1. Visual Impairment Awareness A Collaboration between University Hospital, Ophthalmology The Low Vision Services Committee and Community Services Sensory Impairment Team & Coventry Society for the Blind

2. Session aims To understand - What a visual impairment is? What causes visual impairments? How visual impairments affect people? What can we do to help those who have a visual impairment?

3. What is a visual impairment? Bob Wright (The Low Vision Services Committee)

4. A Snap Shot!

5. Terminology! “People with Impaired Vision” Why “People with impaired vision”, rather than “Visually impaired people”? Because they are people first who happen to have a disability attached to them.

6. How Many? 1 in 60 people in the UK has impaired vision which equates to 1.4 million people. The incidence of impaired vision is increasing: Between 1982 and 2000 the incidence of those registered as blind rose by 41% and the incidence of those registered as partially sighted rose by 50%. Between 1982 and 2000 the incidence of those registered as blind rose by 41% and the incidence of those registered as partially sighted rose by 50%.

7. What the RNIB says… Currently there are 1,500 people registered severely sight impaired/blind or sight impaired/partially sighted in Coventry - recent research suggests that these figures could be 20% higher the number of people eligible to register in Coventry therefore could be as high as 1,800 the majority (85%) of people with sight problems are older people, aged over 65

8. Why? Largely because: impaired vision is age related the demographers tell us that the proportion of older people will continue to increase until at least 2050 It is expected that the number of people with visual impairments will reach 3 million by 2030

9. Department of Health Estimates that as many as 4 million older people do not have regular eye examinations that could detect some conditions that are treatable

10. Key message You will often meet people with a significant visual impairment in your work there are many people with a significant visual impairment now and there will be many more in the future

11. What is it like to live with a visual impairment? Bob Wright (Low Vision Services Committee)

12. Common Causes of Vision Loss Annette Ryman Clinic 9 – Coventry & Warwickshire NHS Trust (Clinical Nurse Specialist for Retinal Services)

13. Commonest forms of vision loss

14. Commonest conditions associated with loss of vision Cataracts (Temporary vision loss) Age Related Macular Degeneration (ARMD) Glaucoma Diabetic Retinopathy

15. Quick anatomy lesson!

16. What is a cataract? It is an opacity or clouding of the lens

17. Causes of Cataract Development AgeTraumaBirth Certain medications: long term oral steroids, Tamoxifen, long term aspirin usage, Amiodarone, Allopurinal Medical disorders such as Diabetes, Glaucoma, other metabolic disorders Long term over indulgence of alcohol Smoking Poor diet Long term exposure to ultraviolet light/radiation http://www.docshop.com/education/vision/eye-diseases/cataracts/causes/

18. Symptoms Reduced depth perception Diminished colour perception Glare in sunlight/ sensitivity to bright light Poor night vision Headaches/ eye fatigue (eye strain)

19. Cataracts

20. How do we treat cataracts? Usually surgical removal – cataract extraction with a lens implant

21. Cataract Surgery

22. What is Age Related Macular Degeneration? It is the most common cause of blindness in the United Kingdom for individuals over 60 years of age. There are two types wet and dry: The wet type (10%) is treatable and the dry (90%) is not.

23. Normal eye

24. What happens? With age, tissues break down and fluids begin to seep between the layers of the retina, causing them to separate. As they do, the result is macular degeneration.

25. ARMD degeneration process

26. Age Related Macular Degeneration

27. Symptoms Distorted vision Inability to read print Central part of the vision is missing Wavy lines

28. Age Related Macular Degeneration

29. Treatments There is no known cure for macular degeneration, but there are treatments which may help to slow it down Thermal Laser treatment Photodynamic Therapy Intravitreal Steroid injection Intravitreal drugs – Macugen/Lucentis/Avastin Patients do not go totally blind but all of these patients will require Low Vision and/or Social Services support at some point.

30. Charles Bonnet Sometimes as a result of severe vision loss people can see hallucinations, not necessarily exclusive to people with AMD This is the result of the brain creating images and filling in the missing pieces of vision Often people describe little people, gargoyles, distorted faces, scenery Can make navigation difficult No cure but it may disappear in a year to 18 months The key to helping these people is to reassure them, and their family, that they are not going mad Not everyone will recover but as long as they realise that what they see is not real they can cope reasonably well

31. What is Glaucoma? Pressure created by the fluid in one or both eyes builds up to an abnormally high level. When this pressure remains elevated over a period of time, damage occurs to the delicate visual structures. Left untreated, blindness often results. Can be chronic or acute

32. The Drainage System of the Eye http://webeye.ophth.uiowa.edu/dept/service/glaucoma/images/open-closed.jpg

33. Cupping of the Optic Disc

34. Incidence/Prevalence of Glaucoma By the age of 40 it is estimated that 1 in 100 people develop some form of glaucoma By the age of 70 this increases to 1 in 10 High risk groups include people of African descent,people who are short-sighted, have diabetes and have a family history. (BBC News 24 – January 2004)

35. What are the symptoms? There are no warning symptoms until late in the disease. Peripheral vision is lost It often goes unnoticed until it's too late – sometimes referred to as the “thief of sight”

36. Glaucoma

37. Treatment? No cure, but, it can be controlled. The most common treatment for glaucoma is eye drops to lower the pressure. If the pressure does not decrease treatment may involve laser treatment or laser surgery which opens the drainage system in the eye so fluid will flow freely. Early detection and treatment are the only ways to prevent permanent vision loss.

38. What is Diabetic Retinopathy? It is a complication of diabetes caused by the deterioration of blood vessels nourishing the retina. Glucose is thought to damage retinal and renal capillaries This condition can cause blindness at any age. Incidence is affected by how long a person has had diabetes and how stable their diabetes has been.

39. Diabetic Retinopathy

40. Symptoms Gradual blurring of vision may occur. Changes may go undetected without a retinal examination. Deterioration of vision potentially leading to severe visual impairment.

41. Diabetic Retinopathy

42. Treatment In many cases, treatment may not be required BUT in others, laser treatments may be recommended to halt further progress of the disease. Where swelling is present, steroids or intravitreal treatments may be considered. Early diagnosis and treatment are vital to preventing visual loss from diabetic retinopathy. Early diagnosis and treatment are vital to preventing visual loss from diabetic retinopathy.