Penaksiran dan Diagnosis Kanak-kanak Bermasalah Penglihatan Dr Safinaz Mohd Khialdin Pensyarah & Pakar Oftalmologi Jabatan...
 
<ul><li>Visual impairment or low vision  </li></ul><ul><ul><li>reduction in vision that cannot be corrected with standard ...
<ul><li>Functional limitation of the eye(s) or visual system </li></ul><ul><li>Can manifest as </li></ul><ul><ul><li>Reduc...
<ul><li>Clearness of vision </li></ul><ul><ul><li>dependent on the sharpness of the retinal focus within the eye  </li></u...
VISION TESTING IN CHILDREN
Contrast sensitivity <ul><li>How well your eyes function in dim light  </li></ul><ul><li>How well you can distinguish obje...
<ul><li>The total area in which objects can be seen in the peripheral vision while you focus your eyes on a central point....
<ul><ul><li>PHOTOPHOBIA – glaring </li></ul></ul><ul><ul><li>DIPLOPIA – double vision </li></ul></ul><ul><ul><li>VISUAL DI...
<ul><li>Definition: </li></ul><ul><ul><li>Visual impairment :  </li></ul></ul><ul><ul><ul><li>visual acuity of less than  ...
6/60 6/18
<ul><li>HISTORY TAKING – SYMPTOMS </li></ul><ul><li>EXAMINATIONS – SIGNS </li></ul><ul><li>INVESTIGATIONS – CONFIRM DIAGNO...
<ul><li>Ocular History </li></ul><ul><ul><li>Diagnosis and onset of symptoms </li></ul></ul><ul><ul><li>Past, current, or ...
<ul><li>Visual Functioning </li></ul><ul><ul><li>Ability to read print and specific reading needs (schooling) </li></ul></...
<ul><li>Medical History </li></ul><ul><ul><li>General health review </li></ul></ul><ul><ul><li>Current medications </li></...
<ul><li>EXAMINATION </li></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><li>Visual field </li></ul></ul><ul><ul><li...
<ul><li>To confirm eye problem </li></ul><ul><ul><li>Ultrasound </li></ul></ul><ul><ul><li>CT scan </li></ul></ul><ul><li>...
Eye problems in children <ul><li>Importance  </li></ul><ul><ul><li>Early detection & treatment of peadiatric ocular diseas...
<ul><li>Eye pathology :  Structural impairment or damage to one or more parts of the eye </li></ul><ul><li>Refractive erro...
Eye problems in children causing visual impairment
Anatomy of the eye
Congenital glaucoma <ul><li>Rare (1:10000), 65% males </li></ul><ul><li>Diagnosed shortly after birth or during 1 st  year...
Leucocoria <ul><li>White   eye  reflex </li></ul><ul><li>Differential diagnosis </li></ul><ul><ul><li>R etinoblastoma  </l...
1.Leucocoria:  Retinoblastoma <ul><li>Most common intraocular malignancy of childhood </li></ul><ul><li>Rare (1 in 14000-2...
1.Leucocoria:  Retinoblastoma <ul><li>Present with: </li></ul><ul><ul><li>Leucocoria (white reflex) </li></ul></ul><ul><ul...
 
Retinoblastoma <ul><li>Sight threatening </li></ul><ul><li>Life threatening </li></ul><ul><li>Treatment option </li></ul><...
2. Leucocoria:  Cataract Definition of cataract : Opacity involving the lens
Leucocoria:  Cataract <ul><li>Leading cause of blindness </li></ul><ul><li>Interferes with normal visual develoment </li><...
Nuclear cataract Lamellar cataract Cortical cataract CONGENITAL CATARACT
SECONDARY  Ocular - Anterior subcapsular –  Atopic dermatitis Systemic – oil droplet cataract –  Galactossaemia Vossius ri...
Presentations of childhood cataract <ul><li>Lack of visual interest </li></ul><ul><li>Strabismus/squint </li></ul><ul><li>...
Action <ul><li>Prompt detection & dedicated screening </li></ul><ul><li>Referral to Ophthalmologist (urgent) </li></ul><ul...
