Sensory impairment seminar

Question 1

senses

Answer 1

The Big 5 senses
•	Sight				
•	Hearing			
•	Smell				
•	Touch				
•	Taste	
But really up to 21
•	Nociception
•	Equilibrioception
•	Chemoreception
•	Proprioception
•	Magnetoception

Question 2

sensory impairment

Answer 2

When one or more of a person’s senses is no longer normal

A person does not have to have full loss of a sense to be sensory impaired

Question 3

dentistry and sensory impairment impact

Answer 3

Sensory impaired patients want & need dental treatment like all of us

UK law requires that we accommodate patients with a disability as “far as reasonably practicable”

Sight & hearing impairment patients are most relevant to dentistry

You may end up treating sensory impaired patients…

Question 4

judgement preconceptions

Answer 4

Instant unconscious judgement – be aware when see sensory impaired as will affect how you see them

Seeing people how they want to be seen

Question 5

equal access for those who are sensory impaired

Answer 5

Those with sensory impairment often have:
- Low confidence
- Require support
In how they experience and interact with the environment around them

Question 6

people with sensory disability

WANT TO

Answer 6

feel safe

have things to do

stay health

not have to deal with discriminations

Question 7

people with sensory disability

ACHIEVE BY

Answer 7

feeling listened to

have a say in the support they are provided with

respected

services that response to their needs and wishes

Question 8

people with sensory disability

results in

Answer 8

confidence

skills

mobility

Question 9

what services are needed for people with a disability (5)

Answer 9

communication

accessing services

mobility

rehabilitation

accessibility and isolation
- should be able to do everything - walk, cycle, sport etc

HIGHLIGHTS BARRIERS

Question 10

2 disabled groups that are often forgotten

Answer 10

older people

learning disabled

Question 11

older people disability

Answer 11

Sensory impairments are not responded to

Major factor in falls

Dementia and sensory loss

Question 12

learning disabled

Answer 12

10 x more likely to have a hearing impairment

Question 13

new terminology for

partially sighted

Answer 13

sight impaired

Question 14

new terminology for

blind

Answer 14

severely sight impaired

Question 15

visual impairment prevalence

Answer 15

least 1 billion people have a near or distance vision impairment that could have been prevented or has yet to be addressed.

The majority of people with vision impairment and blindness are over the age of 50 years.

There are 1.2 million people living with sight loss who are aged 75 years and over:

• 1 in 9 people aged 60 years and over
• 1 in 5 people aged 75 years and over
• 1 in 2 people aged 90 years and over

Most live in developed countries

Question 16

leading cause of vision impairment and blindness

Answer 16

uncorrected refractive errors and cataracts.

Question 17

sight loss in UK

Answer 17

More than two million people are estimated to be living with sight loss in the UK today.

This sight loss is severe enough to have a significant impact on their daily lives

Question 18

cost of eye health and sight loss in UK

Answer 18

Estimated cost of eye health and sight loss in the UK is estimated to be around £28 billion every year

The UK’s healthcare cost linked to eye health is estimated to be at least £3 billion every year
- It is predicted that by 2050 the number of people with sight loss in the UK will double to over four million

Question 19

frequency of sight loss UK

Answer 19

Every day 250 people start to lose their sight in the UK.
- equivalent to one person every six minutes

One in five people will live with sight loss in their lifetime

Question 20

is sight loss avoidable

Answer 20

yes

At least half of all cases of sight loss in the UK are avoidable

Question 21

how can sight loss be amended

Answer 21

The majority of sight loss due to refractive error can be corrected by wearing the right prescription glasses.

Many forms of cataract are treatable.

If detected and treated early, some sight loss due to glaucoma, AMD and diabetic retinopathy could be avoided.

Question 22

inequalities in vision impairment

Answer 22

People on low incomes:
- Prevalence of sight loss is associated with having a lower income .

Difficulty in getting to an optometrist and concerns about the cost of glasses can result in people not going for eye tests as often as they want, or delaying visits until they experience symptoms – forced

Question 23

variation across countries

Answer 23

Proportion of vision impairment attributable to cataract is higher in low- and middle-income countries than high-income countries.

In high income countries, diseases such as diabetic retinopathy, glaucoma and age-related macular degeneration are more common.

In low-income countries congenital cataract is a leading cause, whereas in middle-income countries it is more likely to be retinopathy of prematurity.

