Vision, Driving

Question 1

What is considered low vision?
A] best-corrected visual acuity less than <20/40
B] best-corrected visual acuity less than <20/60
C] best-corrected visual acuity less than <20/160

Answer 1

A] best-corrected visual acuity less than <20/40

Question 2

Mild vision loss
(near-normal vision)

Answer 2

20/30 to 20/60

Question 3

Moderate visual impairment
(moderate low vision)

Answer 3

20/70 to 20/160

Question 4

Severe visual impairment, or severe low vision:

Answer 4

20/200 or worse

Question 5

Profound visual impairment or profound low vision:

Answer 5

20/500 to 20/1000

Question 6

Near-total visual impairment or near-total low vision:

Answer 6

<20/1000

Question 7

Total visual impairment, or total blindness:

Answer 7

No light perception

Question 8

Blindness

Answer 8

1. best-corrected visual acuity of 6/60
2. worse (=20/200) in the better-seeing eye

Question 9

What is defined as the Best-corrected vision?

Answer 9

the sharpest, clearest vision attainable by the client, under the best circumstances, using vision out of the best eye, with standard corrective lenses (glasses or contact lenses)

Question 10

Visual acuity can be measured by the Snell fraction. What does 20/20 mean?

Answer 10

1. 20/20 means that when standing at a distance of 20 ft, the viewer can see the letter that a person with normal vision can see at 20 ft.
2. 20/200 means that the view can see the letter at 20 ft that a person with normal vision can see at 200ft

Question 11

Presbyopia

Answer 11

1. difficulty focusing on near objects
2. a common age-related change in adults over age 50.
3. The lens of the eye becomes less flexible, reducing the ability to read small print

Question 12

Myopia

Answer 12

nearsightedness

Question 13

hyperopia

Answer 13

farsightedness

Question 14

Central visual field

Answer 14

emcompasses the central 20d of vision

Question 15

Macular Degeneration

Answer 15

affects the macula, the central portion of the eye that is responsible for providing the fine detail required for near-distance activities, including reading
1. distorted shapes
2. straight lines appear wavy/crooked
3. difficulty identifying low-contrast surfaces (falls)

Question 16

Glaucoma

Answer 16

Occurs when the intraocular fluid becomes blocked, resulting in increased intraocular pressure. This pressure reduces blood flow to the optic nerve, causing loss of peripheral vision

1. inability to see objects in pathways
2. object/people outside of their residual peripheral vision suddenly appearing and startling the client
3. Can only see small portion of page while reading/writing

Question 17

Diabetic Retinopathy

Answer 17

is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina

1. fluctuating vision (blur, spots, floaters) and central vision loss
2. Dec. contrast sensitivity; difficulty wiht low contrast items
3. night driving is an issue d/t impaired color discrimination required to identify traffic signals

Question 18

Cataracts

Answer 18

occur when the lens of the eye becomes more opaque or clouded, reducing the light going into the retina and altering vision; common in older adults

1. cloudy/blurry vision
2. faded colors
3. glare
4. poor night vision

Question 19

Homonymous Hemianopsia

Answer 19

a type of vision loss following brain injury in which half of the visual field in each eye is lost
1. difficulty with reading d/t inability to see full line of text
2. difficulty with functional mobility d/t reduced visual field and visual search/scanning patterns

Question 20

Oculomotor Function

Answer 20

1. makes it possible to achieve and maintain focus on an object by the retinas of both eyes
2. provides binocular vision, ensuring that one object is seen even though two images are being provided to the central nervous system
3. Impairment causes difficulty wiht
   -reduced speed control
   -hand-eye coordination
   -reading, walking, driving
   -leisure activities

Question 21

Visual Neglect

Answer 21

a combination of hemi-inattention and visual field deficit resulting in exaggerated inattention toward the left (or right) half of the visual space surrounding the body. The client often does not move the eyes past midline

1.All daily tasks
2. implications depend on visual attention
3. reading and driving altered

Question 22

Melbourne Low-Vision ADL Index

Answer 22

1. assesses the impact of a person’s visual impairment on ADLs (activities of daily living) and IADLs

Question 23

COPM

Answer 23

1. semistructured interview used to identify a person’s perception of his or her performance in the areas of self-care, productivity, and leisure.
2. It is also used to rate the importance of activities to the person and how the person’s perception of performance changes over time.

