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Visual Health in Learning Disability NHFN Birmingham

Discover the significance of visual health in individuals with learning disabilities and the impact it has on their safety, wellbeing, and quality of life. Learn about the actions that can be taken to ensure equal access to eye care and improve outcomes.

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Visual Health in Learning Disability NHFN Birmingham

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  1. Visual Health in Learning DisabilityNHFN Birmingham Gordon Ilett Optometrist gordonilett@gmail.com

  2. Disclosure • Partner Linklater Warren Optometrists • Trustee SeeAbility • Co-Director Special Olympics Opening Eyes GB • Councillor Association of Optometrists

  3. Sight • Up to 90% of our sensory information will come from the sense of sight • Most daily tasks are more difficult when vision is impaired • We all tend to assume others perception of their environment is the same as ours

  4. Vision • People with learning disabilities are 10x more likely to have serious sight problems • 60% will need spectacles and may need support to get used to them • 9.3% meet the criteria for sight impaired or serious sight impairment (partial sight or blind) registration • Those with severe and profound learning disabilities are most likely to have sight problems Emerson & Robertson 2011

  5. Questions • Do you know the visual status of all of your service users? • How does undetected visual impairment affect • Safety, health and wellbeing? • Effective allocation of resources? • Will detecting and treating an individuals sight problem reduce the amount of support required? • Can you empower the individual?

  6. Drivers for Change • Valuing People & Valuing People Now • Death by Indifference (Mencap 2007) • ‘Healthcare for All’ (2008) • Must offer ‘equality of care’ Human Rights Act, DDA / EA, ECHR, Mental Capacity Act • Support for GP DES for people with severe and profound LD and maintenance of registers of people with LD on practice lists • Doing the right thing!

  7. The Eye and Vision

  8. Embryology • Human eye starts to develop at 3 weeks gestation • Blood supply from approx 4 months • Retinal blood vessels reach nasal ora at 36 weeks, temporal vessels 40 weeks • Development of eye and visual pathway continues throughout pregnancy and early life. • The eye is an extension of the brain

  9. The Human Eye • Vision – Optic Nerve CN2 • Motor – Oculormotor CN3, Trochlear ON 4, Abducens ON 6 • Sensation Trigeminal • ON 5 http://www.99main.com/~charlief/theeyebg.gif

  10. Development of Acuity

  11. Visual Pathway Retinocalcerine and tectal pathway Lea Hyvärinen

  12. LGN d Parvo Magno Interlaminar Primary Visual Cortex Higher Visual Areas in Cortex Superior Colliculus Pulvinar Retinogeniculate Geniculostrate ‘Traditional’ Pathway’ LGN v Pretectum ‘Primative’ pathways to mid brain and other neuclei Neuclei of Accessory optic tract From Milner & Goodale 2006 Suprachiasmatic nucleus

  13. Cortical Visual Processing • From primary cortex links to visual association areas • Dorsal (Where?) pathway • Ventral (What?) Pathway

  14. The Reading Process • Location of word on page • Accurate accommodation and gaze directed so image on fovea – mid brain and CN 2, 3,4,6 • Image to Brodman’s Area (BA) 17 & 18 (via CN2) • Temp Occipital Cortex BA39 – Structure and form • To BA 21 & 42 Wernicke’s area – phonetic representation • BA 44&45 Broca’s area - speech MRC Cognition and Brain Sciences Unit

  15. Process in reading a word • To read ‘FOX’ • Recognise letters and order – F(1)O(2)X(3) • To lexicon or brains dictionary –recognition of familiar order of letters • Semantic system then associates features with word • Speech output converts word into phonetic sound • Speech generated using motor control of jaw, tongue, voice-box and breathing

  16. Learning Disability and Vision • Neuro-developmental disorder causes LD so all parts of eye and visual development may be affected • Structural defects may be caused by developmental abnormalities • Developmental defects may lead to further structural damage • Behavioural changes may lead to injuries to the eye

  17. Periventricular Leucomalacia • Damage to white matter adjacent to ventricles • Present in up to 25% of pre term infants • Affects visual and acoustic tracts as well as descending cortico-spinal tracts • Up to 60% may develop cerebral palsy • Visual impairment and perceptual abnormalities www.pedsradiology.com

  18. Actions Needed • Functional Assessment of all clients • Document visual abilities • Commission Pathways to allow extended eye exams • Ensure regular 2 yearly eye examinations • Work with Secondary Care Providers to ensure equal access • Document outcomes and advice given

  19. Functional Vision Assessment • Designed for use by Carers • SeeAbility Functional Vision Assessment Tool • www.lookupinfo.org • Checklist 1 - Appearance of the eyes • the appearance of a persons eyes may raise concerns about their eye health • Checklist 2 - Behaviour • a persons behaviour may be related to poor vision or other eye care needs • Checklist 3 - Poor central vision • this is when a person cannot see straight ahead very well • Checklist 4 - Poor peripheral vision • sometimes a person has difficulties seeing to the sides and up and down • Checklist 5 - Sensitivity to light • some people experience difficulties because their eyes are very sensitive to light • Checklist 6 - Poor colour vision (or contrast sensitivity) • some people do not see colours very well and can find it difficult to see objects clearly against different backgrounds • Checklist 7 - Poor vision in one eye • some people have poor vision in one eye only

  20. Eye Examination Pathways • KAB – Bexley • RNIB Bridge to Vision • SeeAbility Eye 2 Eye • LOCSU Sight test pathway • WOPEC - Accreditation for practitioners

  21. LOCSU Pathway

  22. Can Eye Examinations be done? • Yes

  23. Pathway Support • Pre examination reporting – Telling the Optometrist about me form – SeeAbility • Appropriate facilities and equipment – desensitisation visits • Funding of extended eye examinations and repeat visits • Includes domiciliary services • Feedback forms and reporting – SeeAbility forms or PHP/Health Passports completed • Information leaflets on Eye health and Spectacles - SeeAbility

  24. Secondary Care • Royal College of Ophthalmologists Guidelines • GMC Guidelines • Good Practice eg Sheffield • Advocacy and support

  25. Remember • Assess Visual Function • Record Functional Ability • Organise Eye Examinations • Create Pathways • Record Results • Modify Care Plans • Empower Individuals

  26. SeeAbilitywww.lookupinfo.orgwww.seeAbility.org Paula Spinks-Chamberlain LOCSU www.locsu.co.uk Katrina Venerus Information & Help

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