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Findings from Epidemiological Research Owsley C. This presentation will summarize the results of two studies examining to what extent vision impairment from two common eye conditions of the elderly -- cataract and glaucoma -- is associated with MVC.
Visual field impairment in the central 30 degrees at severe levels AGIS scores , particularly in the worse eye, elevates crash risk among those with glaucoma. This presentation will also discuss the paucity of data available on crash risk among those with age-related macular degeneration and the need for future research to focus on this population of older drivers. Some European countries make special provisions for specific types of visual field defects, expressing the opinion that, for some disabilities, compensations may be effective.
Homonymous Hemianopia HH is a visual field defect affecting half of the binocular visual field that results from post-chiasmal brain damage. Previous research has shown that compensation and restoration techniques can be developed and might have success. However, the target population, goals to be obtained, and method of rehabilitation is still an open issue.
A two-part European trial has been conducted to evaluate whether the monocular peripheral prism approach of providing visual field expansion for HH Peli is helpful as a driving aid. The second Belgian part of the trial implemented improvements in rehabilitation and assessment methodology and introduced the oblique prism design shifting the field expansion effect closer to the horizontal meridian. After screening to ensure that patients had complete HH, no visual neglect and no significant cognitive impairments, a practical driving test was performed on one of three predefined routes using a standardised evaluation protocol.
Subsequently, the oblique peripheral prisms were dispensed using press-on prisms 40 PD. Before the final fitness-to-drive evaluation, all subjects were given 2 hours of supervised driving while wearing the prisms.
Post-treatment evaluation consisted of two standardised driving tests. In one test, subject wore their personal prisms. For most subjects, the prisms were well tolerated and subjectively rated helpful. Although the final and global fitness to drive decision was not influenced either positively or negatively by the prisms, clear evidence is provided of the positive influence of the prisms on specific elements of the driving task e.
The implications for HH driver evaluation and licensing will be discussed. With the aging of the population, the number of elderly drivers with reduced visual acuity and central visual field loss CFL , e. This presentation will address whether there are differences in BT usage between low vision drivers with and without CFL, and whether using a BT affects self-restriction of driving by older adults with AMD.
Drivers with reduced visual acuity, with and without CFL, who had recent experience of BT driving completed a telephone interview. BT usage patterns were quantified with questions designed specifically for the study. Both older and younger drivers with CFL spent a greater percentage of driving time looking through the BT than drivers without CFL, suggesting that they either had less efficient BT viewing behaviors or had a greater dependency on the BT.
The findings also suggest that being permitted to drive with a BT reduces self-imposed driving restrictions of people with AMD, which is likely to have a positive effect on their independence and quality of life, but may increase their exposure to accidents. A focusable bioptic enables a person to target any image from about one foot to "infinity". Thus, among many usages, it has quotidian value in looking at labels in a cabinet, wall- mounted menus in a fast food-restaurant, messages on a bulletin board, finding a person in a crowd, television and reading signage on the roadways.
The serendipity of a bioptic is so valuable to all aspects of daily living, that this is where the development of efficiency resides. The idea of teaching a person to effectively use a bioptic for driving gives the perception that it is its only or main value.
What if a person who wanted a bioptic for driving were taught that it has much more intrinsic value to the wearer if he uses it daily? My teaching protocol is to give the wearer full functionality of the bioptic. There are essentially four areas where the bioptic serves the wearer. It is applied when the user is stationary looking at stationary objects: It is used when stationary looking at moving targets: While moving, the user looks at stationary objects: The user is moving looking at moving targets: I always acquire a driving instructor to teach the person to drive or assess their ability to continue to drive.
Misconceptions versus Reality Huss C. Thirty-nine of these States also permit the use of prescription bioptic lens systems for visual assistance in the driving task. Approximately half of those States that allow driving with bioptics require participation and satisfactory completion of formalized programs of low vision driver education training including but not limited to hours of behind-the-wheel instruction as a requirement for driver licensure.
Some States require bioptic lens users to participate in comprehensive driver license testing including passage of a standardized on-road test. In some States, bioptic drivers with good accrued driving records are permitted to participate in additional driver training and testing in efforts of securing less restrictive or non-restrictive driving privileges. This presentation will provide an overview of some of the common misconceptions related to low vision driving with bioptics that surface in discussion amongst professionals and consumers.
The latter will include the following: Information presented is based in part on the knowledge and experiences gained by this Orientation and Mobility Specialist as a member of a multi-disciplinary team of professionals involved in the West Virginia Pilot Low Vision Driving Study, , and its continuum of related direct services, and indirect services, Vision interventions can come in many forms. This presentation will delineate different aspects of vision intervention methodology and will also present some systematic approaches to intervention.
More specificity about vision intervention processes will help in the design of studies of intervention and will provide some guidance in the interpretation of intervention outcomes. In a provocative article in the Journal of Visual Impairment and Blindness, Ferrell and Muir stated that scientific research into the effects of visual stimulation and training is ambiguous and that, therefore, stimulation and training should be abandoned.
The scientific support for this statement is reviewed by describing the scientific relevance and plausibility of the aims and presuppositions of visual stimulation and training programs as well as the results of empirical intervention studies.
Despite the fact that visual stimulation and visual training are common practice, only 10 empirical studies were published in peer-reviewed journals over the last 40 years. However, the empirical evidence is still too sparse to draw convincing conclusions.
There is an urgent need for good randomized, controlled trials with dependent variables that are relevant to the everyday lives of children with visual impairments. Besides the results of the review study, the first steps of a prospective intervention study will be presented.
