LOW VISION EXAMINAION Edited

LOW VISION
EXAMINATION
PROTOCOL
A SEMINAR PRESENTATION TO THE FACULTY OF LOW VISION AND
REHABILITATIVE OPTOMETRY,NIGERIAN COLLEGE OF
OPTOMETRISTS,PRESENTED BY UDOH ANNABEL ANYIEMA
ABSTACT
Protocol is a system of rules that explain the correct conduct and procedures to be
followed in formal situations, medical treatment or procedure. The low vision examination
protocol consist of different components with the aim of improving patients’ vision and
using the patient’s available vision to perform activities of daily living, improve the
patient’s quality of life and work on the patient’s psychic or morale to allow them to live
independent life’s without being a burden to themselves or society. Primarily low vision
aims at maximizing magnification of images and objects by series of tests and use of low
vision devices .The aim of this seminar is to understand low vision examination protocol or
components of low vision examination and aid in better understanding of a low vision
patient’s emotional status on visual impairment. Low vision examination consist of general
observation, evaluation of visual function, functional vision assessment objective and
subjective refraction, magnification assessment and training. Low vision examination may
be tedious but is extremely rewarding to see patient’s gain confidence and surmount
challenges.
Keywords: low vision, magnification, refraction, functional vision, visual function, visual
impairment.
OUTLINE
• ABSTACT
• COMPONENTS OF LOW VISION EXAMINATION
• PATIENTS PSHYCHOLOGICAL SETTING
• EVALUATION OF VISUAL FUNCTION
• EVALUATION OF FUNCTIONAL VISION
• REFRACTION
• MAGNIFICATION
• NON-OPTICAL AIDS
• OFFICE VISITS
• REFERENCES
COMPONENTS OF OF CASE HISTORY OF LOW
VISION EXAMINATION
•Ocular History
•Visual Function
•Medical History
•Social History
•Specific Needs or Goals
PATIENTS PSYCHOLOGICAL SETTING
DENIAL
GRIEF
ANGER
DEPRESSION
ACCEPTANCE
PATIENTS PHYSIOLOGICAL SETTING
OVERALL BLURRED VISION
CONDITIONS:MYOPIA,HYPEROPIA
SIGNS :↓VA , ↓CONTRAST,POOR
NIGHT VISION,
PHOTOPHOBIA
SYMPTOMS :BUMPING INTO OBJECTS,
DIFFICULTY IN WRITING /
READING,UNABLE TO
WRITE IN STRAIGHT
LINES.
INTERVENTIONS: PREFERENTIAL
SEATING , FILTERS ,
COLOUR CUES ,
FAMILIARITY WITH TASK.
SOURCE :COMMUNITY EYE HEALTH,2012.

PATIENTS PHYSIOLOGICAL SETTING CONTD
CENTRAL VISUAL FIELD LOSS
CONDITIONS:DIABETIC MACULOPATHY
SIGNS :POOR COLOUR VISION ,
CANNOT DISCRIMINATE
FINE DETAILS,
VA IN BRIGHT LIGHT
SYMPTOMS:INABILITY TO RECOGNIZE
FACES,CANNOT IDENTIFY
CLOTHES COLOUR ,
DIFFICULTY READING
INTERVENTIONS:PREFERENTIAL
SEATING , VISUAL
TRAINING,INTRODUCTION
OF FAMILY/FRIENDS
SOURCE:CITY OF VISION,2017
PATIENTS PHYSIOLOGICAL SETTING CONTD
PERIPHERAL VISUAL FIELD LOSS
CONDITIONS:GLAUCOMA,RP
SIGNS :MOBILITY PROBLEMS ,
SLOW DARK ADAPTATION,
POOR NEAR READING ,
GLARE,PHOTOPHOBIA
SYMPTOMS:KNOCKING OBJECTS OVER
UNCERTAINTY IN MOVEMENT,
INABILITY TO FIND OBJECTS
INTERVENTIONS:ILLUMINATION ,
↓GLARE WITH SUNWEAR,
PREFERENTIAL SEATING
SOURCE:EYE CENTER OF LA JOLLA,1991
VISUAL FUNCTION
• DISTANCE VA
• NEAR VA
• VISUAL FIELD
• CONTRAST SENSITIVITY
• COLOUR VISION
• GLARE TEST
• BINOCULARITY
EVALUATION OF FUNCTIONAL VISION
• OBSERVATION
• INDIVIDUAL TESTING
• COMBINATION
THESE STEPS ARE BASED ON
-PATIENTS AWARENES TO OBJECTS
-CONTRAST
-VISUAL BEHAVIOUR E.G FIXATION,CONVERGENCE,TRACKING,SHIFT OF
GAZE
-EFFECT OF LOW VISION E.G WITHDRAWN,HOBBIES,TRAVEL
REFRACTION
OBJECTIVE REFRACTION SUBJECTIVE REFRACTION
• AUTOREFRACTION • TRIAL FRAME WHEN INDICATED
• STANDARD TECHNIQUES WITH • JUST NOTICEABLE(JND)
TRIAL FRAMES TECHNIQUE
• RADIAL RETINISCOPY • HANDHELD JACKSON CROSS
CYLINDER
• OFF-AXIS RETINISCOPY • NON—STANDARD DISTANCE
• NEAR RETINOSCOPY • STENOPAIC SLIT
• KERATOMETRY • MULTIPLE PINHOLES
MAGNIFICATION
•RELATIVE SIZE
MAGNIFICATION
•RELATIVE DISTANCE
MAGNIFICATION
•ANGULAR
MAGNIFICATION
•PROJECTION
MAGNIFICATION
SOURCE :COMMUNITY EYE
HEALTH,2004
NON –
OPTICAL AIDS
AIM-BBB : BIGGER,BOLDER ,BRIGHTER
-CCC : CLOSER,COLOUR,CONTRAST
GROUPED ACCORDING TO
• ENHANCE IMAGES
• ENHANCE CONTRAST
• ADJUST WORKING DISTANCE
• CHANGES TO THE ENVIRONMENT
• AUDITORY AIDS
• MOBILITY ASSISTING DEVICES
OR GROUPED TO LOCATION OF USE EG
KITCHEN,AROUND HOUSE,MEDICAL USE
SOURCE: VISIONWARE,2017
OFFICE VISITS
• BUILDING ENTRANCE
• STAIRS
• HALLWAYS
• SIGNAGE
• RECEPTION AREA
• EXAMINATION ROOM
REFERENCES
Brown, B. (2007) The Low vision handbook for eye care professionals 2nd edition. Slack
Incorporated. Pg 69 – 103
Chandhry, M. (2006) Low vision aids. Jaypee Brother Medical Publisher Ltd. Pg 18 – 96.
Jackson, A. J., Wolftschn, J. S, Bailer, I. L (2007) Low vision manual . Butterworth
Heinemann Elsevier. Pg 103 – 182
Massatt, S. (2014) .Make your office safer for patients with low vision. American Academy
of Ophthalmology. Eyenet magazine. Nov. 2014
Ormerod, L.D, Massat, S. (2012), Low vision assessment and rehabilitation. Virtual health
care team, school of health professions. University of Missouri – Columbia.
Virtual health Care Team (2012) Low vision assessment and rehabilitation. School of Health
Professions. University of Missouri – Columbia. Retrieved from
https://www.ashp.missouri.edu/vhet
Willings, C. (2017) What is the FVE? Teaching students with visual impairments. Retrieved
from www.teachingvisuallyimpaired.com
THANK YOU
Source :visualllyimpaired,2017

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SOURCE :COMMUNITY EYE HEALTH,2012.

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