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Low Vision Care in Private Practice

Low Vision Care in Private Practice. JERRY DAVIDOFF O.D., F.A.A.O. JPDOD@COMCAST.NET 610-356-3933. LV EQUIPMENT NEEDED. Lane equip such as proj, vf, sl, bio, chair, stand, trial lens set, etc. LV charts, contrast test, reading material, Devices- MS, TS, Filters, CCTV, Mags, Stands, Light

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Low Vision Care in Private Practice

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  1. Low Vision Care in Private Practice JERRY DAVIDOFF O.D., F.A.A.O. JPDOD@COMCAST.NET 610-356-3933

  2. LV EQUIPMENT NEEDED • Lane equip such as proj, vf, sl, bio, chair, stand, trial lens set, etc. • LV charts, contrast test, reading material, • Devices- MS, TS, Filters, CCTV, Mags, Stands, Light • OD with proper attitude

  3. TRADITIONAL OPTOMETRY vs LV • PHOROPTOR • HAND HELD CHART • TRIAL LENSES • DEVICES • STAFF • FLEXIBILITY • COMPASSION

  4. GLAUCOMA EQUIPMENT NEED ED • Lane Equipment • Automated perimetry • OCT, HRT, GDx, Pachymeter etc • Mindset

  5. VT EQUIPMENT NEEDED • Lane Equipment • Vectographs • Binoc. Vision Tests • Computer VT Equipment

  6. Case 1 • 84 YO WF with AMD referred by a colleague. Hx of AMD CNVM and variable vision. First seen Oct 2004. • No retinal Tx except monitoring • Per referring OD- BVA 20/200 and complaint of inability to do job of collecting professor evaluations from students.

  7. Case 1 • Exam Findings BVA OD 20/60, OS 20/80 Near OD 1.0M @20 cm w/ +2.25 add and OS 2.5M @20 cm w/ +2.25 add AG- Metamorphopsia OS > OD and slight difference in color perception OS > OD. PERL, EOM intact, FNC, Contrast Sensitivity OD=OS, • Refraction= OD +1.00 OR, OS +2.50 OR = 20/50 OD OS= 20/70.

  8. CASE 1 • SLE neg except for slight NS and Cort cats • With +6.00 Add improved to 0.5M text at 17 cm with good fluency and speed. Lighting helped. +3.00 add improved to 1.0 M text at 33cm. • RX’d spec MS with +6.00 Trifocal for use at work. Be aware of lighting on desk surface and keep room lights low on CRT.

  9. CASE 1 • Returned after disp of trifocal w/ c/o small reading area and has to lift head. Can do job but difficult • Same findings incl acuity • Rx’d +3 add at top and +6 add at bottom of FT 28 bifocal along with 3x (+8) HH MAG • FU w/ Retinologist and Nephew OD

  10. AMD CONVERTS TO WET • RETURNED AFTER 6 MONTHS CC VA DECREASE • VA W Rx OD 20/80 – 20/200 & OS 20/150 • NO IMPROVEMENT W/ REFRAC. • LAST VISIT W/ OMD 6 WEEKS- NO CHANGE THEN • DFE- HEME AND EDEMA W/ EXUDATE • REFERRED BACK TO RETINOLOGIST

  11. DILATION- NOT LV?

  12. AMD WITH BIFOC. MICROSCOPE

  13. AMD WITH STAND MAG

  14. AMD PROPER LIGHT

  15. FOLLOW-UP • HAS HAD APPROX. 6 LUCENTIS INJECTIONS AND IS STABLE FINALLY AT 10/100 OD AND 10/200 OS BY REPORRT AND IS RETURNNING FOR LV ASSESSMENT IN 1 MONTH. • PROBABLY GOOD CANDIDATE FOR ELECTRONIC MAG AND CONTRAST ENHANCEMENT

  16. ELECTRONIC MAG

  17. BLEPHAROSPASM W/ VF DEFICIT • 62 YO WF • CC: CAN’T WALK UP STEPS W/O HOLDING LIDS UP W/ FINGERS OR DRIVE UNLESS SHE HOLDS LID UP (1 HANDED DRIVING) • CAN SEE WELL WITH LIDS HELD UP • 3 TRIES W/ BOTOX W/O SUCCESS • SURGICAL OPTIONS POOR

  18. BLEPHAROSPASM

  19. PTOSIS CRUTCH FABRICATION

  20. PTOSIS CRUTCH

  21. PTOSIS CRUTCH

  22. ROD MONOCHROMAT • 36 YO WF • VISUALLY IMPAIRED SINCE BIRTH • CC: DESIRE TO WORK IN COMPUTER FIELD (MEDICAL TRANSCRIPTION) • INCREASED LIGHT SENSITIVITY AND GLARE • VA OD 10/300, OS 10/250 • DECREASED CONTRAST SENSITIVITY • MARKED PHOTOPHOBIA

  23. ROD MONOCHROMAT • INITIALLY SEEN IN CLINIC AND DISP’D CCTV, COMPUTER LITERACY TRAINING, JAWS, 8X MAG, CPF 527XD LENSES and 4x w/ 2x doubler WALTERS TS SYSTEM • VA W/ 8X TS SYSTEM = 10/30 W/ GOOD LOCALIZATION, FOCUSING AND SCANNING • EXCELLENT COMPUTER SKILLS AFTER 9 MONTH

