Low Vision Rehabilitation/What is low vision

Enquiry
Use this enquiry to guide your understanding of the concept of low vision and the impact of eye disease when treatment is no longer an option. Consider the principles of low vision care with discussion of the reasons why patients do not access or have difficulty accessing services that could help them. You will also be introduced to the concept of low vision care within a multi-disciplinary team.

Focus on Low Vision is an excellent publication by the Centre for Eye Research which will be useful to complete all the topics in this enquiry. You should refer to it often.

The estimated time commitment for this enquiry is 10-12 hours.

Impact of Ocular Disease (visual & psychosocial)
The topic area is designed to teach you to analyse information about an ocular disease and determine the likely functional impairment (Learning outcome #1). You will therefore be able to discuss the psychosocial and physical impacts related to different forms of vision impairment. Access the Class Guide.

Task 1

This material will be presented face to face in week 1.

Listen to the two audio recordings of patients from See Well Australia who have vision impairment. They are describing the impact of the impairment on their lives. If possible listen to the interviews before coming to class in week 1.


 * Audio 1 - group of elderly ladies
 * Audio 2 - younger patient with Stargardt disease

After you have listened to the recordings, work through the questions below.

Meet Mrs Kirkman, Mrs Muirhead and Mrs Sevoir.

All are older women who have bilateral AMD that has progressed to the wet phase - all are legally blind. Mrs Kirkman is a widow who also has significant hearing loss, she wears hearing aids. Mrs Muirhead is also a widow she lives in a large rural city. Mrs Sevoir is married and living with her husband in metropolitan Melbourne. As you listen to their stories make notes on the following:
 * 1) How has sight loss impacted on the lives of the three women?
 * 2) Do any of them refer to their living situation?
 * 3) What are the emotions they express in relation to losing their sight?
 * 4) How has sight loss impacted on their social relationships?
 * 5) What are some of the strategies they are using to overcome the handicaps of sight loss?
 * 6) One has a very philosophical out look, describe this lady’s response.
 * 7) Is there a difference in response between the ladies and what seems to be making this difference?

Now meet Lesley a young woman in her 30’s. She is legally blind due to Stargardt Disease. Lesley lives alone in an inner Melbourne suburb. As you listen to Lesley’s story make notes about the following questions: Consider the differences in response and impact between Lesley and the older ladies. Discuss your answers with your group and try to provide answers to all of the above questions.
 * 1) How did Lesley first realize she was losing her sight?
 * 2) What was her initial response to sight loss?
 * 3) How did sight loss impact on Lesley’s working life?
 * 4) How did sight loss impact on Lesley’s personal life?
 * 5) What has been Lesley’s emotional response to sight loss and her perception of the thoughts of others?
 * 6) What are Lesley’s strategies for coping?
 * 7) What comments does Lesley make about the way people treat her?

Task 2

Task 2 utilises case studies and additional materials that will allow you to consider the impact of sight loss on social and emotional wellbeing.

Watch the interview with Krister Inde Support needed when one loses his or her vision

Refer to Krister Inde's book See bad feel good This will form the basis for the Class Activity related to the psychosocial impact of vision impairment.

Task 3

To consolidate your knowledge, read of Scheiman M, Scheiman M & Whittaker S (2007) Low Vision Rehabilitation, Chapter 4 Eye Diseases Associated with Low Vision.

What is low vision?
Mrs Thelma Scope is a patient at See Well Australia. Through Mrs Scope you will come to understand what low vision is, how it is defined and what it means to have an impairment. In addition, you will consider the epidemiology and impact of low vision in Australia.

Task 1

Watch the What is Low Vision? lectorial where you will find out about your new patient Mrs Thelma Scope.

Consult the resources below in addition to finding your own resources to answer the Task 1 questions. When answering the questions, think about what you know so far about Mrs Scope. Discuss and compare your answers with the students in your group.


