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MANAGEMENT OF

CHILDREN WITH
LOW VISION

Ria Sandy Deneska


REMINDING
ABOUT LOW VISION
visual acuity of
6/18 to light
even after
perception
treatment a visual field of
and/or 10 from the
standard point of
refractive fixation
correction

but who uses, or is


one who has potentially able to
impairment Low use, vision for the
planning and/or
of visual Vision execution of a task for
functioning which vision is
essential
The Facts
WHO 2011
>285 millions : visual USA : 1 : 20 preschooler have
impairment visual problem education
39 millions : totally blind involvement

246 millions : low vision

The prevalence of low vision


12 millions--- 5-15 yrs children
among children is only
suffer from low vision
partially known the
because of uncorrected
magnitude of the problem
refractive error
being underestimated
20% among children in
A majority of children with
special schools for the blind
visual impairment have
have vision that could be
some vision
used in daily activities

WHO

its existence often ignored children are rarely


by medical & educational encouraged to develop the
staff use of that vision
Development

Behaviour &
Educational
the family

The
implication
low vision
for children
The Assessment
What is the
Why does the
prognosis for
child have
the childs
low vision?
vision

What is the
Does the
childs
child have
functional
low vision?
Clinical vision?
assessment
Developmental
Genetic History
History

Task Related
Ocular History
History
History
taking
Visual Function

Visual Contrast Visual


Acuity Sensitivity Field

Glare Colour Binocular


Sensitivity Vision Vision
Distance Acuity

Early Infancy Infants & Preverbal Older


Children Children

Catford - Optotype
Blink Using
Pupillary Head turns drum, - Symbol is
response optotype
reaction to towards a preferential prefered
to a bright may not be
bright light light source looking,
light possible - Shorter
VEP distance
Near Acuity
Range of Reading chart
Accomodation should not be
in children >> used The target size
allows them to
depends on age
bring objects
Single letters/ & academic level
very close to the
eyes to increase symbols is
image size prefered
Contrast Sensitivity, Colour Perception,
Visual Field
The
Management
Non Optical
Optical Devices
Devices

Management of
Low Vision

Rehabilitation Electronic Devices


Study in Asia
Standard (2005) For many
distance - low children, this
refractive visionchildren level of vision
correction aged 415 is sufficient to
with spectacle years allow them to
or contact lens read a
will enhance - > 2/3 could blackboard
the visual achieve a from the front
function in distance visual row in a
many acuity of 6/60 classroom
High Plus
Magnifying
Spectacles

Telescopes Optical Hand


Devices Magnifiers

Stand
Magnifier
High Plus Magnifying Spectacles

Normally, the spectacles


can be prescribed near Can be given:
up to +3.50D - Monocular/ Binocular
Anything higher called - Single vision/ Bifocal
high plus add lens

How to prescribe ?
- give an addition over the distance
correction
- cylinder unless sigificant is ignored
- patient has to read at the focal
point
Prediction of Add

First determine : Reciprocal of the distance


- The corrected distance - Near acuity : 2M /40cm
acuity To read 1M 20cm
- The goal of the size print
add = 100/20 = +5.00 D
first

Reciprocal of Snellens
Other methods
visual acuity
- N notation
- Kestenbaums Rule
- LogMAR visual acuity
- BCVA : 6/30 add +5.00
Advantage Disadvantage

The hands are free to hold the close reading distance causes
reading material fatigue

reduced illumination due to bending


The field of view is larger
over the book

Reading can be done in patient with eccentric fixation are


prolonged time unable to fix

may not be effective in patient with


easily portabel
contricted field of vision

normal appearance
Hand Magnifier
Can be used with or without
glasses The selection depend on the
Available from +4.00 to +48.00 patients requirement & the
The quality degraded > +32.00 task he wants it for
Illuminated & non illuminated

Trial set : should include 2x


(+8.00D) to 10x (+40.00D)
Most patiens accept up to 6x
Start from less magnification to
higher gradually
Advantage Disadvantage

Normal reading distance It occupies both


Most convenient for short hands
term tasks
Problem with
Easily available
Work well in eccentric maintaining focus,
viewing especially in elderly
Constricted field benefit with tremors
with them
Stand Magnifier
Illuminated & non
Prefocused & rest on illuminated
the rigid mount
Range from 2x to 20x

A choice for patients


with constricted or
central field loss
Telescope
Can be monocular or binocular
Range : 2x to 10x

Magnify the apparent size of the distant objects,


making them appear closer
Types : Field of view decreased with
Hand Held power
Clip on, spectacle mounted. 3x telescopes 12.5
Monocular/binocular 4x telescopes -- 10
Bioptics design

Disadvantage
Advantages : - Restriction field of view
- The only possible device to - The appearance
date which enhances distant - Constricted fields dont
vision benefit much
- Can be used in classroom or - Focusing requires hand &
outdoor eye coord
- Relatively expensive
Non Optical
Optical Devices
Devices

Management of
Low Vision

Rehabilitation Electronic Devices


Other than lenses (power) Promote independent
Can be used independently living

Non Optical
Devices

Function : Alter the environtment :


Enhance the visibility of 3B : bigger, brighter,
retinal image
blacker
Optimize the use of
magnifiers 3C : closer, color , contrast
Non Optical
Optical Devices
Devices

Management of
Low Vision

Rehabilitation Electronic Devices


Electronic Devices
Non Optical
Optical Devices
Devices

Management of
Low Vision

Rehabilitation Electronic Devices


The doctor may guide you the
Training & counseling after tools, but rehabilitation
low vision examination counceller make the tools
work

Vision Rehabilitation

Rehabilitation Personnels :
Objective : - Rehabilitation counselors
- Vision rehabillitations therapist
- to develop the independent living
- O & M instructor
skills of visually impaired people
- Teachers of the Visually Impaired
-help them to regain self-confidence -Occupational therapist
for reintegrating into the community
Entertaintment
like music Counseling

Home Employment &


Management placement

Usage of the
Communicating
low vision
in Braille
devices

Training course
Orientation & Technology
in rehabilitation
mobilization usage
center
THANK YOU