Question 24

Model of Human Occupation Screening Tool (MOHOST)

Answer 24

1. provides information regarding the impact of volition, habituation, skills, and the environment on occupational performance
2. It can be used during informal observation.

Question 25

Visual Acuity Assessments

Answer 25

1. Assess near visual acuity using the Lighthouse Near Visual Acuity Test
2. Assess distance visual acuity using the Snellen E chart or the Tumbling E chart (for individuals who are illiterate or may have aphasia)

Question 26

Assessment for contrast sensitivity

Answer 26

Pelli-Robson Contrast Sensitivity Chart

Question 27

Visual field assessments

Answer 27

1. use confrontation testing, which provides a gross measurement of visual field; Client fixed on central target and acknoledges the appearance of stimuli in the visual fields
2. Amsler grid

Question 28

Oculomotor Function assessment

Answer 28

1. vision history
2. self-report if client is experiencing diplopia
3. Use Brain Inurj Visual Assessment Battery for Adults (complete and observe eye movements)

Not within OT scope of practice:
1. Occlusion: covering one of the eyes to reduce diplopia. OT practitioners can provide occlusion only under the direction of an ophthalmologist or optometrist.
2. Prism: used to re-establish single vision. Prisms can be provided only by an ophthalmologist or optometrist.
3. Eye exercises: restore binocular function. Eye exercises are provided under the direction of an ophthalmologist or optometrist.
4. Surgery: changes the position of the eye in the socket to eliminate diplopia. Surgery is performed by an ophthalmologist.

Question 29

Clock Drawing Test

Answer 29

1. client is asked to reproduce the face of a clock set to a specific time.
2. This test may detect difficulties with visuospatial skills, visual perception, selective attention, memory, abstract thinking, and executive functioning.

Question 30

Optec Functional Visual Analyzer

Answer 30

This tool assesses a variety of visual skills by providing a series of illuminated slides that address areas such as depth perception, acuity, contrast sensitivity, phorias, glare recovery, peripheral fields, and color perception and sign recognition.

Question 31

Ishihara Color Test

Answer 31

This measure of color perception tests for red or green color deficiencies

Question 32

Contrast sensitivity

Answer 32

measures how well a person can discern objects with fuzzy, poorly defined edges or low-contrast objects that may be only slightly brighter or darker than their surroundings, which is an important factor in night driving.

Question 33

Depth perception

Answer 33

the ability to perceive the environment in three dimensions and to understand the distance of objects in relation to each other. It is created by stereopsis, the two eyes working together to view objects in the environment

Question 34

Glare recovery

Answer 34

This test assesses vision impairment and how quickly a person recovers vision after exposure to a bright light source.

Question 35

Letter–number cancellation test

Answer 35

These assessments test visual scanning and selective attention as a client scans a grouping of letters and has to select and draw a line through the targeted letter (H).

Question 36

Motor-Free Visual Perception Test

Answer 36

1. assesses a person’s visual–perceptual ability in the domains of spatial relationships, visual closure, visual discrimination, visual memory, and figure ground.
2. No motor involvement is needed to make a response.

Question 37

Ocular movement

Answer 37

1. Includes ocular ROM, convergence, divergence, saccades, and the vertical and lateral phorias

Assessments:
1. drawing the letter H or triangle and request that the client follow the pattern with their eyes
2. Optec 2500
3. 5500 Functional Visual Analyzer

Question 38

Eccentric viewing technique

Answer 38

1. looking around the blind spot to view the object of interest
2. can be used for macular degeneration

Question 39

An OTR® is screening an older adult who has had a stroke. The physician’s referral notes that the client eats food on only half of the plate and completes grooming tasks swiftly, making many mistakes. Which scanning pattern would be MOST likely to prompt the OTR to recommend additional testing for unilateral neglect?

