Vision Aid

Overseas
helping the world to
see
Low Vision

The Visually Impaired Patient

 VISION 20/20
The RIGHT TO SIGHT
A world in which no one is
needlessly blind

• Working together to eliminate the

main causes of avoidable blindness
by 2020
• Support those with unavoidable
vision loss to achieve their full
potential
• Partners include WHO, IAPB, NGOs,
Governments, Professionals & Eye
Care Institutions.
LOW VISION & VISION 20/20
• The link between visual impairment
and poverty is clear
• 80% of world blindness is avoidable
• 90% of avoidable blindness occurs
in the developing world
• People in the developing world are
ten times more likely to be blind or
visually impaired than those in the
developed world
• An estimated 670 million people
worldwide are blind or visually
impaired due to uncorrected
refractive error
• Correcting refractive error is one of
the most cost effective and efficient
of ALL health care interventions
 Blindness worldwide

From Vision 2020:

• 40-45 million blind, around 50% from cataract

• 180 million visually impaired
• 35 million need low vision care
• 60% live in Sub Saharan Africa, India &China
• An estimated 1.4 million children are
blind, 320,000 of whom live in sub-
Saharan Africa
• around 7.1 of the world's 38 million blind
people live in sub-Saharan Africa
• Around 60% of Africa's blind are women
• Africa has 1 ophthalmologist per
1,000,000 population
Causes of blindness worldwide

Uncorrected refractive
error is a significant
cause of visual
impairment worldwide
DEFINITIONS
LOW VISION -
Best VA of <6/18 after appropriate
medical, surgical and/or optical
intervention, divided into :
Moderate visual impairment (6/18-6/60)
Severe visual impairment (<6/60)
Near vision has no specific standard
Visual field loss is not quantified
FUNCTIONAL CLASSIFICATION

• Functionally blind

• Functionally sighted

• Functionally sighted with aided literacy

• Functionally sighted with aided mobility

Enormous inter px variability in

how they cope.
 Causes of blindness in
developed countries
• Age related macular degeneration
• Diabetic retinopathy
• Glaucoma
 Causes of blindness in
developing countries
• Cataract
• Glaucoma
• Corneal injury due to disease and/or trauma
- Measles
- Trachoma
- Xerophthalmia/malnutrition
- Traditional medicines
• HIV related pathologies
• Albinism
How to help a person with low vision

1. Find out what they want to do

2. Refract
3. Measure VA
4. Spectacles or magnifiers?
REFRACTING A LOW VISION Px

• Larger step sizes

• Use of pinhole
• Assess near vision, with/without Rx
• Accommodation

ADDS
• Starting point +4.00 add @ 25cm
• Increase add in +2 & +4 steps.
• Is Px binocular?
ASSESSING DISTANCE VISION/VA
• Quantify standard of vision/VA
• Use of pinhole
• Ensure px refracted –distance VA
• Dilate px if you think it is required

REALISTICALLY
Distance LVAs are generally less
commonly used, require high levels of
personal motivation and are often
difficult to learn to use. On a VAO
outreach programme you may have few
options
ASSESSING NEAR VISION
• Assess near VA
• Identify the required visual task
• Estimate level of magnification required
• Is px binocular?

Possible options
• High adds
• Hand mag
• Stand mag
• Illuminated / non-illuminated
- can Px get batteries?
Spectacles or magnifiers?

Does refraction improve VA?

Yes No

prescribe spectacles try magnifiers

 Magnification
To help people with low vision, we
need to provide

magnification
 What is magnification?
Reference standard:

• x1 magnification for object at 25cm

• Person would need +4.00 add (or
enough accommodation) to view object
at 25cm
 How do we provide
magnification?
1. Increase size of object: relative size
magnification

2. Hold object closer: relative distance

magnification

3. Telescope: angular magnification

increase retinal image size

 Relative size magnification
Example:
• Large print
Relative distance magnification
• Example:
Hold print closer

• If hold print at 10cm

instead of 30cm, gives
x3 magnification
 What is magnification?
• Nominal magnification = F/4

e.g. +8.00 lens, magnification = x 2

+12.00 lens, magnification = x 3
 High plus lens spectacles
• Advantages
– Hands free to hold object e.g. book, needle
and thread

• Disadvantages
– Short working distance
– Only suitable for mild/
moderate visual impairment
Hand magnifiers
 Hand magnifiers
• Advantages
– Good range of powers available e.g. x 8
magnification

• Disadvantages
– Need good manual dexterity
– Not hands free
Stand magnifiers
 Stand magnifiers
• Advantages
– Rests on object, fixed working distance
– Can write/ thread needle underneath
 Other ways to improve vision
Practical methods
• Contrast
• Colour
• Lighting
 Other ways to improve vision
• Improve contrast

e.g. write with thick

black pen on white
paper
Other ways to improve vision
 Other ways to improve vision
• Improve lighting
GLARE
Identify

Discomfort glare
Disability glare

Resolution:

Hats

Tints / sunglasses
• REFERRAL TO OTHER
SERVICES
• Ophthalmic/medical
review
• Special education
including Braille
• Long cane skills training
• Local groups supporting
the visually impaired
and their families
IF YOU REMEMBER NOTHING ELSE ......
Remember the 3 ‘B’s of low vision -

BIG

BOLD

BRIGHT
 Low vision = usable vision
• Many or most people with low vision
can be helped with simple spectacles or
magnifiers