vision and visual assessment in significant learning disability - Lisa

Question 1

definition of learning disability

Answer 1

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

Question 2

how much more likely is someone to have a problem with their eyes if they have a learning disability?

Answer 2

10 x
in children up to 28 x

Question 3

what does diagnostic overshadowing mean?

Answer 3

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

Question 4

prevalence of learning disability in the UK

Answer 4

2.16%
increasing due to improved health care and better survival rates in complicated and premature births

Question 5

systemtic associations of learning disability

Answer 5

prematurity/low birth weight
down syndrome
cerebral palsy
autism
hydrocephalus

Question 6

what counts as premature?

Answer 6

before 37 weeks

Question 7

what counts as low birth weight?

Answer 7

<2.5kg

Question 8

what is retinopathy of prematurity?

Answer 8

proliferative vascular disease

Question 9

how is retinopathy of prematurity treated?

Answer 9

laser, anti vegf drugs or surgery

Question 10

who is at a higher risk of developing retinal detachment and glaucoma?

Answer 10

people with a learning disability who have a history of ROP

Question 11

px with a history of ROP may present in practice as …

Answer 11

aphakic

Question 12

ocular associations of prematurity?

Answer 12

7x more likely to have strab
increased incidence of myopia and astigmatism→→ hardeep + anisha

Question 13

systemic associations of trisomy 21 (downs)

Answer 13

learning disability
hearing loss
congenital heart defects
epilepsy
hypothyroidism
anaemia
diabetes
early menopause
premature ageing - including dementia

Question 14

ocular associations of downs

Answer 14

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

Question 15

if someone with downs presents with keratoconus, what do you NEED to make sure you do?

Answer 15

REFER EARLY - collagen cross linking is VITAL

Question 16

systemic signs of cerebral palsy

Answer 16

poor motor muscle control, spasms, weakness
poor balance
50% learning disability
>60% speech and language problems
20-50% epilepsy

Question 17

ocular signs of cerebral palsy

Answer 17

refractive error
weak accommodation
10% are SSI
disc abnormalities - pallor
nystagmus
poor eye movement control - inaccurate saccades
field defects - hemianopia associated with hemiplegia

Question 18

what is autisic spectrum disorder?

Answer 18

A lifelong developmental disability that affects how
people perceive the world and interact with others

Question 19

systemic associations of ASD?

Answer 19

learning disability but not everyone
strongly associated with prematurity

Question 20

ocular associations of ASD?

Answer 20

significant refractive error
accommodative problems
strabismus
‘seeing it differently’ - visual processing issues
abnormal eye movements

Question 21

what is hydrocephalus?

Answer 21

build up of fluid inside brain

Question 22

what is hydrocephalus commomnly caused by?

Answer 22

spina bifida - neural tube defect

Question 23

systemtic associations of hydrocephalus

Answer 23

learning disability
epilepsy
speech difficulties
motor difficulties

Question 24

ocular associations of hydrocephalus

Answer 24

optic atrophy
strabismus
eye movement anomalies
refractive error

Question 25

adaptations you could do before a test with someone with a learning disability?

Answer 25

• 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

Question 26

how can you adapt H+S?

Answer 26

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?

Question 27

how can you adapt the eye test?

Answer 27

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

Question 28

if you can’t occlude, what can you do instead?

Answer 28

10 or 20 base out prism

Question 29

how should you do visual fields?

Answer 29

confrontation / gross perimetry

Question 30

how do you check the fundus?

Answer 30

20D or panoptic

Question 31

how do you take IOPs?

Answer 31

iCare tonometer

Question 32

what can you use to asses visual function?

Answer 32

bradford visual function box

Question 33

how do you measure VA?

Answer 33

cardiff cards
or bradford visual function box
kays pictures (APP)
Peekaboo APP

Question 34

after the eye test, hat should you do?

Answer 34

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

Question 35

some dispensing considerations

Answer 35

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