Good Hope Eye Clinic

Low Vision Assessment at Good Hope

David Kinshuck

Who should have a LV (Low Vision) appointment?

  • Anyone who after medical treatment or new specs is not able to see well enough to do the things they would like (or need to do!)
  • Anyone who says they cannot read properly
  • Anyone who says their glasses are still not correct
  • Anyone with ARMD who you would refer for surgery if they had 'cataracts'
  • Anyone who cannot drive their car or read n10
  • Anyone who asks for LV appointment or a magnifier.

Remember

  1. You do not have to be certified or registered with a BD8
  2. There is no age limit
  3. Children and people with learning disabilities can benefit from LV appointments
  4. There are no charges -devices are loaned

The assessment

  • The assessment -this is with a LV nurse or orthoptist.
    A questionnaire will be completed you will have the chance to ask questions about their eyesight and about LV
  • The optometrist will briefly discuss the points raised in your assessment, carry out the refraction and explain the test results.
    The optometrist will then show and trial any magnifiers.
  • The low vision therapist -this is a practical appointment and will take place on another day after the device has been supplied.
    The therapist should be the same nurse or orthoptist the user saw at the first appointment.
    The therapist will check the use of the magnifier, assess visual function (with and without devices) and practice some reading/ viewing techniques.
    You should bring examples of things you would like to be able to see to do, such as knitting or reading music.
  • The optometrist will refer you on to other agencies that may help, such as social services, computer training,  job-training, and so on. See our local information page.

Low vision service in more detail

Two senior part-time optometrists, previously with an orthoptist assisting, provide an excellent service

  1. 1 hour new assessment, (1.5h needed), 45 mins  follow up
  2. First, we identify how patient is coping: reading, social, reading large print, large print bills/shopping /cooker reading dial, pouring liquids, shaving, TV (how far away), good lighting, good contrast for food labelling, crossing roads, talking bokes, watch needed,  identifying money.
  3. Identifying all problems form this list and addressing them, directly or by referral to other departments /agnecies, some in the voluntary sector
    1. Referral to the falls prevention team in next corridor..consulted 25% patients
    2. Referral to Socials services or a voluntary agency for issues such as mobility training or home assessment addressing.
    3. Suggestions: e.g. an extra trolley in kitchen..for support, carrying.
    4. Counselling: referring to the Birmingham Focus psychologist directly or over phone
    5. There different agencies according to postcode for each service.
    6. Work access referral : CV preparation, training for work, support finding a job
    7. Rehab officer or ECLO referral in some departments.
  4. Refraction
    1. distance, near, add, high add, are bifocals appropriate with falls
    2. Low vison aids such as magnifiers, optical and electroni;c LED magnifiers, stand magnifiers, spec mounted, using Kindle/Ipads, smart phones on low vision settings
    3. Demonstrate electronic aids
    4. Teaching reading skills: e.g. finding the beginning of a line
    5. Addressing glare if a problem
    6. Charles bonnet coping strategies.
    7. Advice coping with poor sight..better illumination, large print, high contrast
    8. Distances telescopes
    9. Further appointments if magnifiers  given
    10. Is patient registered sight impaired ?... start this process if eligible
  5. Further signposting to other agencies, such as
    1. Social services
    2. A home visit service proved by Birmingham Focus
    3. IT  training for younger or gadget-liking patients (voluntray agency)
    4. Macular Society for more information
    5. Deaf-blind Society
    6. Local support groups
    7. Leaflets..Macular Society, library, RNIB TV guide, etc
  6. Telephone follow-up to ensure the best aid possible and advice has been provided etc.
  7. Any patient with visual problems is referred, whatever their measured acuity.
  8. Patients may be referred directly from primary care GPs or optometrists: OCT access on  the day is available if the optometrist suspects or wants to exclude active wet-armd.

Evidence

There is considerable evidence that a Low Vision program can be very helpful  and here .   BJO 2011. Navigation training is required if the visual field is restricted 2011. "Our study suggests that: practitioners should be alert to potential mobility difficulties when the visual field is less than about 1.2 sr (70° diameter); assessment for mobility rehabilitation may be warranted when the visual field is constricted to about 0.23 to 0.63 sr (31 to 52° diameter) depending on the nature of their visual field loss and previous history (at risk); and mobility rehabilitation should be conducted before the visual field is constricted to 0.05 sr (15° diameter; critical)."

Eccentic Viewing

This can help and is discussed etc in the clinic. Review

References

Reading speed