- Email: [email protected]
Poster 35
Poster Presentations Conclusion: RP preferred and performed best with a 14⫻ full-diameter wide-angle system. It provided a similar magnification through relative distance magnification (RDM), but it also allowed him an increase in the magnification power that enabled him to read continuous text 0.5 M print @ 4 cm. Issues that were notably different were the peripheral distortions. This poster will also provide a summary of the benefits and limitations of the available optical options when having to deal with powers greater than 6⫻ for reading tasks. Poster 33 Low Vision Management of a Patient with Leber’s Optic Neuropathy Nicole Patterson, O.D., Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: Leber’s optic neuropathy is marked by a rapid, painless, progressive visual loss of both eyes, typically with one eye loss within days to months of the other eye. The disease is marked by mild swelling of the optic disk, progressing over weeks to optic atrophy. The disease usually occurs in men ages 15 to 30 years. Leber’s is transmitted by mitochondrial DNA through the mother. Fifty to 70% of males and 10% to 15% of carriers manifest the disease. Visual acuity is 20/200 to counting fingers with a cecocentral visual-field defect. Low vision evaluation and management is essential to ensure patients maintain their quality of life. Management should include necessary referrals to support services. Method: A 44-year-old woman came to us with vision loss OU secondary to Leber’s optic neuropathy. Entering visual acuities were 3/300 O.D. and 3/225 O.S., as measured with Feinbloom. On presentation, the patient had not accepted vision loss, and evaluation had to be terminated secondary to patient frustration. Much of the examination time was spent counseling the patient. The patient was referred for counseling and classes at a local center for the blind. After receiving support services, the patient returned. She returned to us 3 months later with similar acuities and stated goals. At that visit she was prescribed a 28 D microscope for near tasks and an 8 ⫻ 20 telescope for spotting. She underwent training with the devices and was able to achieve her goals. She currently volunteers biweekly at the center for the blind where she received her counseling. Conclusion: Leber’s causes a sudden rapid loss of vision. Vision loss is devastating to patients. The devastation is compounded when the loss is sudden in active individuals, leaving little or no time for adaptation. Achieving maximum visual potential is the goal of the low vision evaluation. This case report emphasizes the importance of patient acceptance of vision loss before visual potential can be reached.
279 Poster 34 Low Vision Rehabilitation of a Patient with Vogt–Koyanagi–Harada Syndrome Tuan Du, O.D., M.S., The Center for the Partially Sighted, 12301 Wilshire Boulevard, Suite 600, Los Angeles, California 90025 Background: Vogt–Koyanagi–Harada syndrome (VKH) is characterized by bilateral, granulomatous panuveitis. It is believed to be caused by an auto-immune response directed against melanocytes. The visual prognosis is generally fair. However, complications like cataracts, exudative retinal detachment, and choroidal neovascularization can cause significant vision loss. Case Report: A 47-year-old woman was referred to our center for a low vision evaluation. She manifested visual acuities of NLP O.D. and 2/600 O.S., with severe visual field restriction. The patient denies any significant ocular conditions, aside from a history of bilateral cataract extraction and retinal detachment O.D. Communication with the patient’s ophthalmologist revealed that she has Vogt–Koyanagi–Harada syndrome. Methods: On low vision evaluation, the patient was correctable to 10/225 O.S. and 1.5 M print. Based on the patient’s visual goals and examination findings, the following low vision aids were recommended: tinted spectacle correction, an illuminated hand magnifier, and a CCTV. In addition, the patient was referred for orientation and mobility, independent living skills, and lighting evaluation to assist with other aspects of her life. Conclusion: Despite having a fair visual prognosis, Vogt– Koyanagi–Harada syndrome can cause significant visual symptoms. In these cases, a low vision referral is indicated to help the patient maximize visual function and promote independence. Poster 35 Characteristics of Children with Visual Impairment in the State of Oregon John Lowery, O.D., and Julene Pena, O.D., Pacific University, College of Optometry, 2043 College Way, Forest Grove, Oregon 97116 Background: The purpose of this study was to create a useful overview of the population of children who are likely to be treated by the optometrist specializing in low vision. Methods: Case history, examination findings, and treatment plans were analyzed from 410 children and adolescents (ages 6 months to 21 years) who were evaluated in a pediatric low vision clinic in the State of Oregon from 1999 to 2004. Results: The most prevalent primary visual diagnoses were: cortical vision impairment (32%), optic atrophy (12%), ROP (9.5%), albinism (7%), optic nerve hypoplasia (4.8%), and congenital efferent nystagmus (4.8%). It was found that 71.7% of the subject population was multiply handicapped.
