Diabetic Retinopathy Low Vision Management Help patients reassure that they can learn new skill sets that allow them to live independently and remain productive.
Press these keys while on Present mode! Special techniques Optical Correction Electronic or Assistive Devices Low Vision Devices Contrast enhancement Non-optical Devices LOW VISION MANAGEMENT Lighting INTRODUCTION Orientation and Mobility Activities of Daily Living Counselling or Support Group A B
recommend low vision management for diabetic retinopathy explore how we can help people with low vision describe diabetic retinopathy At the end of the book, you'll be able to: DID YOU KNOW?
What is Diabetic Retinopathy?
Diabetic Retinopathy A serious sight-threatening complication of diabetes! Diabetic retinopathy, often bilateral, occurs when tiny blood vessels damaged by diabetes, leak blood and other fluids, causing retinal tissue to swell, resulting in cloudy or blurred vision TWO TYPES : 1.PROLIFERATIVE 2.NON-PROLIFERATIVE
SIGNS SYMPTOMS Microaneurysms Dot and blot hemorrhages Flame-shaped hemorrhages Retinal edema and hard exudates Cotton-wool spots Venous loops and venous beading Intraretinal microvascular abnormalities Macular edema Floaters Blurred vision Progressive visual acuity loss. Poor night vision Having a dark or empty spot in the center of vision
accurate refraction the spectacle corrections produce a sharp retinal image. Optical Correction Refractive Correction A magnified sharp retinal image is more clear and legible than a magnified blurred image. Prescribing Optical Aids for distance and near Accurate Retinoscopy cataracts corneal opacities small pupils difficult due to secondary membranes; Keratometer obtain an accurate corneal measurement Correction of corneal astigmatism of 2 diopters (D) or more, especially against the rule, generally makes a significant improvement.
Low vision devices Intended specifically for near vision. Ideal for extended periods as they may be used hands-free Beneficial to persons with shaky hands Comes in a variety of forms and sizes and magnifications Their stands are designed to offer a suitable viewing distance. For brief reading It helps to enlarge the print Can be tiring for extended use Easy to carry Comes in different shape and sizes Relatively cheap Wider field of vision Hands-free Suitable for those who loves to read Can be used to do other things other than reading Easy to use Ideal for extended period A bit costly Clip on to existing glasses Enlarges the print Clipped on monocularly Could scratch the lens A bit heavy Made specifically for near task Provide a suitable reading distance Provide clear images A bit costly
Non Optical Device LLaarrggee PPrriinntt MMaatteerriiaallss BOOKS MAGAZINES NEWSPAPER GAMES PLAYING CARDS BANK CHECKS
Electronic or Assistive Devices Diabetes Technology for Low Vision Audio glucometers that can read glucose numbers out loud Example: insulin pens that click audibly glucose monitors give audio alerts for high and low glucose readings Smartphones and Smart Home Devices Example: Voice-activated personal assistants (Apple’s Siri) - summon information on command Smart home devices (Google Home) - perform routine tasks Closed-Circuit TVs (CCTV) Magnified image onto a computer or television screen Head-Mounted Technology Help people better see distances, faces, the television Example: IrisVision eSight 4 NuEyes Example: can be mounted on a stand handheld
Colour Filter Modify specific light wavelengths that reach the eyes Help: Reduce glare Increase contrast Filter particular wavelength Study findings (Sadeghpour et al.,2015): 527 ± 10 nm (greenish-blue) filter - increase VA and contrast sensitivity 511 ± 10 nm (green) filter - increase contrast sensitivity Contrast Enhancement Iris is the colored part of the eye. It increases or decreases the size of the pupil to control the amount of light entering it. Aids with contrast setting Such as electronic magnifiers Allow users to adjust the contrast levels to their preference To enhance the visibility of text and objects Example of contrast setting features: Gamma correction Histogram equalization High pass filtering Colour mapping Adaptive contrast enhancement
Lighting Task Lighting Magnifying Lamp Lighting Controls Dimmer switches Lamps with adjustable brightness controls Even so, some do prefer illuminances that are high Incorporate both a magnifying lens and illumination Create a bright, well-lit space that facilitates close-up work Focused lighting that illuminates particular spaces or objects where visual tasks are carried out Help to: Reduce shadows Improve visibility of reading materials or work surfaces