People from certain ethnic communities are at greater risk of some of the leading causes of sight loss yet many are unaware of this

• Black African and Caribbean people are four to eight times more at risk of developing certain forms of glaucoma compared to white people
• The risk of diabetic eye disease is around three times greater in South Asian people compared to white people
• Black African and Caribbean people are also at a higher risk of diabetic eye disease

Question 24

visual impairment classification categories

Answer 24

Distance vision impairment:

Near vision impairment:

Question 25

distance vision impairment divisions

Answer 25

Mild – presenting visual acuity worse than 6/12

Moderate – presenting visual acuity worse than 6/18

Severe – presenting visual acuity worse than 6/60

Blindness – presenting visual acuity worse than 3/60

Question 26

near vision impairment

Answer 26

Presenting near visual acuity worse than N6 or M.08 with existing correction.

Question 27

AMD

Answer 27

age related macular degeneration

Question 28

causes of visual impairment UK

from most to least

Answer 28

uncorrected refracted error 42%

AMD 25%

Cataract 20%

Glaucoma 8%

Diabetic Retinopathy 5%

Question 29

symptoms of visual impairment

Answer 29

Severe, sudden eye pain

Recurrent pain in or around the eye

Hazy, blurred, or double vision

Seeing flashes of light or sudden bright floating spots

Seeing rainbows or halos around lights

Seeing floating “spider webs”

Seeing a “curtain coming down” over one eye

Sensing a “cup filling up with ink” in one eye

Unusual, even painful, sensitivity to light or glare

Swollen, red eyes

Changes in the colour of the iris

White areas in the pupil of the eye

Sudden development of persistent floaters

Itching, burning, or a heavy discharge in the eyes

Gritty Feelings

Any sudden change in vision

get any changes in eye appearance, feeling etc – get checked

Question 30

cataract

Answer 30

Cataract is clouding of the lens of the eye which prevents clear vision.

Majority related to ageing process

Occasionally children can be born with the condition

Cataract may develop after eye injuries, inflammation, and some other eye diseases.

According to the latest assessment, cataract is responsible for 51% of world blindness
- Although cataracts can be surgically removed, in many countries’ barriers exist that prevent patients to access surgery.

Cataract remains the leading cause of blindness.
- As people in the world live longer, the number of people with cataract is anticipated to grow.

Cataract is also an important cause of low vision in both developed and developing countries.

Question 31

leading cause of blindness

Answer 31

cataract

Question 32

age related macular degeneration

Answer 32

Age-related macular degeneration (AMD) is a condition affecting older people

Involves the loss of the person’s central field of vision.

It occurs when the macular (or central) retina develops degenerative lesions.

• The macula, a tiny area within the retina at the back of the eye.
• The cells of the macula are photoreceptor cells, which means they’re sensitive to light and play a vital role in our ability to see details and colour. These cells become damaged and scarred.
• It is thought that circulatory insufficiency, with reduction in the blood flow to the macular area, also plays a part.

Several forms of AMD exist

Question 33

two classes of AMD

Answer 33

wet - severe, sudden, BAD

dry

Question 34

wet AMD

Answer 34

Causes severe sight loss in a matter of months

can develop very rapidly, resulting in more sudden sight loss.

Growth of new vessels under retina which then break and leak into the macula

Occurs when unhealthy new blood vessels begin to grow under the macula and leak blood and fluid (this is why it’s called ‘wet’ macular degeneration), which then causes scarring to develop within the macula cells

Question 35

dry AMD

Answer 35

Bilateral condition

90% of cases

Thought to have a hereditary element and myopia may be a predisposing factor.

Gradual loss of central vision.

Person becomes unable to recognise people because they cannot see their faces clearly, cannot see bus numbers etc.

Layers of the macula become progressively thinner, causing it to function less effectively.

Question 36

glaucoma

Answer 36

group of diseases that have as a common end-point

Characteristic optic neuropathy which is determined by both structural change and functional deficit.

It’s usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.
- Caused by a rise in intraocular pressure.
(Normal pressure is 10-21mmHg)
Normally > 50 yrs.

It can affect people of all ages but is most common in adults in their 70s and 80s.

Symptoms not generally noticed until there is a marked visual loss (coming in from edges)

Sight will never recover

Generally, a bilateral condition, affects one eye before the other

Question 37

2 most common forms of glaucoma are

Answer 37

primary open angle glaucoma (POAG)

angle closure glaucoma (ACG)

Question 38

primary open angle glaucoma (POAG)

Answer 38

Slow and insidious onset

Anterior chamber angle is open

Caused by the drainage channels in the eye becoming gradually clogged over time

Question 39

angle closure glaucoma (ACG)

Answer 39

Less common

More acute

Caused by the drainage in the eye becoming suddenly blocked,

Can raise the pressure inside the eye very quickly

Question 40

diabetic retinopathy

Answer 40

composed of a characteristic group of lesions found in the retina of individuals having had diabetes mellitus for several years.

