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

  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
  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: 40