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Visual Function and Low Vision
Rehabilitation
Lissa V. Rivero, OD, FAAO
Sarasota Retina Institute
Sarasota, FL
1
Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday
activities that...
Typical Impairments from Macular Degeneration
Reading
Driving
Watching

TV

Computer
Seeing

faces

Writing

checks
Additional Impairments from Vision
Loss
 Shopping
 price tags, labels

 Hobbies
 crafts, playing cards

 Activities o...
Goals of Vision Rehabilitation
 Adjustment to vision loss
 Functional Maximize remaining vision
with devices and trainin...
Who pays for Low Vision Care?
Low vision exam is covered by
Medicare and most
Insurances, except for
refraction fee.
OT tr...
What can I expect in a Low Vision Exam?
 Thorough history
 Measurements of functional
vision
 Acuity - Specialized char...
Central Field Loss and
Eccentric Viewing (EV)

Train patients to move their
eyes in a consistent way to
look around their ...
Careful Refraction is First Step

 Changes in prescription
are often missed in ARMD
patients
 Use Special Charts
 Refra...
Lighting
OttLite Better
Vision
Series

 Special lamps
 High intensity
flashlights
Ottlite.com
Glare Control
 Macular degeneration patients benefits
from Blue Blocker lenses:
 Indoor glare control: Yellow or light
a...
Low Vision Devices for AMD Patients
 Depends on:






level of vision
blind spots (scotoma)
goals
Patient’s motivat...
“I just need stronger glasses”
Higher power reading glasses,
require a closer viewing distance.

+10D(3.5X)=10 cm
viewing ...
Telescopic Glasses
For reading with a +3.00
reading cap

For distance activities like TV viewing, and enjoying the theater
For Writing, Sewing, Computer
 Custom made
 Prescribed magnification
 Requires training and
practice
 Small field of v...
What is an Occupational Therapist and
what is their role in vision rehab?
 An OT is a licensed health
professional with e...
Implantable Telescope Technology
How It Works
Scarred Macula

Telescope Implant

Central Visual Field Projection (Natural Lens/IOL)

Central Visual Field P...
Field of View
3X Implant:
20°

3X External:
8°

19
How It Works

20
How It Works
Telescope Eye = Central Vision
Distance: Faces, TV, signs
NO driving
Near: Reading, playing cards, dining
Oth...
Not ‘Cataract Surgery’
• Not the solution to drive again
• Improves functional vision
• Care given by a team
• Patient par...
Telescope Implant Program

Sele
ction
Trea
•Med
tme
Reh
ical
nt
abilit
•Low
•Sur
atio
Visio
gical
n
n

23
Key Indications
Low Vision Evaluation
Pre-surgery assessment
Informed decision
Agree to participate in
visual rehab tra...
Post-Implantation

25
Indication For Use
• VisionCare’s Implantable Miniature
Telescope (by Dr. Isaac Lipshitz) (intraocular
telescope) is indic...
Magnifiers The larger the magnifier the weaker it is.
Over the counter (+6 diopters or 2X) vs.
Low Vision magnifiers (up t...
Traditional Magnifiers –
 Stand magnifiers
Makrolux
(2.2x, 3.6X)
Scribolux
(2.8X)
Menas Lux
(3.0X)
Video Magnifiers
Closed Circuit Television (CCTV)
Closed Circuit
Television$2000 to $3000

Topaz by Freedom Scientific
Cle...
Video magnifiers that read to you
DaVinci by
Enhanced Vision

Clear View +
Speech by Optelec

Prodigy Duo
2 in 1 by
Humanw...
Hand-held video magnifiers

Ruby by
Freedom Scientific
Pebble HD 4.3 by
Enhanced Vision
Smartlux Digital
by Eschenbach
$40...
Mobilux Digital Magnifier
by Eschenbach
Magnification range from
3x to 6x
High Definition LED screen
Feels like a regular ...
Compact 7 HD
Continuous magnification
from 2X to 24 X
Computer Adaptations
Large print keyboard

 Operating system
accessibility options
 Computer glasses
 Large Print Softw...
Tablets and other eReaders
Apple iPad
Samsung Galaxy Note

Kindle Fire HD
Nook
BigMagnify Application
Available for smartphones free of charge!!
Adapted Communication
Large Print Phone

Bold Line Paper, Felt Tip
Pens
Adapted Leisure Activities
Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday
activities that...
Resources
For Patients/Family:
www.CentraSight.com

40
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Lissa's mda presentation keynote short copy oct 12 2013 copy

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Low vision therapy options presented by Dr. Lisa Rivero.

