Lv presentation (final)
Transcript of Lv presentation (final)
LOW VISION PRESENTATION
QUESTION 6 & 7
Prepared by : Ting Kiet HanYap Teck YuenHu Li PingChang Hui Leng @ Sharon
6. TYPE OF VISUAL TRAINING/THERAPY FOR ASD VISUALLY RELATED SYMPTOMS
AMBLYOPIAi. Correcting refractive error
optical should correct the full refractive error as determined with cycloplegic
ii.Patching Forcing use of the poorer eye by limiting use of the
better eye – occlusion of the better eye To patch dominant eye if there is a fixation
preference. Aim to alternate the squint
iii.Optical penalization - cycloplegic drugs
STRABISMUS
Distance Exotopiai. Vision Therapy
Used if angle of deviation < 20 ∆ diopters Antisuppresion exercise –enable appreciation of
pathological diplopia +ve fusional range improved with prism Synopthophore exercise +ve relative convergence improved with stereogram
(near fixation) Bino. convergence improved with convergence exercise
ii. Adding Minus Lens up to -3.00DS to stimulate convergence by inducing
accommodation to reduce the power of lens gradually until treatment
can be discontinued
iii. Prisms (Base In) Only good for small angle deviation (<10 PD) Used pre-operatively to obtain control & often
combined with orthoptic exercise Prism should be worn constantly and the strenght
of the prism should be gradually reduced over several weeks
iv. Tinted Glasses For patient who are photophobic Reducing the amount of light entering the eye
can improve patient’s control over exotropia
CONVERGENCE INSUFFICIENCY
o Penci-to-nose exercise This so-called push-up is repeated 10 times, 2-4
times a day, until the patient is able to hold fixation to the tip of the nose.
*Be Caution :While doing the pencil push-ups exercise it is important that you do not strain your eyes while looking at the pencil. Straining your eyes causes accommodative insufficiency.
AMBIENT LENSES OR YOKED PRISMS
Also known as conjugate prisms or
performance or transitional lenses which
can be used to help modify ambient vision They are special lenses that bend light in
the same direction: up, down, left or right They are used to improve posture, head-
tilt, and coordination is autistic youngsters These lenses can have dramatic results by
creating a difference in how the world is
seen and allows the person to change how
their world is perceived
AMBIENT LENSES OR YOKED PRISMS
During visual evaluation, an activity such as
throwing and catching a ball, walking up and
down stairs may be done While wearing different powers of yoked
lenses, the same activity is repeated and
evaluated Yoked prisms may be prescribed for special
activities or for full time wear
TRYING OUT YOKED PRISMS
Try five prism dioptres of
yoked prism in several
different directions to elicit an
improvement in walking,
sitting down and even playing
catch If one direction works best,
introduce a lower amount into
the spectacle prescription Yoked prism alters the
oculomotor state, affecting
sensory function
IRLEN LENSES Is a non-invasive technology that uses colored
overlays and filters to improve the brain's ability
to process visual information It improves an individual’s behavior and/or
reading ability by filtering out those frequencies
of the light spectrum to which the individual is
uniquely sensitive It can improve reading fluency, comfort,
comprehension, attention, and concentration
while reducing light sensitivity It is not a method of reading instruction but a
color-based technology that filters out offensive
light waves so that the brain can accurately
process visual information
RAPID EYE MOVEMENT THERAPY (R.E.M)
It is a non-evasive technique
The therapist has an object (a stick
or a wand) for the patient to focus
on, and quickly moves it back and
forth, in various eye levels and
positions to simulate the movement
and fluttering of R.E.M.
The therapist then gives commands
to the patient to release the traumas
and emotions that are surfacing, and
these are released via the eyes
through rapid blinking
ATTENTION TRAINING
The use of overcorrection avoidance to increase the eye contact of autistic children.
Functional movement training (an overcorrection procedure) plus edibles and praise to develop eye contact.
