Visual Impairment AwarenessVisual Impairment Awareness

A Collaboration between University Hospital, A Collaboration between University Hospital, OphthalmologyOphthalmology

The Low Vision Services Committee and The Low Vision Services Committee and Community Services Community Services

Sensory Impairment Team Sensory Impairment Team & Coventry Society for the Blind& Coventry Society for the Blind

Session aimsSession aims

To understand -To understand -

What a visual impairment is?What a visual impairment is?

What causes visual impairments?What causes visual impairments?

How visual impairments affect people?How visual impairments affect people?

What can we do to help those who have a What can we do to help those who have a visual impairment?visual impairment?

What is a visual impairment?What is a visual impairment?

Bob Wright Bob Wright (The Low Vision Services (The Low Vision Services

Committee)Committee)

A Snap Shot!A Snap Shot!

Terminology!Terminology!“People with Impaired Vision”“People with Impaired Vision”

Why Why “People with impaired vision”, “People with impaired vision”, rather than rather than “Visually impaired “Visually impaired people”?people”?

Because they are Because they are peoplepeople first who first who happen to have a happen to have a disabilitydisability attached attached to them.to them.

How Many?How Many?

1 in 60 people in the UK has impaired 1 in 60 people in the UK has impaired vision which equates to 1.4 million people.vision which equates to 1.4 million people.

The incidence of impaired vision is The incidence of impaired vision is increasing: increasing:

Between 1982 and 2000 the incidence of Between 1982 and 2000 the incidence of those registered as those registered as blindblind rose by 41% and rose by 41% and the incidence of those registered as the incidence of those registered as partially sightedpartially sighted rose by 50%. rose by 50%.

What the RNIB says…What the RNIB says…

Currently there are 1,500 people registered Currently there are 1,500 people registered severely sight impaired/blind or sight severely sight impaired/blind or sight impaired/partially sighted in Coventry - impaired/partially sighted in Coventry - recent research suggests that these figures recent research suggests that these figures could be 20% highercould be 20% higher

the number of people eligible to register in the number of people eligible to register in Coventry therefore could be as high as 1,800Coventry therefore could be as high as 1,800

the majority (85%) of people with sight the majority (85%) of people with sight problems are older people, aged over 65problems are older people, aged over 65

Why?Why?

Largely because:Largely because:

impaired vision is age relatedimpaired vision is age related

the demographers tell us that the the demographers tell us that the proportion of older people will continue to proportion of older people will continue to increase until at least 2050increase until at least 2050

It is expected that the number of people It is expected that the number of people with visual impairments will reach 3 million with visual impairments will reach 3 million by 2030by 2030

Department of Health Department of Health

Estimates that as many as 4 million older Estimates that as many as 4 million older people do not have regular eye people do not have regular eye examinations that could detect some examinations that could detect some conditions that are treatableconditions that are treatable

Key messageKey message

You will often meet people with a You will often meet people with a significant visual impairment in your worksignificant visual impairment in your work

there are many people with a significant there are many people with a significant visual impairment now and there will be visual impairment now and there will be many more in the futuremany more in the future

What is it like to live with a What is it like to live with a visual impairment?visual impairment?

Bob WrightBob Wright(Low Vision Services (Low Vision Services

Committee)Committee)

Common Causes of Vision Common Causes of Vision LossLoss

Annette Ryman Annette Ryman Clinic 9 – Coventry & Warwickshire Clinic 9 – Coventry & Warwickshire

NHS TrustNHS Trust(Clinical Nurse Specialist for Retinal (Clinical Nurse Specialist for Retinal

Services)Services)

Commonest forms of vision lossCommonest forms of vision loss

Commonest conditions associated Commonest conditions associated with loss of visionwith loss of vision

Cataracts (Temporary vision loss)Cataracts (Temporary vision loss)

Age Related Macular Degeneration Age Related Macular Degeneration (ARMD)(ARMD)

GlaucomaGlaucoma

Diabetic RetinopathyDiabetic Retinopathy

Quick anatomy lesson!Quick anatomy lesson!

