Low Vision Rehabilitation Case reports - PowerPoint Presentation

1. Low VisionRehabilitation Case reports

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3. Low Vision exam History, Chief complaints, ADL, GoalsEducation to patient about their eye conditionLV refraction in trial frameLighting a. filters b. contrast c. glareMagnificationa person with low vision is one who has an impairment of visual functioning

4. MagnificationRelative SizeThe object is manipulated to gain the magnification The actual size of the object is increased thereby increasing the retinal imageIn most cases this is a simple type of magnification, copier enlargement

5. MagnificationAngular MagnificationUses two or more lenses in a system to create magnificationEffective when the object it too far away to move closer or when it is too big to make largerOcular lens goes closest to the eye, objective lens is closest to the object. Usually a telescopic systemOther lenses or prisms may be found between the lenses

6. MagnificationRelative –distanceMicroscope (reading glasses, bifocal, loupe)Magnifiers ( hand held, stand, dome, )Magnification that uses relative distance, tends to bring the image closer to the eye and that is relative distance

7. MagnificationElectronic Also referred to as projection magnification It is the enlargement of an object by projecting it onto a screenWorks the same way as relative size mag but with the use of technologyThis results in an electronic size increase of the object with out as much loss of field of view

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9. Low vision Exam48 yo WM (RK)Dx: Born with congenital glaucoma, s/p corneal transplant/ senile nuclear sclerosis, degenerative retinal drusenGoals: Works with patients of his own and would like to ‘see’ them better while talking to them in his new office

10. low Vision ExamEntering Visual acuities with out glasses OD: 20/100-2 near: 4 pt (J1) @ 1 ½ inch OS: 20/200 near: 3 pt ( J1+)@ 1 inchLow vision refraction: OD: -4.00-1.00x025 20/60 OS: -2.00-1.00x180 20/200

11. recommendationStella floor lamp for his office for better illumination, his office did not have any windows or natural lightWalters 4x12 telescope, for distance spot reading for taking the bus VA 20/25- h/o using a Bioptic but did not want oneNew glasses for in his office- for help with identifying faces

12. LightingStella lamp10 point level dimmingTrispectrum technology cool light warm light bright light- similar to “natural light”Flexible arm- to control glare

13. Lighting Uno day light lamp3 point touchNatural day liteLight weight

14. Telescopes Telescopes are an afocal optical systems consisting of two lenses, separated in space, in air. There are two types of telescopic systems, Keplerian and Galilean. The optical principles of the two telescopes are visually identical. An enlarged retinal image falls over a larger area of photoreceptor cells, providing the patient with additional information and better acuity

15. Keplerian telescopes have a weak (+) objective lens and a strong (+) eyepiece lens.form an inverted image so they require an erecting lens or prism4x or stronger, and give an optically superior image, but are more expensive with a smaller exit pupil requiring better centering and aiming. Telescopes Galilean telescopes have a weak (+) objective lens and a strong (-) eyepiece lens. form an erect/upright image.Galilean telescopes have several practical advantages for low vision work. Typically they are 2x, 3x or 4x in strength, inexpensive, light, and have a large exit pupil, which makes centering less difficult.

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18. L.V Refraction90 yo F ( FH)Dx : wet ARMD c h/o injectionsTaking care of her husband with dementia Goals include; wants stronger reading glasses, difficult for her to read small print labels Already has strong reading glasses OD: +4.00-0.75x087 OS: +4.50

19. L.V RefractionEntering Visual acuities with current distance glassesOD: +0.25-1.50x110 20/100+ OS: -2.00 5/125-3 ADD: +3.50 Near: 32 pt @ 30 cm OULV refraction: OD: -1.75-0.75x110 20/50 OS: -1.00-1.50x105 5/125 ADD: +3.00 32 pt @ 30 OU Stella lamp/ dome: read newsprint comfortably, thrilled with increased DVA and reading VA

20. L.V Refraction80 yo W M (RH)Dx: h/o strabismus OD, dry ARMD OS, wet ARMD OD h/o injections OD and cataract removed OS- which decreased the vision.Goals: reading choir music in Church, reading newsprint, dials on TV remote

21. L.V RefractionEntering Visual acuities with current specsOD: -0.25-2.50x014 20/60-2OS: -1.00-0.75x085 20/250 ADD: +2.75 Near: 16 pt @ 30 cm OULV refraction: OD: +0.50-1.00x135 20/50 OS: +0.25-0.50x085 20/225 ADD: +3.00 14 pt @ 30 cm OUNew specs for choir, typoscope/ large print checks/Stella lamp for increased illumination/ large TV remote ( with large buttons)

22. L.V. Refraction86 yo WM (R. S)dx: + dry ARMD OU, + Fuchs corneal dystrophy OSc/o just bought new specs and now seeing double with them. Can not drive with one image above the other.

