LOW VISION REHABILITATION OF CHILDREN WITH ANIRIDIA

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LOW VISION REHABILITATION OF CHILDREN WITH
ANIRIDIA

• Sarah Appel, O.D.
• William Feinbloom Vision Rehabilitation Center

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ANIRIDIA

• Visual Acuity
• typically 20/100 to 20/200
• Visual Field Defects
• none unless glaucoma present
• Contrast Sensitivity
• decreased due to presence of anterior polar
  cataract
• decreased if glaucoma is present

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ANIRIDIA

• Light Adaptation
• photophobia due to lack of pupil
• associated polar cataract and corneal clouding
  further increase photosensitivity and glare
  sensitivity
• increased photosensitivity due to scattering of
  light by cataract

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ANIRIDIA
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ANTERIOR POLAR CATARACT
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LOW VISION EXAMINATION

• HISTORY
• VISUAL ACUITIES
• REFRACTION
• EYE MOVEMENT EVALUATION
• EYE ALIGNMENT EVALUATION
• VISUAL FIELDS ANALYSIS

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LOW VISION EXAMINATION

• CONTRAST SENSITIVITY TESTING
• COLOR VISION TESTING
• OCULAR HEALTH EVALUATION
• EVALUATION OF LOW VISION DEVICES
• INSTRUCTION IN THE USE OF LOW VISION DEVICES

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HISTORY

• Explore ocular history
• Surgeries lensectomy, strabismus, nystagmus,
  glaucoma
• Medication glaucoma
• Previous examination results corrective eyeware,
  low vision devices
• Visual concerns
• Goals for examination

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HISTORY

• Explore systemic history
• Surgeries
• Developmental age
• Medication explore potential visual side effects
• Explore visual concerns
• Mobility
• Learning based visual issues
• Identify goals for evaluation

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VISUAL ACUITIES

• Developmental ages of infancy to 3 years

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VISUAL ACUITY

• Developmental ages 3 years and older

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VISUAL ACUITIES

• Children with reading ability

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REFRACTION

• Ensure optimal focus which results in increased
  visual attention, safer mobility
• Polycarbonate lenses provide protection in cases
  of significantly reduced vision
• Correct prescription may reduce eye turns,
  enhance visual efficiency

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REFRACTION

• Consider correction for near tasks in cases of
  significantly reduced viewing distances
• In cases of aphakia or pseudophakia , make sure
  that child has a near prescription incorporated
  into corrective lenses

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EYE MOVEMENT EVALUATION

• Evaluate range of eye movements
• Evaluate nystagmus for null point
• Identify head turns to achieve a null point
• Identify positions of gaze that intensify
  nystagmus
• Evaluate for latent nystagmus with occlusion

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EYE ALIGNMENT EVALUATION

• Hirschberg light reflex test
• Cover testing

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VISUAL FIELDS ANALYSIS

• Confrontation testing in adults or
  developmentally older children
• Confrontation testing in developmentally younger
  children

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VISUAL FIELD TESTING

• Peripheral Visual Field Testing

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CONTRAST SENSITIVITY TESTING

• Evaluates visual discrimination of lower contrast
  items
• Translates to ability to identify lower contrast
  targets curbs, drop-offs, identifying faces
  etc.
• Especially important in cases of cataracts,
  corneal clouding and optic atrophy

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COLOR VISION TESTING
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OCULAR HEALTH EVALUATION

• External evaluation
• Cornea
• Evaluation of intraocular pressure
• Evaluation of lenses for anterior polar cataracts
• Retinal/optic nerve evaluation
• Identify optic nerve changes related to glaucoma

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EVALUATION OF LOW VISION DEVICES

• PROVIDE MAGNIFICATION FOR DISTANCE VISUAL TASKS
• PROVIDE MAGNIFICATION FOR NEAR VISUAL TASKS
• PROVIDE LIGHT FILTRATION
• PROVIDE CONTRAST ENHANCEMENT

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HAND HELD TELESCOPES
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SPECTACLE MOUNTED TELESCOPES
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MaxTV
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Designs for Vision Bioptic Telescope
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Selsi Sportglasses
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Ocutech VES Telescope
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HAND MAGNIFIERS
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STAND MAGNIFIERS
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SPECTACLE MAGNIFIERS
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CLOSED CIRCUIT TELEVISION READING SYSTEMS
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PORTABLE CCTV(Quicklook, Clearview)

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ADAPTIVE TECHNOLOGY
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MAGNILINK S CCTV
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ENHANCED VISION ACROBAT
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ABSORPTIVE LENSESSUNLENSES
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REDUCED APERTURE CONTACT LENSES
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TINTED CONTACT LENSES
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LAMPS
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NON OPTICAL DEVICES
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LAP DESKS
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READING STANDS
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WRITING AIDS

• Bold line paper
• 20/20 pen
• Clip board

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Enlarging Mirrors

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INSTRUCTION IN THE USE OF LOW VISION DEVICES
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REPORT TO TEACHERS

• description of visual status
• print size recommendations
• print media recommendations
• recommendations for optical devices
• adaptive technology recommendations
• environmental modifications

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ENVIRONMENTAL MODIFICATIONS

• seating close to board
• enhanced contrast boards
• directed illumination
• seating away from windows

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REHABILITATION SERVICES

• State agencies
• orientation and mobility
• rehabilitation teaching
• transition to college
• counseling/support
• social work
• psychology
• peer support groups

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RESOURCES

• Special education programs
• Early intervention programs
• State agencies for visually impaired
• Schools for visually impaired

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SUPPORT GROUPS

• American Council for the Blind
• American Foundation for the Blind
• National Association for Parents of the Visually
  Impaired