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  1. 1. Visual Function and Low Vision Rehabilitation Lissa V. Rivero, OD, FAAO Sarasota Retina Institute Sarasota, FL 1
  2. 2. Vision Rehabilitation Purpose is not to get back your sight, but to regain your ability to do the everyday activities that have been affected by the loss of vision • Specialized equipment and training
  3. 3. Typical Impairments from Macular Degeneration Reading Driving Watching TV Computer Seeing faces Writing checks
  4. 4. Additional Impairments from Vision Loss  Shopping  price tags, labels  Hobbies  crafts, playing cards  Activities of Daily Living (ADLs)  food on plate, plugging in appliances, setting appliances  Using phone, cell phone  Trouble walking  Increased risk of falls
  5. 5. Goals of Vision Rehabilitation  Adjustment to vision loss  Functional Maximize remaining vision with devices and training  Emotional LV patients are at 20x greater risk of depression Also inform patients about community resources available
  6. 6. Who pays for Low Vision Care? Low vision exam is covered by Medicare and most Insurances, except for refraction fee. OT training is covered by Medicare and most Insurances Devices are not covered by insurance.  Patients pay  VA if patient qualifies  DBS if patient qualifies  Lions club
  7. 7. What can I expect in a Low Vision Exam?  Thorough history  Measurements of functional vision  Acuity - Specialized charts  Contrast  Visual Fields  Check eyeglasses - Refraction  special technique for LV  Determine level of magnification  Trial of LV devices  Develop a rehab plan
  8. 8. Central Field Loss and Eccentric Viewing (EV) Train patients to move their eyes in a consistent way to look around their blind spot
  9. 9. Careful Refraction is First Step  Changes in prescription are often missed in ARMD patients  Use Special Charts  Refract with a trial frame
  10. 10. Lighting OttLite Better Vision Series  Special lamps  High intensity flashlights Ottlite.com
  11. 11. Glare Control  Macular degeneration patients benefits from Blue Blocker lenses:  Indoor glare control: Yellow or light amber  Outdoor glare control: Orange or Brown
  12. 12. Low Vision Devices for AMD Patients  Depends on:      level of vision blind spots (scotoma) goals Patient’s motivation cost
  13. 13. “I just need stronger glasses” Higher power reading glasses, require a closer viewing distance. +10D(3.5X)=10 cm viewing distance +20D(5X)= 5cm viewing distance
  14. 14. Telescopic Glasses For reading with a +3.00 reading cap For distance activities like TV viewing, and enjoying the theater
  15. 15. For Writing, Sewing, Computer  Custom made  Prescribed magnification  Requires training and practice  Small field of view  $ 800 and up • Standard • MaxDetail glasses • $180
  16. 16. What is an Occupational Therapist and what is their role in vision rehab?  An OT is a licensed health professional with expertise in rehabilitation  Some OT’s have special training in vision rehabilitation  Eccentric View training  Device training  Adaptive strategies  Home visits and modifications,  Fall prevention
  17. 17. Implantable Telescope Technology
  18. 18. How It Works Scarred Macula Telescope Implant Central Visual Field Projection (Natural Lens/IOL) Central Visual Field Projection CAT 18
  19. 19. Field of View 3X Implant: 20° 3X External: 8° 19
  20. 20. How It Works 20
  21. 21. How It Works Telescope Eye = Central Vision Distance: Faces, TV, signs NO driving Near: Reading, playing cards, dining Other Eye = Peripheral Vision Allows orientation and mobility 21
  22. 22. Not ‘Cataract Surgery’ • Not the solution to drive again • Improves functional vision • Care given by a team • Patient participates in rehabilitation! 22
  23. 23. Telescope Implant Program Sele ction Trea •Med tme Reh ical nt abilit •Low •Sur atio Visio gical n n 23
  24. 24. Key Indications Low Vision Evaluation Pre-surgery assessment Informed decision Agree to participate in visual rehab training 24
  25. 25. Post-Implantation 25
  26. 26. Indication For Use • VisionCare’s Implantable Miniature Telescope (by Dr. Isaac Lipshitz) (intraocular telescope) is indicated for monocular implantation to improve vision in patients greater than or equal to 75 years of age with stable severe to profound vision impairment (best corrected distance visual acuity 20/160 to 20/800) caused by bilateral central scotomas associated with end-stage age-related macular degeneration. 26 Source: FDA Professional Use Information labeling
  27. 27. Magnifiers The larger the magnifier the weaker it is. Over the counter (+6 diopters or 2X) vs. Low Vision magnifiers (up to +56 diopters or 14X)  Hand held mags  LED illuminated
  28. 28. Traditional Magnifiers –  Stand magnifiers Makrolux (2.2x, 3.6X) Scribolux (2.8X) Menas Lux (3.0X)
  29. 29. Video Magnifiers Closed Circuit Television (CCTV) Closed Circuit Television$2000 to $3000 Topaz by Freedom Scientific Clearview by Optelec Merlin by Enhanced Vision
  30. 30. Video magnifiers that read to you DaVinci by Enhanced Vision Clear View + Speech by Optelec Prodigy Duo 2 in 1 by Humanware
  31. 31. Hand-held video magnifiers Ruby by Freedom Scientific Pebble HD 4.3 by Enhanced Vision Smartlux Digital by Eschenbach $400 - $650
  32. 32. Mobilux Digital Magnifier by Eschenbach Magnification range from 3x to 6x High Definition LED screen Feels like a regular magnifier
  33. 33. Compact 7 HD Continuous magnification from 2X to 24 X
  34. 34. Computer Adaptations Large print keyboard  Operating system accessibility options  Computer glasses  Large Print Software  Zoom Text  Jaws
  35. 35. Tablets and other eReaders Apple iPad Samsung Galaxy Note Kindle Fire HD Nook
  36. 36. BigMagnify Application Available for smartphones free of charge!!
  37. 37. Adapted Communication Large Print Phone Bold Line Paper, Felt Tip Pens
  38. 38. Adapted Leisure Activities
  39. 39. Vision Rehabilitation Purpose is not to get back your sight, but to regain your ability to do the everyday activities that have been affected by the loss of vision • Specialized equipment and training • “Can do” attitude • Willingness to learn “new tricks”
  40. 40. Resources For Patients/Family: www.CentraSight.com 40
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