Low Vision Rehabilitation/What is low vision and low vision rehabilitation?
Your first patient at See Well Australia is Mrs Thelma Scope. Through working with Mrs Scope you will come to understand the concept of low vision and the impact of eye disease when treatment is no longer an option. You will be exposed to the roles and approaches of a range of professionals who might work with a patient with vision impairment. You will be challenged to determine your role as an Orthoptist in this multidisciplinary environment.
There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer. You should spend around 6-8 hours with this topic.
Question[edit | edit source]
What is the impact of eye disease on how you see and how you feel? Who can help you with the challenges you will face as a vision impaired person?
Use the scenarios and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions.
Case studies[edit | edit source]
Primary case study:
Mrs Thelma Scope - coping with vision loss
Supplementary case studies:
- A group of elderly ladies with bilateral AMD
- A young woman with Stargardt disease
- A variety of patients: Edith Wright; Mark Bollinger; Jack Tomazetti; Barry Gentle; Peter Brown; Margaret Moriartis and Martin Skase
Mrs Thelma Scope is a patient at See Well Australia. Through Mrs Scope you will come to understand what low vision is, how it is defined and what it means to have an impairment. In addition, you will consider the epidemiology and impact of low vision in Australia.
Activities[edit | edit source]
Task 1 (Keywords: #low vision #vision impairment #legal blindness)
Watch the What is Low Vision? lectorial where you will find out about your new patient Mrs Thelma Scope.
Consult the resources below in addition to finding your own resources to answer the Task 1 questions. When answering the questions, think about what you know so far about Mrs Scope. Discuss and compare your answers with the students in your group.
Questions - Task 1
- Why is it important to a patient that we define disability or vision impairment?
- How does the World Health Organization (WHO) define ‘low vision’
- According to the WHO definition, can you classify Mrs Scope as having ‘low vision’?
- What is the definition of ‘impairment’? How does this definition specifically relate to vision?
- Do you think Mrs Scope has an ‘impairment’? Discuss.
- Define ‘disability’ and explain how this relates to the sense of vision.
- Do you think Mrs Scope is disabled? Explain why/why not.
- Define ‘handicap’ and explain whether this definition can be applied to Mrs Scope.
- Do you think you have enough information about her case history in order to classify Mrs Scope as either having impairment, disability or handicap? What other information would you need?
Task 2 (Keywords: #economic cost #financial impact #direct & indirect costs)[edit | edit source]
Referring to the Eye Research Australia (Clear Insight) Economic Impact and Cost of Low Vision in Australia publication, answer Task 2 questions. Don't forget to consider your patient Thelma when answering the questions.
Questions - Task 2
- Of a composition of the total cost of vision disorders in 2004, what is the total cost of suffering? What do you think “cost of suffering” means? Explain your answer in the context of Mrs Scope.
- On page 4 of the report it states: “the share of pharmaceutical costs has increased to 11.4% of the total and of ‘other health practitioners’ to 10.6%. Why would this be so? What would contribute to this?
- There are significant indirect costs associated with vision impairment. In the context of Mrs Scope, explain how each indirect cost could impact on her life.
- Mrs Scope is 73 years old and she is expected to live quite a few more years, especially as she is generally healthy. What are the most likely reasons that her vision impairment would prevent healthy and independent ageing in her case?
- What are the top 3 causes of blindness in people aged over 40 in Australia?
- What age groups are most pre-disposed to each of the 3 causes you selected?
- What are the projected forecasts for visual impairment and blindness in Australia for the future?
- Why is addressing vision impairment a serious issue in this country?
Task 3 (Keywords: #visual function #blurry vision #central field loss #peripheral field loss)[edit | edit source]
Next, we will analyse the likely impact of a particular ocular disease on a person’s visual function. You will also consider the impact vision impairment might have on a person's social interactions and general well-being. You will therefore be able to discuss the psychosocial and physical impacts related to different forms of vision impairment.
Begin by watching this introductory video
Task 4[edit | edit source]
Watch the three short lectorials on the three areas of functional vision loss and answer the related questions.
- Blurred vision
- Central field loss
- Peripheral field loss
Questions - Task 4
1. Blurred vision no field loss:
- What are the ocular structures involved?
- What is the function of these structures?
- Explain in terms of these functions the impact these types of eye diseases or systemic conditions will have on sight.
2. Central field loss:
- What is the ocular structure involved?
- What is the function of this structure?
- Explain in terms of these functions the impact on sight of disease impacting this part of the eye.
3. Peripheral field loss:
This is the most complex area in relation to function and can be considered as disseminated or scattered field loss, hemianopia or half field loss and severely constricted field loss.
- What structures of the vision pathway might be impacted?
- What is the function of these structures?