280 Medical histories reveal a common theme of congenital or early-acquired brain injury or pathology among the multiply handicapped. The most common etiologies included brain injury from ischemic vascular compromise, trauma, or infection (15.3%); complications of prematurity (12.2%); congenital central nervous system malformations (11.2%); neuro-metabolic conditions (10%); and hydrocephalus (5.8%). These conditions underlying multiple handicaps are also highly associated with the most prevalent visual conditions (CVI and optic atrophy). Acuities were measurable on 88% of patients in this sample, with 52% demonstrating binocular distance acuities in the 20/70 to 20/200 range. Ninety percent of patients were responsive to confrontation field testing, with 10% demonstrating peripheral field restriction and 9% demonstrating central field loss. Corrective lenses were recommended for ametropia in 51% of the sample and 28.7% were written a new prescription. Eightyseven individuals (21.2%) were dispensed new low vision aids, and specific optical devices were recommended for another 49 patients (12%). Conclusion: Due to the significant number of children with multiple handicaps, an interdisciplinary approach must be implemented in order to better understand and serve this unique population. Poster 36 Rehabilitation of Functional Vision using Eccentric Viewing Training in Advanced Ocular Disease Lisa Fuller, O.D., and Stephanie Schmiedecke, O.D., Lake City VA Medical Center, 619 South Marion Avenue, Lake City, Florida 32025 Background: Eccentric viewing (EV) is a technique used to move the line of sight away from the visual axis in order to utilize other areas of the retina to see. Visually impaired patients with bilateral age-related macular degeneration must often resort to EV as a tool to regain functional vision. While this process can be arduous and frustrating, visual results can be phenomenal with a dedicated patient and proper training. Case Report: CS, a 77-year-old man with bilateral advanced wet-ARMD, was referred to our low vision clinic with documented vision of counting fingers at 12 inches O.D. and 16 inches O.S. He entered the examination room gripping his wife and functioning like a patient with no light perception vision. He donated optical devices previously prescribed from another clinic because they “did not work.” These included multiple hand-held magnifiers, reading glasses, and a closed-circuit television. Although he expressed frustration and discouragement toward low vision, his goals remained to read again, to become more independently mobile, and to see for welding projects. His uncorrected vision was 3/120 O.D. and 5/180 O.S., both with gross EV. A fundus examination with photos revealed large disciform scars approximately 4 ⫻ 5 disk diopters in each eye. Through rehabilitation using a tailored EV program,
Optometry, Vol 77, No 6, June 2006 CS can now walk independently and see 20/240 EV with each eye. He can also read 1.6 M text with EV and a JORDY™ magnification system. Conclusion: CS is an excellent role model of how rehabilitation with eccentric viewing may benefit patients with advanced ocular disease. His experience reiterates how low vision devices dispensed without proper training can cause patient frustration and reduce motivation for rehabilitation. This case proves that patients with even the most severe forms of macular degeneration can have hope. Poster 37 Low Vision Rehabilitation in a Case of Simultaneous Pseudoxanthoma Elasticum and Sickle Cell Disease Swati Modi, O.D., and Stanley Woo, O.D., University of Houston, College of Optometry, 505 J. Davis Armistead Building, Houston, Texas 77204 Background: Pseudoxanthoma elasticum (PXE) is a rare systemic connective tissue disorder characterized by calcification of elastic fibers. Two of the characteristic ocular manifestations of PXE are a peau d’orange appearance to the retina and angioid streaks, which may lead to choroidal neovascular membranes (CNVM). Visual impairment occurs in 50% to 70% of PXE patients. Sickle-cell disease (SCD) is a separate entity that also manifests angioid streaks. SCD is characterized by rigid erythrocytes, which have abnormal oxygen transport. This may result in retinal hypoxia, neovascularization, and ischemia. Peripheral neovascular fronds manifest a sea-fan appearance. This case presents an interesting patient with both PXE and sickle cell-related functional vision loss that was addressed through low vision rehabilitation (LVR). Case Report: A 55-year-old woman with both PXE and SCD came to us for a low vision evaluation. Past ocular history was significant for angioid streaks, drusen, and sea-fan neovascularization OU. The patient was also status post-panretinal photocoagulation for proliferative sickle cell retinopathy OU, laser photocoagulation for juxtafoveal CNVM O.D., photodynamic therapy, and pars plana vitrectomy with membrane peel for subfoveal CNVM O.S. Fundus examination revealed extensive macular scarring in both eyes. Best-corrected visual acuity was 10/100 in each eye with temporal eccentric viewing. Goals were to spot at a distance and read newspapers and the Bible. A scanning laser ophthalmoscope was utilized to confirm the optimal preferred retinal locus for the patient. With LVR and training, a 6 ⫻ 16 hand-held telescope and 5⫻ LED-illuminated hand-held magnifier were prescribed to meet her visual needs. Conclusion: Both PXE and SCD can result in significant visual impairment. However, LVR can maximize functional vision and should be considered the standard of care in comanagement of patients to meet visual goals and maintain independence.
