Low vision 2 Flashcards
What observations can we pick up on without starting routine?
- Posture
- Appearance
- Alone or with company
- Do they have a magnifier
History taking
- HOS
- Stability of the condition and any differences between the eyes
- Their knowledge on the condition and the prognosis
- Are they registered as impaired? And if they are eligible then why not?
- Education/employment , access to work scheme
- Present aids and spectacles . Do they use smart phones? Are they using any apps on the phone.
- Have they tried aids before?
- What the reason for the visit
What do we need to consider with distance vision?
- Do they have difficulty seeing faces
- Does there vision fluctuate ; changes according to the day
- Eccentric viewing loss ; AMD
- Glare problems
- Vision better inside or outside
How is their mobility?
Do they need someone to walk with / go out with
How should we measure VA?
- Measure binocular and monocular.
- Use tumbling E instead of counting fingers
- Start doing the tests at close distances ; Not far!
- Also record their reading speed
What to do if the ret reflex is dull?
Move closer to the px,m but remember the Working distance
What to do if the ret reflex is dull?
Move closer to the px
What can we use to help measure prescription?
- Use their old glasses.
- Use bigger steps and bracketing technique
What do we do when the add increases?
We should move the reading chart closer to the px
What do we check once the add has been deduced?
We check stereovision ; Frisby
What other tests should we do?
- Goldman perimeter
- Amsler grid
- Contrast sensitivity
- Visual fields
When do we actually change their Rx?
2 lines or more difference
What do we need to think of when giving out magnifications?
If we want to give it monocular or binocular ; normally an aid is given monocular
How do we predict distance magnification?
- Required VA / Presenting VA = Mag
(Required will normally be 6/6)
This mag will be an estimate ; we trial and error from this magnification.
How do we predict near mag?
Mag = (Present VA / Required VA) x Acuity reserve
How does cataract affect near vision?
Nuclear better for near- MYOPIC SHIFT
Posterior pole better in the reading.
What is this
hand held mag
How do we pick a magnifier?
Distance : Telescope. This can be mono or bono. This can be variable or a fixed amount. Astronomical or Galilean. Max is a mounted telescope on the glasses
Near: spec mounted magnifier, hand magnifier, stand magnifier, near vision telescope
We pick depending on history and what tasks they will need it for
How do we trial the magnifer?
Assess the px va with the selected aid.
Increase and decrease the mag, depending on the task.
Why is giving out the smallest possible Mag important?
For the px to have the best FOV
Why might you give a px a higher mag then they need?
When you know their disease is progressing
What advise do we give when giving aids?
Consider, with or without rx.
Normally for telescopes, we use their rx
With hand mags, they need their dist correction. The rays of light is given out parallel
Stand mag the rays of light will b diverging. This means the older px needs to wear near rx
when do we follow up?
after 3 weeks - then yearly or when the px has difficulties
what to do when the aid is unsuccessful?
- Maybe give a stronger aid
- Electronic aid
- Using the aid wrong ; lighting and distance = training and advice
Explain the usage of the aid ; the task
How to complete the visit?
- Give advice and practise and encourage the px
- Charities
- Report to the GP, consultant ect where appropriate
- Registration services
Technology ; apps ect
How is remote VI diff to face to face?
There might be confidentially issues with third party.
It is hard to assess the VA and contrast sensitivity charts. Can use the home acuity test
Might not be able to do all aspects of the eye exam. It can be good for venerable px who might not be able to get out the house well
What is the acuity reserve for optimum reading?
6:1
what is the acuity reserve for fluent reading?
2:1
what is the acuity reserve for spot reading?
1:1
