Presentation on theme: "Visual Health in Learning Disability NHFN Birmingham"— Presentation transcript:
1 Visual Health in Learning Disability NHFN Birmingham Gordon IlettOptometrist
2 Disclosure Partner Linklater Warren Optometrists Trustee SeeAbility Co-Director Special Olympics Opening Eyes GBCouncillor Association of Optometrists
3 SightUp to 90% of our sensory information will come from the sense of sightMost daily tasks are more difficult when vision is impairedWe all tend to assume others perception of their environment is the same as ours
4 VisionPeople with learning disabilities are 10x more likely to have serious sight problems60% will need spectacles and may need support to get used to them9.3% meet the criteria for sight impaired or serious sight impairment (partial sight or blind) registrationThose with severe and profound learning disabilities are most likely to have sight problemsEmerson & Robertson 2011
5 Questions Do you know the visual status of all of your service users? How does undetected visual impairment affectSafety, health and wellbeing?Effective allocation of resources?Will detecting and treating an individuals sight problem reduce the amount of support required?Can you empower the individual?
6 Drivers for Change Valuing People & Valuing People Now Death by Indifference (Mencap 2007)‘Healthcare for All’ (2008)Must offer ‘equality of care’ Human Rights Act, DDA / EA, ECHR, Mental Capacity ActSupport for GP DES for people with severe and profound LD and maintenance of registers of people with LD on practice listsDoing the right thing!
8 Embryology Human eye starts to develop at 3 weeks gestation Blood supply from approx 4 monthsRetinal blood vessels reach nasal ora at 36 weeks, temporal vessels 40 weeksDevelopment of eye and visual pathway continues throughout pregnancy and early life.The eye is an extension of the brain
9 The Human Eye Vision – Optic Nerve CN2 Motor – Oculormotor CN3, Trochlear ON 4, Abducens ON 6Sensation TrigeminalON 5
10 Development of Acuity Age (months) OKN FPL VEP 1 20/300 20/400 6 20/60 20/15020/201220/4020/10036
11 Visual Pathway Retinocalcerine and tectal pathway Lea Hyvärinen From the occipital lobe, the visual information is sent to other visual centers in the brain through two major pathways: the dorsal and the ventral stream. The dorsal stream starts in the occipital lobe and travels on the superior portion of the brain to the parietal lobes for interpretation in space, positioning, orientation and motor coordination. The ventral stream starts in the occipital lobe and travels through the inferior and lateral portions of the brain on both sides to the temporal lobe and other sub cortical areas for interpretation and recognition of images.In the next two slides, you will have the chance to experience the roles of the dorsal and ventral stream in daily life situations.Lea Hyvärinen
12 Higher Visual Areas in Cortex LGN dParvoMagnoInterlaminarPrimary Visual CortexHigher Visual Areas in CortexSuperiorColliculusPulvinarRetinogeniculateGeniculostrate‘Traditional’Pathway’LGN vPretectum‘Primative’ pathways to mid brain and other neucleiNeuclei of Accessory optic tractFrom Milner & Goodale 2006Suprachiasmatic nucleus
13 Cortical Visual Processing From primary cortex links to visual association areasDorsal (Where?) pathwayVentral (What?) PathwayThe dorsal stream controls visually guided movements, spatial planning and mapping, rapid eye movements and motor planning. It is closely related and coordinated with the motor planning and execution portion of the frontal lobe. The dorsal stream is “vision for movement”.The ventral stream helps us in recognizing, analyzing and storing visual information. The ventral stream is responsible for recognizing faces, objects, words, maps, shapes, patterns and the significance of the images we see.Of course, both the ventral and dorsal stream are interconnected, coordinated and acting as a team in all visual activities we perform daily, each one of them in its own specific role. When there is damage to any of these areas in the brain, visual processing and understanding can be impaired in a variety of degrees depending on the severity of the lesion. This type of visual impairment is neurologically based or also called cerebral vision impairment or neurologically based vision loss.
14 The Reading Process Location of word on page Accurate accommodation and gaze directed so image on fovea – mid brain and CN 2, 3,4,6Image to Brodman’s Area (BA) 17 & 18 (via CN2)Temp Occipital Cortex BA39 – Structure and formTo BA 21 & 42 Wernicke’s area – phonetic representationBA 44&45 Broca’s area - speechMRC Cognition and Brain Sciences Unit
15 Process in reading a word To read ‘FOX’Recognise letters and order – F(1)O(2)X(3)To lexicon or brains dictionary –recognition of familiar order of lettersSemantic system then associates features with wordSpeech output converts word into phonetic soundSpeech generated using motor control of jaw, tongue, voice-box and breathing
16 Learning Disability and Vision Neuro-developmental disorder causes LD so all parts of eye and visual development may be affectedStructural defects may be caused by developmental abnormalitiesDevelopmental defects may lead to further structural damageBehavioural changes may lead to injuries to the eye
17 Periventricular Leucomalacia Damage to white matter adjacent to ventriclesPresent in up to 25% of pre term infantsAffects visual and acoustic tracts as well as descending cortico-spinal tractsUp to 60% may develop cerebral palsyVisual impairment and perceptual abnormalities
19 Actions Needed Functional Assessment of all clients Document visual abilitiesCommission Pathways to allow extended eye examsEnsure regular 2 yearly eye examinationsWork with Secondary Care Providers to ensure equal accessDocument outcomes and advice given
20 Functional Vision Assessment Designed for use by CarersSeeAbility Functional Vision Assessment ToolChecklist 1 - Appearance of the eyesthe appearance of a persons eyes may raise concerns about their eye healthChecklist 2 - Behavioura persons behaviour may be related to poor vision or other eye care needsChecklist 3 - Poor central visionthis is when a person cannot see straight ahead very wellChecklist 4 - Poor peripheral visionsometimes a person has difficulties seeing to the sides and up and downChecklist 5 - Sensitivity to lightsome people experience difficulties because their eyes are very sensitive to lightChecklist 6 - Poor colour vision (or contrast sensitivity)some people do not see colours very well and can find it difficult to see objects clearly against different backgroundsChecklist 7 - Poor vision in one eyesome people have poor vision in one eye only
21 Eye Examination Pathways KAB – BexleyRNIB Bridge to VisionSeeAbility Eye 2 EyeLOCSU Sight test pathwayWOPEC - Accreditation for practitioners
24 Pathway SupportPre examination reporting – Telling the Optometrist about me form – SeeAbilityAppropriate facilities and equipment – desensitisation visitsFunding of extended eye examinations and repeat visitsIncludes domiciliary servicesFeedback forms and reporting – SeeAbility forms or PHP/Health Passports completedInformation leaflets on Eye health and Spectacles - SeeAbility
25 Secondary Care Royal College of Ophthalmologists Guidelines GMC GuidelinesGood Practice eg SheffieldAdvocacy and support
26 Remember Assess Visual Function Record Functional Ability Organise Eye ExaminationsCreate PathwaysRecord ResultsModify Care PlansEmpower Individuals
27 Information & Help SeeAbility www.lookupinfo.org www.seeAbility.org Paula Spinks-ChamberlainLOCSUKatrina Venerus