23. L.V RefractionEntering VA with new specs: OD: +0.25-1.75x125 20/20 OS: +2.00-2.50x080 20/30-1 Add: +3.00 5 pt @ 35 cmVon Graffe: OD: 1^ BD OS: 1^ BOTrial frame: 3^ base up OS Called to say thank you, he can drive now

24. Diplopia Warning about prisms – visual acuity will be slightly blurry with a large amount of prism, however vision may actually appear clearer due to the loss of diplopiaprism doesn’t always work- when it does, so happycan take up to several months for the eyes to adjust

25. L.V. Refraction65 yo W F , worked as an accountant (K.W)Dx; acute retinal necrosis 2/2 viral infection. Can be due to VZV, HSV I, or II , or CMVh/o meningitis- RD OU, and 5 hours of surgery in the hospitalUsing +4.50 OTC OU specs used to help with TV and walking around. Now, not helpfulh/o cataract extraction 10+ years ago

26. ARNGeneral pathologyThere appear to be two distinct disease phases:  Acute Herpetic Phase: episcleritis or scleritis, anterior (usually granulomatous) uveitis, vitreous opacification, and inflammation of the retina, retinal arteries, and choroidal vasculature. Optic neuropathy can also occur.Late Cicatricial Phase: Retinal holes and tears occur at the junction of normal and atrophic retina, leading to retinal detachment in 50-75% of untreated eyes. Subsequent proliferative vitreoretinopathy with fibrosis and traction on the retina also contribute to retinal detachment. Multiple retinal holes with the appearance of a sieve are typical. Most retinal breaks occur in the necrotic retina and the junction between normal and necrotic retina. 

27. ARNEntering VA with her glasses: OD: 5 “/125 OS: HMLV refraction: OD: +8.50-2.00x180 20/500 OS: HMADD: +3.00 63 pt print at 30 cmCCTV

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29. Glare control RED/Orange: corning lens/ NOIR for R/C dystrophies or achromatopsiaAMBER: macula dystrophies or disturbancesYELLOW: increased contrast in nighttime driving. useful early ARMD *GREEN: usually chosen by glaucoma patients* BLUE: usually stroke related vision loss (blue/ yellow on CCTV)FL-41/PLUM: for glare and migraine controlGRAY: over all good tint

30. Glare / Filter 18 yo WM (AR)Dx with mild oculotanous albinismDifficulty with glare while driving, new driverHard to read his sheet music while in choir: black notes on white paper

31. glareEntering acuities:OD: 20/30 OS: 20/20Refraction: OD: -0.50 20/20 OS: -0.25 20/20A/R coating and blue blocking Crizal/ prevencia for indoor glarePolarized amber fit overs for drivingFl-41 specs for choir cut the glare from overhead lighting to see his sheet music more comfortably

32. GLARE/ filters 61 yo WM ( LA)Dx: congenital nystagmus, and (2014) cataracts.Goals: gets lost in grocery stores can not read labelsA LOT of glare issues currently wearing yellow tinted specsCan not see his phone, wants to learn about features on his iPhone

33. FiltersEntering VA with out glasses: OD: 20/350 OS: 20/350Near VA: 80 pt @ 20 cmsRefraction: OD: +4.00-1.75x165 20/300 OS: +4.00-1.75x175 20/300 ADD: +2.50 20 pt @ 35 cm+6.00 OTC reader- 20 pt @ 35 cm

34. recommendations6x ill stand c posture desk for reading Referred to our OT for iPhone training Tried every single filter and he loved the U 26 30% Blue

35. Eccentric view77 yo WM+ dry ARMD for 20 years. Just now having problems with near work. Really enjoys doing art, he has taught, and like to do wood carving. He is still driving during the dayVA according to his record OD: 20/400 OS: 20/25VA with EV: OD: 20/ 80 Down OS: 20/25So happy * 3.5x ill hand held* fine print, menus etc.

36. RUBY28 yo AAMDx: optic atophy 2^ to MS, vision loss began 2 years agoGoals: he wants to live independently, read his own mail, bills, cook for him self.

37. Hand Held techVisual acuity : OD: 20/225 OS: 3/125+ Near: 40 pt @ 25 cmRefraction NI at all, auto refractor indicated a low myopicDemonstrated hand held, stands,Did best with electronics- RUBY HD hand held electronic magnifierrefer to Erin/ OT for help with Low vision aides Orientation and mobility training.