The abnormalities that characterise diabetic retinopathy occur in predictable progression with minor variations in the order of their appearance.

Diabetic retinopathy is considered to be the result of vascular changes in the retinal circulation.

In the early stages vascular occlusion and dilations occur.
- It progresses into a proliferative retinopathy with the growth of new blood vessels.

Macular oedema (the thickening of the central part of the retina) can significantly decrease visual acuity.

Question 41

causes of diabetic retinopathy

Answer 41

The retina is the light-sensitive layer of cells at the back of the eye. It converts light into electrical signals which are sent to the brain through the optic nerve. Once received, the brain interprets these signals to produce the images that you see.

To work effectively, the retina needs a constant supply of blood, which it receives through a network of tiny blood vessels.

Over time, continuously high blood sugar levels can cause the blood vessels to become blocked or to leak.

This damages the retina and stops it from working, usually in 3 main stages:

• background retinopathy – tiny bulges develop in the blood vessels, which may bleed slightly but this doesn’t usually affect vision
• pre-proliferative retinopathy – more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye
• proliferative retinopathy – scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina. This can result in some loss of vision

Question 42

3 stages of diabetic retinopathy

Answer 42

background retinopathy

pre-proliferative retinopathy

proliferative retinopathy

Question 43

background retinopathy stage in diabetic retinopathy

Answer 43

tiny bulges develop in the blood vessels, which may bleed slightly but this doesn’t usually affect vision

Question 44

pre-proliferative retinopathy stage in diabetic retinopathy

Answer 44

more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye

Question 45

proliferative retinopathy stage in diabetic retinopathy

Answer 45

scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina. This can result in some loss of vision

Question 46

risk factors for diabetic retinopathy

Answer 46

Duration of diabetes

Level of glycemia

Presence of high blood pressure

Dependence on insulin

Pregnancy

Levels of selected serum lipids

Nutritional

Genetic factors

Question 47

hemianopia

Answer 47

blindness in one half of the visual field.
- Hemianopia is a functional defect which can affect the right or left side.

This loss can be caused by a variety of medical conditions – stroke being the most common
- Stroke patients with weakness of, for example, the right arm and leg have right sided poor vision.

Sight loss can be upper, lower, left or right

Question 48

treatment of visual impairment

Answer 48

Treatment depends on the condition diagnosed

Early diagnosis may be crucial

Medical
Surgical
Non-invasive

Question 49

prevention of visual impairments

Answer 49

Regular eye exams

Protect eyes from the sun

Protective eye wear at work

Know family history

Seek treatment quickly

Stop smoking

Eating healthy and managing obesity

Question 50

misconceptions of those with visual impairment

Answer 50

They are all totally blind

They must wear dark glasses

They must use a white cane or a guide dog to get around

They have sensitive hearing and special sense of touch (heightened)

They use Braille to read (uncommon now)

Certain activities are too difficult for them to try

They do not look at you when you talk to you

Question 51

examples of difficulties experienced by those with visual impairment

Answer 51

Not being able to access printed material

Difficulty in accessing the Internet/electronic devices

Difficulty in getting to destinations and around the built environment

Lack of awareness of others as to how to help

Accessing unfamiliar buildings and environments

Question 52

maximising communication for people with visual impairment in dental setting

Answer 52

Always identify yourself even in known surroundings

Always use names to identify people - especially in a group situation

Keep the visually impaired person informed of people moving around and/or leaving the room

Tell them what your doing before you do it – putting the chair back / LA / slow speed

Do not use non-verbal communication e.g. pointing in the direction of something, shrugging shoulders, pulling faces

Provide information in alternative formats:
- CD, email, extra large print, audio tapes, electronic formats, braille, moon,

Allow extra time

Prepare the surgery appropriately

Arrange for the alternative formats to be provided

Take time to get the environment right

Question 53

hearing can be affected by (3)

Answer 53

Disease
Disorder
Injury

Estimated 9 million people affected in UK

Approx. 75% are > 60 years old

Question 54

hearing impairment prevalence

Answer 54

Around 466 million people worldwide have disabling hearing loss, and 34 million of these are children.
- estimated by 2050 over 900 million people will have disabling hearing loss.

Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise, and ageing.

60% of childhood hearing loss is due to preventable causes.
- billion young people (aged between 12–35 years) are at risk of hearing loss due to exposure to noise in recreational settings.

