Low Vision

Question 1

What is low vision

Answer 1

Can not be corrected by medical/surgical intervention, glasses, or contacts
Has an ability to complete functional activities independently

Question 2

Legal Blindness

Answer 2

20/200 or worse in better eye or a visual field of 20 degrees or less in better eye
Legally blind individuals have a large amount of fx’l vision remaining.
Some people w/ 20/800 can still continue to participate in ADL’s w/ specialized adaptive equipment.

Question 3

Low Vision Stats (1)

Answer 3

3 million people have some form of low vision
The number is expected to double in the next 25 years
Pt.’s with visual impairment had an ALOS 2.4 days longer than that of pt.’s with no visual impairment.

Question 4

Low Vision Stats Continued (2)

Answer 4

48% of individuals in nursing homes have a visual impairment
86.5 of veterans responding to a survey reported that receives a great deal of benefit from using optical devices-> most common tasks included reading, med management, reading, checking telephone #’s

Question 5

Low Vision Stats Continued (3)

Answer 5

2/3 of older people w/ vision impairments have at least one other chronic condition that limits their mobility of independent functioning
A decline in visual stats is associated with lower emotional, physical, and social function.
85% of those who are visually impaired have some usable vision and can benefit from vision rehab

Question 6

Macular Degeneration

Answer 6

*Leading cause of legal blindness in people over the age of 60
Causes damage to the macula.
Maculs is responsible for capturing & directing light, seeing detail, color, CENTRAL VISION

Question 7

Dry Macular Degeneration

Answer 7

Light sensitive cells slowly break down causing gradual blurring of the central vision in the affected eye.
Most common form of macular degeneration

Question 8

Wet Macular Degeneration

Answer 8

Abnormal blood vessels grow under the macula that leak blood and fluid causing rapid damage to the macula

Question 9

Causes of Macular Degeneration

Answer 9

Smoking, obesity, race (whites more than blacks)

Family history, gender (women are at greater risk)

Question 10

Macular Degeneration : Functional Implications

Answer 10

Decreased ability to perform “straight ahead” activities (reading, sewing, driving)
Early sx. include straight lines appearing curvy
Sx. of Charles Bonet Syndrome- seeing images that aren’t there (stars,flowers)
Detailed vision is reduced and a person may have trouble seeing up close or at a distance
Decreased ability to judge height, distance, and depth

Question 11

Macular Degeneration : Treatment

Answer 11

Environmental modifications 
Magnification 
Don't smoke, diet & exercise 
Medication/vitamins 
Laser surgery (wet) 
Photodynamic Therapy (wet) 
Mantain good Bp 
Clinical trials

Question 12

Glaucoma

Answer 12

Approximatley 5,500 more people became legally blind each year as a consequence of glaucoma
The “sneak-thief” of vision
#1 cause of preventable blindness

Question 13

Glaucoma : Causes

Answer 13

Age 60+
Family history
Blacks (40 +)
Diabetic pt.’s

Question 14

Glaucoma : Functional Implications

Answer 14

Decreased peripheral vision
Sensitivity to light 
Blurred, misty, or foggy vision 
Pain (anywhere from forehead to cheeks) 
"Halo" around lights

Question 15

Glaucoma : Treatment

Answer 15

Any damage is permanent; tx. can only prevent the disease from progressing 
Medication - eye drops and oral meds 
Laser 
Surgery - installing a safety valve 
Environmental Modifications 
Regular check-ups

Question 16

Cataracts

Answer 16

Clouding of the normally clear lens of the eye
The purpose of the lens to bend light rays to provide a clear image of the retina on the back on the eye.
Clouding of the lens leads to a distortion of light passing through the eye.
Progression of cataracts can vary in each individual, and each eye.

Question 17

Cataracts : Causes

Answer 17

Disturbance of metabolism in the lens
Effects of ultraviolet light
Cigarette smoking

Question 18

Cataracts : Functional Implications

Answer 18

Blurred vision 
Decreased sensitivity to light
Sensitive to glare 
Bright lights are uncomfortable 
Difficulty identifying color 
Decreased contrast resulting in objects appearing dull

Question 19

Cataracts : Treatment

Answer 19

Change in glasses may benefit 
Cataract surgery 
Increase/change lighting 
Absorptive lenses 
Magnifiers, large print materials 
Use of a hat on sunny days 
Use bright colors with high contrast 
Adjust shades to reduce direct light/glare

Question 20

Diabetic Retinopathy

Answer 20

80% of diabetics have diabetic retinopathy
40% of diabetics have retinopathy after 5 years of onset
Diabetic pts. are at in increased risk for cataracts & glaucoma

