Central Vision loss.pptx

Central vision loss

1. Central Vision loss DIABETIC MACULOPATHY NAMES : WENDY SHANKOTI 190101937 MIDAS MOONGA 190103357 BEATRICE MPOYO 190101904 KENNEDY CHISI 190103337 TEZYA SIMAZUO 190104236

2. Central Vision Definition : Is t he field of view in the center of your vision as you look straight ahead in one’s primary position of gaze that allows you to read, drive and see pictures and faces. It is the vision within the macula which is found on the central part of the retina where visual acuity is sharpest.

3. Central vision loss DEFINATION : Is the loss of vision in center of the visual field typically as the result of damage to the macula, hence having difficulty seeing things in the center of vision, things such as faces and pictures also having difficulties in driving and reading . Since most of our activities we perform depends primarily on central vision therefore the loss of central vision can result in reduction of functional performance e.g you can imagine that you are in your final academic year and you lose your central vision (meaning you cant even read and study properly for your final exam)

4. Diabetic Maculopathy Definition : it is the type of diabetic eye disease that affects the macula . When blood vessels become narrow due to diabetes other blood vessels enlarge to compensate for the narrowed blood vessels, as these vessels are enlarging they become leaky and fluid builds up on the macula which lead to swelling in the macular ( at the center of the retina) which is called diabetic macular oedema . Over time, this disease can destroy sharp vision in this part of the retina (The macula which is responsible for central vision) thus leading to loss of central vision and everything appears blurred as if one is looking through a layer of fluid more common in people with type two diabetes and it’s a leading cause of vision loss in people with type 1 and 2 diabetes, there is no cure of maculopathy if early detected we can reduce its progression hence preventing complete visual loss but if left undetected can lead to total impairment of vision.

5. Cont’d Normal Retina Diabetic Maculopathy

6. ASSESMENT OF LOW VISION PATIENTS WITH DIABETIC MACULOPATHY Distance visual acuity , is assessed using a log MAR chart that is designed to be used at 10 feet under normal room illumination.it is a chart having a consistent number of 5 letters in each row. There is a geometric progression of 0.1 log units in each line. If the subject is unable to read the top line at 10 feet, the chart was brought nearer (8f, 6f, 4f, 2f or 1f) until they were able to identify those letters

7. CONT’D Objective and subjective refraction is undertaken to achieve the best distance acuity.to determine the refractive error the power is estimated by the bracketing technique in which plus and minus lenses of equal power is compared, in subjective refraction it requires patients cooperation for proper estimation of the refractive error( a trail frame is used) while in objective refraction, refractive error is determined by using a R etinoscopy . S ubjective Refraction Objective Refraction

8. CONT’D Near visual acuity, t his test is done to determine how the patient can cope with near tasks. This test helps in making decisions about the low vision devices the patients can benefit from. And year after year, their VA decreases and the power increases. The LogMAR near chart used.

9. CONT’D

10. contd 4. Contrast sensitivity is assessed monocularly as well as binocularly using the Pelli -Robson chart at one meter distance, with best distance refractive correction and near addition of +0.75 D in presbyopic subjects

11. cond 6. Visual field testing , Daibetic Maculopathy affects the central vision, therefore an Amsler grid chart is used. This chart will be used to test the central scotomas of the patient and it explains the reason why the patient is able or unable to read the text. The larger the scotoma , the more the magnification is needed Amsler grid for central visual field testing  

12. Fundus examination This test is done especially when the pupils are dilated for more complete view of the retina, allows for examination of the retina to identify risk factors for potential vision loss associated with the retina in this case diabetic maculopathy . we are able to tell from the fundus examination how severe the condition is by observing the retina through an ophthalmoscopy, funduscopy also helps to find out other conditions of the retina that could affect the remaining vision.

13. LOW VISION MANAGEMENT OPTICAL DEVICES D iabetic Maculopathy is one of the causes of low vision. These subjects have difficulty accomplishing visual tasks, but can enhance their ability by using compensatory strategies, optical devices and by modifying the environment. They include the following: CLOSED CIRCUIT TVs (CCTVs), cctvs are cameras that project a magnified image onto a computer or television screen. Some cameras are mounted on a stand (for example, next to a desktop computer), while others are handheld and can be brought to the grocery store or bank.

14. Cont’d MAGNIFYING GLASSES , magnifying lenses can help you see objects up close, at a distance, and everywhere in between. They also come in a variety of sizes and types; recommended buying of one that is outfitted with a light. Handheld magnifiers are portable and easy to use and stand magnifiers can prop themselves up on a page or other object . e.g Handheld magnifiers these can be used in patients with eccentric fixation. Eccentric viewing is beneficial, if central vision is affected.

15. Cont’d TELESCOPE – Its an optical instrument designed to make distance objects appear nearer hence making distant objects appear larger. Telescopes with magnification power from 2x to 10x are prescribed

16. Cont’d E-READERS, many people feel more comfortable reading large print on e-readers than books, especially in public, with e-readers, you can adjust the font size and color contrast to a setting that feels comfortable for you. Some people prefer black text on a white background, but others see better when there is white text on a black background. Some e-readers also have voiceover, and can read the book out loud-no audiobook subscription required.