- Explain in terms of these functions the impact on sight.
[edit | edit source]
Listen to the two audio recordings of patients from See Well Australia who have vision impairment. They are describing the impact of the impairment on their lives.
- Audio 1 - group of elderly ladies
- Audio 2 - younger patient with Stargardt disease
After you have listened to the recordings, work through the questions below.
|Questions - Audio interviews|
Meet Mrs Kirkman, Mrs Muirhead and Mrs Sevoir.
All are older women who have bilateral AMD that has progressed to the wet phase - all are legally blind. Mrs Kirkman is a widow who also has significant hearing loss, she wears hearing aids. Mrs Muirhead is also a widow she lives in a large rural city. Mrs Sevoir is married and living with her husband in metropolitan Melbourne.
As you listen to their stories make notes on the following:
Now meet Lesley a young woman in her 30’s. She is legally blind due to Stargardt Disease. Lesley lives alone in an inner Melbourne suburb.
As you listen to Lesley’s story make notes about the following questions:
Consider the differences in response and impact between Lesley and the older ladies. Discuss your answers with your group and try to provide answers to all of the above questions.
Task 2 utilises case studies and additional materials that will allow you to consider the impact of sight loss on social and emotional wellbeing.
Watch the interview with Krister Inde Support needed when one loses his or her vision
Once you have watched Krister's movie, work through the questions below. Refer to Krister Inde's book See bad feel good.
|Questions - See bad feel good|
1. The following passage has been taken from Krister Inde’s book See Bad Feel Good, an autobiographical account of sight loss. Discuss the following statements and think
about what they are telling you of Krister’s response to his diagnosis.
Impact of Ocular Disease (visual)[edit | edit source]
What is the impact of eye disease and refractive error on vision? Use the MSD Ophthalmics Vision Simulator to help you answer this question.
Watch the lectorials to consolidate your understanding of the themes presented in Task 1:
- Loss of macular function
- Loss of peripheral retinal function
- Pathologies that impact the clear media
Multi-disciplinary approach[edit | edit source]
Working with your group, research the following professions and what their role in low vision rehabilitation is. In your discussion, include some scenarios of when it would be useful to refer a patient to one of these professionals.
- Low Vision Therapist
- Occupational Therapist
- Orientation and Mobility Instructor
- Social Worker
- Special Education Teacher (Vision Impaired)
Next, watch the lectorial on the role of the Orthoptist in vision rehabilitation. (Needs developing)
Other resources & links
In your group, work through the following case studies related to functional impact of sight loss & multi-disciplinary intervention, which require you to analyse information and then discuss the likely functional impact associated with each case. You will then determine the appropriate professionals to assist in the management of each patient.
|Case Study 1 - Edith Wright|
Edith Wright is 70 years old. She has been diagnosed age-related macular degeneration (AMD).
|Case Study 2 - Mark Bollinger|
A referral comes to you from the visiting teacher service, asking you to assess a 17 year old boy who has been recently diagnosed with Leber's optic atrophy. Mark presents as a mature and intelligent young man. The history is of a sudden onset, bilateral centre field loss.
|Case Study 3 - Jack Tomazetti|
Jack is a 17 year old boy who had acid thrown in his face in a classroom fight and has severe corneal scarring as a result. Jack's vision is reduced to 6/24 bilaterally. He is hoping to gain an apprenticeship in the building industry and has a prospective employer.
|Case Study 4 - Barry Gentle|
Mr Gentle has been completely devastated by the sudden loss of vision in his left eye. He has given up any hope of retaining some independence and is prepared to rely on his wife totally. Mrs Gentle has always looked after the household and is prepared to do anything for her husband, but she has cataracts and her vision is now reduced to Visual Acuity R) 6/18 L) 6/ 12.
|Case Study 5 - Peter Brown|
Peter is a 23 year old university student who is studying accounting. Peter has significantly reduced visual fields due to retinitis pigmentosa (RP), he was first diagnosed with this disorder when he was 7 years old. Peter’s father also has RP.
Visual Acuity R&L) 6/ 6, Near n5
|Case Study 6 - Margaret Moriartis|
Margaret is a 50 year old type 2 diabetic. She has a demanding job and is inclined to miss lunch and buy take away for her evening meal. She currently takes tablets which she often forgets when racing out in the morning. Her GP has warned that if she does not reduce her blood sugar she will be put on insulin.
|Case Study 7 - Martin Skase|
Martin is a 45 year old business man who has suffered a stroke impacting his right temporal lobe. Martin is married with two teenage children.
Resources and help[edit | edit source]
- Focus on Low Vision is an excellent publication by the Centre for Eye Research which will be useful to complete all the topics in this enquiry. You should refer to it often.