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Low vision aids dr. d p shah
1. LOW VISION AIDS
Dr. Divyesh P. Shah
Sight First Technical Advisor, MD 322
Lions Clubs International Foundation
2. LOW VISION DEFINITION
“A PERSON WITH LOW VISION IS ONE WHO HAS
IMPAIRMENT AND /OR STANDARD REFRACTIVE
CORRECTION AND HAS A VISUAL ACUITY OF
LESS THAN 6/18 TO LIGHT PERCEPTION IN THE
BETTER EYE OR A VISUAL FIELD OF LESS THAN
10 DEGREES FROM THE POINT OF FIXATION, BUT
WHO USES OR IS POTENTIALLY ABLE TO USE ,
VISION FOR THE PLANNING AND / OR EXECTUION
OF A TASK” (WHO/PBL/93.27)
3. What is Low Vision?
• Low vision can be described as reduced vision which
cannot be corrected by optical or surgical means
World Health Organisation definition: Best corrected VA
less than 6/18 to PL or a Visual field of less than 10
degrees in better eye
4. Low Vision and Low Vision Rehabilitation:
• A person with a significant reduction in visual acuity
due to ocular disease that is not correctable by
surgery, conventional eyeglasses or contact lenses has
Low Vision
• The process of helping a person with low vision
achieve the highest level of visual function,
independence, and quality of life possible is Low
Vision Rehabilitation
5. • The role of a low vision specialist
(optometrist or ophthalmologist) is to
maximize the functional level of a patient's
vision by optical or non-optical means
called LOW VISION AIDS
6. A Global Estimate of Low Vision Care Needs
• 148 million visually disabled (blind+ low vision, ref. ICD-10)
8 million blind, without any perception of light
140 million partially sighted
(of whom 30 million blind, but having some residual vision)
25%
35 million in need
of low vision care
75%
105 million in need of cataract
surgery and/or routine refraction
7. • Worldwide, for each blind person, an
average of 3.4 people have low vision, with
country and regional variation ranging from
2.4 to 5.5.
8. 95% of people with low vision have some level of
useful vision.
9. • Those with worsening sight and the
prognosis of eventual blindness are at
comparatively high risk of suicide
• These people can be helped with Low
Vision Aids
10. Lack of Services – The Impact
to Children
• For children, the lack of low vision
services means:
– Developmental delay
– Loss of educational opportunity
– Isolation
– Dependency
– Inability to participate in family and society
– Put into the category of blind and they are provided
with braille instead of general stream.
11. Lack of Services – The Impact
to Adults and Seniors
For adults, the lack of low vision
services means
• – Isolation
• – Dependency
• – Inability to participate in family and society
• – Unemployment/underemployment
• – For the elderly it may mean increased risk
• for psychological and health effects; even
12. Woeful lack of awareness
•
•
•
•
•
Patients
Society
Doctors
Opthalmologists
Facilities providing services
LACK OF AVAILABILITY OF SERVICES
AND TRAINED MANPOWER
13. Conditions causing Low Vision
Include :
• A R M D- central loss
• Diabetes- retinopathy Laser treatment
• Retinal Disorders
• Stroke +/- Field Loss
• Nystagmus
• Congenital Conditions
• Multiple Sclerosis
• Glaucoma
15. • Macular
Degeneration
VISUAL
EFFECTS
LOW VISION
AIDS
V a: may vary with the extent of the deg:
with dry-stage ARMD,acuity can range
from 20/20 to 20/400.With wet-stage
(exudative) ARMD,the acuity can show loss
worse than 20/400.
Main problem is very difficulty to reading or
writing.
Should be prescribe optical glass & direct
illumination should be recommended for
all near tasks. Most of the patients respond
well to magnification at distance & near.
Non-optical aids . CPF lens improved
contrast & control glare.
16. Age-related Macular
degeneration
• The most common cause
of visual loss in Western
countries
• >50% of all registered
VI
• >70% of all visually
impaired over 75 years
of age
18. Glaucoma
VISUAL
EFFECTS
LOW VISION
AIDS
CCTV or max are useful because increase
contrast & brightness along with
Photophobia ,seeing halos around light,
opacity or haze on lens, central visual acuity magnification,CPF are beneficial in
is generally unaffected until the end stage of reducing glare, reverse telescopes can be
used to enhance visual field, flashlight can
this disease.
be helpful for night travel, long cane also
Visual loss in end –stage glaucoma pt:
creates problem with orientation & mobility. helpful for travel (end-stage).
Blurred vision which is gradual.
20. Albinism
VISUAL
EFFECTS
LOW VISION
AIDS
Albinism has the most severe effect
on visual acuity, ranging from 20/200
to 20/400.
