vision and visual assessment in significant learning disability - Lisa Flashcards
definition of learning disability
difficulty with understanding and learning new things, and in generalising any learning to new situations, as well as difficulty with social tasks, for example, communication, self care, awareness of health and safety
how much more likely is someone to have a problem with their eyes if they have a learning disability?
10 x
in children up to 28 x
what does diagnostic overshadowing mean?
signs and symptoms of another diagnosis hide a different condition they have
e.g. being autistic could be mistaken as having high myopia or low vision due to lack of eye contact etc
prevalence of learning disability in the UK
2.16%
increasing due to improved health care and better survival rates in complicated and premature births
systemtic associations of learning disability
prematurity/low birth weight
down syndrome
cerebral palsy
autism
hydrocephalus
what counts as premature?
before 37 weeks
what counts as low birth weight?
<2.5kg
what is retinopathy of prematurity?
proliferative vascular disease
how is retinopathy of prematurity treated?
laser, anti vegf drugs or surgery
who is at a higher risk of developing retinal detachment and glaucoma?
people with a learning disability who have a history of ROP
px with a history of ROP may present in practice as …
aphakic
ocular associations of prematurity?
7x more likely to have strab
increased incidence of myopia and astigmatism→→ hardeep + anisha
systemic associations of trisomy 21 (downs)
learning disability
hearing loss
congenital heart defects
epilepsy
hypothyroidism
anaemia
diabetes
early menopause
premature ageing - including dementia
ocular associations of downs
high incidence and magnitude of refractive error (increase with age)
poor amp and accuracy of accommodation
strabismus
epicanthal folds/peudostrab
some reduction in VA
early cataracts
keratoconus
if someone with downs presents with keratoconus, what do you NEED to make sure you do?
REFER EARLY - collagen cross linking is VITAL
systemic signs of cerebral palsy
poor motor muscle control, spasms, weakness
poor balance
50% learning disability
>60% speech and language problems
20-50% epilepsy
ocular signs of cerebral palsy
refractive error
weak accommodation
10% are SSI
disc abnormalities - pallor
nystagmus
poor eye movement control - inaccurate saccades
field defects - hemianopia associated with hemiplegia
what is autisic spectrum disorder?
A lifelong developmental disability that affects how
people perceive the world and interact with others
systemic associations of ASD?
learning disability but not everyone
strongly associated with prematurity
ocular associations of ASD?
significant refractive error
accommodative problems
strabismus
‘seeing it differently’ - visual processing issues
abnormal eye movements
what is hydrocephalus?
build up of fluid inside brain
what is hydrocephalus commomnly caused by?
spina bifida - neural tube defect
systemtic associations of hydrocephalus
learning disability
epilepsy
speech difficulties
motor difficulties
ocular associations of hydrocephalus
optic atrophy
strabismus
eye movement anomalies
refractive error
adaptations you could do before a test with someone with a learning disability?
- ask px to visit practice first, meet reception staff/DO and optom
- prepare in advance with easy read info and be forewarned about drops/dark/touch
- complete a history questionnaire
- ensure appt is at a good time (quiet practice/px not tired)
- consider splitting appt
- may need domicillary
- may need to ask carers to complete a functional vision assessment
how can you adapt H+S?
get as much info as possible before the test
understand how the person communicates
just because someone can’t speak doesn’t mean they can’t understand
what activities do you need to correct for?
how can you adapt the eye test?
start with something engaging (e.g motility/gross perimetry)
have fun toys/lights
having things that can be touched
if something isnt working - MOVE ON
try ret without trial frame first/over specs
always check accommodation - DYNAMIC RET
always check distance and near acuity
if you can’t occlude, what can you do instead?
10 or 20 base out prism
how should you do visual fields?
confrontation / gross perimetry
how do you check the fundus?
20D or panoptic
how do you take IOPs?
iCare tonometer
what can you use to asses visual function?
bradford visual function box
how do you measure VA?
cardiff cards
or bradford visual function box
kays pictures (APP)
Peekaboo APP
after the eye test, hat should you do?
give written info - including need for specs/which and when/ size of font possible/visual fields for position in class/null point nystagmus
share info with school/all supporters
if you are referring, think about learning disability nurse at hospital, FLAG
some dispensing considerations
posture
facial characteristics
follow up appt
may need diff pairs for diff tasks/distances if poor accomm
EMPHASISE IMPORTANCE OF SPECS - not a guessed prescription
