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7 Geriatrics > L5 Vision Therapy > Flashcards

L5 Vision Therapy Flashcards

1
Q

What is vision therapy?

A

used to develop or improve a person’s visual abilities as it relates to everyday activities

OTs modify the task or environment to minimize limitations so pt can adequately participate

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2
Q

What does vision therapy entail?

A

typically done at outpatient clinic with OT

each pt is different, POC is created based on diagnosis, disease progression, severity

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3
Q

Younger population typical dx

A
  • vision changes due to neurologic event
  • exotropia and esotropia
  • convergence insufficiency
  • accommodative insufficiency
  • ocular motor dysfunction
  • amblyopia
  • challenges with reading and writing
  • headaches with reading
  • visual perception changes
  • visual motor deficits
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4
Q

Aging population typical diagnoses

A
  • change in vision
  • blurry vision
  • blindness
  • glaucoma
  • macular degeneration
  • wet AMD
  • dry AMD
  • diabetic retinopathy
  • congenital eye diseases
  • trauma to the eye
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5
Q

Does a patient need vision therapy?

A
  1. do they have a condition that is progressive or are they going to lose their vision?
  2. do glasses not really help them anymore?
  3. do they have balance issues that are not vestibular related?
  4. are they in vestibular therapy and not progressing due to vision?
  5. do they trip or fall frequently?
  6. are they a child not meeting a milestone?
  7. Do they have difficulty reading?
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6
Q

How do pts get to vision therapy?

A
  1. pts start by seeing pcp, ophthalmologist, optometrist
  2. pt has to be medically managed first before going to OT for vision
  3. Contact PCP for a referral to OT for vision therapy
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7
Q

Cost of vision therapy

A
  • most insurance companies cover vision therapy with OT
  • some equipment will be covered, usually if pt is a part of VA
  • grants, committees, and access tech can help to cover extra costs
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8
Q

What does a vision therapy session look like?

A
  • eye exercises
  • adaptive equipment
  • referrals to the oregon commission for the blind
  • connection to community resources
  • connection to vision therapy and PT if needed
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9
Q

Vision therapy concepts

A
  1. Oculomotor control, visual fields, visual acuity
  2. Attention
  3. Scanning
  4. pattern recognition
  5. visual memory
  6. visual cognition
  7. adaptation through vision
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10
Q

Cornea

A

protects the inside of your eye like a windshield, helps bed the light as it enters the eye

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11
Q

Sclera

A

white part of your eye that forms the general shape and structure of your eyeball

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12
Q

Aqueous humor

A

fluid that fills the anterior chamber

pressure of aqueous humor helps maintain your eye’s shape

floaters are in the humor due to trauma

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13
Q

Iris

A

contains the muscles that control the size of your pupil, responsible for eye color

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14
Q

Pupil

A

black circle inside the iris
widens and narrows to control how much light enters the eye

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15
Q

Lens

A

focuses light that enters the eye and directs it to the back of the eye

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16
Q

Vitreous humor

A

clear, gel like fluid fills the space between lens and retina. helps the eye hold its shape

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17
Q

Retina

A

thin layer of light-sensitive cells at back of eyes that converts light into electrical signals, contains rods and cones

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18
Q

Macula

A

responsible for center of visual field, helps with color and fine details

if it’s damaged, it will show up as central scotoma or loss at middle of vision field

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19
Q

Optic nerve

A

connects the retina to the visual cortex

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20
Q

Ciliary body and muscle

A

found behind the iris and includes the ring-shaped muscle that changes the shape of lens when eye is focused

21
Q

External muscles

A

control your eye’s position, alignment, accommodation, and movement. also contribute to eye’s shape. controlled by cranial nerves 3, 4, 6

22
Q

Optic Nerve

A

bundle of nerve fibers that begins at optic disk at back of the eye

when light hits the retina, rods/cones turn the light into electrical signals

electrical signals travel through optic nerve to brain, to optic chiasm, then occipital lobe

23
Q

Optic chiasm is damaged..