Photophobia, may high refractive
error,
nystagmus, color vision is normal.
Correct refractive errors. Controlling
illumination sun lenses, CPF & color
contact lenses or pin hole cl, visors &
hat can often reduce photophobia.
Telescope for distance.
21. Retinopathy
VISUAL
EFFECTS
Depending on the severity of retinopathy,
visual acuity ranges from 20/20 to total
blindness. Loss of color vision. Most
commonly , decreased vision is a result of
lens changes (due to fluctuation in blood
sugar level) or macular edema.
LOW VISION
AIDS
Correct refractive error.CPF & sun lenses
that block blue wavelenths may inprove
contrast & eliminate glare & photophobia.
Direct illumination for near tasks is
generally helpful. Prismetic glass ,hand
mag & CCTV may helpful for near task.
23. Retinitis Pigmentosa
VISUAL
EFFECTS
LOW VISION
AIDS
Central vision ranges from 20/20 to no
light perception. In early stages of the
disease, acuity usually remains normal. In
later stages, acuity may become
moderately to severely decreased
secondary to lens or macular changes.
Photophobia, night blindness, color vision
problem. Slow reading & mobility
problem.
Refractive error should be evaluated
carefully. CCTV or Max are useful
(increasing contrast & brightness along
with magnification ). Prismatic lens &
good illumination helpful for near
task.CPF lenses are helpful for improving
contrast & reducing glare. Reverse
telescope for distance. Vision rehabilitation is
also needed.
24. Purpose of Low Vision Assessment
• Low vision rehabilitation allows people to
resume or continue to perform daily living
tasks, reading being one of the most
important
• This can be achieved by providing non
optical and optical devices as well as
training in the use of residual vision
25. Assessment
• Establish patient’s understanding of eye
condition
• Explanation given if necessary, backed up
with written or taped information if required
• Aim to dispel myths:
-Tend to retain peripheral vision in ARMD
-Can’t ‘use up’ remaining vision
-Don’t feel guilty about using sight
26. REFRACTION
• Encouraged to have up-to-date refraction
• Many patients with low vision benefit from
having separate readers, rather than using
bifocals or varifocals, especially if a
magnifier is to be used, or eccentric viewing
taught
28. Counseling and Emotional
Support
• Counselling and Emotional SupportPatients may experience similar feelings to
the various stages of bereavement
• Charles Bonnet syndrome- patients need
reassurance that their visual hallucinations
are a common symptom of visual loss
29. Establish visual needs and
requirements
• Near / Distance
• Hobbies / Leisure
• ‘Survival’ reading such as :
correspondence
labels / prices
food packets & use-by dates
medication instructions/syringe markings
30. Optical Aids
• Magnification: aim to
use lowest possible
• Higher magnification
=smaller magnifier
lens, therefore smaller
field of view
33. Stand Magnifiers
• May be non-illuminated or
illuminated with an LED
• Location of image inside of
the focal point of the F1
requires accommodation or an
add to resolve the image.
35. Distance Telescopes
• Used to magnify the
apparent size of a distant
object when the patient
cannot move closer to the
object
• Tasks: viewing faces across a
room, grocery store isle
markers, bird watching,
sporting events, tv
36. Tints/Filters/Glare Control
Wrap around filters
available to control both
indoor and outdoor
glare.
Optical coatings such as
AR, and Polaroid lenses
may reduce glare
40. •Touch screens -are devices placed on the
computer monitor(or built into it) that
allow direct selection or activation of the
computer by touching the screen.
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41. Magnification with CCTV
• If the CCTV is viewed
from a distance closer
to the screen than 40cm,
the total magnification.
Achieved is the product
of RDM x RSM.
43. • Large /bold print bank
statements and Utility
bills
• Clipboards and reading
stands
• Shades and Visors
• Large button phone
• Aids:Talking clocks,
watches, tins.
• Talking microwave,
measuring jug and scales,
spirit level and rulers
• Electronic colour
detectors
44. 1.
2.
3.
4.
5.
Listen, Listen and Listen..
Detail explanation low vision rehab programme.
Psychological management.
Friendly advise & counseling.
Important of follow up.
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45. • The sooner the patient
receives support, the
better
• NSF for older people
states that patients
should be enabled to
retain their
independence
46. •
Low vision care AND Vision rehabilitation is the crying need of the day
•
Low vision rehabilitation offers the practitioners a feel good niche and the
patient a real choice to regain visual independence.
•
A large section of totally underserved partially blind population is waiting
to be served
WE HAVE TO MAKE SURE THAT WE ARE READY TO SERVE
10/30/13
46
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