Assessing and Managing Low Vision - #32Take Quiz
How to manage patients once it is determined they have low vision.
- Occupational vision demands
- rank vision and functional goals
- history of falls
- familial support (3)
- daily living problems (3)
- ocular pathology in terms of field loss and sensitivity to light and glare (2)
Thorough Eye Assessment
- Visual acuity (3)
- Refraction (3)
- Near vision (3)
- Contrast sensitivity (2)
- Using prescribed and over the counter assistive devices (e.g., glasses, magnifiers (2,3))
- Establish preferred retinal locus for fixation (AMD) (5)
Ability to Perform Visual Tasks (4)
- reading continuous print
- using a cell phone
- using a computer
- navigating steps
Discussion of Patient's Vision Needs (2,3,4)
- paying bills
- maintaining hygiene
- dressing ousekeeping
- food preparation
- driving or taking public transportation
- watching television
- assess for dual losses vision and hearing, preferably hearing before vision
- confirm with patient the results of his / her visual screening (3)
Management and Referral
Discuss patient’s understanding of their condition
- Discuss the future of patient’s condition
- Discuss activities that may be beneficial/detrimental to his/her condition
- Set attainable goals and help patients understand what they will and will not be able to do (3)
- Establish management solutions based on patients’ needs and goals, with OT if available (eg. adaptive equipment, lifestyle changes that can improve performance)
- Gauge if patient can use assistive device correctly. Refer back to OT if not.
- Determine appropriateness of a support group (5)
- Assess how the patient is coping.
- Screen for depression.
- Consider social work or Department of Aging referral to assist with transportation needs.
Referral to Low Vision
- Referral from optometrist/ ophthalmologist is preferred but not necessary; possible direct referral from primary care, but this can result in inappropriate referral.**
- Referral to Occupational Therapy
- Referral from optometrist/ ophthalmologist or primary care provider is required for assistance through insurance.
OT= Occupational Therapy
*"Psychosocial adaptation to age-related vision loss encompasses three domains including acceptance of sensory loss, a persons attitude toward rehabilitation and finally, attitude toward social relationship"
**If primary care refers to ophthalmology they can mention low vision to clients if there is a possibility of continued functional impairment. Need to be sure of accurate diagnosis for the vision impairment and sure that surgical, medical and other modalities have been maximized as the patient's general condition allows.
Elderly patients who require vision management and assessment not addressed by medical and surgical interventions.
Ensure optimal function in the face of vision loss after proper assessment and management of the underlying ophthalmologic disorder.
Low vision crosses every section of life and will increase 4x over the next 40 years1. The older population is disproportionately affected. The growth of the geriatric population will result in more disability.
Have a clear understanding how to assess for low vision using history, assessment and tasks to measure. How to manage patients once it is determined they have low vision.
Review of Systems (ROS)
- National Eye Institute. http://www.nei.nih.gov/eyedata/lowvision
- Lampert J, Lapolice DJ. Functional considerations in evaluation and treatment of the client with low vision. Am J Occup Ther. 1995 Oct;49(9):885-90. PubMed PMID: 8572047. http://www.ncbi.nlm.nih.gov/pubmed/8572047
- Silverstone B et al, eds. The Lighthouse Handbook on Vision Impairment and Vision Rehabilitation. Oxford; New York: Oxford University Press, 2000. Print.
- American Academy of Ophthalmology: Vision Rehabilitation 2012 Preferred Practice Patterns., n.d.Web 22 April 2013. http://one.aao.org/guidelines-browse?filter=preferredpracticepatterns
- Warren M. Providing low vision rehabilitation services with occupational therapy and ophthalmology: a program description. Am J Occup Ther. 1995 Oct;49(9):877-83. PubMed PMID: 8572046. http://www.ncbi.nlm.nih.gov/pubmed/8572046
- Heine C, Browning CJ. Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions. Disabil Rehabil. 2002 Oct 15;24(15):763-73. Review. PubMed PMID: 12437862. http://www.ncbi.nlm.nih.gov/pubmed/12437862
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Barbieri K, Sheth B, Duthie E., Assessing and Managing Low Vision in the Elderly, April 2013.
Disclaimer: Geriatric Fast Facts are for informational, educational and research purposes only. Geriatric Fast Facts are not, nor are they intended to be, medical advice. Health care providers should exercise their own independent clinical judgment when diagnosing and treating patients. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.