PRESENTED BY Chris Schell, O.D. Primary Eyecare Private Practice Member of the College of Optometrists in Vision Development Member of the Neuro-Optometric Rehabilitation Association

Role of Vision To direct action and guide movement

Role of Vision To direct action and guide movement Impaired vision leads to impaired movement

Role of Vision To direct action and guide movement Impaired vision leads to impaired movement Impaired movement leads to increased risk of falling

Who has a cataract?

Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011)

Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011) Every 12 minutes, someone in Canada begins to lose their eyesight (CNIB 2012)

Canadian Statistics Seniors with vision loss experience double the incidence of falls (National Coalition for Vision Health, 2011) Every 12 minutes, someone in Canada begins to lose their eyesight (CNIB 2012) 75 per cent of vision loss can be prevented (CNIB 2012)

Video simulation

Types of Vision Impairment Simpler and Treatable

Types of Vision Impairment Simpler and Treatable Problems with eyeglasses

Types of Vision Impairment Simpler and Treatable Problems with eyeglasses Cataracts

Types of Vision Impairment Complex and Manageable

Types of Vision Impairment Complex and Manageable Glaucoma

Types of Vision Impairment Complex and Manageable Glaucoma AMD

Types of Vision Impairment Complex and Manageable Glaucoma AMD Diabetes

Types of Vision Impairment Complex and Manageable Glaucoma AMD Diabetes ABI/TBI

Eyewear – What to look for? Are their glasses giving them their best vision?

Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads

Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches

Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches coatings peeling off

Eyewear – What to look for? Are their glasses giving them their best vision? missing nose pads scratches coatings peeling off bent or twisted frames

Cataracts

Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction

Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints

Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate

Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate Often worse in one eye compared to the other

Cataracts – What to look for? Complaints of poor night driving, especially glare sensitivity and overall contrast reduction Constant complaints Vision is poor and does not fluctuate Often worse in one eye compared to the other Painless

Glaucoma

Glaucoma – What to look for? Family history

Glaucoma – What to look for? Family history Peripheral vision loss – inside out

Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless

Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless Only at end stage is there advanced vision loss

Glaucoma – What to look for? Family history Peripheral vision loss – inside out Painless Only at end stage is there advanced vision loss Early detection can slow disease progression

Macula Degeneration

AMD – What to look for? Non-modifiable risk factors:

AMD – What to look for? Non-modifiable risk factors: Family history

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors:

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet High blood pressure

AMD – What to look for? Non-modifiable risk factors: Family history Skin/Eye Colour Age Modifiable risk factors: Smoking Excessive weight Diet High blood pressure UV Exposure

AMD – What to look for? 2 types:

AMD – What to look for? 2 types: slow dry

AMD – What to look for? 2 types: slow dry fast wet

AMD – What to look for? 2 types: slow dry fast wet Central vision problems

AMD – What to look for? 2 types: slow dry fast wet Central vision problems distortion

AMD – What to look for? 2 types: slow dry fast wet Central vision problems distortion missing areas

AMD – What to look for? Home Monitoring with Amsler Grid

Diabetic Vision Loss

Diabetes – What to look for? Fluctuating vision

Diabetes – What to look for? Fluctuating vision Random pattern to blind spots in vision

Diabetes – What to look for? Fluctuating vision Random pattern to blind spots in vision More stable blood sugar = more consistent vision

Brain Injury Visual Field Loss

BI VF – What to look for? May be acquired or traumatic brain injury

BI VF – What to look for? May be acquired or traumatic brain injury Case history

BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world

BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident

BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident Orientation and mobility issues

BI VF – What to look for? May be acquired or traumatic brain injury Case history Missing information on one side of world Head turn/tilt may be evident Orientation and mobility issues This group is at a VERY HIGH risk of falling

Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference)

Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference) Depth perception is gone

Double Vision - What to look for? Noticeable misalignment of eyes (often patient will report the difference) Depth perception is gone Closing one eye

DEMO TIME – Volunteers?

Sight threatening eye diseases are silent and painless.

What can we do?

Preventing Falls Encourage your patients, your friends and your family to get regular eye exams

How to Help Ask the Question –

How to Help Ask the Question – When was your last eye exam?

Where to refer To find an Optometrist in your area visit: The Ontario Association of Optometrists

Due Diligence Visit a few clinics

Due Diligence Visit a few clinics Meet the staff and doctor

Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients?

Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients? Are they prepared to examine senior patients?

Due Diligence Visit a few clinics Meet the staff and doctor Are they comfortable examining senior patients? Are they prepared to examine senior patients? Are they accepting new patients?

Why might your patients refuse or be hesitant to have an eye exam?

Objections to Eye Exams Fear

Objections to Eye Exams Fear of loosing their driver’s license

Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease

Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease Cost

Objections to Eye Exams Fear of loosing their driver’s license of having an eye disease Cost OHIP covers the cost of a general eye exam for ages 65 and over

How to Help Glasses – encourage them to wear them, get them fixed

How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting

How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds

How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds Macula Degeneration – Amsler Grid at home, meds

How to Help Glasses – encourage them to wear them, get them fixed Cataracts – increase lighting Glaucoma – compliance with meds Macula Degeneration – Amsler Grid at home, meds Diabetes – control sugars

Low Vision The CNIB is the best resource for people with low vision. Find out if your area has a CNIB clinic.

Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision

Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision Use specialized equipment and materials such as:

Vision Therapy Optometrists who specialize in developing, rehabilitating and enhancing vision Use specialized equipment and materials such as: prisms filters patches

Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it

Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it Difficulties with balance, coordination, posture

Visual Midline Shift VMS – a mismatch between where the eyes perceive our midline and where the brain perceives it Difficulties with balance, coordination, posture Leaning forward or backward – leaning to one side

DEMO TIME – Volunteers?

Behavioural Optometrist Where to you find a Vision Therapy clinic?

Behavioural Optometrist Where to you find a Vision Therapy clinic? Visit them and find out how you can work together to help your patients.

“A good objective of leadership is to help those who are doing poorly to do well and to help those who are doing well to do even better.” ~ Jim Rohn, author, motivational speaker

Remember! 20/20 does not automatically mean “healthy”

For more information… Come visit us, we are always welcoming new patients! Ferndale Drive (in the plaza at Ardagh) Barrie, ON L4N 6B9