Unaddressed hearing loss poses an annual global cost of US$ 750 billion.

Current estimates suggest an 83% gap in hearing aid need and use

Question 55

hearing loss classed as

Answer 55

A person who is not able to hear as well as someone with normal hearing – hearing thresholds of 25 dB or better in both ears

may be mild, moderate, severe, or profound.

affect one ear or both ears and difficulty in hearing conversational speech or loud sounds.

Question 56

functional impact of hearing impairment

Answer 56

Ability to communicate with others

Spoken language development is often delayed in children

Adverse effect on the academic performance of children

Increased rates of grade failure and greater need for education assistance

Access to suitable accommodations is important for optimal learning experiences but are not always available

Question 57

social and emotional impact of hearing impairment

Answer 57

Exclusion from communication can have a significant impact on everyday life causing feelings of:

• Loneliness
• Isolation
• Frustration

Question 58

financial impact of hearing impairment

Answer 58

Annual global cost of US$ 750 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs.

In developing countries, children with hearing loss and deafness rarely receive any schooling.

Adults with hearing loss also have a much higher unemployment rate.

Higher percentage of people with hearing loss and in employment are in the lower grades of employment compared with the general workforce.

Question 59

hearing impairment thresholds

Answer 59

(along with measurement in decibel loss - dBHL (25 normal))

Mild 20 – 40 decibels

Moderate 41 – 70 decibels

Severe 71 – 95 decibels

Profound 95+ decibels

Question 60

‘normal conversation’ level

Answer 60

at a distance of 1 meter is between 50-60dBHL

COVID19:

• masks - stop lipreading,
• social distancing double distance

Question 61

causes of hearing loss can be

Answer 61

congenital

acquired

Question 62

congenital hearing loss causes

Answer 62

Maternal rubella, syphilis or certain other infections during pregnancy;

Low birth weight;

Birth asphyxia

Inappropriate use of particular drugs during pregnancy, such as aminoglycosides, cytotoxic drugs, antimalarial drugs, and diuretics;

Severe jaundice in the neonatal period

Question 63

acquired hearing loss causes

Answer 63

Infectious diseases including meningitis, measles and mumps;

Chronic ear infections;

Collection of fluid in the ear (otitis media);

Medicines, such as those used in the treatment of neonatal infections, malaria, drug-resistant tuberculosis, and cancers;

Injury to the head or ear;

Excessive noise, including occupational noise such as that from machinery and explosions;

Recreational exposure to loud sounds

Ageing, in particular due to degeneration of sensory cells;

Wax or foreign bodies blocking the ear canal

Question 64

signs of hearing impairment

Answer 64

Inactivity

Reduced development of speech & language skills

Deterioration of speech

Reduced social & emotional development

Irritability

Autistic like behaviour/ Confusion

Question 65

clues to a hearing problem in a person

Answer 65

Unawareness of surroundings

Failure to respond to sound

Asking for sentences to be repeated

Speaking in an unusually loud voice

Change in tone

Withdrawing from life

spending time alone

Question 66

treatment and prevention of hearing impairments

Answer 66

Early detection

Early management – surgical or medical

Rehabilitation

Immunisation

• key component in prevention in children
• need to know science behind to have effective conversation with pt,

Avoidance of some drugs

Reducing occupational exposure
e.g. high-speed use with ear plugs

Question 67

types of hearing aid (4)

Answer 67

• Behind the ear – most common
• In the ear
• In the canal
• Completely in the canal

Battery operated – may struggle with dexterity

Question 68

maximising communication with hearing impaired in dental setting

Answer 68

Ask if they want to use a loop system

Try to establish the person’s preferred communication method
- If necessary, book BSL interpreters, lip reader, note taker well in advance. This should be recorded in patients’ notes.

Face the person, don’t turn away
Use clear speech, normal lip pattern, don’t shout
Use finger spelling
Speak at ear level
Repeat, rephrase
Write things down, type 
Reduce background noise
- Ensure there is no echo - room with soft furnishings
No radio etc

Ask people to repeat important information back to you – understanding

Make sure hearing aids are switched on and functioning

Allow extra time – reduce stress for dentist

Prepare an appropriate room

Book the necessary communication support

Question 69

good ways to act in dental setting with hearing impaired pts

Answer 69

Face the person, don’t turn away

Use clear speech, normal lip pattern, don’t shout

Use finger spelling

Speak at ear level

Repeat, rephrase

Write things down, type

Reduce background noise
- Ensure there is no echo - room with soft furnishings
No radio etc

Book the necessary communication support