What is a cataract?What is a cataract?

It is an opacity or clouding of the lensIt is an opacity or clouding of the lens

Causes of Cataract DevelopmentCauses of Cataract Development

Age Age TraumaTraumaBirthBirthCertain medications: long term oral steroids, Tamoxifen, Certain medications: long term oral steroids, Tamoxifen, long term aspirin usage, Amiodarone, Allopurinallong term aspirin usage, Amiodarone, AllopurinalMedical disorders such as Diabetes, Glaucoma, other Medical disorders such as Diabetes, Glaucoma, other metabolic disordersmetabolic disordersLong term over indulgence of alcohol Long term over indulgence of alcohol SmokingSmokingPoor dietPoor dietLong term exposure to ultraviolet light/radiationLong term exposure to ultraviolet light/radiation

http://www.docshop.com/education/vision/eye-diseases/cataracts/causes/http://www.docshop.com/education/vision/eye-diseases/cataracts/causes/

SymptomsSymptoms

Reduced depth perceptionReduced depth perception

Diminished colour perceptionDiminished colour perception

Glare in sunlight/ sensitivity to bright Glare in sunlight/ sensitivity to bright lightlight

Poor night visionPoor night vision

Headaches/ eye fatigue (eye strain)Headaches/ eye fatigue (eye strain)

CataractsCataracts

How do we treat cataracts?How do we treat cataracts?

Usually surgical removal – cataract Usually surgical removal – cataract extraction with a lens implantextraction with a lens implant

Cataract SurgeryCataract Surgery

What is Age Related Macular What is Age Related Macular Degeneration?Degeneration?

It is the most common cause of It is the most common cause of blindness in the United Kingdom for blindness in the United Kingdom for individuals over 60 years of age. individuals over 60 years of age.

There are two types wet and dryThere are two types wet and dry::

The wet type (10%) is treatable and The wet type (10%) is treatable and the dry (90%) is not.the dry (90%) is not.

Normal eyeNormal eye

What happens?What happens?

With age, tissues break down and With age, tissues break down and fluids begin to seep between the fluids begin to seep between the layers of the retina, causing them to layers of the retina, causing them to separate. As they do, the result is separate. As they do, the result is macular degeneration.macular degeneration.

ARMD degeneration processARMD degeneration process

Age Related Macular DegenerationAge Related Macular Degeneration

SymptomsSymptoms

Distorted visionDistorted vision

Inability to read printInability to read print

Central part of the vision is missingCentral part of the vision is missing

Wavy linesWavy lines

Age Related Macular DegenerationAge Related Macular Degeneration

TreatmentsTreatmentsThere is no known cure for macular There is no known cure for macular degeneration, but there are treatments which degeneration, but there are treatments which may help to slow it down may help to slow it down

Thermal Laser treatmentThermal Laser treatment

Photodynamic TherapyPhotodynamic Therapy

Intravitreal Steroid injectionIntravitreal Steroid injection

Intravitreal drugs – Macugen/Lucentis/AvastinIntravitreal drugs – Macugen/Lucentis/Avastin

Patients do not go totally blind but Patients do not go totally blind but allall of of these patients will require Low Vision and/or these patients will require Low Vision and/or Social Services support at some point.Social Services support at some point.

Charles BonnetCharles Bonnet

Sometimes as a result of severe vision loss people can see Sometimes as a result of severe vision loss people can see hallucinations, not necessarily exclusive to people with AMDhallucinations, not necessarily exclusive to people with AMDThis is the result of the brain creating images and filling in the This is the result of the brain creating images and filling in the missing pieces of visionmissing pieces of visionOften people describe little people, gargoyles, distorted faces, Often people describe little people, gargoyles, distorted faces, scenerysceneryCan make navigation difficultCan make navigation difficultNo cure but it may disappear in a year to 18 monthsNo cure but it may disappear in a year to 18 monthsThe key to helping these people is to reassure them, and their The key to helping these people is to reassure them, and their family, that they are not going madfamily, that they are not going madNot everyone will recover but as long as they realise that what Not everyone will recover but as long as they realise that what they see is not real they can cope reasonably wellthey see is not real they can cope reasonably well

What is Glaucoma?What is Glaucoma?