<ul><li>Eye disease that affects prematurely born babies </li></ul><ul><li>Caused by disorganized growth of retinal blood ...
Leucocoria:  Retinopathy of prematurity
<ul><li>Risk factor for ROP </li></ul><ul><ul><li>Pre-term babies – screening </li></ul></ul><ul><ul><li>Low birth weight ...
Strabismus/squint <ul><li>Definition: Deviation of the eyes so that their visual axes are no longer parallel </li></ul>
Causes of squint <ul><li>Muscle imbalance </li></ul><ul><li>Refractive errors </li></ul><ul><li>Ocular abnormalities – cat...
Other presenting features <ul><li>Symptoms </li></ul><ul><ul><li>None </li></ul></ul><ul><ul><li>Noted by parents </li></u...
Management for squint <ul><li>Refer to ophthalmologist (urgent) </li></ul><ul><ul><li>Treatment of refractive errors </li>...
REFRACTIVE ERROR <ul><li>Physiological condition whereby the refracting system of the eye does not focus objects on the re...
<ul><ul><li>Myopia </li></ul></ul><ul><ul><li>Hyperopia </li></ul></ul><ul><ul><li>Astigmatism </li></ul></ul>Refractive e...
Refractive errors <ul><li>Various presentations: </li></ul><ul><ul><li>Squeezing eyes </li></ul></ul><ul><ul><li>Squint </...
<ul><li>Visual acuity screening in schools </li></ul><ul><ul><li>Performed in Standard 1 </li></ul></ul><ul><ul><li>Referr...
Amblyopia <ul><li>‘ Lazy eye’ </li></ul><ul><li>Definition:  </li></ul><ul><ul><li>Unilateral/ bilateral decrease of  best...
Critical period: Why is visual development important? <ul><li>Sensory function continues to develop after birth </li></ul>...
How does amblyopia develop? <ul><li>Brain receives stimuli from both eyes </li></ul><ul><li>Child’s maturing brain will se...
Causes of amblyopia <ul><li>Ammetropia (bilateral high refractive error) </li></ul><ul><li>Anisometropia (large/ asymmetri...
Treatment <ul><li>Can be treated or reversed if detected earlier (critical period) </li></ul><ul><li>Treat underlying cond...
Visual pathway
<ul><li>As a result of the damage to the brain. </li></ul><ul><ul><li>Cerebral palsy </li></ul></ul><ul><ul><li>Seizure di...
<ul><li>The process of treatment and education that helps individuals who are visually disable </li></ul><ul><li>attain ma...
<ul><li>OPTICAL DEVICES </li></ul><ul><li>NON OPTICAL DEVICES </li></ul><ul><li>HOLISTIC APPROACH </li></ul><ul><ul><li>Cl...
<ul><li>OPTICAL DEVICES </li></ul><ul><li>Reduced Visual Acuity </li></ul><ul><ul><li>Magnification for near </li></ul></u...
HAND HELD MAGNIFIERS MAGNIFICATION FOR NEAR STAND MAGNIFIERS SPECTACLE-MOUNTED MAGNIFIER CLOSE-CIRCUIT TELEVISION SYSTEM
TELESCOPE MAGNIFICATION FOR FAR
TREATMENT OF CENTRAL VISUAL FIELD LOSS MODIFIED TEXT <ul><li>Training for  eccentric viewing- avoid fixating using the fov...
TREATMENT OF PERIPHERAL VISUAL FIELD LOSS MIRROR PRISMS <ul><li>Acts like a side mirror of a car </li></ul><ul><li>Able to...
TREATMENT  FOR REDUCED CONTRAST SENSITIVITY AND GLARE TINTED LENSES COLOUR CONTRAST TYPOSCOPE : reduce reflected glare fro...
<ul><li>NON-OPTICAL METHODS  </li></ul><ul><li>Move  CLOSER : use an angled reading desk </li></ul><ul><li>Use  COLOUR  to...
