1. PRESENTED BY Chris Schell, O.D. Primary Eyecare Private Practice Member of the College of Optometrists in Vision Development Member of the Neuro-Optometric Rehabilitation Association

2. Role of Vision To direct action and guide movement

3. Role of Vision To direct action and guide movement Impaired vision leads to impaired movement

4. Role of Vision To direct action and guide movement Impaired vision leads to impaired movement Impaired movement leads to increased risk of falling

5. Who has a cataract?

6. Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011)

7. Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011) Every 12 minutes, someone in Canada begins to lose their eyesight (CNIB 2012)

8. Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011) Every 12 minutes, someone in Canada begins to lose their eyesight (CNIB 2012) 75 per cent of vision loss can be prevented (CNIB 2012)

9. Video simulation

11. Types of Vision Impairment Simpler and Treatable

12. Types of Vision Impairment Simpler and Treatable Problems with eyeglasses

13. Types of Vision Impairment Simpler and Treatable Problems with eyeglasses Cataracts

14. Types of Vision Impairment Complex and Manageable

15. Types of Vision Impairment Complex and Manageable Glaucoma

16. Types of Vision Impairment Complex and Manageable Glaucoma AMD

17. Types of Vision Impairment Complex and Manageable Glaucoma AMD Diabetes

18. Types of Vision Impairment Complex and Manageable Glaucoma AMD Diabetes ABI/TBI

19. Eyewear – What to look for? Are their glasses giving them their best vision?

20. Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads

21. Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches

22. Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches coatings peeling off

23. Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches coatings peeling off bent or twisted frames

24. Cataracts

26. Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction

27. Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints

28. Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate

29. Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate Often worse in one eye compared to the other

30. Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate Often worse in one eye compared to the other Painless

31. Glaucoma

33. Glaucoma – What to look for? Family history

34. Glaucoma – What to look for? Family history Peripheral vision loss – inside out

35. Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless

36. Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless Only at end stage is there advanced vision loss

37. Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless Only at end stage is there advanced vision loss Early detection can slow disease progression

38. Macula Degeneration

40. AMD – What to look for? Non-modifiable risk factors:

41. AMD – What to look for? Non-modifiable risk factors: Family history

42. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour

43. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age

44. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors:

45. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking

46. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight

47. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet

48. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet High blood pressure

49. AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet High blood pressure UV Exposure

50. AMD – What to look for? 2 types:

51. AMD – What to look for? 2 types: slow dry

52. AMD – What to look for? 2 types: slow dry fast wet

53. AMD – What to look for? 2 types: slow dry fast wet Central vision problems

54. AMD – What to look for? 2 types: slow dry fast wet Central vision problems distortion

55. AMD – What to look for? 2 types: slow dry fast wet Central vision problems distortion missing areas

56. AMD – What to look for? Home Monitoring with Amsler Grid

57. Diabetic Vision Loss

59. Diabetes – What to look for? Fluctuating vision

60. Diabetes – What to look for? Fluctuating vision Random pattern to blind spots in vision

61. Diabetes – What to look for? Fluctuating vision Random pattern to blind spots in vision More stable blood sugar = more consistent vision

62. Brain Injury Visual Field Loss

64. BI VF – What to look for? May be acquired or traumatic brain injury

65. BI VF – What to look for? May be acquired or traumatic brain injury Case history

66. BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world

67. BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident

68. BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident Orientation and mobility issues

69. BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident Orientation and mobility issues This group is at a VERY HIGH risk of falling

70. Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference)

71. Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference) Depth perception is gone

72. Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference) Depth perception is gone Closing one eye

73. DEMO TIME – Volunteers?

74. Sight threatening eye diseases are silent and painless.

75. What can we do?

76. Preventing Falls Encourage your patients, your friends and your family to get regular eye exams

77. How to Help Ask the Question –

78. How to Help Ask the Question – When was your last eye exam?

79. Where to refer To find an Optometrist in your area visit: The Ontario Association of Optometrists www.optom.on.ca

80. Due Diligence Visit a few clinics

81. Due Diligence Visit a few clinics Meet the staff and doctor

82. Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients?

83. Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients? Are they prepared to examine senior patients?

84. Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients? Are they prepared to examine senior patients? Are they accepting new patients?

85. Why might your patients refuse or be hesitant to have an eye exam?

87. Objections to Eye Exams Fear

88. Objections to Eye Exams Fear of loosing their driver’s license

89. Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease

90. Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease Cost

91. Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease Cost OHIP covers the cost of a general eye exam for ages 65 and over

92. How to Help Glasses – encourage them to wear them, get them fixed

93. How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting

94. How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds

95. How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds Macula Degeneration – Amsler Grid at home, meds

96. How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds Macula Degeneration – Amsler Grid at home, meds Diabetes – control sugars

97. Low Vision The CNIB is the best resource for people with low vision. Find out if your area has a CNIB clinic.

98. Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision

99. Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision Use specialized equipment and materials such as:

100. Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision Use specialized equipment and materials such as: prisms filters patches

101. Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it

102. Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it Difficulties with balance, coordination, posture

103. Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it Difficulties with balance, coordination, posture Leaning forward or backward – leaning to one side

104. DEMO TIME – Volunteers?

105. Behavioural Optometrist Where to you find a Vision Therapy clinic? www.covd.org

106. Behavioural Optometrist Where to you find a Vision Therapy clinic? www.covd.org Visit them and find out how you can work together to help your patients.

107. “A good objective of leadership is to help those who are doing poorly to do well and to help those who are doing well to do even better.” ~ Jim Rohn, author, motivational speaker

108. Remember! 20/20 does not automatically mean “healthy”

109. For more information… Come visit us, we are always welcoming new patients! 705-734-5700 225 Ferndale Drive (in the plaza at Ardagh) Barrie, ON L4N 6B9