L5 Vision Therapy Flashcards
What is vision therapy?
used to develop or improve a person’s visual abilities as it relates to everyday activities
OTs modify the task or environment to minimize limitations so pt can adequately participate
What does vision therapy entail?
typically done at outpatient clinic with OT
each pt is different, POC is created based on diagnosis, disease progression, severity
Younger population typical dx
- vision changes due to neurologic event
- exotropia and esotropia
- convergence insufficiency
- accommodative insufficiency
- ocular motor dysfunction
- amblyopia
- challenges with reading and writing
- headaches with reading
- visual perception changes
- visual motor deficits
Aging population typical diagnoses
- change in vision
- blurry vision
- blindness
- glaucoma
- macular degeneration
- wet AMD
- dry AMD
- diabetic retinopathy
- congenital eye diseases
- trauma to the eye
Does a patient need vision therapy?
- do they have a condition that is progressive or are they going to lose their vision?
- do glasses not really help them anymore?
- do they have balance issues that are not vestibular related?
- are they in vestibular therapy and not progressing due to vision?
- do they trip or fall frequently?
- are they a child not meeting a milestone?
- Do they have difficulty reading?
How do pts get to vision therapy?
- pts start by seeing pcp, ophthalmologist, optometrist
- pt has to be medically managed first before going to OT for vision
- Contact PCP for a referral to OT for vision therapy
Cost of vision therapy
- most insurance companies cover vision therapy with OT
- some equipment will be covered, usually if pt is a part of VA
- grants, committees, and access tech can help to cover extra costs
What does a vision therapy session look like?
- eye exercises
- adaptive equipment
- referrals to the oregon commission for the blind
- connection to community resources
- connection to vision therapy and PT if needed
Vision therapy concepts
- Oculomotor control, visual fields, visual acuity
- Attention
- Scanning
- pattern recognition
- visual memory
- visual cognition
- adaptation through vision
Cornea
protects the inside of your eye like a windshield, helps bed the light as it enters the eye
Sclera
white part of your eye that forms the general shape and structure of your eyeball
Aqueous humor
fluid that fills the anterior chamber
pressure of aqueous humor helps maintain your eye’s shape
floaters are in the humor due to trauma
Iris
contains the muscles that control the size of your pupil, responsible for eye color
Pupil
black circle inside the iris
widens and narrows to control how much light enters the eye
Lens
focuses light that enters the eye and directs it to the back of the eye
Vitreous humor
clear, gel like fluid fills the space between lens and retina. helps the eye hold its shape
Retina
thin layer of light-sensitive cells at back of eyes that converts light into electrical signals, contains rods and cones
Macula
responsible for center of visual field, helps with color and fine details
if it’s damaged, it will show up as central scotoma or loss at middle of vision field
Optic nerve
connects the retina to the visual cortex
Ciliary body and muscle
found behind the iris and includes the ring-shaped muscle that changes the shape of lens when eye is focused
External muscles
control your eye’s position, alignment, accommodation, and movement. also contribute to eye’s shape. controlled by cranial nerves 3, 4, 6
Optic Nerve
bundle of nerve fibers that begins at optic disk at back of the eye
when light hits the retina, rods/cones turn the light into electrical signals
electrical signals travel through optic nerve to brain, to optic chiasm, then occipital lobe
Optic chiasm is damaged..
outer fields of both eyes are lost
bitemporal hemianopia
Visual pathways after optic chiasm are damaged
the visual fields on the opposite side of the lesion are lost
contralateral homonymous hemianopia
i.e both left fields are lost with a right lobe damage
Optic nerve is damaged
vision is completely lost only on affected side
monocular vision loss
Central vision
has color and detail
makes up 20% of vision
macula is responsible
Peripheral Vision
- allows you to see color, movement, shapes outside of the central vision
- lacks detail
- makes up 80% of vision
- vestibular dysfunction often have peripheral sensitivity
- tunnel vision is a loss of peripheral vision
Scotoma
- blind spot in vision
- may be small or large, permanent or temporary
- can move around to different places in visual fields
Impacts of CVA on vision
- visual field cuts such as neglect, hemianopia
- midline shift in vision
- ocular occlusion
- diplopia
when can you use an eye patch?
only during OT session, not to be used outside of treatment
Diplopia due to CVA
may need patching
can use in clinic, not allowed to recommend pt wear a patch without optometrist or opthalmologist
might be a convergence insufficiency and eye exercise would be indicated
Hemineglect
- not aware of defect
- extinction is common
- contralateral cueing improves neglect
- during drawing, lacks contralateral details
- more often right hemisphere lesion
- multimodal deficits
- can spontaneously recover within 6 mo of CVA
Hemianopia
- aware of deficits
- extinction is unusual
- contralateral cueing has no effect
- drawing is normal
- lesion can be on right or left
- visual only deficit
- can spontaneously recover within 6 mo of CVA
Dry age-related macular degeneration
- most common form of AMD is dry
- appearance of small yellow deposits called drusen (waste), forming under retina
- drusen can cause retinal cells in macula to die, cannot process light anymore
- usually slowly worsens over time
- 3 stages of early, intermmediate, and advanced
Wet AMD
- known as neovascular AMD, causes rapid and serious vision loss
- less common type of late AMD, and will cause faster degeneration. wet AMD is always late stage
- occurs when abnormal blood vessels grow in back of eye and damage in macula
- may be treated with various treatments from ophthalmologist
Wet and Dry connection
any stage of dry can turn into wet
no stage of wet can become dry
dry is often less serious compared to wet, and wet faster degeneration
How does AMD impact treatment?
affects the patients’ central vision
pt will have a difficult time participating in head positioning such as VOR, gaze stabilization, cover/uncover test
Diabetic retinopathy
- causes vision loss and blindness in people who have diabetes
- impacts blood vessels in retina
- preventable with proper diabetic management
- vision will fluctuate with hypoglycemic level
Having diabetes makes you
2 to 5 times more likely to develop cataracts
more likely to get cataracts at a younger age
How does diabetic retinopathy impact treatment?
reading handouts/home program
high contrast
may go blind eventually without treatment
Cataracts
- cloudy area in lens of the eye
- common in aging population
- more than 1/2 of all americans 80+ age either have cataracts or had surgery to remove cataracts
How doe cataracts impact treatment?
high contrast
increased lighting for tasks
Glaucoma
- group of eye diseases that can cause vision loss and blindness by damaging the optic nerve
- no cure for glaucoma
- early treatment can often stop the damage and protect vision
- treatments include eye injections, vitamins, eye drops
How does glaucoma impact treatment?
peripheral vision
scanning strategies
pt’s vision will be dependent on what stage of glaucoma is occurring
Low vision adaptive treatment
- Low tech = colored tape, magnifiers, lights
- high tech = CCTV, electronic magnifiers, phone apps, liquid indicators
can also include white can and guide dog training by orientation/mobility specialists
What can OTs teach in regards to white cane?
only inside the clinic, they can’t do it outside or in the community
Brock String
used for vergence problems, such as convergence insufficiency, amblyopia (lazy eye) and strabismus (eye turn), to improve double vision, blurred vision, headaches, visual discomfort, dizziness and imbalance
Hart Chart
used to help with the accommodative systems in vision
helps with changing from distances far to near quickly
