Low Vision Rehab: Defintions, Epidiology, Psychosocial Aspects Flashcards
Reasons to pay attention to low vision
- increasing demand for low vision services as baby boomers age
- need to know enough to make intelligent referrals and evaluate the care provided
- skills learned here are applicable to primary care optometry
- referring patients who need it for low vision evils is now standard of care
Importance of vision to patients
47.4% rates losing vision as the worst possible health outcome
What is low vision
- vision that is not adequate for a persons needs
- implies some reduction in VA and/or VF
- according to the NEI, low vision is defined as BCVAless than 6/12 (<20/40) in the better seeing eye (excluding those who are categorized as being blind by the US definition)
Legal blindness main definition
The BCVA in the better seeing eye is less than or equal to 20/100 or, if the VA in that eye is better than 20/00, that the visual field is less than or equal to 20 degrees in the widest diameter
Legal blindness side law
If acuity is measured using a chart that has lines between 20/100 and 20/200, and if no letters can be read on the 20/100 line, the patient meets the definition of statutory blindness and is considered to be 20/200 for the purposes of social security disability determination
Possible eligibility for SSI
- not dependent on previous work experience, only on household income
- also eligible for Medicaid
Eligibility of SSDI in low vision
- funded through payroll taxes and dependent on work credits earned
- 5 month waiting period, eligible for Medicare after 2 years
- under 65 years of age
Working and disability and low vision
- blind workers are able to earn $1950 per month and still receive disability benefits
- other disabilities may only earn $1170
- disability is based on inability to perform “substantial gainful activity”
Other benefits for vision impairment
- property tax reduction (up to $12000 property value)
- audio books through the KY library for the blind
- KY department of rehab services
- KY school of the blind
- directory assistance exemption
- data plan exemption
KY vision impairment stats
A lot of DR, glaucoma, AMD
Ethnicity and low vision
Most are Caucasian
Prevalence
How many people have it in total
Prevalence of 80+ low vision
AA the highest
The older you are the more likely you will have low vision
Low vision gender
More common in females because they live longer
Stages of reaction to vision loss
Shock Denial Anger Depression Acceptance Adjustment
Reaction to leber’s congenital amaurosis
Less shock because it’s congenital and they habe it their whole life
Similar to oculocutaneous albinimism
Reaction to ARMD
Wonder why they cant see through better glasses, depression and questioning why
Diabetic retinopathy
Wonder why they cant see through better glasses, depression and questioning why. Guilt because they can control their blood sugar
Reaction to vision loss from car accident
Shock and anger
Reaction to brain tumor
Shock and anger
Depression among seniors with VI
- 30% of those with AMD suffered from depression
- 2x the rate of community dwelling elderly
- equal to or higher than other conditions
- depression exacerbates vision related disability and poorer self rated visual function
Implications of depression for rehab in low vision
- can interfere with process by causing fatigue, pessimism and poor motivation
- should be acknowledged and managed. Patient reassurance, referral to PCP, referral to mental health treatment
- suicides among peopl >65 accounted for 18.2% of all suicides in US
- depressed patients may be less likely to be referred for vision rehab
- depressed patients may be less likely to accept or keep scheduled appointments for VR
- low vision rehab may have an “antidepressant” effect for some people
Social support and low vision
- family invovlemt increases participant in LVR
- but taking over patients reposnbilities may actually promote depression and dependence
- veterans with family support in the home were more likely to use prescribed devices
Cognitive impairment and low vision
- memory problems may make it difficult to learn techniques
- reorganizing the home to acommodative VI may result in disorientation
- impairments in executative function may inhibit initiation of novel ways of task performance
