1 / 38

Low Vision in Older People

Low Vision in Older People. Carol Allen Senior Orthoptist Clinical Lead Low Vision Service Worcester Royal Hospital October 2010. What is Low Vision?. Low vision can be described as reduced vision which cannot be corrected by optical or surgical means

marina
Download Presentation

Low Vision in Older People

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Low Vision in Older People Carol Allen Senior Orthoptist Clinical Lead Low Vision Service Worcester Royal Hospital October 2010

  2. What is Low Vision? • Low vision can be described as reduced vision which cannot be corrected by optical or surgical means • Vision may not be poor enough to be at Registration level when people have quality of life issues World Health Organisation definition: Best corrected VA less than 6/18 to PL or a Visual field of less than 20 degrees in better eye

  3. Registration with CVI • CVI or Certificate of Visual Impairment is used by Ophthalmologist to register patients with low vision. • Severely sight impaired category is used if vision > 3/60 in the better eye, or better vision with significant field loss • Sight impaired or partially sighted category is used if vision is substantially impaired (no legal definition) eg 6/60 with full field, 6/18 or better with field loss such as homonymous hemianopia

  4. Incidence • It is predicted that by 2020 40% 0f UK will be over 50yrs • 20% of 75yrs and over are sight impaired • It is estimated that between 1.6 - 2.2 million over 65 year olds in UK have sight impairment of varying levels (1) • Sensory Impairment is a significant risk factor in falls

  5. Conditions Include : • A R M D- central loss • Diabetes- retinopathy Laser treatment • Retinal Disorders • Stroke +/- Field Loss • Nystagmus • Congenital Conditions • M S • Glaucoma

  6. Central Loss

  7. Diabetic retinopathy

  8. Homonymous hemianopia

  9. End Stage Glaucoma

  10. 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

  11. Low Vision Clinics Worcester • Two clinics per week, led by 2 Orthoptists • Offer one am, one pm • 5 patients in each session • Each patient allotted 40 minutes

  12. Referral from • Ophthalmologists • Staff Grades/ Associate Specialists in Ophthalmology • GPs via Consultant referral • Referral encouraged as soon as vision is causing problems-not necessarily at CVI registration stage.

  13. Prior to attending LVA clinic • 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

  14. 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

  15. Counselling and Emotional Support • Counselling and Emotional Support- Patients 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

  16. Charles Bonnet Syndrome • This condition (CBS) is named after a Swiss philosopher, and describes the visual hallucinations that can occur following visual impairment, particularly through macular disease. • Estimated to occur in at least 12% of pts with ARMD • Can last from days to years, but most pts find it eventually disappears • The hallucinations can be simple colours or shapes, or elaborate patterns, grids or lattices.

  17. CBS • Can be disembodied faces, plants or animals • Can be seen singly or in processions • Can be distracting or frightening • Cause unknown- postulated to be connected with brain’s response to impoverished visual input • Reassurance required for pt and family that CBS does not signify dementia • Largely goes undetected, as pts unwilling to admit, therefore relatively unknown even amongst some GPs

  18. The Good….

  19. The Bad…

  20. And the ugly…

  21. 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

  22. Motivation • Some wish to read own correspondence and retain independence • Others do not want to read, if it means losing the visitors who read for them

  23. Non-optical aids • Light : Directed onto text/task

  24. Non-optical aids • Training to use eccentric point of retina • Steady eye strategy • Occlusion of poorer eye when reading

  25. Typoscope Non-optical aids

  26. Framing and Underlining

  27. Non-optical aids Increase contrast

  28. Contrast

  29. Practical Issues • 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

  30. Optical Aids • Magnification: aim to use lowest possible • Higher magnification =smaller magnifier lens, therefore smaller field of view

  31. Optical Aids • Choices: hand/stand/lighted/ dome depends on: • pt choice • general health issues • Task

  32. Binoculars and MonocularsTV glasses and Clip ons

  33. Further information/support needed • Patient directed to support groups for particular eye condition • For counselling/ emotional support • Sight Concern Worcestershire • Given information about talking newspapers and magazines, books on tape, Big Print company, large TV guide

  34. Further information/support needed continued.. • Accessibility options on computer • Specialist software companies • Input from Social Services (RVI) • Holidays for sight impaired people

  35. In Conclusion • The sooner the patient receives support, the better • NSF for older people states that patients should be enabled to retain their independence • The LVA Clinic does not have to be the ‘last resort’

  36. Thank you for Listening

  37. Contacts • ‘Low Vision- The Essential Guide’ from Guide Dogs and College of Optometrists • Cobalt catalogue for daily living aids • www.sightconcern.co.uk • Macular Disease Society www.maculardisease.org • RNIB helpline 0303 123 9999 • Thomas Pocklington Trust www.pocklington-trust.org.uk • Action for Blind People www.actionforblindpeople.org.uk

More Related