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LOW VISION REHABILITATION OF CHILDREN WITH ANIRIDIA

LOW VISION REHABILITATION OF CHILDREN WITH ANIRIDIA. Sarah Appel, O.D. William Feinbloom Vision Rehabilitation Center. ANIRIDIA. Visual Acuity typically 20/100 to 20/200 Visual Field Defects none unless glaucoma present Contrast Sensitivity

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LOW VISION REHABILITATION OF CHILDREN WITH ANIRIDIA

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  1. LOW VISION REHABILITATION OF CHILDREN WITH ANIRIDIA Sarah Appel, O.D. William Feinbloom Vision Rehabilitation Center

  2. ANIRIDIA • Visual Acuity • typically 20/100 to 20/200 • Visual Field Defects • none unless glaucoma present • Contrast Sensitivity • decreased due to presence of anterior polar cataract • decreased if glaucoma is present

  3. ANIRIDIA • Light Adaptation • photophobia due to lack of pupil • associated polar cataract and corneal clouding further increase photosensitivity and glare sensitivity • increased photosensitivity due to scattering of light by cataract

  4. ANIRIDIA

  5. ANTERIOR POLAR CATARACT

  6. LOW VISION EXAMINATION • HISTORY • VISUAL ACUITIES • REFRACTION • EYE MOVEMENT EVALUATION • EYE ALIGNMENT EVALUATION • VISUAL FIELDS ANALYSIS

  7. LOW VISION EXAMINATION • CONTRAST SENSITIVITY TESTING • COLOR VISION TESTING • OCULAR HEALTH EVALUATION • EVALUATION OF LOW VISION DEVICES • INSTRUCTION IN THE USE OF LOW VISION DEVICES

  8. HISTORY • Explore ocular history • Surgeries: lensectomy, strabismus, nystagmus, glaucoma • Medication: glaucoma • Previous examination results: corrective eyeware, low vision devices • Visual concerns • Goals for examination

  9. HISTORY • Explore systemic history • Surgeries • Developmental age • Medication: explore potential visual side effects • Explore visual concerns • Mobility • Learning based visual issues • Identify goals for evaluation

  10. VISUAL ACUITIES • Developmental ages of infancy to 3 years

  11. VISUAL ACUITY • Developmental ages 3 years and older

  12. VISUAL ACUITIES • Children with reading ability

  13. REFRACTION • Ensure optimal focus which results in increased visual attention, safer mobility • Polycarbonate lenses provide protection in cases of significantly reduced vision • Correct prescription may reduce eye turns, enhance visual efficiency

  14. REFRACTION • Consider correction for near tasks in cases of significantly reduced viewing distances • In cases of aphakia or pseudophakia , make sure that child has a near prescription incorporated into corrective lenses

  15. EYE MOVEMENT EVALUATION • Evaluate range of eye movements • Evaluate nystagmus for null point • Identify head turns to achieve a null point • Identify positions of gaze that intensify nystagmus • Evaluate for latent nystagmus with occlusion

  16. EYE ALIGNMENT EVALUATION • Hirschberg light reflex test • Cover testing

  17. VISUAL FIELDS ANALYSIS • Confrontation testing in adults or developmentally older children • Confrontation testing in developmentally younger children

  18. VISUAL FIELD TESTING • Peripheral Visual Field Testing

  19. CONTRAST SENSITIVITY TESTING • Evaluates visual discrimination of lower contrast items • Translates to ability to identify lower contrast targets: curbs, drop-offs, identifying faces etc. • Especially important in cases of cataracts, corneal clouding and optic atrophy

  20. COLOR VISION TESTING

  21. OCULAR HEALTH EVALUATION • External evaluation • Cornea • Evaluation of intraocular pressure • Evaluation of lenses for anterior polar cataracts • Retinal/optic nerve evaluation • Identify optic nerve changes related to glaucoma

  22. EVALUATION OF LOW VISION DEVICES • PROVIDE MAGNIFICATION FOR DISTANCE VISUAL TASKS • PROVIDE MAGNIFICATION FOR NEAR VISUAL TASKS • PROVIDE LIGHT FILTRATION • PROVIDE CONTRAST ENHANCEMENT

  23. HAND HELD TELESCOPES

  24. SPECTACLE MOUNTED TELESCOPES

  25. MaxTV

  26. Designs for Vision Bioptic Telescope

  27. Selsi Sportglasses

  28. Ocutech VES Telescope

  29. HAND MAGNIFIERS

  30. STAND MAGNIFIERS

  31. SPECTACLE MAGNIFIERS

  32. CLOSED CIRCUIT TELEVISION READING SYSTEMS

  33. PORTABLE CCTV(Quicklook, Clearview)

  34. ADAPTIVE TECHNOLOGY

  35. MAGNILINK S CCTV

  36. ENHANCED VISION ACROBAT

  37. ABSORPTIVE LENSES“SUNLENSES”

  38. REDUCED APERTURE CONTACT LENSES

  39. TINTED CONTACT LENSES

  40. LAMPS

  41. NON OPTICAL DEVICES

  42. LAP DESKS

  43. READING STANDS

  44. WRITING AIDS • Bold line paper • 20/20 pen • Clip board

  45. Enlarging Mirrors

  46. INSTRUCTION IN THE USE OF LOW VISION DEVICES

  47. REPORT TO TEACHERS • description of visual status • print size recommendations • print media recommendations • recommendations for optical devices • adaptive technology recommendations • environmental modifications

  48. ENVIRONMENTAL MODIFICATIONS • seating close to board • enhanced contrast boards • directed illumination • seating away from windows

  49. REHABILITATION SERVICES • State agencies • orientation and mobility • rehabilitation teaching • transition to college • counseling/support • social work • psychology • peer support groups

  50. RESOURCES • Special education programs • Early intervention programs • State agencies for visually impaired • Schools for visually impaired

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