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Lv presentation (final)



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  • 1. LOW VISION PRESENTATIONQuestion 6 & 7
    Prepared by :
    Ting Kiet Han
    Yap Teck Yuen
    Hu Li Ping
    Chang HuiLeng @ Sharon
  • 2. 6. Type of visual training/therapy for asd visually related symptoms
    Correcting refractive error
    • optical should correct the full refractive error as determined with cycloplegic
    • Forcing use of the poorer eye by limiting use of the better eye – occlusion of the better eye
    • 3. To patch dominant eye if there is a fixation preference. Aim to alternate the squint
    Optical penalization - cycloplegic drugs
  • 4. Strabismus
    Distance Exotopia
    Vision Therapy
    • Used if angle of deviation < 20 ∆ diopters
    • 5. Antisuppresion exercise –enable appreciation of pathological diplopia
    • 6. +vefusional range improved with prism
    • 7. Synopthophore exercise
    • 8. +ve relative convergence improved with stereogram (near fixation)
    • 9. Bino. convergence improved with convergence exercise
    Adding Minus Lens
    • up to -3.00DS to stimulate convergence by inducing accommodation
    • 10. to reduce the power of lens gradually until treatment can be discontinued
  • Prisms (Base In)
    • Only good for small angle deviation (<10 PD)
    • 11. Used pre-operatively to obtain control & often combined with orthoptic exercise
    • 12. Prism should be worn constantly and the strenght of the prism should be gradually reduced over several weeks
    Tinted Glasses
    • For patient who are photophobic
    • 13. Reducing the amount of light entering the eye can improve patient’s control over exotropia
    • Penci-to-nose exercise
    • 14. This so-called push-up is repeated 10 times, 2-4 times a day, until the patient is able to hold fixation to the tip of the nose.
    *Be Caution :While doing the pencil push-ups exercise it is important that you do not strain your eyes while looking at the pencil. Straining your eyes causes accommodative insufficiency.
  • 15. Ambient lenses or Yoked prisms
    Also known as conjugate prisms or performance or transitional lenses which can be used to help modify ambient vision
    They are special lenses that bend light in the same direction: up, down, left or right
    They are used to improve posture, head-tilt, and coordination is autistic youngsters
    These lenses can have dramatic results by creating a difference in how the world is seen and allows the person to change how their world is perceived
  • 16. Ambient lenses or Yoked prisms
    During visual evaluation, an activity such as throwing and catching a ball, walking up and down stairs may be done
    While wearing different powers of yoked lenses, the same activity is repeated and evaluated
    Yoked prisms may be prescribed for special activities or for full time wear
  • 17. Trying out yoked prisms
    Try five prism dioptres of yoked prism in several different directions to elicit an improvement in walking, sitting down and even playing catch
    If one direction works best, introduce a lower amount into the spectacle prescription
    Yoked prism alters the oculomotor state, affecting sensory function
  • 18. Irlen Lenses
    Is a non-invasive technology that uses colored overlays and filters to improve the brain's ability to process visual information
    It improves an individual’s behavior and/or reading ability by filtering out those frequencies of the light spectrum to which the individual is uniquely sensitive
    It can improve reading fluency, comfort, comprehension, attention, and concentration while reducing light sensitivity
    It is not a method of reading instruction but a color-based technology that filters out offensive light waves so that the brain can accurately process visual information
  • 19. Rapid Eye Movement Therapy (R.E.M)
    It is a non-evasive technique
    The therapist has an object (a stick or a wand) for the patient to focus on, and quickly moves it back and forth, in various eye levels and positions to simulate the movement and fluttering of R.E.M.
    The therapist then gives commands to the patient to release the traumas and emotions that are surfacing, and these are released via the eyes through rapid blinking
  • 20. Attention Training
    The use of overcorrection avoidance to increase the eye contact of autistic children.
    Functional movement training (an overcorrection procedure) plus edibles and praise to develop eye contact.
    With the overcorrection procedure, the child is given food and praise when eye contact occurres within 5 sec of the therapist's verbal prompt: "Look at me."