Organized, symmetrical scanning
Rescanning with an organized scanning pattern
Scanning with multiple short saccades
Disorganized, random scanning

Answer 39

Solution: The correct answer is D.

A disorganized, random scanning pattern is characteristic of unilateral neglect, or hemiinattention, which can be further assessed using a cancellation, drawing, or reading task.

A, B, C: An organized and symmetrical scanning pattern, rescanning with an organized scanning pattern, and an scanning pattern with multiple saccades are all characteristic of visual field deficit, not unilateral neglect.

Question 40

A client reports diplopia, or side-by-side double images, and demonstrates asymmetrical pupil sizes and a droopy eyelid. What would be MOST appropriate for the OTR® to evaluate?

Oculomotor function
Visual acuity deficit
Contrast sensitivity
Visual field deficit

Answer 40

Solution: The correct answer is A.

Oculomotor function is responsible for the symptoms the client is reporting. When images double side by side for near-vision tasks, pupils are asymmetrical, and ptosis (droopiness) of the eyelid occur, cranial nerves may be injured.

B: Clients with visual acuity problems most often report blurred vision.

C: Clients with decreased contrast sensitivity most often report difficulty going out in the evening because of the challenges associated with maneuvering in low light.

D: Clients with visual field deficits most often report bumping into objects, difficulty locating items, and difficulty reading.

Question 41

An OTR® is evaluating a client with a diagnosis of blindness. The OTR observes the client bumping into objects, people, and the door frame and is worried about the client’s potential for injury. What referral should the OTR make FIRST?

To physical therapy, to address balance, gait, and mobility aids
To a physician, to determine whether the client’s medical condition has changed
For guide dog services, to promote safety in the community
To orientation and mobility services, to assess for use of a white cane

Answer 41

Solution: The correct answer is D.

Orientation and mobility specialists teach travel (mobility) skills, including use of a white cane, to clients with a vision impairment to promote safe and independent travel. At this time, this client may not be safe for independent mobility; these specialists can provide the techniques and skills to promote safety.

A: The client’s difficulty navigating results from an inability to see and negotiate the environment, not from difficulty with balance or gait, for which a referral to physical therapy would be appropriate.

B: A referral to the physician would be unnecessary because the client has been diagnosed with blindness.

C: Orientation and mobility specialists also may provide guide dog services, but such services require more lengthy evaluation and training than use of a white cane.

Question 42

During an intervention session in which a client with unilateral neglect reads single letters across several lines, the OTR® uses a vertical line on the left side of the page to cue the client to read the correct line. Which intervention technique is the OTR using?

Patching
Attention
Anchoring
Prisms

Answer 42

Solution: The correct answer is C.

Anchoring, a cue on the impaired side to indicate starting position, brings attention back to the neglected side. Vertical anchoring lines are generally used on the left side.

A: Patching increases eye movements to the contralateral side, decreasing neglect.

B: Attention training increases attention and general alertness to reduce unilateral neglect.

D: Prisms shift the visual field toward the intact side, enabling the client to see things on the involved side.

Question 43

An OTR® recommends task lighting for a client with age-related macular degeneration. Where should the task light be positioned to promote the client’s vision?

On top of a shiny surface that reflects light
On a patterned surface or cloth to decrease glare
Opposite the writing hand or nearest to the best seeing eye
On top of dull, low-contrast fabric to reduce reflected light

Answer 43

Solution: The correct answer is C.

Lighting should be positioned opposite the writing hand or nearest to the best seeing eye to promote the client’s vision.

A: Shiny surfaces should be avoided or covered to reduce reflection and improve visibility.

B, D: Patterns should be reduced and high contrast used so task lighting more effectively promotes the visibility of objects in the environment.

Question 44

An older adult client who has difficulty completing feeding tasks demonstrates compensatory movements including holding food close, tilting the head when eating, and closing one eye when moving the fork to the mouth. Which factor would the OTR® assess FIRST during evaluation?