<ul><li>Prognosis for success depends on: </li></ul><ul><ul><li>Ocular condition </li></ul></ul><ul><ul><li>Vision loss – ...
<ul><li>THANK YOU </li></ul>
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Lecture fakulti pendidikan 2011

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  • 60 Nasal /100 degrees temporal / 60 degrees above / 75 below the horizontal meridian
  • Resnikoff et al. (2004),
  • (Stiles &amp; Knox, 1996):
  • Affected pt – 40% children affected, 10 % carriers, 50 % normal
  • (Hughes 1995).
  • Lecture fakulti pendidikan 2011

    1. 1. Penaksiran dan Diagnosis Kanak-kanak Bermasalah Penglihatan Dr Safinaz Mohd Khialdin Pensyarah & Pakar Oftalmologi Jabatan Oftalmologi PPUKM
    2. 3. <ul><li>Visual impairment or low vision </li></ul><ul><ul><li>reduction in vision that cannot be corrected with standard glasses or contact lenses </li></ul></ul><ul><ul><li>reduces a person's ability to function at certain or all tasks </li></ul></ul>Visual Impairment
    3. 4. <ul><li>Functional limitation of the eye(s) or visual system </li></ul><ul><li>Can manifest as </li></ul><ul><ul><li>Reduced visual acuity </li></ul></ul><ul><ul><li>Reduced contrast sensitivity </li></ul></ul><ul><ul><li>Visual field loss </li></ul></ul><ul><ul><li>Photophobia </li></ul></ul><ul><ul><li>Diplopia </li></ul></ul><ul><ul><li>Visual distortion </li></ul></ul>Visual Impairment
    4. 5. <ul><li>Clearness of vision </li></ul><ul><ul><li>dependent on the sharpness of the retinal focus within the eye </li></ul></ul><ul><ul><li>the sensitivity of the interpretative parts of the brain. </li></ul></ul>Visual acuity
    5. 6. VISION TESTING IN CHILDREN
    6. 7. Contrast sensitivity <ul><li>How well your eyes function in dim light </li></ul><ul><li>How well you can distinguish objects from similarly colored or shaded backgrounds. </li></ul>
    7. 8. <ul><li>The total area in which objects can be seen in the peripheral vision while you focus your eyes on a central point. </li></ul>Visual field
    8. 9. <ul><ul><li>PHOTOPHOBIA – glaring </li></ul></ul><ul><ul><li>DIPLOPIA – double vision </li></ul></ul><ul><ul><li>VISUAL DISTORTION </li></ul></ul>
    9. 10. <ul><li>Definition: </li></ul><ul><ul><li>Visual impairment : </li></ul></ul><ul><ul><ul><li>visual acuity of less than 6/18, but equal or better than 3/60 in the better eye </li></ul></ul></ul><ul><ul><ul><li>Visual field less than 20 degree from fixation </li></ul></ul></ul><ul><ul><li>Blindness: </li></ul></ul><ul><ul><ul><li>visual acuity is less than 3/60 in the better eye </li></ul></ul></ul><ul><ul><ul><li>Visual field less than 10 degree from fixation </li></ul></ul></ul>Visual Impairment
    10. 11. 6/60 6/18
    11. 12. <ul><li>HISTORY TAKING – SYMPTOMS </li></ul><ul><li>EXAMINATIONS – SIGNS </li></ul><ul><li>INVESTIGATIONS – CONFIRM DIAGNOSIS </li></ul>EVALUATION & DIAGNOSIS OF VISUAL IMPAIRMENT
    12. 13. <ul><li>Ocular History </li></ul><ul><ul><li>Diagnosis and onset of symptoms </li></ul></ul><ul><ul><li>Past, current, or planned surgeries or treatments </li></ul></ul><ul><ul><li>Stability of vision </li></ul></ul><ul><ul><li>Family history of eye disease </li></ul></ul><ul><ul><li>Previous history of eye disease or vision problems </li></ul></ul><ul><ul><li>Current or previous use of spectacles, contact lenses, or low vision aids </li></ul></ul>EVALUATION & DIAGNOSIS: HISTORY
