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Low Vision Managment, Age Related Macular Degeneration ARMD

Low vision management of age-Related macular degeneration.

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Low Vision
Management in Age
Related Macular
Degeneration
Mr. Mahendra Singh
PhD (Scholar) M.Optom, FLVPEI (Hyd)
Assistant Professor and consultant Optometrist.
CL Gupta Eye Institute. UP India
DEFINITION
 ARMD is defined as the Presence of
some degree of visual loss in
association with Drusen and
geographical atrophy of RPE or
changes associated with sub retinal
neo vascularisation in individual over
50 yrs of age
DEMOGRAPHICS
AMD
•1998 approximately 8.3
on people over the age
of 65 in England
and Wales
–4.3 million have impaired
vision
–AMD is the leading
cause in over 65s
By 2020
–A 25% increase in the
over 65 population is
expected
–Incidence of ARMD
expected to rise by 31%
Types of ARMD
 Atrophic(Dry,Non-exudative): It is the most
common slowly Progressive disease
characterised by Drusen and geographic
atrophy of RPE
 Exudative(Wet,Neovascular):Less common
but devastating is characterised by
choroidal neovascularization and subretinal
scarring
Drusen
 It is an asymtomatic yellow
excrescences beneath the RPE
 Dusen are rarely clinically visible
before the age of 45 yrs
Types of Drusens
 Hard Drusen : They are small,round
discrete yellow white spots which are
associated with focal dysfunction of
RPE
 Soft Drusen : They are larger and have
indistinct margins
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Low Vision Managment, Age Related Macular Degeneration ARMD

  • 1. Low Vision Management in Age Related Macular Degeneration Mr. Mahendra Singh PhD (Scholar) M.Optom, FLVPEI (Hyd) Assistant Professor and consultant Optometrist. CL Gupta Eye Institute. UP India
  • 2. DEFINITION  ARMD is defined as the Presence of some degree of visual loss in association with Drusen and geographical atrophy of RPE or changes associated with sub retinal neo vascularisation in individual over 50 yrs of age
  • 3. DEMOGRAPHICS AMD •1998 approximately 8.3 on people over the age of 65 in England and Wales –4.3 million have impaired vision –AMD is the leading cause in over 65s By 2020 –A 25% increase in the over 65 population is expected –Incidence of ARMD expected to rise by 31%
  • 4. Types of ARMD  Atrophic(Dry,Non-exudative): It is the most common slowly Progressive disease characterised by Drusen and geographic atrophy of RPE  Exudative(Wet,Neovascular):Less common but devastating is characterised by choroidal neovascularization and subretinal scarring
  • 5. Drusen  It is an asymtomatic yellow excrescences beneath the RPE  Dusen are rarely clinically visible before the age of 45 yrs
  • 6. Types of Drusens  Hard Drusen : They are small,round discrete yellow white spots which are associated with focal dysfunction of RPE  Soft Drusen : They are larger and have indistinct margins
  • 8.  Only 10 % of Patients have exudative form whereas have 90% Patients have Non-exudative form
  • 9. Quality of Vision in ARMD  Central Scotoma as shown in the Picture
  • 11. Risk factors  Most Prevalent in caucasian  Genetic and environmental factor modify the risk of Visual loss  Cigaratte smoking is the only modifiable risk factor
  • 12. Functional implications of Symptoms  Effect of disease causing a central field defect is a scotoma at or near fixation  Symptoms vary on the number size.location and the density of the scotoma
  • 13.  Difficulty seeing in central visual field details for Distance,Intermediate and Near task  Common complain deal with reading print,recognising faces and reading signs
  • 14. Problems in Daily Activities  Increased morbidity / falls / fractures  Increased road accidents  Increased anxiety & depression  Poorer self care & independence  Greater need for community & institutional resources  Social isolation - quality of life  Loss of income
  • 15. Functional test  Visual Acuity : 20/40 to 20/1000  Amsler grid may demonstrate distortion or scotoma or be normal
  • 16. Impaired Contrast  High and mild frequency retention of low frequency loss can predict response to magnification  Mid and low frequency loss extra magnification needed
  • 17.  Severe loss : Optical magnification of little benefit,CCTV may be a only useful reading aid  Visual field testing is useful to establish the extent and location of Scotoma Glare test : Not necessary unless patient has cataract or corneal pathology
  • 18. Evaluation of ARMD Patients  Refraction : A careful refraction is always important since even a modest increase in best corrected acuity may translate a large improvement in reading performance
  • 19.  In case of good acuity proper spectacle Rx with an increased add  Light and glare control : Increased illumination usually improves contrast and reduces the amount of magnification needed for a given task in the Presence of relative scotoma
  • 20. Management  Patient with macular degeneration benefit from most rehabilitation strategies  Early disease require a proper refraction,increased add and improved lightening in order to read
  • 21.  Disease progresses acuity and contrast sensitivity worsens and patient may adopt a eccentric viewing strategies  Different amount of magnification may be needed for different task but the goal should be to prescribe the least magnification and the widest field possible
  • 22. Magnification  Increase magnification and illumination are the main strays of therapy  All types of magnification devises may be used for reading including spectacles,hand and stand magnifiers and CCTV
  • 23.  Another possibility is moving the image to the preffered retinal locus(PRL) by a means of a prism position with its apex in the direction of the viable retina  Illuminated stand magnifiers are useful with poor acuity
  • 24. Telescope  Telescope is useful in earlier stages for Distance task wide field,low power,spectacle mounted telescopes may be helpful for watching television,play or sporting events
  • 25. Non Optical devices  Reading Lamp(Long arm adjustable with 60 watts incandescent or 11 watt Fluorescein bulb)  Reading stand  Felt tipped markers
  • 26.  Yellow filters indoors and outdoors  Signature guide  Writing guide  Notex (currency identification)  Needle threader
  • 27. Summary  Proper Counselling  Approach Magnification for Visualizing Distance objects  Head Scanning  Distance vision Glasses  Environment modification to enhance Contrast
  • 28.  Magnifier (Stand, Spectacle or pocket)  Reading Lamp  Reading Stand  Other Non Optical Device which are useful according to need of patient should be Prescribed
  • 29.  It is crucial that patient be introduced to optical devises earlier in the course of their disease  Most patients progress slowly gradual adaptation is possible allowing more complex and more powerful aid to be used later
  • 30. The ‘NEW’ AMD Pathway PATIENT PRESENTS WITH VISUAL PROBLEM AND IS EXAMINED BY COMMUNITY OPTOMETRIST IN TRIAGE CAPACITY – DIFFERENTIAL DIAGNOSIS SELF REFERRAL REFERRED BY ANOTHER CLINICIAN OR CARER OTHER SOURCE NOT ARMD APPROPRIATE CARE AS INDICATED SYMPTOMS SUGGESTIVE OF ARMD ‘DRY’ (NON-NEOVASCULAR) ARMD ‘WET’ (NEOVASCULAR) OR SUSPECTED ‘WET’ ARMD DIRECT REFERRAL TO HES FOR FLUORESCEIN AGIOGRAPHY AND FURTHER INVESTIGATION TREATABLE UNTREATABLE ACCESS TO TREATMENT OPTICAL / OPHTHALMIC LOW VISION SERVICES COUNSELLING SOCIAL SERVICE SUPPORT REHABILITATION BD8/LV1 AS REQUIRED