Visual foundation skills
Visual perception skills
Environmental factors
Motor planning skills

Answer 44

Solution: The correct answer is A.

Visual foundation skills, including visual acuity, oculomotor control, visual pursuits, saccades, and visual fields, should be assessed before completing a visual perception evaluation to screen out visual problems. Underlying problems with visual foundation skills may interfere with the accuracy of visual perception testing.

B, D: The client’s compensatory techniques suggest disruptions in visual foundation skills, which should be screened before assessing visual perception and motor planning.

C: Environmental factors do not influence the compensatory movements this client demonstrates.

Question 45

An OTR® is selecting intervention activities for a young adult client with a diagnosis of accommodative infacility. Which activity will be MOST difficult for this client?

Watching sports
Reading a book
Driving a car
Watching a play

Answer 45

Solution: The correct answer is C.

Accommodation is the ability of the eye to adjust focus at different distances. Accommodative facility is the speed of focus adjustment and ability to maintain focus over time. Driving a car would be most difficult for this client because looking at the speedometer and then at the road requires adjusting focus at different distances (near distance for the speedometer and farther distance for the road).

A, D: Watching sports or a play requires visual tracking or smooth pursuits; accommodative facility would not be challenged.

B: Reading a book or other materials requires convergence and ability to focus on an object at near distance; accommodative facility would not be challenged.

Question 45

An older adult client with age-related macular degeneration (AMD) presents for evaluation and demonstrates difficulty reading and signing consent forms. What visual function should the OTR® evaluate FIRST?

Visual acuity
Tolerance to glare
Peripheral vision
Visual scanning

Answer 45

Solution: The correct answer is A.

In AMD, the macular scotoma develops within the central visual field, creating a blind spot that reduces the person’s ability to see color and visual details. When the scotoma encroaches on the fovea, the area of the retina with the greatest number of cone cells and the best visual acuity, the person begins to experience significant challenges in reading. Both visual acuity and reading speed decline as the size of the central scotoma increases. Because the client is presenting with reading challenges, visual acuity should be evaluated first.

B: This client is not presenting with complaints about glare.

C: Peripheral vision loss is not characteristic of AMD.

D. Visual scanning is a technique for compensating for central vision loss and may be a useful intervention for this client.

Question 45

An older adult client has lost significant vision and reports difficulty with reading, sewing, writing, recognizing faces, and responding to social gestures. Which visual deficit is the client exhibiting?

Age-related macular degeneration
Glaucoma
Myopia
Presbyopia

Answer 45

Solution: The correct answer is A.

Reading, recognizing faces and social gestures, and performing detail work are characteristic functional limitations associated with age-related macular degeneration, which causes loss of central visual acuity and difficulty seeing fine detail.

B: Glaucoma alters peripheral vision, not central vision.

C: Myopia, where the image of an object is focused at a point in front of the retina and is therefore blurred when it reaches the retina, results in nearsightedness. Myopia can be corrected using a concave lens.

D: Presbyopia is a normal age-related change that occurs when the lens of the eye gradually becomes less flexible, thereby reducing the lens’ ability to keep images in focus as they come closer. This condition can be corrected using reading glasses.

Question 46

A client has visual acuity of 20/200 in the right eye and 20/400 in the left eye. With what technology will the client MOST likely be able to operate a microwave with a flat panel?

A prescribed magnifier
Color-coded buttons
Raised dots on the panel
Task light over the microwave

Answer 46

Solution: The correct answer is C.

The client’s visual impairment is such that the remaining vision is not adequate as a sensory input, which means using an alternative sensory pathway. Tactile or auditory substitution is common. Putting raised dots on the microwave panel is an example of tactile substitution.

A, B, D: These answers use methods to augment the visual sensory pathway; however, the client’s visual impairment is such that the remaining vision is not adequate as a sensory input. These options would be suitable if the client had adequate vision to provide sensory input for information processing.