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

2. 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

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

4. Main Rehabilitation Goal Improve independence and quality of life

5. How does the exam flow? Patients 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.

6. 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

7. Dispensing Visit Patients 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

8. 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

9. 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)

10. EXAM COMPONENTS Trial frame refraction

11. 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

12. 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…

13. 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

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

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

16. Glare Treatment Various colored filters (lens tints) –NoIR –Corning –Plastic Photochromic (Chadwick Optical) –Cocoons

17. Electronic Magnification: CCTV

18. 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

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

20. Whats new in LV? –Computer technology with adaptive software –Volunteer at ECC provides one-on-one computer appointments for low vision patients

21. Whats 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