 * Terminology in Eye Health
 * WHO | Visual Impairment and Blindness factsheet
 * Oxford Dictionary


 * 1) Why is it important to a patient that we define disability or vision impairment?
 * 2) How does the World Health Organization (WHO) define ‘low vision’
 * 3) According to the WHO definition, can you classify Mrs Scope as having ‘low vision’?
 * 4) What is the definition of ‘impairment’? How does this definition specifically relate to vision?
 * 5) Do you think Mrs Scope has an ‘impairment’? Discuss.
 * 6) Define ‘disability’ and explain how this relates to the sense of vision.
 * 7) Do you think Mrs Scope is disabled? Explain why/why not.
 * 8) Define ‘handicap’ and explain whether this definition can be applied to Mrs Scope.
 * 9) Do you think you have enough information about her case history in order to classify Mrs Scope as either having impairment, disability or handicap? What other information would you need?

Task 2

Referring to the Eye Research Australia (Clear Insight) Economic Impact and Cost of Low Vision in Australia publication, answer Task 2 questions. Don't forget to consider your patient Thelma when answering the questions.


 * 1) Of a composition of the total cost of vision disorders in 2004, what is the total cost of suffering? What do you think “cost of suffering” means? Explain your answer in the context of Mrs Scope.
 * 2) On page 4 of the report it states: “the share of pharmaceutical costs has increased to 11.4% of the total and of ‘other health practitioners’ to 10.6%. Why would this be so? What would contribute to this?
 * 3) There are significant indirect costs associated with vision impairment. In the context of Mrs Scope, explain how each indirect cost could impact on her life.
 * 4) Mrs Scope is 73 years old and she is expected to live quite a few more years, especially as she is generally healthy.  What are the most likely reasons that her vision impairment would prevent healthy and independent ageing in her case?
 * 5) What are the top 3 causes of blindness in people aged over 40 in Australia?
 * 6) What age groups are most pre-disposed to each of the 3 causes you selected?
 * 7) What are the projected forecasts for visual impairment and blindness in Australia for the future?
 * 8) Why is addressing vision impairment a serious issue in this country?

Principles of low vision rehabilitation
Through your patient, Mrs Thelma Scope, you have come to understand what the difference is between low vision, vision impairment and legal blindness. You have also considered the psychosocial and financial/economic impact of vision impairment. The next task is to consider the key elements are of a low vision assessment and the principles of low vision rehabilitation. Once again, Thelma Scope's case study will assist your understanding of these concepts.

Task

Watch the playlist related to Principles of Vision Rehabilitation.

Read the following articles:
 * Markowitz SN. Principles of modern low vision rehabilitation. Can J Ophthalmol 2006;41:289–312
 * Vukicevic M. Functional vision assessment. Aust Orth J 2008; 40(2).

These readings are essential to your understanding of the principles of low vision rehabilitation.

Service models and barriers to access
Task

Working with the members of your group, read the following two articles and answer the questions below.


 * Matti AI et. al. Access to low-vision rehabilitation services: barriers and enablers. Clin Exp Optom. 2011; 94: 2: 181–186
 * O’Connor PM et. al. Access and utilization of a new low-vision rehabilitation service. Clin Exp Ophthal. 2008; 36: 547–552


 * 1) What is the definition of “low-vision” according to O’Connor?
 * 2) How does Matti define “low-vision rehabilitation”? Does this differ from what your perception of it had been? Explain.
 * 3) How many patients access low-vision services in Australia and what factors stop them from doing so?
 * 4) Describe the differences in the provision of low vision services across Australia and across different agencies, as indicated in the article by Matti.
 * 5) Briefly describe the referral process/patient journey as described by Matti. What criticisms/comments do you have about this process? How could it be improved?
 * 6) In the studies by Matti and O’Connor what are the main barriers that inhibit low-vision patients from accessing services?
 * 7) What do you think could be done to help improve access to low-vision rehabilitation services in Australia?