Intro

Question 1

General patterns of visual field loss

Answer 1

1. Central field defect
2. Peripheral field defect
3. Overall blur without field defect (aniridia)
   - Reduced contrast (optic atrophy)
   - Light sensitivity/glare (K dystrophy)
   - Color vision issues (achromatopsia)

Question 2

How does one start receiving low vision rehab care?

Answer 2

Self referral

Referral by eye care professional, low vision professional, other health care professional or community partner.

Question 3

Low vision rehab goals

Answer 3

Improve how the vision functions.
Purpose is to maximize their remaining vision. Help them maintain independence, build confidence, and enhance quality of life.

Question 4

Low vision team (3 main groups)

Answer 4

Low vision drs- optometrists and MD
Rehab therapists- ADL help (OT, LVT, VRT) and orientation & mobility
Support- community and vocational

Question 5

Who can help with device training

Answer 5

LVT, OD, OT

Question 6

Types of orientation and mobility training

Answer 6

Sighted guide
White cane for tactile and auditory feedback
Guide dog
Safe travel skills

Question 7

Two services for children

Answer 7

IDEA- Free, appropriate public education. States must provide essential education services including LV exams, devices, and training.

IEP- plan developed with goals to meet student’s needs in school.

Question 8

What department oversees O&M training and rehab training

Answer 8

Department of human services.

Question 9

Services for legally blind

Answer 9

Income assistance (SSDI and SSI)
Income taxes 
Free library 
Mail 
Phone directory assistance 
Transportation benefits 
Vocational sericee

Question 10

SSDI

Answer 10

Income assistance for legally blind financed by SS taxes. Federally run program.

• Permanent
• Paid taxes previously
• Are legally blind/disabled
• Eligible for medicare in 2 years

Question 11

SSI

Answer 11

Income assistance for legally blind by general tax revenue. Federally run program.

• No work required
• Have limited money or assets
• Either blind, disabled, or 65 yrs+

Question 12

Legal blindness

Answer 12

BCVA worse than 20/100 in better seeing eye.

VF less than 20 degrees using III4e Isoptera.

Question 13

3 acceptable VF tests for legal blindness

Answer 13

1. Automatic static perimeter.
   - III4e
   - 10 dB stimulus with less than 20% fixation losses and less than 33% FP or FN.
2. Kinetic perimeter (octopus)
   - 31.5 apostle background.
3. Goldman
   - III4e

Question 14

which parts of your case history should you extend?

Answer 14

Medical history, ocular history and school/work/hobbies.

Question 15

Each visual goal should be SMART

Answer 15

S-specific 
M- measurable 
A- Achievable 
R- realistic 
T- Timely

Question 16

What happens with insurance if the rehab prognosis is poor?

Answer 16

Insurance may stop paying if their condition will not improve

Question 17

What to document when taking VA

Answer 17

VA
Type of chart
Lighting
VF status- presence of eccentric viewing/head turn or tilt.
***For legal blindness, eccentric viewing is not allowed.

Question 18

Metric notation at near

Answer 18

Linear

1M= 1.45mm optotype = 20/50 = 8 point = newspaper print

Question 19

1m/1M = what snellen

Answer 19

20/20

1M subtends 5 min of arc at 1 meter

Question 20

EOM modifications

Answer 20

Slower
Use pt’s finger
Tell them which gazes to look in
Turn their head- doll

Question 21

Color VA testing

Answer 21

Jumbo D15 test plates.

Konan test on the computer can adjust size of stimulus

Question 22

Color vision deficiency found in __% of low vision pts.

What % due to ON disease and what % due to retinal pathology?

Answer 22

48.8%

62% bc ON
51% bc retina

Question 23

CVF modification

Answer 23

For extent of field, use vision disc. Cannot be used for legal blindness certification tho

Question 24

Which add to use with amsler

Answer 24

+3

Question 25

Common conditions with high cyl

Answer 25

Albinism, aniridia, KCN, nystagmus

Question 26

Cyl refinement - What target to use? - Which JCC to use based on VA?

Answer 26

Use target 2 lines larger than VA found with sphere power +/- 0.50DC if VA is 20/30-20/50 +/- 1.00DC if VA is 20/200 or worse

Question 27

Axis refinement

Answer 27

Make 15 degree jumps initially Then add power Repeat axis refinement with smaller degree changes (10 and 5)

Question 28

Sequence of refraction

Answer 28

1. Take initial VA through starting point. Calculate VA 2. Sphere check. Change JND throughout if VA improves. 3. Cyl refinement/probe 4. Check VA and recalculate JND 5. Sphere refinement

Question 29

Refractive errors: ``` Albinism K scarring Pendular nystagmus Cataracts Down syndrome ROP Cerebral palsy Microphthalmos Diabetes ```

Answer 29

``` Albinism- high refractive error and WTR astig K scarring- astig Pendular nystagmus- WTR astig Cataracts - myopia Down syndrome- Myopia ROP-Myopia Cerebral palsy - hyperopia Microphthalmos - hyperopia Diabetes -Shifts ```

Question 30

When to do binocular vision testing

Answer 30

Those whose VA differs no more than a factor of 1.5 Ex: 20/40 and 20/60

Question 31

Importance of binocularity

Answer 31

``` Psychological importance Enhance acuity Larger VF Better contrast Better depth May stabilize eye alignment ```

Question 32

Binocular testing

Answer 32

1. Worth 4 dot- 4 circles seen 2. Maddox rod- see pink line. 3. 4 prism test. Twist and see if they notice diplopia

Question 33

5 emotional stages of loss

Answer 33

1. Shock/denial 2. Anger 3. Depression 4. Bargaining 5. acceptance

Question 34

Denis Diderot wrote a letter on the blind and was thrown in jail. When did attitudes change about blind?

Answer 34

1800s - schools started to open and brail was invented

Question 35

Low vision depression prevention trial for ARMD (VITAL)

Answer 35

Demonstrated improvement in depression scales with LV rehabilitation. Pts working towards goal improved depression

Question 36

SPIKES approach for delivering bad news

Answer 36

``` S- set up the interview P- look at pt's perception I- Ask for their invitation K- Share knowledge E- address emotions S- Summary and plan ```

Question 37

Charles Bonnet Syndrome

Answer 37

- Pleasant, humorous images. - At times of rest - Prevalence increases with age. 10% report to providers. Half given info about syndrome. Tx: - Change visual activity - Talk to hallucinations - SSRIs