test room Flashcards
store accessibility for disabled patients
- no stairs
- all test rooms etc on one floor
- both stores have at least one long form room with a movable chair
- disabled toilet access
how to adapt clinical routine for disabled px
- longer test time may be required (consider 2 appts)
- remove any obstacles
- face px (talk slowly + clearly)
- use letter matching/ Kays pictures/ single letter optotype
- direct ophthalmoscopy
- bracketing (refract in larger steps)
- Perkins
hand magnifier instructions
- lay magnifier on page + slowly pull away from page until image clear
- use distance rx (near rx only for short magnifier-eye distance)
- larger FOV holding magnifier closer to eye
hand magnifier advantages
- low cost
- compact, lightweight, portable
- can have long eye to magnifier distance
- used with DV rx because emergent light is parallel
hand magnifier disadvantages
- difficult for px with arthritis etc
- increased distortions as lens held further from the eye
stand magnifier advantages
- incorporated illumination
- good for px with hand tremors
- small and portable
- relatively inexpensive
stand magnifier disadvantages
- can be bulky
- limited field of view
- posture + fatigue problems
- wear SVN
bar/ flat field magnifiers advantages
- normal reading posture possible
- very bright - light gathering
- useful for px with hand tremor
- clear image across whole lens (minimal aberrations)
bar/ flat field magnifiers disadvantages
- large lenses (heavy)
- low magnification
- reading material must be flat + on firm surface
CCTV
closed circuit television
EVES
electronic vision enhancement systems
what is CCTV?
- example of real image (electronic) magnification of retinal image
- good for px with central loss as allows to train for eccentric viewing and to adopt steady eye strategy (eye still + material/ target moves)
CCTV advantages
- aberration free
- max mag up to 70x
- zoom control
- electronic contrast reversal
- binocular viewing
- normal viewing distance/ posture
CCTV disadvantages
- cost (to buy or service/ repair)
- size
- practice required to use
- depth of field
disability and equality act 2010
person cannot be discriminated against because:
- they have a disability
- someone thinks they have a disability (discrimination by perception)
- they are connected to someone with a disability
low vision leaflet
issued by optometrist
self referral form to eye clinic for assessment and determination of eligibility for RVI
RVI form
- registration of VI px
- voluntary and confidential
- referral to eye clinic by optom/GP
CVI
officially certified px as sight impaired or severely sight impaired
ophthalmologist examines eye health and vision to determine whether px is eligible for certification
benefits for CVI
- free bus/ rail travel
- assessment by social services
- UC/ pension credit/ tax credit
- council tax reduction
if SSI
- blue badge, 50% off TV license, blind person tax allowance
ECLOs
eye care liaison officers - run low vision clinics
sight impaired criteria
VA 3/60 - 6/60 with full VF
VA up to 6/24 with mod VF reduction or central part of vision cloudy/blurry
VA 6/18 or better if large VF reduction (whole half of vision/ peripheral)
severely sight impaired criteria
VA less than 3/60 with full VF
VA between 3/60 - 6/60 with severe VF reduction (e.g., tunnel vision)
VA 6/60 or less with very reduced VF (especially if missing in lower part)
acuity reserve
1:1 for spot reading, 2:1 for fluent reading
spot reading = min mag required
fluent requires higher mag so less strain for px
typoscopes
matt black card with window cut in width of a line
if px has had stroke and lost RHS VF reading is difficult as eye scanning into nothing
galilean vs astronomical
galilean lighter + shorter with small field of view of poor quality (low cost)
astronomical heavier + longer with larger field of view of better quality inverted image (high cost)
disability glare
impairs visual performance due to intraocular light scatter or straylight
can reduce retinal image contrast
caused by cataract, keratoconus, PCO, corneal oedema
discomfort glare
subjective visual discomfort but no effect on VA
usually relieved by tints
uveitis, ocular albinism, cone-rod dystrophy, retinitis pigmentosa
