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Visual Impairment Care Needs of the Public Through Clinical Care, Research, and Education, All of Which Enhance the Quality of Life

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Visual Impairment Care Needs of the Public Through Clinical Care, Research, and Education, All of Which Enhance the Quality of Life OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. Approximately 37,000 full-time equivalent doctors of optometry practice in more than 7,0000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Visual Impairment care needs of the public through clinical care, research, and education, all of which enhance the quality of life. (Low Vision Rehabilitation) OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH VISUAL IMPAIRMENT (LOW VISION REHABILITATION) Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Low Vision Kathleen Fraser Freeman, O.D., Principal Author Roy Gordon Cole, O.D. Eleanor E. Faye, M.D. Paul B. Freeman, O.D. Gregory L. Goodrich, Ph.D. Joan A. Stelmack, O.D. Reviewed by the AOA Clinical Guidelines Coordinating Committee: David A. Heath, O.D., Chair John F. Amos, O.D., M.S. Stephen C. Miller, O.D. Approved by the AOA Board of Trustees June 11, 1997 and October 18, 2007 © American Optometric Association 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881 Printed in U.S.A. iii Visual Impairment TABLE OF CONTENTS INTRODUCTION......................................................................... 1 I. STATEMENT OF THE PROBLEM .............................. 2 A. Description and Classification of Visual Impairment ... 4 B. Epidemiology of Visual Impairment ............................ 7 l. Prevalence and Incidence ........................................ 7 2. Risk Factors ............................................................ 7 C. Goals of Comprehensive Visual Impairment Care ....... 8 II. CARE PROCESS ............................................................ 11 A. Diagnosis of Visual Impairment ................................. 11 l. Patient History ...................................................... 11 2. Ocular Examination .............................................. 12 a. Visual Acuity .................................................. 12 b. Refraction ........................................................ 15 c. Ocular Motility and Binocular Vision Assessment ...................................................... 16 d. Visual Field Assessment ................................. 17 e. Ocular Health Assessment .............................. 18 3. Supplemental Testing ............................................ 19 B. Management of Visual Impairment ............................ 20 NOTE: Clinicians should not rely on the Clinical l. Basis for Treatment ............................................... 21 Guideline alone for patient care and management. 2. Available Treatment Options ................................ 22 Refer to the listed references and other sources a. Management Strategy for Reduced Visual for a more detailed analysis and discussion of Acuity .............................................................. 22 research and patient care information. The b. Management Strategy for Central Visual Field information in the Guideline is current as of the Defects ............................................................ 28 date of publication. It will be reviewed periodically and revised as needed. c. Management Strategy for Peripheral Visual Field Defects ................................................... 30 d. Management Strategy for Reduced Contrast Sensitivity and Glare Sensitivity ..................... 32 e. Non-optical Devices ........................................ 33 f. Training/Instruction Considerations ............... 34 g. Additional Services ......................................... 35 3. Patient Education .................................................. 36 Impaired Vision iv 4. Prognosis and Follow up ....................................... 37 CONCLUSION ........................................................................... 38 III. REFERENCES ................................................................ 41 IV. APPENDIX ...................................................................... 57 Figure 1: Optometric Management of the Patient with Visual Impairment: A Brief Flowchart ............. 57 Figure 2: Potential Components of the Comprehensive Examination of the Patient with Visual Impairment ......................................................... 58 Figure 3: ICD-9-CM Classification of Visual Impairment ......................................................... 60 Abbreviations of Commonly Used Terms ........................ 64 Glossary ............................................................................ 65 Introduction 1 2 Visual Impairment INTRODUCTION I. STATEMENT OF THE PROBLEM Optometrists, through their didactic and clinical education, training, experience, and broad geographic distribution, have the means to provide Visual impairment is defined as a functional limitation of the eye(s) or effective primary eye and vision care services, including vision visual system1 and can manifest as reduced visual acuity or contrast rehabilitation services, to children and adults in the United States. sensitivity, visual field loss, photophobia, diplopia, visual distortion, visual perceptual difficulties, or any combination of the above. These This Optometric Clinical Practice Guideline for Care of the Patient with functional limitations can result from congenital (e.g., prenatal or Visual Impairment describes appropriate examination and treatment postnatal trauma, genetic or developmental abnormalities), hereditary procedures for the evaluation of the visual abilities and eye health of (e.g., retinitis pigmentosa or Stargardt's macular degeneration), or people with visual impairments. It contains recommendations for timely acquired conditions (e.g., ocular infection or disease, trauma, age-related diagnosis, management, and, when needed, referral for consultation with changes, or systemic disease). A visual impairment can cause (or treatment by) another health care provider or rehabilitation disability(ies) by significantly interfering with one's ability to function professional. This Guideline will assist optometrists in achieving the independently, to perform activities of daily living, and/or to travel safely following goals: through the environment. 1,2 Specific problems include, but are not limited to, loss of the ability to read standard-sized print, inability or • Identify patients with visual impairment(s) who might benefit limitation with respect to driving, difficulty performing work-related from low vision care and rehabilitation tasks or leisure activities, and/or inability to recognize faces of familiar • Evaluate visual functioning of a compromised visual system people. When these disabilities limit personal or socioeconomic effectively independence, a visual handicap exists.1 • Emphasize the need for comprehensive assessment of patients with impaired vision and referral to, and interaction with, other An impairment of the visual system present at birth, or developing 3,4 appropriate professionals shortly thereafter, can adversely affect development. Visually • Maintain and improve the quality of eye and vision care impaired children are often developmentally delayed in the areas of gross 4-6 rendered to visually impaired patients and fine motor skills and perception. For students, the inability to read • Inform and educate other health care practitioners and the lay standard-sized print, to see the chalkboard, overhead projection, or the public regarding the availability of vision rehabilitation computer, or to discriminate color can have a significant impact on their services educational development. Parents, caretakers, and educators need • Increase access for the evaluation and rehabilitative care of information regarding the student's visual abilities, as well as how to individuals with visual impairment(s), thereby improving their maximize the use of remaining vision, and strategies to modify the environment or task to minimize the disabling effect of the visual quality of life. 7-9 impairment on performance. Visually impaired adults are concerned with securing and maintaining employment, productivity, and independence, as well as maintaining a home and fulfilling family and social obligations.10,11 Older adults who have new visual impairment(s) face a significant challenge at a time when they may also be experiencing other major life changes, such as Statement of the Problem 3 4 Visual Impairment general health limitations or loss of a spouse.11-13 Loss of independence lessened by appropriate vision rehabilitation, including optometric low and the ability to enjoy leisure activities are predominant concerns of the vision intervention.21-31 older adult with a visual impairment.11 A. Description and Classification of Visual Impairment It is estimated that there are between 1.5 and 3.4 million visually impaired adults (adults (or 40
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