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41. Homonymous hemianopsia48 yo Mh/o stroke on left side. Loss of right side vision . Things disappear and he runs into people, bumps his head doesn’t like to go places at night. In other words he does not have neglect. “neglect” is an official diagnosis.LV refraction: OD: +0.50-0.25x120 20/20 OS: +0.50-0.25x 060 20/20

42. Fresnel prismStarted with 30^ yolked base right fresnel prism on the inside of his glasses lined up with the outer limbus. Next referred to our Erin/ OT for training Very happy with outcomeNO DRIVING

43. chorioretinitis sclopetariaDefinition: chorioretinitis sclopetaria- proliferation of fibrous tissue in the choroid and retina as the result of contusion of the sclera by a high velocity missile to the orbit.The term sclopetaria may originate from the old English word “sclow” which means to claw or tear, or from the Latin word “sclopetum” which was a Roman gun. When a high-velocity projectile such as a BB passes adjacent to the globe, there are direct and indirect shock wave forces which can lead to simultaneous retraction of the choroid and retina leaving an area of bare sclera at the site of the break. Immediately after the injury, there is usually extensive intraocular hemorrhage, with subretinal, intraretinal, and vitreous hemorrhage, with large overlying retinal breaks. The hemorrhage resorbs and organizes, leaving extensive fibrous proliferation that seems to fuse the retina and the choroid. The lesion has irregular borders, sometimes with a claw-like configuration. Due to significant post-traumatic fibrovascular proliferation and scar formation, there is very low risk of retinal detachment after injury (1).

44. K.M.28 yo MDx: 6 GSW to the head and 11 to the bodyFractured orbital bones and subsequent reconstruction of facec/o diplopia, blur at distance and inability to read his mail or any formsSeems like his eyes don’t feel like they are side to side and don’t work well together. He sees a second image over the first one

45. K.M.Entering VA s rx: OD: 20/150 OS : 20/500 Near: 16 pt @ 30 cmRefraction: OD: -0.75-0.75x165 20/40 2^ BD OS: -0.50-2.50x005 20/60 3^ BI ADD: +1.75 he could read standard print with good lighting.

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48. J.s.60 yo WMDx: has surgery in 2008 for a pituitary adenoma. Feb 2016 debulk the pit tumorSymptoms: in 2008 the tumor was pressing on his right optic nerve causing vision loss. Recently he was having memory problems

49. J.S.c/o biggest problem is glare/lighting. His new cubical at work has fluorescent lights and he can not control his own lighting. The new cubicle is only waist high allowing light from other desks. He needs print to be 12 pt size, reverse contrast, and he needs walls so he does not get extra glare. Has a CCTV Magic on his computer. – adaptive computer softwareLetter to his employer

50. J.S.VA cc 2018: OD: 20/60 OS: 20/40 ( worse from 2017: OD: 20/30 OS: 20/25)Letter written to his employerFilters and he likes FL 41- fluorescent light glare

51. Electronics Hand held CCTV- RUBY Desk top CCTV Omni reader- scanner OrcamIris vision- uses the Samsung galaxy smart phoneAccessibility Apps on i Phone- Erin will discuss

52. Iris Vision 69 yo Mh/o optic atrophy 2/2 swelling in the brain from a car accident in 1985. Entering VA : OD: NLP OS: 3/100 Nv: 63 pt @ 30 cmWants something portable so he can read when not at home. Has a CCTV that works well for him at homeWants to recognize faces.

53. Iris VisionUses Samsung Galaxy S7 smart phoneUses Virtual realty glasses It uses the camera on the phone itself as a CCTV cameraDigital binoculars on your face Two modes; live view mode reading mode

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59. OrCam35 yo WFDx: aniridia OU, advanced juvenile glaucoma OU, aphakia OU failed PK OSCorrected Visual acuities; OD: 20/250-1 OS: HM@1”Goals: needed something to help her in storesCurrently uses : Merlin at home, Onyx at work, magnifier on her smart phone, 7x/ and 10 x ill hh for spot reading labels Works as a licensed TVI and LV rehab therapist

60. OrCam We do not sell the OrCamYou need to contact the company if patients are interestedClip on to your glasses and it will read labels and faces for you.

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63. -It is best used to read to you, the groceries labels, text, long or short term. It can identify currency, some facial recognition has to be taught. Product recognition. Does it work for distances? It works best intermediate for reading, however, the print has to be standard font. Not fancy. Not hand written textIt’s light weight, convenient- newest model is wireless and magnetizes to glasses frameOCR – optical character recognition

64. Thank youWe hope you enjoyed our presentation We look forward to working with you and your patients and helping them reach their goals. I would like to present to you, Erin St. Denis our OT