Eye Care CenterEye Care Centerat the Southern California College of at the Southern California College of

OptometryOptometry

MaryAnn Walls Low Vision MaryAnn Walls Low Vision CenterCenter

Dr. Becky Kammer, ChiefDr. Becky Kammer, Chief

714-449-7415714-449-7415

rkammer@scco.edu rkammer@scco.edu

What is Low Vision?What is Low Vision?

Patients may be blind or just partially Patients may be blind or just partially sighted (visually impaired) 20/70 or worse sighted (visually impaired) 20/70 or worse in better eyein better eye

Legally Blind is 20/200 or worse with best Legally Blind is 20/200 or worse with best correction on correction on

What can Rehabilitative Optometry What can Rehabilitative Optometry do to help?do to help?

Help patients see to readHelp patients see to read

Help patients see to driveHelp patients see to drive

Help patients meet specific vision goalsHelp patients meet specific vision goals

Main Rehabilitation GoalMain Rehabilitation Goal

Improve independence Improve independence and quality of lifeand quality of life

How does the exam flow?How does the exam flow?

Patient’s come for at least 2-3 visits where Patient’s come for at least 2-3 visits where a full eye exam is given and then devices a full eye exam is given and then devices are introduced to meet goalsare introduced to meet goals

First Visit: Team is introduced to patientFirst Visit: Team is introduced to patient– Occupational therapistOccupational therapist– Student doctorStudent doctor– Faculty professor Faculty professor

OT will schedule a home evaluation before OT will schedule a home evaluation before patient returns for second visit.patient returns for second visit.

Second VisitSecond Visit

OT summarizes their home visit for Dr. OT summarizes their home visit for Dr. and the second optometric visit is planned and the second optometric visit is planned for the patient.for the patient.

More visual goals are evaluated, devices More visual goals are evaluated, devices are orderedare ordered

Possibly more training visits with OT are Possibly more training visits with OT are scheduled in the meantimescheduled in the meantime

Dispensing VisitDispensing Visit

Patient’s glasses or devices are given to Patient’s glasses or devices are given to patient and basic training in office is patient and basic training in office is providedprovided

OT schedules 2-4 more home visits to OT schedules 2-4 more home visits to make sure patient uses device correctly make sure patient uses device correctly and is using residual vision correctly and is using residual vision correctly (eccentric viewing training if needed)(eccentric viewing training if needed)

OT reports back to Dr. for follow upOT reports back to Dr. for follow up

EXAM COMPONENTSEXAM COMPONENTSCase historyCase history

Summarize to obtain basic goalsSummarize to obtain basic goals– Sustained Near: Sustained Near: Reading continuous textReading continuous text– Spotting Near: Spotting Near: Seeing bills, shoppingSeeing bills, shopping– Sustained Distance: Sustained Distance: Watching TVWatching TV– Spotting Distance: Spotting Distance: Driving, seeing signsDriving, seeing signs – Illumination and Glare: Illumination and Glare: often need often need

enhanced contrast indoor, need better enhanced contrast indoor, need better lighting indoorlighting indoor

EXAM COMPONENTS EXAM COMPONENTS Functional visual acuitiesFunctional visual acuities

Distance VisionDistance Vision– Feinbloom chart (Designs of Vision) Feinbloom chart (Designs of Vision)

Near VisionNear Vision– Single digit chart (M notation – Lighthouse Single digit chart (M notation – Lighthouse

charts)charts)– Continuous text chart (M notation - Continuous text chart (M notation -

Lighthouse)Lighthouse)

EXAM COMPONENTS EXAM COMPONENTS Trial frame refractionTrial frame refraction

EXAM COMPONENTS EXAM COMPONENTS Functional visual fieldsFunctional visual fields

Several tests available to help determine Several tests available to help determine how much usable vision is presenthow much usable vision is present

Nystagmus patients usually have full Nystagmus patients usually have full fieldsfields

– This is great for rehabilitation processesThis is great for rehabilitation processes

EXAM COMPONENTS EXAM COMPONENTS Contrast sensitivityContrast sensitivity

Testing is critical for determining if Testing is critical for determining if low contrast objects can be seen in low contrast objects can be seen in dim lightingdim lightingPoor contrast sensitivity may slow Poor contrast sensitivity may slow down reading or cause problems down reading or cause problems driving at night…driving at night…

EXAM COMPONENTS EXAM COMPONENTS BinocularityBinocularity

Functional considerationsFunctional considerations

– Depth perception up close (3D)Depth perception up close (3D)Many nystagmus patients have no Many nystagmus patients have no depth perception (or true depth perception (or true binocularity)binocularity)

– Most Low Vision patients are Most Low Vision patients are functionally monocularfunctionally monocular

EXAM COMPONENTS EXAM COMPONENTS Calculations to determine the Calculations to determine the best type of magnification or best type of magnification or

modificationsmodifications

EXAM COMPONENTS EXAM COMPONENTS A Few Treatment optionsA Few Treatment options

Spectacle plane – high plus/microscopeSpectacle plane – high plus/microscope

Loupe – Hand magnifier, stand Loupe – Hand magnifier, stand magnifier, head mountedmagnifier, head mounted

TelescopesTelescopes

Electronic devicesElectronic devices

Filters/lightingFilters/lighting

Glare TreatmentGlare Treatment

Various colored Various colored filters (lens tints)filters (lens tints)

– NoIRNoIR– CorningCorning– Plastic Photochromic Plastic Photochromic

(Chadwick Optical)(Chadwick Optical)– Cocoon’s Cocoon’s

Electronic Magnification: CCTVElectronic Magnification: CCTV

Nonoptical aidsNonoptical aids

Relative Size Devices:Relative Size Devices: Large Print Large Print BooksBooksPosture and Positioning Devices: Posture and Positioning Devices: Lap Lap boards boards Writing DevicesWriting Devices:Felt tip pens:Felt tip pensMedical Devices: Medical Devices: Talking glucometers Talking glucometers Mobility DevicesMobility Devices: Cane, Dog guide: Cane, Dog guideSensory Substitution Devices: Sensory Substitution Devices: Talking Talking clocksclocks

ReferralsReferrals

Orientation and mobilityOrientation and mobility

Visual impairment instructor – Visual impairment instructor – independent living skillsindependent living skills

Department of RehabilitationDepartment of Rehabilitation

Support Groups/counselingSupport Groups/counseling

Braille Institute for ILS classesBraille Institute for ILS classes

What’s new in LV?What’s new in LV?

– Computer technology with adaptive softwareComputer technology with adaptive software– Volunteer at ECC provides one-on-one Volunteer at ECC provides one-on-one

computer appointments for low vision patientscomputer appointments for low vision patients

What’s on the horizon for LV?What’s on the horizon for LV?

Blind Art Exhibit in September 05Blind Art Exhibit in September 05

ResearchResearch– SCCO is now part of a progressive group that is SCCO is now part of a progressive group that is

attempting to initiate clinical trials in the U.S.attempting to initiate clinical trials in the U.S.– Completion of a small multi-center study with Completion of a small multi-center study with

hemianopic patientshemianopic patients