Low Vision Rehab: Defintions, Epidiology, Psychosocial Aspects

Question 1

Reasons to pay attention to low vision

Answer 1

• increasing demand for low vision services as baby boomers age
• need to know enough to make intelligent referrals and evaluate the care provided
• skills learned here are applicable to primary care optometry
• referring patients who need it for low vision evils is now standard of care

Question 2

Importance of vision to patients

Answer 2

47.4% rates losing vision as the worst possible health outcome

Question 3

What is low vision

Answer 3

• vision that is not adequate for a persons needs
• implies some reduction in VA and/or VF
• according to the NEI, low vision is defined as BCVAless than 6/12 (<20/40) in the better seeing eye (excluding those who are categorized as being blind by the US definition)

Question 4

Legal blindness main definition

Answer 4

The BCVA in the better seeing eye is less than or equal to 20/100 or, if the VA in that eye is better than 20/00, that the visual field is less than or equal to 20 degrees in the widest diameter

Question 5

Legal blindness side law

Answer 5

If acuity is measured using a chart that has lines between 20/100 and 20/200, and if no letters can be read on the 20/100 line, the patient meets the definition of statutory blindness and is considered to be 20/200 for the purposes of social security disability determination

Question 6

Possible eligibility for SSI

Answer 6

• not dependent on previous work experience, only on household income
• also eligible for Medicaid

Question 7

Eligibility of SSDI in low vision

Answer 7

• funded through payroll taxes and dependent on work credits earned
• 5 month waiting period, eligible for Medicare after 2 years
• under 65 years of age

Question 8

Working and disability and low vision

Answer 8

• blind workers are able to earn $1950 per month and still receive disability benefits
• other disabilities may only earn $1170
• disability is based on inability to perform “substantial gainful activity”

Question 9

Other benefits for vision impairment

Answer 9

• property tax reduction (up to $12000 property value)
• audio books through the KY library for the blind
• KY department of rehab services
• KY school of the blind
• directory assistance exemption
• data plan exemption

Question 10

KY vision impairment stats

Answer 10

A lot of DR, glaucoma, AMD

Question 11

Ethnicity and low vision

Answer 11

Most are Caucasian

Question 12

Prevalence

Answer 12

How many people have it in total

Question 13

Prevalence of 80+ low vision

Answer 13

AA the highest

The older you are the more likely you will have low vision

Question 14

Low vision gender

Answer 14

More common in females because they live longer

Question 15

Stages of reaction to vision loss

Answer 15

Shock
Denial 
Anger 
Depression
Acceptance 
Adjustment

Question 16

Reaction to leber’s congenital amaurosis

Answer 16

Less shock because it’s congenital and they habe it their whole life

Similar to oculocutaneous albinimism

Question 17

Reaction to ARMD

Answer 17

Wonder why they cant see through better glasses, depression and questioning why

Question 18

Diabetic retinopathy

Answer 18

Wonder why they cant see through better glasses, depression and questioning why. Guilt because they can control their blood sugar

Question 19

Reaction to vision loss from car accident

Answer 19

Shock and anger

Question 20

Reaction to brain tumor

Answer 20

Shock and anger

Question 21

Depression among seniors with VI

Answer 21

• 30% of those with AMD suffered from depression
• 2x the rate of community dwelling elderly
• equal to or higher than other conditions
• depression exacerbates vision related disability and poorer self rated visual function

Question 22

Implications of depression for rehab in low vision

Answer 22

• can interfere with process by causing fatigue, pessimism and poor motivation
• should be acknowledged and managed. Patient reassurance, referral to PCP, referral to mental health treatment
• suicides among peopl >65 accounted for 18.2% of all suicides in US
• depressed patients may be less likely to be referred for vision rehab
• depressed patients may be less likely to accept or keep scheduled appointments for VR
• low vision rehab may have an “antidepressant” effect for some people

Question 23

Social support and low vision

Answer 23

• family invovlemt increases participant in LVR
• but taking over patients reposnbilities may actually promote depression and dependence
• veterans with family support in the home were more likely to use prescribed devices

Question 24

Cognitive impairment and low vision

Answer 24

• memory problems may make it difficult to learn techniques
• reorganizing the home to acommodative VI may result in disorientation
• impairments in executative function may inhibit initiation of novel ways of task performance

Question 25

One good eye and one bad eye can represent what level of vision related quality of life

Answer 25

Intermediate