Low vision rehabilitation

Paul B. Freeman, OD

This course will review basic low vision rehabilitation as it pertains to macular degeneration. Included will be the psychosocial aspects of visual dysfunction due to macular degeneration as well as well as a basic assessment of low vision patients and some of the rehabilitative treatments available to help them reach their visual goals.

The objectives of this course are:

To underscore the fact that low vision rehabilitation is recognized by both optometry and ophthalmology

To identify the basic psychosocial aspects of vision dysfunction due to macular degeneration

To reviewa basic low vision rehabilitation assessment and treatment of the visually impaired patient

Low vision rehabilitation

  1. Questions to be answered
  2. When should a patient be referred for low vision rehabilitation?
  3. How does anti-VEGF treatment for macular degeneration affect the timing of low vision rehabilitation intervention?
  4. What might be good questions to ask patients to determine if they are candidates for vision rehabilitation?
  5. Should a patient with decreased vision and no specific goals be offered low vision rehabilitation services?
  6. Why shouldn’t I just hand my visually impaired patients a catalog of low vision devices?
  1. Take home messages
  2. Low vision rehabilitation is mainstream eye care
  3. Early intervention medically, environmentally, and functionally is best
  4. A visual impairment is more than just a visual acuity loss
  5. Realize the you can determine the quality of life for a patient/friend/family member
  6. Refer like you would any other patient/friend/family member: do not pre select/pre judge
  7. Overcome the health care confusion: treat the symptom…not the disease
  1. Support of low vision rehabilitation from optometry and ophthalmology
  2. Care of the patient with visual impairment (Low Vision Rehabilitation) AOA
  3. Vision rehabilitation AAO
  1. Psychosocial impact of macular degeneration
  2. Social issues: leisure activities, feelings of isolation
  3. Economic issues: lost productivity, dependent living, caretaking support
  4. Personal issues: self-care, independence, mobility, anxiety, and depression
  1. Who is the visually impaired patient “It is much more important to know what kind of patient has the disease than what sort of disease the person has.”
  1. Understanding how decreased vision affects
  2. reading
  3. driving
  4. mobility
  5. feeling of isolation
  6. detecting medication
  7. family dynamic
  1. Case history questions
  2. chief complaint
  3. last eye examination
  4. visual/ocular history
  5. general health review

VI. Case history questions less often asked

  1. distance visual abilities (present and past)
  2. independent travel
  3. near visual abilities (present and past)
  4. social/ emotional review
  5. environmental challenges (present and past)
  6. education and/or vocation and avocation (present and past)
  7. Specific visual goals and desires in a prioritized order
  1. Are you having difficulty with reading?

ii. Are you having difficulty with driving?

iii. Are you having difficulty getting around?

iv. Can you see faces?

v. Can you watch TV?

vi. Can you see your medication?

vii. Can you perform routine self care

VII. Why a comprehensive (low vision rehabilitation) examination

  1. the LVR doctor will be the last person to assess the patient
  2. why the decrease in vision?
  1. Evaluation objectives and assessment
  2. What can the patient see/what does the patient want to

b. assess the visual skills needed to perform the patient’s “wants”/ “needs”

  1. distance assessment
  2. near assessment
  3. contrast sensitivity function evaluation
  4. visual field assessment
  5. refraction
  6. eye health evaluation

c. supply the methods and allow adequate time for enhancing those visual skills

  1. magnification
  1. Optical presentation and training for success
  2. Conventional Rx
  3. Billboard magnification
  4. Airplane magnification
  5. Angular magnification
  6. Electronic magnification
  1. Device options
  2. Distance
  3. Near
  1. Examples of training
  2. pre activity for microscopic viewing
  3. activity for microscopic viewing

XII. Overview ofother near devices

XIII. Questions