Pressure created by the fluid in one or Pressure created by the fluid in one or both eyes builds up to an abnormally high both eyes builds up to an abnormally high level. level.

When this pressure remains elevated over When this pressure remains elevated over a period of time, damage occurs to the a period of time, damage occurs to the delicate visual structures. Left untreated, delicate visual structures. Left untreated, blindness often results. blindness often results.

Can be chronic or acuteCan be chronic or acute

The Drainage The Drainage System of the System of the

EyeEye

http://webeye.ophth.uiowa.edu/dept/service/glaucoma/images/open-closed.jpg

Cupping of the Optic DiscCupping of the Optic Disc

Incidence/Prevalence of GlaucomaIncidence/Prevalence of Glaucoma

By the age of 40 it is estimated that 1 in By the age of 40 it is estimated that 1 in 100 people develop some form of 100 people develop some form of glaucomaglaucoma

By the age of 70 this increases to 1 in 10By the age of 70 this increases to 1 in 10

High risk groups include people of African High risk groups include people of African descent ,people who are short-sighted, descent ,people who are short-sighted, have diabetes and have a family history. have diabetes and have a family history. (BBC News 24 – January 2004)(BBC News 24 – January 2004)

What are the symptoms?What are the symptoms?

There are no warning symptoms There are no warning symptoms until late in the disease. until late in the disease.

Peripheral vision is lost Peripheral vision is lost

It often goes unnoticed until it's It often goes unnoticed until it's too late – sometimes referred to too late – sometimes referred to as the “thief of sight”as the “thief of sight”

GlaucomaGlaucoma

Treatment?Treatment?

No cureNo cure, but, it can be controlled. , but, it can be controlled.

The most common treatment for glaucoma The most common treatment for glaucoma is eye drops to lower the pressure.is eye drops to lower the pressure.

If the pressure does not decrease If the pressure does not decrease treatment may involve laser treatment or treatment may involve laser treatment or laser surgery which opens the drainage laser surgery which opens the drainage system in the eye so fluid will flow freely.system in the eye so fluid will flow freely.

Early detection and treatment are the only Early detection and treatment are the only ways to prevent permanent vision loss. ways to prevent permanent vision loss.

What is Diabetic Retinopathy?What is Diabetic Retinopathy?

It is a complication of diabetes caused by It is a complication of diabetes caused by the deterioration of blood vessels the deterioration of blood vessels nourishing the retina. Glucose is thought nourishing the retina. Glucose is thought to damage retinal and renal capillariesto damage retinal and renal capillariesThis condition can cause blindness at any This condition can cause blindness at any age.age.Incidence is affected by how long a person Incidence is affected by how long a person has had diabetes and how stable their has had diabetes and how stable their diabetes has been. diabetes has been.

Diabetic RetinopathyDiabetic Retinopathy

SymptomsSymptoms

Gradual blurring of vision may occur.Gradual blurring of vision may occur.

Changes may go undetected without a Changes may go undetected without a retinal examination.retinal examination.

Deterioration of vision potentially leading Deterioration of vision potentially leading to severe visual impairment.to severe visual impairment.

Diabetic RetinopathyDiabetic Retinopathy

TreatmentTreatment

In many cases, treatment may not be requiredIn many cases, treatment may not be required

BUT BUT in others, laser treatments may be in others, laser treatments may be recommended to halt further progress of the recommended to halt further progress of the disease. disease.

Where swelling is present, steroids or intravitreal Where swelling is present, steroids or intravitreal treatments may be considered.treatments may be considered.

Early diagnosis and treatment are vital to Early diagnosis and treatment are vital to preventing visual loss from diabetic retinopathy.  preventing visual loss from diabetic retinopathy.