1. Low vision rehabilitation: skills for occupational therapists
Bethan Collins,
University of Liverpool
Nicholas Collins,
Optima Low Vision Services

2. Intended Workshop Outcomes
Describe the low vision population
Describe occupational performance issues commonly associated with low vision
Discuss assessment methods
Use specific low vision rehabilitation skills
Know where to get further information

3. Functional Effects of Low Vision
Central vision loss
Peripheral field loss
Low acuity without field loss
Cognitive & perceptual difficulties
Individual nature of low vision

4. Functional Vision Assessment
Distance acuity
Near vision acuity
Functional field test
Contrast sensitivity

5. Things to consider…
Educate about the functional implications of low vision
Identify the person’s visual goals
Functional visual assessment
Teaching of vision rehabilitation strategies and techniques
Teaching how to make best use of low vision aids
Support and motivate

6. Occupational Performance Issues
Low vision can affect many aspects of occupational performance, typically,
Reading and writing
Food preparation
Orientation and mobility
Hobbies and leisure activities
Self-care activities

7. Strategies and Techniques
task lighting;
eccentric fixation training for central vision loss;
low vision aids;
correct use and ergonomic positioning of low vision aids;
management of disability glare and/or poor contrast sensitivity

8. The Importance of Task Lighting
“[Participants] reported that daily tasks were easier to carry out, but even more striking was the fact that [they] now said they could carry out tasks that they had previously been unable to do…
participants referred to better safety in
their home. Potentially hazardous areas such as stairs, steps or the bathroom were better lit”
(Cooper, 2013, p.1-3)

9. Eccentric Fixation
Eccentric fixation is a key vision rehabilitation skill when working with individuals with central vision loss
Identify the clearest area of vision - Preferred Retinal Loci (PRL)

10. Identifying a PRL 10

11. Variations of Central Scotoma
Central vision loss can manifest itself in many ways, understanding this in terms of its affect on functional vision is essential when determining whether Eccentric Fixation is appropriate for the patient
Relative Scotoma
Distortion / Oedema
Absolute Scotoma
Ring Scotoma

12. Influence of Task Lighting
A fundamental element of the low vision assessment
For the majority of patients increased illumination can improve reading acuity, and contrast sensitivity
As important, when assessing for the need to teach EV, task lighting can change the size and shape of a scotoma
‘Visual field defects for four subjects who show marked changes in scotoma morphology’

13. Low Vision Aids (LVAs) Problem solving approach needed
The right level of magnification
For the right task
For the right person
May require a combination of LVAs depending on an individual’s needs

14. Ergonomic use of Low Vision Aids
Low vision aids issued to individuals are often not used in the most effective way:
Ergonomic use and positioning of LVAs
Correct working distances of LVAs
Simple advice and instruction can make a lasting difference

15. 15

16. The Importance of Working Distances16

17. 17

18. Cognitive Perceptual Complications
An important skill is ability to determine whether difficulties experienced are due to
low acuity
loss of field of vision
cognitive / perceptual
Or a combination

19. Challenges with cognition and perception
Rules of thumb to indicate cognitive or perceptual (neurological) issues include:
Reading tasks don’t match with observed functional vision.
Person describes confusion with reading

20. Glare and Contrast
Filters and tints are important low vision tools which can:
Reduce disability glare
Improve visual acuity
Improve contrast sensitivity
In combination improve visual function

21. Optima Low Vision Services 2006
Colour Spectrum
Clour Spectrum
Optima Low Vision Services 2006

22. Case studies: enhancing quality of life and occupational performance

23. Education Issues
Use of spectacles – refraction is different from low vision!
Variable vision - factors such as fatigue, blood sugar etc
Impact of lighting
Family awareness / education
Specific conditions such as Charles Bonnet Syndrome

25. http://www. dailymail. co

26. Human stories… differ
As with other aspects of occupational therapy, people’s lives and experiences differ.
Be wary of ‘training’ that focuses on lived experience alone as this sometimes is not based in evidence.

27. When to refer on… and to whom?
Low vision services across the UK and Ireland are delivered in many ways and by various professionals
Hospital based services connected to the ophthalmology department
Community based low vision services
Multidisciplinary low vision resource centres
Refer on and engage in discussions with relevant professionals in your area in order to provide an holistic vision rehabilitation programme

28. References
Colenbrander A & Fletcher DC (1995) Basic concepts and terms for low vision rehabilitation. American Journal of Occupational Therapy 49 (9) 865–869.
Collins J K (1999) Homonymous hemianopia in the low vision clinic – which way to turn? Vision Rehabilitation: Assessment, Intervention and Outcomes Swets & Zeitlinger Publishers, Abingdon
Cooper S (2013) Improving lighting, improving lives. Research Discussion Paper ISBN: (11) 1-3. The Thomas Pocklington Trust
Dahlin Ivanoff S, Sonn U & Svensson E (2001) Development of an ADL instrument targeting elderly persons with age-related macular degeneration. Disability and Rehabilitation 23 (2) 69–79.
Horowitz A (2004) The prevalence and consequences of vision impairment in later life. Topics in Geriatric Rehabilitation 20 (3) 185–195.
Scheiman M, Scheiman M & Whittaker S (2006) Low vision rehabilitation: a practical guide for occupational therapists. SLACK Incorporated.

29. Contact Details Bethan Collins Senior Lecturer in Occupational Therapy
School of Health Sciences,
University of Liverpool
@bethanhc
Nicholas Collins
Certified Low Vision Therapist (CLVT)
Director
Optima Low Vision Services
@OptimaLowVision