Low vision therapy options presented by Dr. Lisa Rivero.

1. Visual Function and Low Vision
Rehabilitation
Lissa V. Rivero, OD, FAAO
Sarasota Retina Institute
Sarasota, FL
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2. Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday
activities that have been affected by the
loss of vision
• Specialized equipment and training

3. Typical Impairments from Macular Degeneration
Reading
Driving
Watching
TV
Computer
Seeing
faces
Writing
checks

4. Additional Impairments from Vision
Loss
 Shopping
 price tags, labels
 Hobbies
 crafts, playing cards
 Activities of Daily Living (ADLs)
 food on plate, plugging in
appliances, setting appliances
 Using phone, cell phone
 Trouble walking
 Increased risk of falls

5. Goals of Vision Rehabilitation
 Adjustment to vision loss
 Functional Maximize remaining vision
with devices and training
 Emotional LV patients are at 20x greater
risk of depression
Also inform patients
about community
resources available

6. Who pays for Low Vision Care?
Low vision exam is covered by
Medicare and most
Insurances, except for
refraction fee.
OT training is covered by
Medicare and most
Insurances
Devices are not covered by
insurance.

Patients pay

VA if patient qualifies

DBS if patient qualifies

Lions club

7. What can I expect in a Low Vision Exam?
 Thorough history
 Measurements of functional
vision
 Acuity - Specialized charts
 Contrast
 Visual Fields
 Check eyeglasses - Refraction
 special technique for LV
 Determine level of
magnification
 Trial of LV devices
 Develop a rehab plan

8. Central Field Loss and
Eccentric Viewing (EV)
Train patients to move their
eyes in a consistent way to
look around their blind spot

9. Careful Refraction is First Step
 Changes in prescription
are often missed in ARMD
patients
 Use Special Charts
 Refract with a trial frame

10. Lighting
OttLite Better
Vision
Series
 Special lamps
 High intensity
flashlights
Ottlite.com

11. Glare Control
 Macular degeneration patients benefits
from Blue Blocker lenses:
 Indoor glare control: Yellow or light
amber
 Outdoor glare control: Orange or Brown

12. Low Vision Devices for AMD Patients
 Depends on:





level of vision
blind spots (scotoma)
goals
Patient’s motivation
cost

13. “I just need stronger glasses”
Higher power reading glasses,
require a closer viewing distance.
+10D(3.5X)=10 cm
viewing distance
+20D(5X)= 5cm viewing
distance

14. Telescopic Glasses
For reading with a +3.00
reading cap
For distance activities like TV viewing, and enjoying the theater

15. For Writing, Sewing, Computer
 Custom made
 Prescribed magnification
 Requires training and
practice
 Small field of view
 $ 800 and up
• Standard
• MaxDetail glasses
• $180

16. What is an Occupational Therapist and
what is their role in vision rehab?
 An OT is a licensed health
professional with expertise in
rehabilitation
 Some OT’s have special
training in vision rehabilitation
 Eccentric View training
 Device training
 Adaptive strategies
 Home visits and modifications,
 Fall prevention

17. Implantable Telescope Technology

18. How It Works
Scarred Macula
Telescope Implant
Central Visual Field Projection (Natural Lens/IOL)
Central Visual Field Projection
CAT
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19. Field of View
3X Implant:
20°
3X External:
8°
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20. How It Works
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21. How It Works
Telescope Eye = Central Vision
Distance: Faces, TV, signs
NO driving
Near: Reading, playing cards, dining
Other Eye = Peripheral Vision
Allows orientation and mobility
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22. Not ‘Cataract Surgery’
• Not the solution to drive again
• Improves functional vision
• Care given by a team
• Patient participates in
rehabilitation!
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23. Telescope Implant Program
Sele
ction
Trea
•Med
tme
Reh
ical
nt
abilit
•Low
•Sur
atio
Visio
gical
n
n
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24. Key Indications
Low Vision Evaluation
Pre-surgery assessment
Informed decision
Agree to participate in
visual rehab training
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25. Post-Implantation
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26. Indication For Use
• VisionCare’s Implantable Miniature
Telescope (by Dr. Isaac Lipshitz) (intraocular
telescope) is indicated for monocular
implantation to improve vision in patients
greater than or equal to 75 years of age
with stable severe to profound vision
impairment (best corrected distance visual
acuity 20/160 to 20/800) caused by bilateral
central scotomas associated with end-stage
age-related macular degeneration.
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Source: FDA Professional Use Information labeling

27. Magnifiers The larger the magnifier the weaker it is.
Over the counter (+6 diopters or 2X) vs.
Low Vision magnifiers (up to +56 diopters or 14X)
 Hand held mags
 LED illuminated

28. Traditional Magnifiers –
 Stand magnifiers
Makrolux
(2.2x, 3.6X)
Scribolux
(2.8X)
Menas Lux
(3.0X)

29. Video Magnifiers
Closed Circuit Television (CCTV)
Closed Circuit
Television$2000 to $3000
Topaz by Freedom Scientific
Clearview by Optelec
Merlin by Enhanced Vision

30. Video magnifiers that read to you
DaVinci by
Enhanced Vision
Clear View +
Speech by Optelec
Prodigy Duo
2 in 1 by
Humanware

31. Hand-held video magnifiers
Ruby by
Freedom Scientific
Pebble HD 4.3 by
Enhanced Vision
Smartlux Digital
by Eschenbach
$400 - $650

32. Mobilux Digital Magnifier
by Eschenbach
Magnification range from
3x to 6x
High Definition LED screen
Feels like a regular magnifier

33. Compact 7 HD
Continuous magnification
from 2X to 24 X

34. Computer Adaptations
Large print keyboard
 Operating system
accessibility options
 Computer glasses
 Large Print Software
 Zoom Text
 Jaws

35. Tablets and other eReaders
Apple iPad
Samsung Galaxy Note
Kindle Fire HD
Nook

36. BigMagnify Application
Available for smartphones free of charge!!

37. Adapted Communication
Large Print Phone
Bold Line Paper, Felt Tip
Pens

38. Adapted Leisure Activities

39. Vision Rehabilitation
Purpose is not to get back your sight,
but to regain your ability to do the everyday
activities that have been affected by the
loss of vision
• Specialized
equipment and
training
• “Can do” attitude
• Willingness to
learn “new tricks”

40. Resources
For Patients/Family:
www.CentraSight.com
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