279 Poster 34 Low Vision Rehabilitation of a Patient with Vogt–Koyanagi–Harada Syndrome Tuan Du, O.D., M.S., The Center for the Partially Sighted, 12301 Wilshire Boulevard, Suite 600, Los Angeles, California 90025 Background: Vogt–Koyanagi–Harada syndrome (VKH) is characterized by bilateral, granulomatous panuveitis. It is believed to be caused by an auto-immune response directed against melanocytes. The visual prognosis is generally fair. However, complications like cataracts, exudative retinal detachment, and choroidal neovascularization can cause significant vision loss. Case Report: A 47-year-old woman was referred to our center for a low vision evaluation. She manifested visual acuities of NLP O.D. and 2/600 O.S., with severe visual field restriction. The patient denies any significant ocular conditions, aside from a history of bilateral cataract extraction and retinal detachment O.D. Communication with the patient’s ophthalmologist revealed that she has Vogt–Koyanagi–Harada syndrome. Methods: On low vision evaluation, the patient was correctable to 10/225 O.S. and 1.5 M print. Based on the patient’s visual goals and examination findings, the following low vision aids were recommended: tinted spectacle correction, an illuminated hand magnifier, and a CCTV. In addition, the patient was referred for orientation and mobility, independent living skills, and lighting evaluation to assist with other aspects of her life. Conclusion: Despite having a fair visual prognosis, Vogt– Koyanagi–Harada syndrome can cause significant visual symptoms. In these cases, a low vision referral is indicated to help the patient maximize visual function and promote independence. Poster 35 Characteristics of Children with Visual Impairment in the State of Oregon John Lowery, O.D., and Julene Pena, O.D., Pacific University, College of Optometry, 2043 College Way, Forest Grove, Oregon 97116 Background: The purpose of this study was to create a useful overview of the population of children who are likely to be treated by the optometrist specializing in low vision. Methods: Case history, examination findings, and treatment plans were analyzed from 410 children and adolescents (ages 6 months to 21 years) who were evaluated in a pediatric low vision clinic in the State of Oregon from 1999 to 2004. Results: The most prevalent primary visual diagnoses were: cortical vision impairment (32%), optic atrophy (12%), ROP (9.5%), albinism (7%), optic nerve hypoplasia (4.8%), and congenital efferent nystagmus (4.8%). It was found that 71.7% of the subject population was multiply handicapped.
