Low Vision Rehabilitation/Mark Bollinger & others

In your group, work through the following case studies related to functional impact of sight loss & multi-disciplinary intervention, which require you to analyse information and then discuss the likely functional impact associated with each case. You will then determine the appropriate professionals to assist in the management of each patient.

Deeper discussion of these cases will take place face to face in week 4 of semester.

Case Study 1 - Mark Bollinger

Keywords: #Leber's #young #student #central field loss

A referral comes to you from the visiting teacher service, asking you to assess a 17 year old boy who has been recently diagnosed with Leber's optic atrophy. Mark presents as a mature and intelligent young man. The history is of a sudden onset, bilateral centre field loss.
Visual Acuity: R & L <6/ 60
Field: Bilateral central scotoma, extending 15 degrees from the fovea.
Background:
Mark has just completed year 11, he hopes to do well in year 12 to enable him to study law at university. His parents are keen to encourage his studious ambitions and have promised him a car if he gains university entrance. He has promised to take his girlfriend to visit her family in Queensland when he gets his car. Mark presents as a very calm and self controlled young man.

Questions:

1. What is the likely impact on visual function of Leber’s optic atrophy?
2. What do you think the social impact of sight loss is for Mark?
3. How has Mark responded to his sight loss? Is this what you would expect?
4. Select an appropriate multi disciplinary team to work with Mark indicating what roles each team member will play.

Case Study 2 - Edith Wright

Keywords: #AMD #elderly #multi-disciplinary #psycho-social

Edith Wright is 70 years old. She has been diagnosed age-related macular degeneration (AMD).
Visual Acuity: R)< 6/60 L) HM.
Background information:
When Ms Wright arrives she is a very forceful lady who is vocally decrying the lack of services and assistance available to her. You establish the following history: her left eye deteriorated some years ago, the right eye only began to deteriorate two months ago following the death of her sister with whom she lived. Her Ophthalmologist has told her she is blind and nothing further can be done. Ms Wright is a retired academic; she was particularly involved in women’s issues and was on a number of Government advisory bodies in this regard.

Questions:

1. Consider the functions associated with the macula. Describe the functional difficulties Ms Wright might be experiencing justifying why you select
2. these functions.
3. What impact do you think this change in vision will have on Ms Wright’s well being? Discuss this response in both emotional and social terms
4. Ms Wright is your patient. Select a multi disciplinary team to support her vision rehabilitation. Which professionals will you include and why?

Case Study 3 - Jack Tomazetti

Keywords: #young #student #recent onset #workforce #functional vision #psycho-social

Jack is a 17 year old boy who had acid thrown in his face in a classroom fight and has severe corneal scarring as a result. Jack's vision is reduced to 6/24 bilaterally. He is hoping to gain an apprenticeship in the building industry and has a prospective employer.

Questions:

1. Explain the impact on vision of corneal scaring and the impact this might have on Jack’s functional abilities.
2. Discuss the range of issues that might be confronting Jack now.
3. What might be the social implications for Jack?
4. Consider an appropriate team to support Jack’s rehabilitation.

Case Study 4 - Barry Gentle

Keywords: #elderly #multi-disciplinary #ADLs #AMD #central field loss #psycho-social

Whilst sitting in the staff room at See Well Australia eating lunch, you are approached by the Occupational Therapist (OT), she is particularly concerned about a patient who has lost all interest in the cookery class. She thinks his sight has deteriorated and would like you to assess him.
Mr Gentle is a courteous and softly spoken 80 year old.
Diagnosis; age-related macular degeneration.
VA: R <6/60 L 6/36
Field: The right eye has extensive loss of the central field; the field loss in left eye at this stage is restricted to the foveal area.

Mr Gentle has been completely devastated by the sudden loss of vision in his left eye. He has given up any hope of retaining some independence and is prepared to rely on his wife totally. Mrs Gentle has always looked after the household and is prepared to do anything for her husband, but she has cataracts and her vision is now reduced to Visual Acuity R) 6/18 L) 6/ 12.

Questions:

1. What might be the impact on the daily activities for both Mr and Mrs Gentle as a result of their respective sight loss?
2. What might be the longer term implications for this couple? - consider social and emotional implications.
3. What are the main issues for rehabilitation planning and which professional groups will assist with this?

Case Study 5 - Peter Brown

Keywords: #RP #peripheral field loss #young #student #functional vision #psycho-social #multi-disciplinary Peter is a 23 year old university student who is studying accounting. Peter has significantly reduced visual fields due to retinitis pigmentosa (RP), he was first diagnosed with this disorder when he was 7 years old. Peter’s father also has RP.

Visual Acuity R&L) 6/ 6, Near n5
Visual field in both eyes severely constricted to within only 8-10 degrees.

Questions:

1. Discuss the functions of the part of the retina impacted by RP.
2. Discuss the impact of the loss of these functions on Peter’s daily activities.
3. Discuss the social implications of RP for Peter.
4. Who will be the most appropriate multi-disciplinary team members to support Peter’s rehabilitation program.

Case Study 6 - Margaret Moriartis

Keywords: #diabetes #functional #psycho-social

Margaret is a 50 year old type 2 diabetic. She has a demanding job and is inclined to miss lunch and buy take away for her evening meal. She currently takes tablets to control her diabetes which she often forgets when racing out in the morning. Her GP has warned that if she does not reduce her blood sugar she will be put on insulin.

Questions:

1. What are the likely changes to vision that Margaret will experience if she cannot control her diabetes?
2. Discuss the types of functional problems Margaret might have with the vision loss associated with diabetes.
3. Discuss the social implications of sight loss for Margaret.
4. Suggest an appropriate rehabilitation care team for Margaret.

Case Study 7 - Martin Skase

Keywords: #stroke #employed #hemianopia #multi-disciplinary

Martin is a 45 year old business man who has suffered a stroke impacting his right temporal lobe. Martin is married with two teenage children.
His distance vision is 6/6 R&L but you are unable to assess his near vision as he has trouble reading and he has a left hemianopia.

Questions:

1. Discuss the range of functional issues that might be facing Martin now.
2. Who will be the team members involved in Martin’s rehabilitation program?