LOWVISIONnystagmus低视力眼球震颤课件

LET’STALK

LOWVISIONSuleimanAlibhai,O.D.

RetinaGroupofWashingtonKristaM.Davis,O.D.,F.A.A.O.

ColumbiaLighthousefortheBlind.LET’STALK

LOWVISIONSuleiman1EyeAnatomy.EyeAnatomy.2DefinitionsLegalBlindnessBestcorrecteddistancevisualacuityof20/200orworseinbettereyeHorizontalvisualfieldof20degreesorlessatwidestpointinthebettereyeLowVisionWorsethan20/60inthebettereyeSignificantfieldlossImpairedfunction.DefinitionsLegalBlindness.3GoalsofLowVision

ManagementIncreasefunctionalityMakethemostoftheremainingvisionProvidelinktocommunityresourcesandsupportservicesEducation.GoalsofLowVision

Management4CommonConditionsMacularDegenerationGlaucomaDiabeticRetinopathyStroke/braininjuryRetinitispigmentosaOpticNervediseaseAlbinismNystagmusCorticalVisualImpairment.CommonConditionsMacularDegen5FunctionalEffectsof

LowVisionLossofcentralvision(visualacuity)Lossofperipheralvision(visualfield)

Glareandcontrast.FunctionalEffectsof

LowVis6IssuesRelatedto

DecreasedAcuityDifficultyreadingProblemswriting/completingpaperworkInabilitytorecognizedistanceobjectsandfaces.IssuesRelatedto

DecreasedA7IssuesRelatedto

VisualFieldLossLocationofscotomaimportant!GeneralizedlossofvisualfielddifficulttocompensateforMobilityandindependenttravelReadingmayrequireadaptations.IssuesRelatedto

VisualField8IssuesRelatedtoContrastNeedforadditionallightingProblemswithglareIncreasedadjustmenttochangesinilluminationVisualdiscomfortandfatigue.IssuesRelatedtoContrastNeed9ExamSequenceHistory/intakeVisualacuityVisualfieldtestingPupilsExtraocularmuscletestingRefractionColorvisionandContrastTestingOcularHealth.ExamSequenceHistory/intake.10TypesofAcuityChartsDistanceSnellen(projection)Feinbloom/SOSHETDRSLeaSymbolsNearSingleletterContinuoustext.TypesofAcuityChartsDistance11DistanceCharts.DistanceCharts.12NearCharts.NearCharts.13InterpretingNearAcuityThresholdacuityDifferencebetweensingleletterandcontinuoustext1.0M=20/50=8-10pointfontNeedtolookatworkingdistanceJaegerchartsnonstandardTypicalsizesNewspaper=1.0MChildren’sbooks=1.2–1.6MLargeprint=1.6–2.0MNewspaperheadlines=4.0–5.0M.InterpretingNearAcuityThresh14VisualFieldTestingConfrontationArcperimeterVisionDiscAutomatedperimetryGoldmannperimetry.VisualFieldTestingConfrontat15ColorandContrastTestsIshiharaColorVisionTestingMadeEasyD-15Pelli-RobsonVistechContrastSystemMr.HappyHidingHeidi.ColorandContrastTestsIshiha16ColorVisionTests.ColorVisionTests.17ContrastTests.ContrastTests.18MagnificationEnlargesimageonretinatostimulatemoreretinalcellsCanbeachievedinmanywaysRelativeDistanceRelativeSizeOptical/AngularElectronic.MagnificationEnlargesimageon19LowVisionDevicesDistanceNearFieldenhancementNon-optical.LowVisionDevicesDistance.20DistanceDevicesHandheldtelescopesMountedtelescopesElectronicsystems.DistanceDevicesHandheldtele21Telescopes.Telescopes.22ElectronicDistanceSystems.ElectronicDistanceSystems.23NearDevicesSpectaclesPrismatic½eyesFull-fieldmicroscopesMagnifiersHandheldvs.standIlluminatedvs.non-illuminatedTelemicroscopesElectronicDevices.NearDevicesSpectacles.24SpectacleMicroscope.SpectacleMicroscope.25NearLoupe.NearLoupe.26HandHeldMagnifiers.HandHeldMagnifiers.27StandMagnifiers.StandMagnifiers.28ElectronicMagnifiers.ElectronicMagnifiers.29Non-opticalDevicesGlarereductiondevicesContrastenhancementdevicesComputersoftwareAccessorydevicesTalkingwatches,clocks,etcWritingguidesTactilemarkers.Non-opticalDevicesGlarereduc30GlareandContrast.GlareandContrast.31Lighting.Lighting.32OtherNon-opticalDevices.OtherNon-opticalDevices.33AdaptiveComputer

Equipment.AdaptiveComputer

Equipment.34AdditionalServicesOrientationandmobilitytrainingIndependentlivingskillstrainingSupportgroupsBrailleinstructionComputertrainingGeneticcounseling.AdditionalServicesOrientation35CommunityResourcesSupportgroupsParatransitServicesBooksontapeAudiodescribedperformancesTactiletoursLargeprintpublicationsEducationalservices.CommunityResourcesSupportgro36CommunicationGoalsEducatepatientoneyeconditionHelpthemtounderstandwhatoptionsareavailableandhowtouse/carefortoolsGlassesLowvisiondevicesTechnologyCommunityresourcesEducateparentsandteachers/professionalsonfunctionalimplications.CommunicationGoalsEducatepat37FunctionalImplicationsPrintsizeVisualefficiencyandfatigueMobilityissuesPositioning/classroomplacementLighting/glarereductionneeds.FunctionalImplicationsPrints38LET’STALK

LOWVISIONSuleimanAlibhai,O.D.

