Low Vision Rehabilitation/Percy Fredericks

You have an appointment to see Percy Fredericks at See Well Australia. He is having difficulty reading his mail. Through Mr Fredericks, you will consider optical and electronic management appropriate to different types of patients, from school aged children to adults and the elderly. Consideration of appropriate low vision intervention in the ophthalmic clinic is also included. There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer.

Question

What is the appropriate method for prescribing a low vision aid for my patient?
Use the scenario and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions. The estimated time commitment for this enquiry is 4-6 hours.

Activities

Your new patient at See Well Australia is Percy Fredericks who is 92 years old. He has been referred to you by his ophthalmologist for a low vision assessment. As part of your new job at See Well Australia, you will be assessing Mr Fredericks. Details about your initial consultation are as follows:

GH: Generally fit, hypertension, arthritic hands and feet
POH: diagnosed with atrophic AMD
SH: lives in a retirement village with his wife (she has early dementia). Has Department of Veterans’ Affairs gold card
Existing LV aids: fluorescent desk light, no magnifiers

C/o difficulty reading newsprint and occasionally the mail.

Near vision c SVN = n12

Near vision @ 10% contrast = n40 (indicates moderate to severe contrast loss)

Task 1

Watch the playlist Optical Low Vision Aids.
Find the Optical Low Vision aids power point presentation here.

Task 2

Use the following resources to help you to answer the questions for this task.

Woo GC and Mah-Leung A. The term magnification. Clin Exp Optom: 2001; 84(3).
Johnston A. Understanding how simple magnifiers provide image enlargement. Clin Exp Optom: 2003; 86(6).
Cheong AMY, Lovie-Kitchin JE & Bowers AR. Determining magnification for reading with low vision. Clin Exp Optom: 2002; 85(4)
Department of Veterans' Affairs Appliances and Aids

Questions - Task 2
1. Mr Fredericks is struggling to read and obviously needs some kind of magnification to assist him. Consider the following types of magnification and discuss whether or not each type would be suitable for him. (Think about the different tasks he might perform with the different types of magnification). Where appropriate, indicate how you would introduce that type of magnification in a practical way for him. (HINT: the playlist contains videos from CNIB where the clinician explains magnification principles in lay terms)

Angular magnification
Relative distance magnification
Relative magnification
Relative size magnification

2. What strength of magnification do you think would be most appropriate for Mr Fredericks? Justify your answer using references from the reading material or your lecture notes.
3. Apart from increasing magnification, are there any other considerations you have to factor in based on the information you have about him?
4. Lovie-Kitchin and Whittaker discuss the importance of acuity reserve when prescribing magnification. What ground-breaking work by Legge et al changed how acuity reserve is catered for and what do the authors suggest that low vision practitioners consider when prescribing low vision aids?
5. Now that you have selected the magnifier most suitable for Mr Fredericks, what advice should you give him? Hint: Alan Johnston’s article has some good tips for advice to patients.
6. Mr Fredericks has a Department of Veterans’ Affairs gold card. He fought in World War II in Burma. Is this important? Why/why not?

Task 3

During your Advanced Optical Aids interactive (face-to-face) class your goal is to consider Mr Fredericks' needs/requirements (i.e. he wants to read his mail and the newspaper) and find 3 options you could recommend for him. Justify your choice for each option.

Task 4

12 months has passed since you saw Mr Fredericks in your clinic. He returns for a review appointment. His wife, who has dementia, has moved into supported care and he is now living alone. George, his son, visits weekly but Mr Fredericks needs to be able to read his mail, bills, write a cheque, manage his banking etc.

Your clinical findings are as follows:

Visual Acuity: R) 6/120 L) 6/60

Near vision: N32 slowly - N40

What strength optical magnifier would now be most suitable for Mr Fredericks?
Are there any other options, for example electronic magnification (i.e. CCTV)?
What disadvantages of optical magnifiers are overcome with the use of a CCTV.
Describe how a CCTV enables magnification.
Think about how you would explain to Mr Fredericks the change in his vision and the impact this is going to have on his ability to use both optical and electronic magnification.

Discuss in your group all the possible activities Mr Fredericks could undertake with the use of a CCTV.

Resources and help

What is a CCTV?
Orabis talking CCTV
Paying bills using a CCTV