  24. ROD MONOCHROMAT

  25. GLARE

  26. NO GLARE

  27. PATH MYOPIA • 62 YO WM • SELF EMPLOYED BLIND VENDOR SELF TAUGHT O&M AND READING W/O SPEC • NO SURG.Hx, LAST DFE 3 YRS • SPECS 3 YRS OLD AND SCRATCHED • WANTS TO READ W/ EASE AND SEE TV

  28. PATH MYOPIA • HAB CORRECTION Vas OD 10/700 OS 10/600, BVA OD-5.00 OR 10/300, OS -6.00 OR 10/300. • 6X EFTS OS 10/250 WITH DIFFICULTY • 4X EFTS OS 10/80 WITH DECENT LOC AND FOCUSING • PICO HH ELECTRONIC MAG 1M W/ FAIR FLUENCY PREFERRED TO OTHERS

  29. PATHOLOGIC MYOPIA

  30. PATHOLOGIC MYOPIA

  31. TRAINING

  32. TRAINING

  33. TRAINING

  34. KERATOCONUS • 35 YO BF W/ PROGRESSIVE VA DECREASE OVER 5 YEARS • REFERRED FOR LV EVAL. WORE CL BUT LOST AND $ A FACTOR- COULD NOT REPLACE- NEVER COMFORTABLE • LOST JOB DUE TO VISION • REFUSES SURGICAL OPTIONS- “I HATE HOSPITALS AND DOCTORS”

  35. KERATOCONUS • HAB SPEC -12.00=-2.00cx 020 10/600 and -10.50=-2.50cx050 10/400 • REFRACTION OD -20.00=-6.00cx040 10/80 and OS -15.00=-4.00cx060 10/40 • SLE MARKED SCARRING OD>>OS. LENS CLEAR OS & OD=??? • TA= 15mmHg OU • BIO= NEG PATHOLOGY

  36. CORNEAL TOPOGRAPHY

  37. KERATOCONUS • LV EVAL REVEALED CCTV MAG CALCULATION W/ BEST SPEC CORRECTION OF 8X = 1M PRINT W/ EASE • DECISION TO TRY CONTACTS AGAIN • FIT IN PVT OFFICE AFTER TOPOGRAPHY • INITIAL TRY RGP UNSUCCESSFUL DUE TO DISCOMFORT AND OD MOVEMENT • FIT W/ PIGGYBACK OU

  38. KERATOCONUS • OD FLEXLENS SCL- Piggyback 55 14.2D plano 9.5 custom 7.0 BC • OD RGP ABBAKONE 64.75 BC/ 8.1 Dia/ -22.00 • OS N&D 8.3 -1.25 • OS ABBAKONE 52.00 BC/ 8.6 Diam/ -12.00 • VA OD 20/60 & OS 20/40 • STILL PREFERS CCTV FOR WORK DUE TO REVERSE CONTRAST W/CL (max WT 8-10 hrs) AND MAG W/O CLS AFTER 8-10 HRS OF WEAR

  39. KERATOCONUS

  40. UPDATE • AFTER WEARING PIGGYBACK FOR 2 YEARS DEVELOPED INTOLERANCE OS • APPROXIMATELY 3 HOURS OF PHONE TIME AND E-MAILS OVER DISCUSSION ABOUT SURGICAL OPTIONS • AGREED TO CORNEAL CONSULT AND EVENTUAL TRANSPLANT WITH 20/40 A/O LAST WEEK BUT POOR COMPLIANCE WITH STEROID DROPS

  41. HEMIANOPSIA • 88 YO WF WITH HOMONYMOUS LEFT HEMIANOPSIA • CVA, CAD, DEPRESSION, MILD SENILE DEMENTIA, MOBILITY DIFFICULTIES, AMD, POAG • BVA OD 10/100, OS 10/80 • NEVER READ • CAREGIVER 24-7

  42. MAIN CONCERN • LIVES WITH SON WHO TRAVELS GREAT DEAL AND LIVE-IN CAREGIVER WHEN SON NOT AT HOME • BUMPS INTO DOORS, FURNITURE SINCE CVA • INITIAL CONTACT WITH US WAS FOR EXAM, OPINION FOR GLAUCOMA CONTROL

  43. MEET HER

  44. SUMMARY • LV AND OPTOMETRY CAN’T BE SEPERATED- PART OF THE CONTINUITY OF CARE • LV TO COMFORT LEVEL OF PRACTITIONER CAN BE DONE IN PRIVATE PRACTICE • ALL ODs CAN AND DO LV- THEY JUST DON’T KNOW IT • REFER WHAT ISN’T COMFORTABLE

  45. CONTINUITY OF CARE • IF YOU TREAT PATIENT FOR DISEASE, YOU ASSUME CARE OF THAT PATIENT • IF YOU LEAVE PATIENT WITH UNRESOLVED VISION LOSS (WITH BVA REDUCED AFTER SURGICAL AND OPTICAL AND MEDICAL TREATMENT) YOU ARE RESPONSIBLE • NEXT STEP IN CARE IS LV- MUST EITHER DO IT OR REFER IT

  46. Glaucoma & AMD • Pat in practice for many years- moderate myopia, Diagnosed POAG 1975- progressed to trabs OU with significant VF loss and cupping. IOP 2-5mmHg OD and 15 OS- no choroidals OD • 20/20 until 10/2001 when fell to 20/100 OU- Dx AMD dry • Progressed to exudative 20/400 OS 2008

  47. Photos

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