RetinaGroupofWashingtonKristaM.Davis,O.D.,F.A.A.O.

ColumbiaLighthousefortheBlind.LET’STALK

LOWVISIONSuleiman39EyeAnatomy.EyeAnatomy.40DefinitionsLegalBlindnessBestcorrecteddistancevisualacuityof20/200orworseinbettereyeHorizontalvisualfieldof20degreesorlessatwidestpointinthebettereyeLowVisionWorsethan20/60inthebettereyeSignificantfieldlossImpairedfunction.DefinitionsLegalBlindness.41GoalsofLowVision

ManagementIncreasefunctionalityMakethemostoftheremainingvisionProvidelinktocommunityresourcesandsupportservicesEducation.GoalsofLowVision

Management42CommonConditionsMacularDegenerationGlaucomaDiabeticRetinopathyStroke/braininjuryRetinitispigmentosaOpticNervediseaseAlbinismNystagmusCorticalVisualImpairment.CommonConditionsMacularDegen43FunctionalEffectsof

LowVisionLossofcentralvision(visualacuity)Lossofperipheralvision(visualfield)

Glareandcontrast.FunctionalEffectsof

LowVis44IssuesRelatedto

DecreasedAcuityDifficultyreadingProblemswriting/completingpaperworkInabilitytorecognizedistanceobjectsandfaces.IssuesRelatedto

DecreasedA45IssuesRelatedto

VisualFieldLossLocationofscotomaimportant!GeneralizedlossofvisualfielddifficulttocompensateforMobilityandindependenttravelReadingmayrequireadaptations.IssuesRelatedto

VisualField46IssuesRelatedtoContrastNeedforadditionallightingProblemswithglareIncreasedadjustmenttochangesinilluminationVisualdiscomfortandfatigue.IssuesRelatedtoContrastNeed47ExamSequenceHistory/intakeVisualacuityVisualfieldtestingPupilsExtraocularmuscletestingRefractionColorvisionandContrastTestingOcularHealth.ExamSequenceHistory/intake.48TypesofAcuityChartsDistanceSnellen(projection)Feinbloom/SOSHETDRSLeaSymbolsNearSingleletterContinuoustext.TypesofAcuityChartsDistance49DistanceCharts.DistanceCharts.50NearCharts.NearCharts.51InterpretingNearAcuityThresholdacuityDifferencebetweensingleletterandcontinuoustext1.0M=20/50=8-10pointfontNeedtolookatworkingdistanceJaegerchartsnonstandardTypicalsizesNewspaper=1.0MChildren’sbooks=1.2–1.6MLargeprint=1.6–2.0MNewspaperheadlines=4.0–5.0M.InterpretingNearAcuityThresh52VisualFieldTestingConfrontationArcperimeterVisionDiscAutomatedperimetryGoldmannperimetry.VisualFieldTestingConfrontat53ColorandContrastTestsIshiharaColorVisionTestingMadeEasyD-15Pelli-RobsonVistechContrastSystemMr.HappyHidingHeidi.ColorandContrastTestsIshiha54ColorVisionTests.ColorVisionTests.55ContrastTests.ContrastTests.56MagnificationEnlargesimageonretinatostimulatemoreretinalcellsCanbeachievedinmanywaysRelativeDistanceRelativeSizeOptical/AngularElectronic.MagnificationEnlargesimageon57LowVisionDevicesDistanceNearFieldenhancementNon-optical.LowVisionDevicesDistance.58DistanceDevicesHandheldtelescopesMountedtelescopesElectronicsystems.DistanceDevicesHandheldtele59Telescopes.Telescopes.60ElectronicDistanceSystems.ElectronicDistanceSystems.61NearDevicesSpectaclesPrismatic½eyesFull-fieldmicroscopesMagnifiersHandheldvs.standIlluminatedvs.non-illuminatedTelemicroscopesElectronicDevices.NearDevicesSpectacles.62SpectacleMicroscope.SpectacleMicroscope.63NearLoupe.NearLoupe.64HandHeldMagnifiers.HandHeldMagnifiers.65StandMagnifiers.StandMagnifiers.66ElectronicMagnifiers.ElectronicMagnifiers.67Non-opticalDevicesGlarereductiondevicesContrastenhancementdevicesComputersoftwareAccessorydevicesTalkingwatches,clocks,etcWritingguidesTactilemarkers.Non-opticalDevicesGlarereduc68GlareandContrast.GlareandContrast.69Lighting.Lighting.7