280 Medical histories reveal a common theme of congenital or early-acquired brain injury or pathology among the multiply handicapped. The most common etiologies included brain injury from ischemic vascular compromise, trauma, or infection (15.3%); complications of prematurity (12.2%); congenital central nervous system malformations (11.2%); neuro-metabolic conditions (10%); and hydrocephalus (5.8%). These conditions underlying multiple handicaps are also highly associated with the most prevalent visual conditions (CVI and optic atrophy). Acuities were measurable on 88% of patients in this sample, with 52% demonstrating binocular distance acuities in the 20/70 to 20/200 range. Ninety percent of patients were responsive to confrontation field testing, with 10% demonstrating peripheral field restriction and 9% demonstrating central field loss. Corrective lenses were recommended for ametropia in 51% of the sample and 28.7% were written a new prescription. Eightyseven individuals (21.2%) were dispensed new low vision aids, and specific optical devices were recommended for another 49 patients (12%). Conclusion: Due to the significant number of children with multiple handicaps, an interdisciplinary approach must be implemented in order to better understand and serve this unique population. Poster 36 Rehabilitation of Functional Vision using Eccentric Viewing Training in Advanced Ocular Disease Lisa Fuller, O.D., and Stephanie Schmiedecke, O.D., Lake City VA Medical Center, 619 South Marion Avenue, Lake City, Florida 32025 Background: Eccentric viewing (EV) is a technique used to move the line of sight away from the visual axis in order to utilize other areas of the retina to see. Visually impaired patients with bilateral age-related macular degeneration must often resort to EV as a tool to regain functional vision. While this process can be arduous and frustrating, visual results can be phenomenal with a dedicated patient and proper training. Case Report: CS, a 77-year-old man with bilateral advanced wet-ARMD, was referred to our low vision clinic with documented vision of counting fingers at 12 inches O.D. and 16 inches O.S. He entered the examination room gripping his wife and functioning like a patient with no light perception vision. He donated optical devices previously prescribed from another clinic because they “did not work.” These included multiple hand-held magnifiers, reading glasses, and a closed-circuit television. Although he expressed frustration and discouragement toward low vision, his goals remained to read again, to become more independently mobile, and to see for welding projects. His uncorrected vision was 3/120 O.D. and 5/180 O.S., both with gross EV. A fundus examination with photos revealed large disciform scars approximately 4 ⫻ 5 disk diopters in each eye. Through rehabilitation using a tailored EV program,
Optometry, Vol 77, No 6, June 2006 CS can now walk independently and see 20/240 EV with each eye. He can also read 1.6 M text with EV and a JORDY™ magnification system. Conclusion: CS is an excellent role model of how rehabilitation with eccentric viewing may benefit patients with advanced ocular disease. His experience reiterates how low vision devices dispensed without proper training can cause patient frustration and reduce motivation for rehabilitation. This case proves that patients with even the most severe forms of macular degeneration can have hope. Poster 37 Low Vision Rehabilitation in a Case of Simultaneous Pseudoxanthoma Elasticum and Sickle Cell Disease Swati Modi, O.D., and Stanley Woo, O.D., University of Houston, College of Optometry, 505 J. Davis Armistead Building, Houston, Texas 77204 Background: Pseudoxanthoma elasticum (PXE) is a rare systemic connective tissue disorder characterized by calcification of elastic fibers. Two of the characteristic ocular manifestations of PXE are a peau d’orange appearance to the retina and angioid streaks, which may lead to choroidal neovascular membranes (CNVM). Visual impairment occurs in 50% to 70% of PXE patients. Sickle-cell disease (SCD) is a separate entity that also manifests angioid streaks. SCD is characterized by rigid erythrocytes, which have abnormal oxygen transport. This may result in retinal hypoxia, neovascularization, and ischemia. Peripheral neovascular fronds manifest a sea-fan appearance. This case presents an interesting patient with both PXE and sickle cell-related functional vision loss that was addressed through low vision rehabilitation (LVR). Case Report: A 55-year-old woman with both PXE and SCD came to us for a low vision evaluation. Past ocular history was significant for angioid streaks, drusen, and sea-fan neovascularization OU. The patient was also status post-panretinal photocoagulation for proliferative sickle cell retinopathy OU, laser photocoagulation for juxtafoveal CNVM O.D., photodynamic therapy, and pars plana vitrectomy with membrane peel for subfoveal CNVM O.S. Fundus examination revealed extensive macular scarring in both eyes. Best-corrected visual acuity was 10/100 in each eye with temporal eccentric viewing. Goals were to spot at a distance and read newspapers and the Bible. A scanning laser ophthalmoscope was utilized to confirm the optimal preferred retinal locus for the patient. With LVR and training, a 6 ⫻ 16 hand-held telescope and 5⫻ LED-illuminated hand-held magnifier were prescribed to meet her visual needs. Conclusion: Both PXE and SCD can result in significant visual impairment. However, LVR can maximize functional vision and should be considered the standard of care in comanagement of patients to meet visual goals and maintain independence.