What is EV technique? An adaptive strategy used to compensate for central vision loss(CVL), in which relatively healthy paracentral areas of the retina are used to fixate objects. How to use EV technique? Locating the Preferred Retinal Locus (PRL). Learning to use the PRL for reading. Apply steady eye strategy using PRL. Combine with magnifier. Yoked Prisms for Reading When use for hemianopia, prisms are used to relocate, reposition and expend the patient’s visual field. 10 prism or more yoked prism can be prescribed for reading purposes. useful for patient with R homonymous hemianopia. binocular prisms mounted to each lens with the apex at the pupil edge in correspondence to a R homonymous hemianopia. Example: RE BO and LE BI prism will shift the image to the left side of the field where the patient can see. Eccentric Viewing Technique Special Techniques
Orientation and Mobility If someone with diabetic retinopathy experiences significant vision loss that affects their ability to travel, recognize obstacles, or navigate unfamiliar environments, O&M training may be beneficial. O&M instructors can teach skills such as using a white cane, understanding auditory cues, and developing spatial awareness to enhance independence and safety. Using a white cane It is essential for a person to find the correct type of cane and learn how to hold and feel with it. An instructor can guide a person on the proper techniques of cane use for mobility. Navigating roadways The ability to safely cross intersections and streets is vital to achieving independence. The individual will learn these techniques using their senses, environmental cues, and mobility aids. Alternative transportation Individuals who cannot drive should know how to access alternative transportation methods such as public transport, paratransit, or rideshare services. Integrating technology A trainer will teach a person with visual impairment to use GPS apps on a smartphone, which can provide auditory guidance on the best route to follow.
Driving; night Reading Sports Working Activities of daily living Recognizing faces
Support Group Connect with others who living with diabetic retinopathy Sharing your challenges, emotional and physical experiences of living will help feels empowered and connected. IN-PERSON MEETING ONLINE MEETING
Help patients move beyond their fears and reclaim a positive outlook about their vision and diabetes management. Counseling Help patients recognize that visual impairment does not mean they will unable to manage their diabetes. Help patients reassure that they can learn new skill sets that allow them to live independently and remain productive. Emotional support
References Living with Low Vision | ADA. (2024, January 18). https://diabetes.org/health-wellness/eye-health/living-low-vision Fonda G. E. (1994). Optical treatment of residual vision in diabetic retinopathy. Ophthalmology, 101(1), 84–88. https://doi.org/10.1016/s0161-6420(13)31241-x Everett, L.A., Paulus, Y.M. Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema. Curr Diab Rep 21, 35 (2021). https://doi.org/10.1007/s11892-021-01403-6 Sadeghpour, N., Alishiri, A. A., Ajudani, R., Khosravi, M. H., Amiri, M. A., & Sadeghpour, O. (2015). Quantity and quality of vision using tinted filters in patients with low vision due to diabetic retinopathy. Journal of ophthalmic & vision research, 10(4), 429. https://doi.org/10.4103/2008-322X.158893 Shah, M., & Khan, M. T. (2021). Clinical Outcomes of Use of Low Vision Aids for Enhancement of Residual Vision in Diabetic Retinopathy. Pakistan Journal of Ophthalmology, 37(1). https://doi.org/10.36351/pjo.v37i1.1138 Shah P, Schwartz SG, Gartner S, Scott IU, Flynn HW. Low vision services: a practical guide for the clinician. Therapeutic Advances in Ophthalmology. 2018;10. doi:10.1177/2515841418776264 Henry, R., Duquette, J., & Wittich, W. (2020). Comparison of Two Lighting Assessment Methods when Reading with Low Vision. Optometry and vision science : official publication of the American Academy of Optometry, 97(4), 257–264. https://doi.org/10.1097/OPX.0000000000001499 Gopalakrishnan S, Muralidharan A, Susheel SC, Raman R. Improvement in distance and near visual acuities using low vision devices in diabetic retinopathy. Indian J Ophthalmol. 2017 Oct doi: 10.4103/ijo.IJO_52_17.
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