17. REHABILITATION OF A LOW VISION PATIENT WITH DIABETIC MACULOPATHY Why Is Low Vision Rehabilitation Necessary? There are some very good reasons for low vision rehabilitation, the most important being increased physical and psychological health. Research has shown that people with low vision tend to have more emotional difficulties and a higher risk of accidents than normally-sighted individuals. Patients who have undergone rehabilitation, however, have reported significant improvements in their functional abilities, a high rate of continued use of low vision devices, improvement in reading and distance vision, and general satisfaction with the quality of life.

18. A Scenario Jim’s Story………“I noticed it after my last class on a Friday. While writing Monday’s assignment on the board, I got some chalk in my right eye. I closed it for a second and couldn’t see the letters I’d just written. I actually thought I’d accidentally erased them. That’s what it looked like. Like I’d smudged them out with my hand or something. Then I opened my other eye, and the letters were there again. I thought maybe there was a smear on my glasses, so I took them off. But that smudge was still there, right in the middle of my left eye. And when I looked at the frame around the board, it was all out of shape…distorted. I don’t know why I hadn’t noticed it before. I couldn’t blink that spot away, or rub it away, or anything. It was just there, and I didn’t know what was going on. I was supposed to attend a staff meeting that afternoon, but I didn’t. I just left. I had to find out what was going on, so I went straight home and called my optometrist. He made time for me that afternoon. To make a long story short, I knew in a few hours that I had an eye disease I never heard of and couldn’t even pronounce. I had become one of the vision-impaired, and I was off on a trip I had never in my life expected to take. I experience the emotional distress and sense of helplessness that I did when I first faced a future with vision impairment.When my right eye went bad, I couldn’t read, and I couldn’t drive. I couldn’t work in my wood shop, which bothered me a lot. I thought I was going totally blind. I became very depressed, and pretty much decided that life as I had known it was pretty much over. There was more stress at home. The family couldn’t accept the fact that I couldn’t see well, and I just couldn’t help out, couldn’t do the carpentry, and couldn’t help my kids with building their houses. My wife, Marie, was very understanding, but it was difficult for her.

19. Cont’d I tried to continue teaching. The students and staff were very supportive in the beginning, but they seemed to forget after a while. Writing lesson plans and grading papers was difficult. I particularly had problems with reading textbooks and journals. But Since my initial low vision assessment and training, I have greatly improved my skills for independent functioning. My social life has slowed somewhat, not so much because of my vision impairment, but because of my retirement from the school system. Marie and I still go out when our budget allows, and we enjoy the closeness and support of our active family. The specialists and doctors at my rehab center were good, but they could be only as good as I would let them be. As I always told my students, if a person doesn’t have a real reason to want to learn–a ton of self-motivation–then there isn’t anyone who is going to be able to teach them. The purpose of the Vision Rehabilitation service is to help these individuals make the most of their limited vision. To accomplish this, state-of-the-art devices will be employed to improve the quality of life of individuals who have experienced a loss of vision

20. How to Rehabilitate A Low Vision Patient With Diabetic Maculopathy Firstly > we will begin by asking questions about your health, eye condition, and visual goals--the things they would like to do, but cannot do now because of loss of vision. We use all of this information to plan what will meet the patients need. Secondly > we will evaluate the patient’s visual skills, talk with them and their family about problems caused by visual impairment and explain how they can make the best use of their vision through training, devices and services Then Together , us and patient develop a rehabilitation plan to help them meet their visual goals. During training sessions , will teach them new ways to use their vision as well as any recommended devices. We can also arrange with them so that we can adapt their homes and integrate their new skills and devices into their daily activities . Finally we provide referrals to state agencies

21. Cont’d

22. contd . Vision rehabilitation services allow people to lead a more productive lives. team is specially trained in vision rehabilitation. Our comprehensive program centers around a treatment plan that meets your needs. We work closely with you, your family and friends, your eye doctor, and the services available in your community. Everything we do; information, evaluation, training and technology, is aimed at helping you live as independently as possible. In addition, we also provide counseling and guidance for individuals with visual impairments and their families that can help with the special problems of vision loss. Advice and help in getting needed services is available. Occupational therapy assistance is also available to help individuals with visual impairment function more efficiently with their daily living activities. Many individuals think that treating visual impairment means "just getting a better pair of glasses", but it isn't that simple. A complete vision rehabilitation program is needed to improve visual function and quality of life.

23. REFERENCE Klein Klein BEK, moss SE, visual impairment in diabetes, ophthalmology 1984. Kanski JJ.clinical ophthalmology 2 nd edition. London butterworth -Heinemann ltd, 1989. World health organization, international classification of impairment disabilities and handcups , Geneva: world health organization 1980 Mehr EB, Fred AN, low Vision Care, Fairch Publication , 1975 http://lowvision.preventblindness.org/2018/02/16/jims-story-a-journey-through-low-vision-rehabilitation/ https://medicine.uiowa.edu/eye/patient-care/clinics/vision-rehabilitation-and-counseling

24. cheers