    13. 14. <ul><li>Visual Functioning </li></ul><ul><ul><li>Ability to read print and specific reading needs (schooling) </li></ul></ul><ul><ul><li>Intermediate visual ability and needs (e.g., use of computer, reading music) </li></ul></ul><ul><ul><li>Distance visual ability and needs </li></ul></ul><ul><ul><li>Photophobia, glare sensitivity, and lighting requirements </li></ul></ul>EVALUATION & DIAGNOSIS: HISTORY
    14. 15. <ul><li>Medical History </li></ul><ul><ul><li>General health review </li></ul></ul><ul><ul><li>Current medications </li></ul></ul><ul><ul><li>Hearing impairment or other disability </li></ul></ul><ul><ul><li>Developmental delay </li></ul></ul>EVALUATION & DIAGNOSIS: HISTORY
    15. 16. <ul><li>EXAMINATION </li></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><li>Visual field </li></ul></ul><ul><ul><li>Refraction </li></ul></ul><ul><ul><li>Eye movement </li></ul></ul><ul><ul><li>Detailed examination of the eye structures </li></ul></ul>EVALUATION & DIAGNOSIS: EXAMINATION
    16. 17. <ul><li>To confirm eye problem </li></ul><ul><ul><li>Ultrasound </li></ul></ul><ul><ul><li>CT scan </li></ul></ul><ul><li>To assess visual impairment </li></ul><ul><ul><li>Contrast sensitivity testing </li></ul></ul><ul><ul><li>Colour vision testing </li></ul></ul><ul><ul><li>Visual evoked potential </li></ul></ul>EVALUATION & DIAGNOSIS: INVESTIGATIONS
    17. 18. Eye problems in children <ul><li>Importance </li></ul><ul><ul><li>Early detection & treatment of peadiatric ocular disease is critical </li></ul></ul><ul><ul><li>Delay in diagnosis results in irreversible vision loss </li></ul></ul><ul><ul><li>Assessment should begin at birth </li></ul></ul>
    18. 19. <ul><li>Eye pathology : Structural impairment or damage to one or more parts of the eye </li></ul><ul><li>Refractive errors : or an inability of the eye to sharply focus images on the back of retina </li></ul><ul><li>Cortical visual impairments : damage to the part of the brain that interprets visual information </li></ul>CAUSES OF VISUAL IMPAIRMENT IN CHILDREN
    19. 20. Eye problems in children causing visual impairment
    20. 21. Anatomy of the eye
    21. 22. Congenital glaucoma <ul><li>Rare (1:10000), 65% males </li></ul><ul><li>Diagnosed shortly after birth or during 1 st year of life </li></ul><ul><li>Improper development of the eye drainage channel </li></ul><ul><li>Leads high pressure in the eye </li></ul><ul><li>Causing damage to optic nerve and results in vision loss </li></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Tearing </li></ul></ul><ul><ul><li>Photophobia (glaring) </li></ul></ul><ul><ul><li>Excessive squeezing of the eye </li></ul></ul><ul><ul><li>Buphthalmos (ox eye) </li></ul></ul>
    22. 23. Leucocoria <ul><li>White eye reflex </li></ul><ul><li>Differential diagnosis </li></ul><ul><ul><li>R etinoblastoma </li></ul></ul><ul><ul><li>C ongenital c ataract </li></ul></ul><ul><ul><li>Retinopathy of P rematurity </li></ul></ul><ul><ul><li>C oat’s disease </li></ul></ul><ul><ul><li>P ersistent Hyperplastic Primary Vitreous (PHPV) </li></ul></ul>
    23. 24. 1.Leucocoria: Retinoblastoma <ul><li>Most common intraocular malignancy of childhood </li></ul><ul><li>Rare (1 in 14000-20000) </li></ul><ul><li>3% of all childhood cancers </li></ul><ul><li>Bilateral in 30-35% </li></ul><ul><li>Age at diagnosis : 18 months (90% less than 3 years old) </li></ul><ul><li>May be inherited </li></ul>
