vision clinic nystagmus低视力门诊眼球震颤课件

Eye Care CenterEye Care Center at the Southern California College of at the Southern California College of OptometryOptometry MaryAnn Walls Low Vision MaryAnn Walls Low Vision CenterCenter Dr. Becky Kammer, ChiefDr. Becky Kammer, Chief 714-449-7415714-449-7415 What is Low Vision?What is Low Vision? Patients may be blind or just partially Patients may be blind or just partially sighted (visually impaired) 20/70 or worse sighted (visually impaired) 20/70 or worse in better eyein better eye Legally Blind is 20/200 or worse with best Legally Blind is 20/200 or worse with best correction on correction on What can Rehabilitative Optometry What can Rehabilitative Optometry do to help?do to help? Help patients see to readHelp patients see to read Help patients see to driveHelp patients see to drive Help patients meet specific vision goalsHelp patients meet specific vision goals Main Rehabilitation GoalMain Rehabilitation Goal Improve independence Improve independence and quality of lifeand quality of life How does the exam flow?How does the exam flow? Patients come for at least 2-3 visits where Patients come for at least 2-3 visits where a full eye exam is given and then devices a full eye exam is given and then devices are introduced to meet goalsare introduced to meet goals First Visit: Team is introduced to patientFirst Visit: Team is introduced to patient Occupational therapistOccupational therapist Student doctorStudent doctor Faculty professor Faculty professor OT will schedule a home evaluation before OT will schedule a home evaluation before patient returns for second visit.patient returns for second visit. Second VisitSecond Visit OT summarizes their home visit for Dr. OT summarizes their home visit for Dr. and the second optometric visit is planned and the second optometric visit is planned for the patient.for the patient. More visual goals are evaluated, devices More visual goals are evaluated, devices are orderedare ordered Possibly more training visits with OT are Possibly more training visits with OT are scheduled in the meantimescheduled in the meantime Dispensing VisitDispensing Visit Patients glasses or devices are given to Patients glasses or devices are given to patient and basic training in office is patient and basic training in office is providedprovided OT schedules 2-4 more home visits to OT schedules 2-4 more home visits to make sure patient uses device correctly make sure patient uses device correctly and is using residual vision correctly and is using residual vision correctly (eccentric viewing training if needed)(eccentric viewing training if needed) OT reports back to Dr. for follow upOT reports back to Dr. for follow up EXAM COMPONENTSEXAM COMPONENTS Case historyCase history Summarize to obtain basic goalsSummarize to obtain basic goals Sustained Near: Sustained Near: Reading continuous textReading continuous text Spotting Near: Spotting Near: Seeing bills, shoppingSeeing bills, shopping Sustained Distance: Sustained Distance: Watching TVWatching TV Spotting Distance: Spotting Distance: Driving, seeing signsDriving, seeing signs Illumination and Glare: Illumination and Glare: often need often need enhanced contrast indoor, need better enhanced contrast indoor, need better lighting indoorlighting indoor EXAM COMPONENTS EXAM COMPONENTS Functional visual acuitiesFunctional visual acuities Distance VisionDistance Vision Feinbloom chart (Designs of Vision) Feinbloom chart (Designs of Vision) Near VisionNear Vision Single digit chart (M notation Lighthouse Single digit chart (M notation Lighthouse charts)charts) Continuous text chart (M notation - Continuous text chart (M notation - Lighthouse)Lighthouse) EXAM COMPONENTS EXAM COMPONENTS Trial frame refractionTrial frame refraction EXAM COMPONENTS EXAM COMPONENTS Functional visual fieldsFunctional visual fields Several tests available to help determine Several tests available to help determine how much usable vision is presenthow much usable vision is present Nystagmus patients usually have full Nystagmus patients usually have full fieldsfields This is great for rehabilitation processesThis is great for rehabilitation processes EXAM COMPONENTS EXAM COMPONENTS Contrast sensitivityContrast sensitivity Testing is critical for determining if Testing is critical for determining if low contrast objects can be seen in low contrast objects can be seen in dim lightingdim lighting Poor contrast sensitivity may slow Poor contrast sensitivity may slow down reading or cause problems down reading or cause problems driving at nightdriving at night EXAM COMPONENTS EXAM COMPONENTS BinocularityBinocularity Functional considerationsFunctional considerations Depth perception up close (3D)Depth perception up close (3D) Many nystagmus patients have no Many nystagmus patients have no depth perception (or true depth perception (or true binocularity)binocularity) Most Low Vision patients are Most Low Vision patients are functionally monocularfunctionally monocular EXAM COMPONENTS EXAM COMPONENTS Calculations to determine the Calculations to determine the best type of magnification or best type of magnification or modificationsmodifications EXAM COMPONENTS EXAM COMPONENTS A Few Treatment optionsA Few Treatment options Spectacle plane high plus/microscopeSpectacle plane high plus/microscope Loupe Hand magnifier, stand Loupe Hand magnifier, stand magnifier, head mountedmagnifier, head mounted TelescopesTelescopes Electronic devicesElectronic devices Filters/lightingFilters/lighting Glare TreatmentGlare Treatment Various colored Various colored filters (lens tints)filters (lens tints) NoIRNoIR CorningCorning Plastic Photochromic Plastic Photochromic (Chadwick Optical)(Chadwick Optical) Cocoons Cocoons Electronic Magnification: CCTVElectronic Magnification: CCTV Nonoptical aidsNonoptical aids Relative Size Devices:Relative Size Devices: Large Print Large Print BooksBooks Posture and Positioning Devices: Posture and Positioning Devices: Lap Lap boards boards Writing DevicesWriting Devices:Felt tip pens:Felt tip pens Medical Devices: Medical Devices: Talking glucometers Talking glucometers Mobility DevicesMobility Devices: Cane, Dog guide: Cane, Dog guide Sensory Substitution Devices: Sensory Substitution Devices: Talking Talking clocksclocks ReferralsReferrals Orientation and mobilityOrientation and mobility Visual impairment instructor Visual impairment instructor independent living skillsindependent living skills Department of RehabilitationDepartment of Rehabilitation Support Groups/counselingSupport Groups/counseling Braille Institute for ILS classesBraille Institute for ILS classes Whats ne