Low Vision Rehabilitation/Lionel Messina

Lionel Messina is 45 years old. He was diagnosed with Retinitis Pigmentosa (RP) about 15 years ago.It is progressively worsening and he has arranged an appointment at See Well Australia to explore his options as he is still in the workforce. Through Lionel, you will develop an understanding of the appropriate low vision rehabilitation for a patient with a severely constricted visual field. There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer.

Lionel's fundus showing RP

Lionels' Visual Field (Right Eye)

Lionels' Visual Field (Left Eye)

Question

What are the appropriate low vision management strategies for patients with severely constricted visual fields?
Use the scenario and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions.

Activities

Lionel Messina, aged 45, attends See Well Australia for the first time. He was diagnosed with RP in his early 30s and the condition has now progressed significantly. He complains of decreased peripheral vision, night blindness, problems with light/dark adaptation and consequently, trouble with mobility. Lionel's referring ophthalmologist indicates that he has typical RP changes on his fundus (bone spicule, attenuated arterioles & waxy optic disc). A fundus image of his left eye is shown here, the right eye appearance is the same.

The findings from your initial consultation are as follows:

GH: Good, no medications
POH: Glasses since teenager
Vert: R) -0.50/-1.00x45 L) -0.75/-1.00x60 (Single vision distance gls)

VA cc: R) 6/12 L) 6/9
Near vision BEO = n5 slowly (takes glasses off to read)

Subj Refn: R) -0.77/-1.00x50 = 6/9 pt L) No change
Add +1.00 = n5 with light, BEO

Contrast (Pelli Robson):0.90 log BEO (moderately reduced contrast)
Colour vision (CUCVT): non-specific colour vision loss, greater in the tritan zone
Visual field (Humphrey): severely constricted R&L to within 10 degrees from fixation

Task 1

Watch the lectorial describing Lionel's case and how to help him.
You can access the Power Point slides that accompany this lectorial here.

Task 2

Once you have watched the lectorial you need to carefully read this article:
Herse P. Retinitis Pigmentosa: visual function and multidisciplinary management. Clinical and Experimental Optometry: 88(5) 335-350.

Task 3

Now that you have watched the lectorial and read the article, answer the following questions about Lionel's case. Discuss the questions in your group.

1. You tested Lionel's contrast using the Pelli Robson test. Why is contrast sensitivity an important factor for Lionel?
   
2. What is the difference between discomfort glare and disability glare?
   
3. Lionel complains of problems with glare and light/dark adaptation. How can you assist him with this problem?
   
4. Apart from the scanning techniques described in the lectorial, what else can you suggest for Lionel to enhance his visual field?
   
5. Paying particular attention to the article by Herse, what multi-disciplinary/external services would be useful for Lionel? Describe these in detail.
   
6. Can Lionel drive? Justify your answer and what tests you need to conduct to reach a conclusion.