI = can be a problem
• Loss of loved ones - can have an impact on adjusting to the VI

Question 30

what 2 things can affect the patient expectations which can affect how they adjust to a visual loss

Answer 30

• Stage of vision loss

- Previous experience

Question 31

how can self concept affect the patient in adjusting to their visual loss

Answer 31

if the px has low self esteem, they can find it harder to adjust to the visual loss compared to a confident person

Question 32

how can depression affect the patient is adjusting to their visual loss

Answer 32

Loss of independence

Find it harder to accept situations in life

Question 33

what is charles bonnet syndrome 
what is it associated with 
which conditions is it mostly associated with 
what is the prevalence 
who is it more common in

Answer 33

• Visual hallucinations in elderly individuals with normal intellectual and psychological functioning
• Associated with bilateral visual impairment
• Association with living alone (more likely to have)
• Commonly associated with AMD, DR, Glaucoma & cataract
• Prevalence ranges from 11%-63%
• More common in women and elderly population although it can be found in children

Question 34

what is the content of hallucinations in charles bonnet syndrome

Answer 34

• Consistent themes include people- adults, faces (often grotesque)
• Geometric shapes (circles, triangles, rectangles etc), spots and flashes
• Less common - animals and plants
• Occur mostly in vivid colour
• Hallucinations appear with greater clarity and detail in comparison to reality and the persons normal vision (appears very clear, even though VI px cannot see clearly in general)

Question 35

list how you will screen for hallucinations in charles bonnet syndrome and quote how you will ask a patient if they are suffering from charles bonnet syndrome

Answer 35

• Establish rapport
  “Apart from blurred vision, have you noticed anything else unusual about your vision? Have you had any unusual visual experiences?” (Menon, 2005)
  “Patients with visual impairment often see things that they know are not there such as patterns, faces and animals, has this ever happened to you?” (Menon, 2005)
• Explanation of CBS and reassurance
• Rule out other etiologies for visual hallucinations before concluding that CBS is present

Question 36

list 6 practical strategies against child bonnet syndrome

Answer 36

• Looking away
• Blinking
• Increasing illumination
• Hitting /shouting at the hallucination
• Distraction (do something else)

(Menon, 2003)
- Watching television/listening to the radio

Question 37

which 2 places can a person get help for dealing with charles bonnet syndrome

Answer 37

• Telephone counselling service : Macular Society

- Eye Clinic Liaison Officer (ECLO) - can council the px

Question 38

list 4 negative outcomes of patients with charles bonnet syndrome experience and how many % of these patients experience this

Answer 38

• frequent, long-lasting or fear-inducing hallucinations
• daily activity affected
• believing hallucinations were due to mental illness
• not knowing about CBS when symptoms first appeared

32%