The first goal in this study was to reach consensus on the content of the intervention, because it was immediately recognized that visual stimulation and training interventions showed large variation with regard to content, materials, intensity, and goals. The first 1 involved design and evaluation of a program to promote visual development PVD for VI babies aged 0 to 13 months of diverse aetiology using a randomised control model.
Treatment was equally effective if introduced under or over 7 months of age; the importance of earlier introduction being to make maximal vision available for general development as young as possible and for establishment of neuronal networking during the era of greatest central nervous system pliancy.
The presence of form vision between 10 and 16 months appeared to exert a protective influence; conversely, its absence constituted a major developmental risk factor; an additional powerful reason for introducing a PVD at the earliest opportunity. Dev Med Child Neurol Patients with will not be referred quickly for low vision aids to consult the low vision professional. Because there is a changing visual acuity and an unstable image at that moment. The goal of this study is to show that it is beneficial to prescribe low vision aids during DRP treatments in an early stage.
In this retrospective study 90 patients are described during 3 years from Sensis-Breda with DRP: But also ergotherapy, social work and psychology. During check ups is diagnosed which chargements have taken place and the percentage of well or none users of low vision aids.
In a period of 3 years, 16 of them needed new low vision aids due to a drop of visual acuity. We will also cover these questions: What is the best way to act with this target group? How is low vision and visual examination with DRP performed? What is the result of social work and ergotherapy? This retrospective study shows that great benefit can be achieved when reliable low vision aids are prescribed in an early stage or during an ophthalmological treatment!
The task of ophthalmologists is to refer during treatment and the task of the low vision professional is to threat professionally in this difficult targetgroup and to prescribe realible low vision aids and also accompany them and to report them back.
People with DRP can during a very difficult period of their beiing ill by means of low vision aids and low vision treatments have a better function, have an increased feeling of self esteem and already experience a better quality of life!
Poor patient education and untimely referral for vision rehabilitation Park W. To test the hypothesis that there is poor patient education and poor patient understanding of uncontrolled diabetes. Retrospective review of patients over a six-month period at a low vision rehabilitation service.
Referred from ophthalmology, neurology, and physical medicine and rehabilitation in academic tertiary medical center. Interventions included measurements of refraction, best-corrected visual acuity, binocularity, stereopsis, contrast sensitivity and visual fields.
Patients referred for specialized services, patient education and knowledge concerning diabetic management, presence of co-morbidities, visual function measurements and difficulty with activities of daily living. The mean duration of disease for Type 2 diabetes was Patients presenting for low vision rehabilitation for the first time were already legally blind to totally blind and profoundly compromised.
This study demonstrates poor patient education about their systemic disease and the lack of timely referral for low vision rehabilitation. A more comprehensive and collaborative approach to care of the diabetic low vision patient Hooper N. In addition to vision loss, other common complications of diabetes include heart disease, stroke, kidney disease, erectile dysfunction, peripheral neuropathy and periodontal disease.
In fact, diabetes also remains the leading cause of both kidney failure and non-traumatic lower-extremity amputation. While visual impairment is the obvious basis for presentation of a diabetic patient for low vision rehabilitation services, a considerable and important opportunity for impact on overall diabetes management through patient and caregiver education, support and awareness of available community and collaborative resources also presents itself.
This presentation emphasizes two case reports in which low vision rehabilitation not only allowed the visually impaired diabetic patient to resume an increased level of independence through the use of multiple optical devices and localization training, but also served as a gateway to a variety of community resources and a collaborative approach to addressing diabetes self-management through patient and caregiver support and education.
A variety of community resources will be highlighted including consideration for transportation needs, orientation and mobility, home health services, diabetes education and self-management training, nutrition, psychosocial support, case management and Hispanic outreach services.
Low vision rehabilitation maximizes remaining vision through the use of optical aids and appropriate training to achieve task-specific goals, facilitating an increased level of independence. Addressing the underlying cause of the visual impairment by promoting a continuous and proactive approach to overall diabetes management contributes to patient satisfaction, reduced risk of further vision loss and other complications, increased patient compliance and ultimately, improved quality of life, all factors to be considered for continued success with low vision rehabilitation.
This presentation proposes that comprehensive low vision care of the diabetic patient is not defined just by successful low vision rehabilitation and functional use of remaining vision, but exists when the low vision professional also assumes a collaborative and continuous role in promoting comprehensive lifetime management of diabetes. To investigate socio-economic variations in diabetes prevalence, uptake of screening for diabetic retinopathy, and prevalence of diabetic retinopathy.
A cross sectional study of people with diabetes entered on a countywide retinopathy-screening database. Diabetes prevalence, uptake of screening, prevalence of any retinopathy and prevalence of sight-threatening retinopathy were compared for different area deprivation quintiles.
With each increasing quintile of deprivation, diabetes prevalence increased, odds ratio 0. Sight threatening diabetic retinopathy was associated with socio-economic deprivation, but non-sight threatening diabetic retinopathy was not. Uptake of screening was inversely related to deprivation. Hoover Rehabiliation Services for Low Vision and Blindness, Baltimore, United States For patients with geographic atrophy GA , the advanced dry form of age-related macular degeneration, visual acuity loss is often a significant underestimate of their true visual impairment.
This is because for many patients with GA, the fovea is preserved until late in the course of the disease. Patients often develop small scotomas blind spots near, but not including, the foveal center.
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