  • 21. Question 7
    Social gaze looking
    Also known as social avoidance
    The autistic child simply chose not to focus on a particular face and gaze randomly
    Autistic child always seemed to be ‘looking through you’ rather than ‘at you’
    Their eyes were working independently, rather than together (depth perception), so they see two pictures instead of one (double vision)
    In order to avoid visual strain, they choose to look away
  • 22. How To Develop Social Gaze Looking??
    Develop and maintain eye contact
    Observe if the child makes eye contact with you and if he/she does, note how long he/she could maintain it
    (This can be your basis of improvement)
    Make it easy for your child to make eye contact with you by positioning your face or your eyes at his/her eye level.
    Play with their toys at eye level. This will also help improve eye contact.
    Eg: If they are lying on the floor, you get on the floor
    Call for the child’s attention often and don’t be afraid to ask the child to look at you
    Signal them to look at your eyes while talking with them
    Positively reinforce eye contact by praising child for looking at you when they talk
    Eg: Tell them that they are good (Praise them)
  • 23. Steps To Improving Eye Contact To Overcome Social Gaze Looking
    STEP 1
    • Point to your nose when talking by drawing their attention to your face by touching your nose with your finger as you start to talk
    • 24. This signals children to look at you when you talk
    • 25. If the child looks away signal them again by pointing to your nose while talking.
    • 26. This may look silly but getting into this habit can help in improving eye contact for children with autism
  • STEP 2
    • Using verbal cues can go a long way to maintaining, sustaining and improving eye contact for children with autism
    • 27. Constantly and frequently remind child to pay attention to you
    • 28. Give instructions to child by calling him/her by name and by asking them to look at you
    • 29. Compliment this by the physical movement of signaling them to look
    Eg: ‘This is important’, ‘listen carefully’, ‘let me repeat’, ‘you need to remember’
  • 30. STEP 3
    • Guiding child’s glance
    • 31. It means to gently guide child’s head so that their face looks up at yours
    • 32. Reinforce this positive eye contact with the use of smiling and praise
    • 33. This is best for children who have difficulty understanding verbal cues and who would prefer physical touch over visual and verbal stimuli
  • STEP 4
    • Be consistent
    • 34. Consistency is part of teaching the child a new skill
    • 35. It helps in improving eye contact for children with autism by repetition and positive reinforcement
    Eg: The child will be given food and praise when eye contact occurred within 5 sec of the therapist's verbal prompt, "Look at me."
  • 36. Vision evaluation of persons with autism varies depending on their developmental, emotional and physical level
    Vision evaluation includes visual acuity, eye tracking and fixations, depth perception, colour vision, eye teaming and focusing, the presence of ametropia, eye health and visual fields
    Due to the variable nature of autism, patient response to treatment also varies
    Children with less severe autism and better cognitive abilities may respond better than those with more limited capabilities
    Approximately 15% of patients can achieve a reasonable amount of self-sufficiency as adults, and another 15% to 20% function with minimal support
  • 37. What to do??
    Creativity is key!
    Don’t be surprised if the examination requires multiple visits to get all the desired information
    Snellen acuities may not be an option, but tumbling E’s, Randolt C’s, and even Teller preferential acuity cards can be used as an alternative
    If the patient is averse to wearing glasses during stereoacuity, use the Lang stereo test, which does not require polarise glasses.
  • 38. Alternative Examination Ways
    Gross motor testing with a colorful toy
    Finger puppets can help to assist in attaining pursuits, saccades, cover test, NPC, binocular indirect and many other exam techniques
  • 39. Alternative Examination Ways
    Extra ocular muscle testing with a light-up toy
    Can also be tested by asking the child to follow or point the direction of a moving penlight
    Eg : Tell the child that the light is a missile and they are playing a missile shooting game
  • 40. Other method
    Working with other professionals such as occupational, speech and language and physical therapists as well as the primary care physician, teachers, reading specialist and of course the parents, optometrists can help to make a difference in these autistic children’s lives