In-patient consultations
- referrals from neuro, rehab, OT, or PT
- assess BV, VF loss, ocular health
- often confounded by communication deficits
- recommended therapy to be incorporated into in patient treatment
- Rx rx at bedside if indicated
Vision rehab partners
- primary ECP
- neurologist
- physical rehab physicians
- OT
- physical therapist
- optician
- vision therapist
- organizations
Primary ECP and low vision
- full ocular health exam. Managing ocular disease
- referral source for low vision
- most common: retina, neuro-OMD, glaucoma, primary/peds
Common chronic conditions in low vision
- ARMD
- glaucoma
- diabetic retinopathy
- NAION/AION
Hereditary and congential things that cause low vision
- RP
- ROP
- achromatopsia
- aniridia
- coloboma
- nystagmus
- optic atrophy
- optic nerve hyperplasia
- stargardts
Neurologist and low vision
- referral often bidirectional
- provide MRI/CT results. Pertinent for TBI, I typically rewuire before seeing patient
- work together with rehab physicians
Physical medicine and rehab physicians and low vision
- oversees rehab of patients. Often hospital settings
- refer to OT, PT, OD
- oversee pateitns medications, consult with sub specialties such as neurology, orthopedics, and ER team
Common conditions seen in low vision from neuro
TBI-MVA, brain aneurysm, stroke
Brain tumor
Neuro-ophth disorders
Non organic vision loss
Low vision role in working as a team
- oversees the patient’s rehab
- proper referrals when indicated (OT, PT, PCP, KYOB, etc)
- communicate with other providers and referring physician. Important for billing purposes if using consultation codes. Consider the speciality and what is pertinent to them.
What’s important in low vision rehab
- Visual function (VAs, VFs, contrast)
- refraction/Rx change
- functional goals. Patient intake, professional concerns
- assessment and plan
Occupational therapist
Works with a client to help them achieve a fulfilled and satisfied state in life though the use of purposeful activity or intervention as designed to achieve occupational outcomes which promote health, prevent injury or disability to develop, improve, sustain or restore the highest possible level of independence
OT specialties
Vision (low vision)
Physical rehab
Driving rehab
Pediatrics (school system)
Vision OT
- in office and home assessments
- activities of daily living (ADLs)
- goal oriented/OD driven
- insurance typically covers. Must meet visual criteria
- assist patient with participation in their chosen daily tasks despite vision impairment. Modify environment, adapting tasks, training with low vision devices
- teach patients how to maximize use of remaining vision
Physical rehab OT
- tend to the first to notice vision deficits in TBI
- incorporate OD recommendations into therapy to improve therapy success
- many incorporate vision OT techniques on a basic level
Driving rehab OT
- assess patients for safety
- recommend mandatory adaptations or restrictions
- behind the wheel assessments
- drivers training. TBI, various impairment (vision), bioptic driving
School based OT
- visual overstimulation, adaptation of vision, ergonomic considerations
- used often fro visual functional deficits
- core strength, handwriting, behavioral issues, difficulty staying on task, organizing, accommodations for any disability including autism
Physical therapist
Therapy for the preservation, enhancement, pr restoration of movement and physical function impaired or threatened by diseases, injury or disability that utilizes therapeutic exercises, physical modalities (such as massage and electro therapy), assistive devices, and patient education and training
Roles of physical therapist
- similar considerations as physical rehab OT. Work together with OT and rehab physician or PCP
- falls considerations
- vestibular dysfunction
Vision therapist role in low vision
Sometimes occupational therapist fills this role
Certified visio therapist is an option
Optician role in low vision
Very impritant to have a good relationship and optician that has good understanding of specialty lenses
Outside organizations and low vision
- Kentucky office of vocational rehab: blind services division. Previously the KY office of the blind
- Kentucky School for the Blind (KSB)
- Support groups
KY Blind Rehab Serveis
- vocational rehab
- independent living skills
- bioptic driving
- serve all 120 counties in KY
Blind rehabilitation
- in patient setting
- length of stay person dependent
- focus: Braille, OnM, assistive technology, adult education, career development, life skills, personal development
Kentucky school for the blind
- serves blind an visually imported birth to 21
- full time K-12 instruction
- short term program
- weekend retreat
- insight college prep program
- O/M
- Braille
- independent living
- work transition
- assistive technology
- outreach program