    24. 25. 1.Leucocoria: Retinoblastoma <ul><li>Present with: </li></ul><ul><ul><li>Leucocoria (white reflex) </li></ul></ul><ul><ul><li>Squint </li></ul></ul><ul><ul><li>Poor vision </li></ul></ul><ul><ul><li>Eye redness, pain </li></ul></ul><ul><ul><li>Proptosis : forward bulging of the eye </li></ul></ul><ul><ul><li>Systemic metastases </li></ul></ul><ul><ul><li>Incidental ocular exam </li></ul></ul>
    25. 27. Retinoblastoma <ul><li>Sight threatening </li></ul><ul><li>Life threatening </li></ul><ul><li>Treatment option </li></ul><ul><ul><li>Radiotherapy </li></ul></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><li>Surgical removal of the eye </li></ul></ul><ul><ul><li>Genetic counselling </li></ul></ul>
    26. 28. 2. Leucocoria: Cataract Definition of cataract : Opacity involving the lens
    27. 29. Leucocoria: Cataract <ul><li>Leading cause of blindness </li></ul><ul><li>Interferes with normal visual develoment </li></ul><ul><li>Inherited –1/3 </li></ul><ul><li>Associated with other diseases – 1/3 </li></ul><ul><li>Idiopathic – 1/3 </li></ul>
    28. 30. Nuclear cataract Lamellar cataract Cortical cataract CONGENITAL CATARACT
    29. 31. SECONDARY Ocular - Anterior subcapsular – Atopic dermatitis Systemic – oil droplet cataract – Galactossaemia Vossius ring in traumatic cataract
    30. 32. Presentations of childhood cataract <ul><li>Lack of visual interest </li></ul><ul><li>Strabismus/squint </li></ul><ul><li>Nystagmus : abnormal movement of the eye </li></ul><ul><li>Developmental delay </li></ul><ul><li>Associated with systemic/ ocular abnormalities </li></ul>
    31. 33. Action <ul><li>Prompt detection & dedicated screening </li></ul><ul><li>Referral to Ophthalmologist (urgent) </li></ul><ul><li>Why? </li></ul><ul><ul><li>Monocular/ binocular cataract in infants results in significant visual deprivation </li></ul></ul><ul><ul><li>Early visual rehabilitation can prevent amblyopia (lazy eye) </li></ul></ul>
    32. 34. <ul><li>Eye disease that affects prematurely born babies </li></ul><ul><li>Caused by disorganized growth of retinal blood vessels </li></ul><ul><li>May be mild and resolves spontaneously </li></ul><ul><li>Severe cases can lead to scarring and retinal detachment. </li></ul>3. Leucocoria: Retinopathy of prematurity
    33. 35. Leucocoria: Retinopathy of prematurity
    34. 36. <ul><li>Risk factor for ROP </li></ul><ul><ul><li>Pre-term babies – screening </li></ul></ul><ul><ul><li>Low birth weight </li></ul></ul><ul><ul><li>Exposure to oxygen </li></ul></ul><ul><li>Screening of premature babies has to continue till school-going age </li></ul><ul><ul><li>Risk of myopia, even with no ROP </li></ul></ul>Leucocoria: Retinopathy of prematurity
    35. 37. Strabismus/squint <ul><li>Definition: Deviation of the eyes so that their visual axes are no longer parallel </li></ul>
    36. 38. Causes of squint <ul><li>Muscle imbalance </li></ul><ul><li>Refractive errors </li></ul><ul><li>Ocular abnormalities – cataract, macular scar, optic disc pathology </li></ul><ul><li>Special syndromes – Duanes, Brown </li></ul><ul><li>Associated disease – hydrocephalus, cerebral palsy, meningitis </li></ul>
    37. 39. Other presenting features <ul><li>Symptoms </li></ul><ul><ul><li>None </li></ul></ul><ul><ul><li>Noted by parents </li></ul></ul><ul><ul><li>Poor vision </li></ul></ul><ul><ul><li>Funny eye movements </li></ul></ul><ul><li>Signs </li></ul><ul><ul><li>Poor vision </li></ul></ul><ul><ul><li>Abnormal head posture </li></ul></ul>