Question 21

Diabetic Retinopathy : Causes

Answer 21

Diabetes 
Obesity 
Family Hx
Diet 
Lifestyle

Question 22

Diabetic Retinopathy : Functional Implications

Answer 22

Decreased visual acuity 
Increase in glare 
Central & Peripheral vision affected 
Overall Blurred/Hazy vision 
Trouble seeing detail (faces, print, TV) ("swiss cheese effect")

Question 23

Diabetic Retinopathy : Treatment

Answer 23

If untreated can result in blindness 
Prevention is best tx 
Routine retinal exam to monitor effect of the disease 
Test blood sugar 3-4 times per day 
Maintain diet and exercise 
Environmental Modifications 
Magnification 
Laser surgery -slows or stops disease 
Vitrecotomy - used when no other option is available (removal of blood, scar tissue, & viterous)

Question 24

Rehab & Medical Model

Answer 24

The opthamlmologist and or optometrist and OT work as a team in the eval process
Team approach

Question 25

Doctors Role

Answer 25

Optometrist or ophthalmologist determine visual capacity to provide OT w/ necessary information for Tx:
Dx, precautions, acuity, contrast sensitivity, visual fields
Scotoma testing, recommendations for best optical device
Prognosis as appropriate

Question 26

Health Care Finance Administration (HCFA) : 1990

Answer 26

Expanded the definition of physical impairment to include low vision as a condition that could benefit from rehab
As a result qualified physicians can now refer low vision pt.’s to OT for vision Rehab

Question 27

OT Role

Answer 27

OT’s understand how changes in visual performance can affect the pt.’s physical social, personal, cultural, & spiritual aspects of their lives
-eval the pt. to determine their needs in order to increase their independence w/ self-care skills
Educate the pt.’s & family members on their Dx, & resources for optical devices
Train pt.’s to use their residual vision, environmental modifications, and use of optical and non-optical devices that are most appropriate or their needs

Question 28

OT Role Continued

Answer 28

Make environmental modifications to the pt.’s home environment to maximize their residual vision
Educate the pt. how to compensate for their low vision by using their other senses
Provide training in many different settings
Educate regarding Medicare and private insurance coverage for low vision rehab
Provide pt.’s w/ the best illumination needed for their self-care, work, & leisure skills

Question 29

Optical Devices

Answer 29

Magnifying specticales 
Hand-help magnification 
Stand magnifiers 
Telescopes 
Video magnifiers 
Electronic telescopes

Question 30

Non-optical Devices : Community Work

Answer 30

Large print maps/directions
Folding cane
Lap desk

Question 31

Non-optical devices : Leisure / Communication

Answer 31

Low vision cards 
Large bingo cards 
Easy reader/stand 
Self-threading needles 
20/20 pen 
Bold line paper 
Writing guides

Question 32

Non-optical Devices : Self-care

Answer 32

Large med. organizer
syringe magnifier
Count-o-dose
Magnfying mirror

Question 33

Non-optical Devices : Home management

Answer 33

Talking alarm clocks 
Large timer 
Liquid level indicator 
Large print checks 
Writing guides 
Talking calculator 
Large button phone 
Low vision cutting boards 
Hi-Marks labeling

Question 34

Assisting a person with low vision needs

Answer 34

Not everyone recognizes voices or remembers names : introduce yourself each time 
Avoid using hand gestures 
Offer your arm 
Tell the person when you are leaving/entering the room 
Dont move personal items 
Weather can effect vision 
Encourage the use of equipment 
Give increased time 
Be specific when giving directions

Question 35

Eating tips

Answer 35

Provide color contrast
Use the clock method to indicate where food is on the plate
Move fork towards the center of the plate to minimize pushing food of the plate
Use the weight of the food on the utensil to determine how much food you need
When reaching for a drink keep your hand low & slide fingers across the table
Wearing solids will cover up food spills
When pouring liquids use your finger to know when to stop
Mark dials or knobs
Simplify appliances

Question 36

Home visits

Answer 36

Eval safety & independence 
Make modifications as necessary
Practice w/ and w/o optical devices 
Determine best position to use devices 
Able to provide training w/in the pt. home for up to 2 visits.

Question 37

Reading Assessmens

Answer 37

Evaluate pts. ability to use PRL to read
VSRT - Pepper Visual Skills for Reading Test (measures reading accuracy)
MnREAD assessment (measures reading acuity)

Question 38

Writing Assessment

Answer 38

Collin Low Vision Writing Assessment
Provides standard to measure their baseline writing ability
Measures 5 item writing assessment: grocery list, check & register, letter, reading ability of their written list, filling out a form
Administer w/in 10-15 min