With the overcorrection procedure, the child is given food and praise when eye contact occurres within 5 sec of the therapist's verbal prompt: "Look at me."
QUESTION 7
Social gaze looking Also known as social avoidance The autistic child simply chose not to focus
on a particular face and gaze randomly Autistic child always seemed to be ‘looking
through you’ rather than ‘at you’ Their eyes were working independently,
rather than together (depth perception), so
they see two pictures instead of one (double
vision) In order to avoid visual strain, they choose to
look away
HOW TO DEVELOP SOCIAL GAZE LOOKING??
Develop and maintain eye contact Observe if the child makes eye contact with you and if
he/she does, note how long he/she could maintain it (This can be your basis of improvement)
Make it easy for your child to make eye contact with you by positioning your face or your eyes at his/her eye level.
Play with their toys at eye level. This will also help improve eye contact.
Eg: If they are lying on the floor, you get on the floor Call for the child’s attention often and don’t be afraid
to ask the child to look at you Signal them to look at your eyes while talking with
them Positively reinforce eye contact by praising
child for looking at you when they talkEg: Tell them that they are good (Praise them)
STEPS TO IMPROVING EYE CONTACT TO OVERCOME SOCIAL GAZE LOOKING
STEP 1
Point to your nose when talking by drawing their
attention to your face by touching your nose with
your finger as you start to talk This signals children to look at you when you talk If the child looks away signal them again by
pointing to your nose while talking. This may look silly but getting into this habit can
help in improving eye contact for children with
autism
STEP 2
Using verbal cues can go a long way to
maintaining, sustaining and improving eye
contact for children with autism Constantly and frequently remind child to
pay attention to you Give instructions to child by calling him/her
by name and by asking them to look at you Compliment this by the physical movement
of signaling them to look
Eg: ‘This is important’, ‘listen carefully’, ‘let
me repeat’, ‘you need to remember’
STEP 3
Guiding child’s glance It means to gently guide child’s head so
that their face looks up at yours Reinforce this positive eye contact with
the use of smiling and praise This is best for children who have
difficulty understanding verbal cues and
who would prefer physical touch over
visual and verbal stimuli
STEP 4
Be consistent Consistency is part of teaching the child
a new skill It helps in improving eye contact for
children with autism by repetition and positive reinforcement
Eg: The child will be given food and praise when eye contact occurred within 5 sec of the therapist's verbal prompt, "Look at me."
Vision evaluation of persons with autism varies depending on their developmental, emotional and physical level
Vision evaluation includes visual acuity, eye tracking and fixations, depth perception, colour vision, eye teaming and focusing, the presence of ametropia, eye health and visual fields
Due to the variable nature of autism, patient response to treatment also varies
Children with less severe autism and better cognitive abilities may respond better than those with more limited capabilities
Approximately 15% of patients can achieve a reasonable amount of self-sufficiency as adults, and another 15% to 20% function with minimal support
WHAT TO DO??
Creativity is key!
Don’t be surprised if the examination requires
multiple visits to get all the desired information
Snellen acuities may not be an option, but
tumbling E’s, Randolt C’s, and even Teller
preferential acuity cards can be used as an
alternative
If the patient is averse to wearing glasses
during stereoacuity, use the Lang stereo test,
which does not require polarise glasses.
ALTERNATIVE EXAMINATION WAYS
Gross motor testing
with a colorful toy
Finger puppets can help
to assist in attaining
pursuits, saccades,
cover test, NPC,
binocular indirect and
many other exam
techniques
ALTERNATIVE EXAMINATION WAYS
Extra ocular muscle
testing with a light-up toy Can also be tested by
asking the child to follow
or point the direction of a
moving penlight Eg : Tell the child that the
light is a missile and they
are playing a missile
shooting game
OTHER METHOD
Working with other professionals such as
occupational, speech and language and
physical therapists as well as the primary
care physician, teachers, reading specialist
and of course the parents, optometrists can
help to make a difference in these autistic
children’s lives