A

outer fields of both eyes are lost

bitemporal hemianopia

24
Q

Visual pathways after optic chiasm are damaged

A

the visual fields on the opposite side of the lesion are lost

contralateral homonymous hemianopia

i.e both left fields are lost with a right lobe damage

25
Q

Optic nerve is damaged

A

vision is completely lost only on affected side

monocular vision loss

26
Q

Central vision

A

has color and detail
makes up 20% of vision
macula is responsible

27
Q

Peripheral Vision

A
  • allows you to see color, movement, shapes outside of the central vision
  • lacks detail
  • makes up 80% of vision
  • vestibular dysfunction often have peripheral sensitivity
  • tunnel vision is a loss of peripheral vision
28
Q

Scotoma

A
  • blind spot in vision
  • may be small or large, permanent or temporary
  • can move around to different places in visual fields
29
Q

Impacts of CVA on vision

A
  • visual field cuts such as neglect, hemianopia
  • midline shift in vision
  • ocular occlusion
  • diplopia
30
Q

when can you use an eye patch?

A

only during OT session, not to be used outside of treatment

31
Q

Diplopia due to CVA

A

may need patching

can use in clinic, not allowed to recommend pt wear a patch without optometrist or opthalmologist

might be a convergence insufficiency and eye exercise would be indicated

32
Q

Hemineglect

A
  • not aware of defect
  • extinction is common
  • contralateral cueing improves neglect
  • during drawing, lacks contralateral details
  • more often right hemisphere lesion
  • multimodal deficits
  • can spontaneously recover within 6 mo of CVA
33
Q

Hemianopia

A
  • aware of deficits
  • extinction is unusual
  • contralateral cueing has no effect
  • drawing is normal
  • lesion can be on right or left
  • visual only deficit
  • can spontaneously recover within 6 mo of CVA
34
Q

Dry age-related macular degeneration

A
  • most common form of AMD is dry
  • appearance of small yellow deposits called drusen (waste), forming under retina
  • drusen can cause retinal cells in macula to die, cannot process light anymore
  • usually slowly worsens over time
  • 3 stages of early, intermmediate, and advanced
35
Q

Wet AMD

A
  • known as neovascular AMD, causes rapid and serious vision loss
  • less common type of late AMD, and will cause faster degeneration. wet AMD is always late stage
  • occurs when abnormal blood vessels grow in back of eye and damage in macula
  • may be treated with various treatments from ophthalmologist
36
Q

Wet and Dry connection

A

any stage of dry can turn into wet

no stage of wet can become dry

dry is often less serious compared to wet, and wet faster degeneration

37
Q

How does AMD impact treatment?

A

affects the patients’ central vision

pt will have a difficult time participating in head positioning such as VOR, gaze stabilization, cover/uncover test

38
Q

Diabetic retinopathy

A
  • causes vision loss and blindness in people who have diabetes
  • impacts blood vessels in retina
  • preventable with proper diabetic management
  • vision will fluctuate with hypoglycemic level
39
Q

Having diabetes makes you

A

2 to 5 times more likely to develop cataracts

more likely to get cataracts at a younger age

40
Q

How does diabetic retinopathy impact treatment?

A

reading handouts/home program

high contrast

may go blind eventually without treatment

41
Q

Cataracts

A
  • cloudy area in lens of the eye
  • common in aging population
  • more than 1/2 of all americans 80+ age either have cataracts or had surgery to remove cataracts
42
Q

How doe cataracts impact treatment?

A

high contrast
increased lighting for tasks

43
Q

Glaucoma

A
  • group of eye diseases that can cause vision loss and blindness by damaging the optic nerve
  • no cure for glaucoma
  • early treatment can often stop the damage and protect vision
  • treatments include eye injections, vitamins, eye drops
44
Q

How does glaucoma impact treatment?

A

peripheral vision
scanning strategies

pt’s vision will be dependent on what stage of glaucoma is occurring

45
Q

Low vision adaptive treatment

A
  • Low tech = colored tape, magnifiers, lights
  • high tech = CCTV, electronic magnifiers, phone apps, liquid indicators

can also include white can and guide dog training by orientation/mobility specialists

46
Q

What can OTs teach in regards to white cane?

A

only inside the clinic, they can’t do it outside or in the community

47
Q

Brock String

A

used for vergence problems, such as convergence insufficiency, amblyopia (lazy eye) and strabismus (eye turn), to improve double vision, blurred vision, headaches, visual discomfort, dizziness and imbalance

48
Q

Hart Chart

A

used to help with the accommodative systems in vision

helps with changing from distances far to near quickly

7 Geriatrics (7 decks)

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