Dr. Becky Kammer, Chief 714-449-7415 rkammer@scco.edu Eye Care Center at the Southern California College of Optometry MaryAnn Walls Low Vision Center Dr. Becky Kammer, Chief 714-449-7415 rkammer@scco.edu

What is Low Vision? Patients may be blind or just partially sighted (visually impaired) 20/70 or worse in better eye Legally Blind is 20/200 or worse with best correction on

What can Rehabilitative Optometry do to help? Help patients see to read Help patients see to drive Help patients meet specific vision goals

Main Rehabilitation Goal Improve independence and quality of life

How does the exam flow? Patient’s come for at least 2-3 visits where a full eye exam is given and then devices are introduced to meet goals First Visit: Team is introduced to patient Occupational therapist Student doctor Faculty professor OT will schedule a home evaluation before patient returns for second visit.

Second Visit OT summarizes their home visit for Dr. and the second optometric visit is planned for the patient. More visual goals are evaluated, devices are ordered Possibly more training visits with OT are scheduled in the meantime

Dispensing Visit Patient’s glasses or devices are given to patient and basic training in office is provided OT schedules 2-4 more home visits to make sure patient uses device correctly and is using residual vision correctly (eccentric viewing training if needed) OT reports back to Dr. for follow up

EXAM COMPONENTS Case history Summarize to obtain basic goals Sustained Near: Reading continuous text Spotting Near: Seeing bills, shopping Sustained Distance: Watching TV Spotting Distance: Driving, seeing signs Illumination and Glare: often need enhanced contrast indoor, need better lighting indoor

EXAM COMPONENTS Functional visual acuities Distance Vision Feinbloom chart (Designs of Vision) Near Vision Single digit chart (M notation – Lighthouse charts) Continuous text chart (M notation - Lighthouse) 1M =20/50 0.8M = 20/40 realistic goal

EXAM COMPONENTS Trial frame refraction

EXAM COMPONENTS Functional visual fields Several tests available to help determine how much usable vision is present Nystagmus patients usually have full fields This is great for rehabilitation processes

EXAM COMPONENTS Contrast sensitivity Testing is critical for determining if low contrast objects can be seen in dim lighting Poor contrast sensitivity may slow down reading or cause problems driving at night…

EXAM COMPONENTS Binocularity Functional considerations Depth perception up close (3D) Many nystagmus patients have no depth perception (or true binocularity) Most Low Vision patients are functionally monocular

EXAM COMPONENTS Calculations to determine the best type of magnification or modifications

EXAM COMPONENTS A Few Treatment options Spectacle plane – high plus/microscope Loupe – Hand magnifier, stand magnifier, head mounted Telescopes Electronic devices Filters/lighting

Glare Treatment Various colored filters (lens tints) NoIR Corning Plastic Photochromic (Chadwick Optical) Cocoon’s

Electronic Magnification: CCTV

Nonoptical aids Relative Size Devices: Large Print Books Posture and Positioning Devices: Lap boards Writing Devices:Felt tip pens Medical Devices: Talking glucometers Mobility Devices: Cane, Dog guide Sensory Substitution Devices: Talking clocks

Referrals Orientation and mobility Visual impairment instructor – independent living skills Department of Rehabilitation Support Groups/counseling Braille Institute for ILS classes

What’s new in LV? Computer technology with adaptive software Volunteer at ECC provides one-on-one computer appointments for low vision patients

What’s on the horizon for LV? Blind Art Exhibit in September 05 Research SCCO is now part of a progressive group that is attempting to initiate clinical trials in the U.S. Completion of a small multi-center study with hemianopic patients