    38. 40. Management for squint <ul><li>Refer to ophthalmologist (urgent) </li></ul><ul><ul><li>Treatment of refractive errors </li></ul></ul><ul><ul><li>Treatment of amblyopia (lazy eye) </li></ul></ul><ul><ul><li>Ocular exercise </li></ul></ul><ul><ul><li>Surgery – mucsle imbalance </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Amblyopia (Lazy eye) </li></ul></ul><ul><ul><li>Loss of binocular single vision </li></ul></ul><ul><ul><li>Cosmetic blemish </li></ul></ul>
    39. 41. REFRACTIVE ERROR <ul><li>Physiological condition whereby the refracting system of the eye does not focus objects on the retina </li></ul><ul><li>A corrective lens has to be placed in front of the eye to enable a sharp image to be seen. </li></ul>
    40. 42. <ul><ul><li>Myopia </li></ul></ul><ul><ul><li>Hyperopia </li></ul></ul><ul><ul><li>Astigmatism </li></ul></ul>Refractive errors
    41. 43. Refractive errors <ul><li>Various presentations: </li></ul><ul><ul><li>Squeezing eyes </li></ul></ul><ul><ul><li>Squint </li></ul></ul><ul><ul><li>Headache – ocular/ frontal/ diffuse </li></ul></ul><ul><ul><li>Tearing </li></ul></ul><ul><ul><li>Complains of tired eyes </li></ul></ul><ul><ul><li>Child is slow at school </li></ul></ul><ul><ul><li>Has problems with attentiveness </li></ul></ul><ul><ul><li>Strong family history of myopia or other refractive error </li></ul></ul><ul><li>Importance: Untreated or undertreated will cause AMBLYOPIA </li></ul>
    42. 44. <ul><li>Visual acuity screening in schools </li></ul><ul><ul><li>Performed in Standard 1 </li></ul></ul><ul><ul><li>Referral to Ophthalmologist/Optometrist </li></ul></ul>Refractive errors
    43. 45. Amblyopia <ul><li>‘ Lazy eye’ </li></ul><ul><li>Definition: </li></ul><ul><ul><li>Unilateral/ bilateral decrease of best corrected visual acuity </li></ul></ul><ul><ul><li>Is potentially reversible during the critical period (before 7-9 years old) </li></ul></ul>
    44. 46. Critical period: Why is visual development important? <ul><li>Sensory function continues to develop after birth </li></ul><ul><li>Requires proper visual stimulation </li></ul><ul><ul><li>Normal vision – receptive cells, clear media and normal retina </li></ul></ul><ul><ul><li>Normal alignment </li></ul></ul><ul><ul><li>Normal brain development </li></ul></ul>
    45. 47. How does amblyopia develop? <ul><li>Brain receives stimuli from both eyes </li></ul><ul><li>Child’s maturing brain will select the better image and ignore the blurry image </li></ul><ul><ul><ul><li>Vision not properly developed in the bad eye (AMBLYOPE) </li></ul></ul></ul>
    46. 48. Causes of amblyopia <ul><li>Ammetropia (bilateral high refractive error) </li></ul><ul><li>Anisometropia (large/ asymmetrical refractive error difference between eyes) </li></ul><ul><li>Strabismic (squint) </li></ul><ul><li>Occlusional / form deprivation (media problem) </li></ul>
    47. 49. Treatment <ul><li>Can be treated or reversed if detected earlier (critical period) </li></ul><ul><li>Treat underlying condition – cataract, squint </li></ul><ul><li>Prescribe spectacles correction – refractive error </li></ul><ul><li>Force to use the amblyopic eye </li></ul><ul><ul><li>Patching the good eye </li></ul></ul><ul><ul><li>Putting atropine eye drops to blur image in the good eye </li></ul></ul>
    48. 50. Visual pathway
