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Visual Function and Low Vision Rehabilitation

Lissa V. Rivero, OD, FAAO

Sarasota Retina Institute

Sarasota, FL

Vision Rehabilitation

Purpose is not to get back your sight,

but to regain your ability to do the everyday activities that have been affected by the loss of vision

• Specialized equipment and training

Typical Impairments from Macular Degeneration

Reading

Driving

Watching TV

Computer

Seeing faces

Writing checks

Additional Impairments from Vision Loss

Shopping price tags, labels

Hobbies crafts, playing cards

Activities of Daily Living (ADLs) food on plate, plugging in

appliances, setting appliances Using phone, cell phone

Trouble walking Increased risk of falls

Goals of Vision Rehabilitation

Adjustment to vision loss

Functional - Maximize remaining vision with devices and training

Emotional -LV patients are at 20x greater

risk of depression

Also inform patients

about community

resources available

Who pays for Low Vision Care?

Low vision exam is covered by Medicare and most Insurances, except for refraction fee.

OT training is covered by Medicare and most Insurances

Devices are not covered by insurance. Patients pay VA if patient qualifies DBS if patient qualifies Lions club

What can I expect in a Low Vision Exam?

Thorough history Measurements of functional

vision Acuity - Specialized charts

Contrast Visual Fields

Check eyeglasses - Refraction special technique for LV

Determine level of magnification

Trial of LV devices Develop a rehab plan

Central Field Loss and Eccentric Viewing (EV)

Train patients to move their eyes in a consistent way to look around their blind spot

Careful Refraction is First Step

Changes in prescription are often missed in ARMD patients

Use Special Charts Refract with a trial frame

Lighting

Special lamps

High intensity flashlights

OttLite -BetterVisionSeries

Ottlite.com

Glare Control

Macular degeneration patients benefits from Blue Blocker lenses:

Indoor glare control: Yellow or light amber

Outdoor glare control: Orange or Brown

Low Vision Devices for AMD Patients

Depends on: level of vision blind spots (scotoma) goals Patient’s motivation cost

Higher power reading glasses, require a closer viewing distance.

+10D(3.5X)=10 cm viewing distance

“I just need stronger glasses”

+20D(5X)= 5cm viewing distance

Telescopic Glasses

For distance activities like TV viewing, and enjoying the theater

For reading with a +3.00 reading cap

For Writing, Sewing, Computer Custom made

Prescribed magnification

Requires training and practice

Small field of view

$ 800 and up

• Standard• MaxDetail glasses• $180

What is an Occupational Therapist and what is their role in vision rehab?

An OT is a licensed health professional with expertise in rehabilitation

Some OT’s have special training in vision rehabilitation

Eccentric View training Device training Adaptive strategies Home visits and modifications, Fall prevention

Implantable Telescope Technology

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Scarred MaculaCentral Visual Field Projection (Natural Lens/IOL)

CAT

Telescope ImplantCentral Visual Field Projection

How It Works

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Field of View

3X External: 8°

3X Implant: 20°

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How It Works

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Telescope Eye = Central Vision

Distance: Faces, TV, signs

NO driving

Near: Reading, playing cards, dining

Other Eye = Peripheral VisionAllows orientation and mobility

How It Works

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• Not the solution to drive again

• Improves functional vision

• Care given by a team

• Patient participates in

rehabilitation!

Not ‘Cataract Surgery’

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Telescope Implant Program

Selection•Medical •Low Vision

Treatment•Surgical

Rehabilitation •Optometric•Occup. Therapy

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Pre-surgery assessment Informed decisionAgree to participate in visual rehab training

Low Vision Evaluation

Key Indications

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Post-Implantation

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• VisionCare’s Implantable Miniature Telescope (by Dr. Isaac Lipshitz) (intraocular telescope) is indicated for monocular implantation to improve vision in patients greater than or equal to 75 years of age with stable severe to profound vision impairment (best corrected distance visual acuity 20/160 to 20/800) caused by bilateral central scotomas associated with end-stage age-related macular degeneration.

Source: FDA Professional Use Information labeling

Indication For Use

Hand held mags

LED illuminated

Over the counter (+6 diopters or 2X) vs. Low Vision magnifiers (up to +56 diopters or 14X)

Magnifiers - The larger the magnifier the weaker it is.

Stand magnifiers

Traditional Magnifiers –

Makrolux (2.2x, 3.6X)Scribolux (2.8X)Menas Lux (3.0X)

Video MagnifiersClosed Circuit Television (CCTV)

Merlin by Enhanced Vision

Closed Circuit Television$2000 to $3000

Topaz by Freedom Scientific

Clearview by Optelec

Video magnifiers that read to you

DaVinci by Enhanced Vision

Clear View +Speech by Optelec

Prodigy Duo 2 in 1 byHumanware

Hand-held video magnifiers

$400 - $650

Pebble HD 4.3 by Enhanced Vision

Ruby by Freedom Scientific

Smartlux Digitalby Eschenbach

Mobilux Digital Magnifierby Eschenbach

Magnification range from3x to 6x

High Definition LED screen

Feels like a regular magnifier

Compact 7 HD

Continuous magnificationfrom 2X to 24 X

Computer Adaptations

Operating system accessibility options

Computer glasses Large Print Software

Zoom Text Jaws

Large print keyboard

Tablets and other eReaders

Apple iPad

Samsung Galaxy Note

Kindle Fire HD

Nook

BigMagnify Application

Available for smartphones free of charge!!

Adapted Communication

Large Print Phone Bold Line Paper, Felt Tip Pens

Adapted Leisure Activities

Vision Rehabilitation

Purpose is not to get back your sight,

but to regain your ability to do the everyday activities that have been affected by the loss of vision

• Specialized equipment and training

• “Can do” attitude• Willingness to

learn “new tricks”

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For Patients/Family:

www.CentraSight.com

Resources