    49. 51. <ul><li>As a result of the damage to the brain. </li></ul><ul><ul><li>Cerebral palsy </li></ul></ul><ul><ul><li>Seizure disorder </li></ul></ul><ul><ul><li>Hydrocephalus, Microcephaly </li></ul></ul><ul><li>Infants and children with cortical vision impairment </li></ul><ul><ul><li>Delayed in reaching developmental milestones </li></ul></ul><ul><ul><li>Sensory motor & activities and social development. </li></ul></ul><ul><ul><li>Intellectual disability </li></ul></ul>Cortical visual impairments
    50. 52. <ul><li>The process of treatment and education that helps individuals who are visually disable </li></ul><ul><li>attain maximum function, </li></ul><ul><li>a sense of well being, </li></ul><ul><li>a personally satisfying level of independence, </li></ul><ul><li>optimum quality of life. </li></ul>Visual Rehabilitation
    51. 53. <ul><li>OPTICAL DEVICES </li></ul><ul><li>NON OPTICAL DEVICES </li></ul><ul><li>HOLISTIC APPROACH </li></ul><ul><ul><li>Clinicians – ophthalmologist, peadiatrician, optometrist </li></ul></ul><ul><ul><li>Teachers, Education ministry </li></ul></ul><ul><ul><li>Occupational therapist </li></ul></ul><ul><ul><li>Counsellors : psychologist, psychiatrist, social worker </li></ul></ul><ul><ul><li>Vocational Rehabilitation centers </li></ul></ul>Visual Rehabilitation
    52. 54. <ul><li>OPTICAL DEVICES </li></ul><ul><li>Reduced Visual Acuity </li></ul><ul><ul><li>Magnification for near </li></ul></ul><ul><ul><li>Magnification for distance </li></ul></ul><ul><li>Central visual field defect </li></ul><ul><li>Peripheral visual field defect </li></ul><ul><li>Reduced contrast sensitivity </li></ul><ul><li>Glare sensitivity </li></ul>Visual Rehabilitation
    53. 55. HAND HELD MAGNIFIERS MAGNIFICATION FOR NEAR STAND MAGNIFIERS SPECTACLE-MOUNTED MAGNIFIER CLOSE-CIRCUIT TELEVISION SYSTEM
    54. 56. TELESCOPE MAGNIFICATION FOR FAR
    55. 57. TREATMENT OF CENTRAL VISUAL FIELD LOSS MODIFIED TEXT <ul><li>Training for eccentric viewing- avoid fixating using the fovea </li></ul><ul><li>Using large print material </li></ul><ul><li>Using prism relocation </li></ul>
    56. 58. TREATMENT OF PERIPHERAL VISUAL FIELD LOSS MIRROR PRISMS <ul><li>Acts like a side mirror of a car </li></ul><ul><li>Able to view objects at the non-seeing area of the eye when glancing into the mirror or prism </li></ul>
    57. 59. TREATMENT FOR REDUCED CONTRAST SENSITIVITY AND GLARE TINTED LENSES COLOUR CONTRAST TYPOSCOPE : reduce reflected glare from printed pages
    58. 60. <ul><li>NON-OPTICAL METHODS </li></ul><ul><li>Move CLOSER : use an angled reading desk </li></ul><ul><li>Use COLOUR to show objects more clearly </li></ul><ul><li>Use CONTRAST : eat white rice off a coloured plate </li></ul><ul><li>Pay attention to LIGHTING : sit near a window in class </li></ul><ul><li>Make objects LARGER: write with larger letters </li></ul><ul><li>Use a LINE-GUIDE such as a ruler when reading and writing. </li></ul>Visual Rehabilitation
    59. 61. <ul><li>Prognosis for success depends on: </li></ul><ul><ul><li>Ocular condition </li></ul></ul><ul><ul><li>Vision loss – nature & extent </li></ul></ul><ul><ul><li>Patient – physical & mental abilities, attitude, expectation, motivation </li></ul></ul><ul><ul><li>Clinician – attitude & motivation </li></ul></ul>Visual rehabilitation
    60. 62. <ul><li>THANK YOU </li></ul>
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