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DisclosurePartner Linklater Warren OptometristsTrustee SeeAbilityCo-Director Special Olympics Opening Eyes
GBCouncillor Association of Optometrists
SightUp to 90% of our
sensory information will come from the sense of sight
Most daily tasks are more difficult when vision is impaired
We all tend to assume others perception of their environment is the same as ours
VisionPeople with learning disabilities
are 10x more likely to have serious sight problems
60% will need spectacles and may need support to get used to them
9.3% meet the criteria for sight impaired or serious sight impairment (partial sight or blind) registration
Those with severe and profound learning disabilities are most likely to have sight problems
Emerson & Robertson 2011
Questions Do you know the visual status of
all of your service users?How does undetected visual
impairment affectSafety, health and wellbeing?Effective allocation of resources?
Will detecting and treating an individuals sight problem reduce the amount of support required?
Can you empower the individual?
Drivers for ChangeValuing People & Valuing People NowDeath by Indifference (Mencap 2007)‘Healthcare for All’ (2008)Must offer ‘equality of care’ Human
Rights Act, DDA / EA, ECHR, Mental Capacity Act
Support for GP DES for people with severe and profound LD and maintenance of registers of people with LD on practice lists
Doing the right thing!
The Eye and Vision
Embryology
Human eye starts to develop at 3 weeks gestationBlood supply from approx 4 monthsRetinal blood vessels reach nasal ora at 36 weeks, temporal
vessels 40 weeksDevelopment of eye and visual pathway continues throughout
pregnancy and early life.The eye is an extension of the brain
The Human EyeVision – Optic
Nerve CN2Motor –
Oculormotor CN3, Trochlear ON 4, Abducens ON 6
Sensation Trigeminal
ON 5http://www.99main.com/~charlief/theeyebg.gif
Development of AcuityAge (months) OKN FPL VEP
1 20/300 20/400 20/300
6 20/60 20/150 20/20
12 20/40 20/100 20/20
36 20/20 20/20 20/20
Visual PathwayRetinocalcerine and tectal pathway
Lea Hyvärinen
LGN dParvo
MagnoInterlamin
ar
SuperiorColliculus
Pulvinar
LGN v
Pretectum
Neuclei of Accessory optic tract
Primary Visual Cortex
Higher Visual
Areas in Cortex
Suprachiasmatic nucleus
From Milner & Goodale 2006
RetinogeniculateGeniculostrate‘Traditional’
Pathway’
‘Primative’ pathways to mid brain and other
neuclei
Cortical Visual ProcessingFrom primary
cortex links to visual association areas
Dorsal (Where?) pathway
Ventral (What?) Pathway
The Reading ProcessLocation of word on pageAccurate accommodation
and gaze directed so image on fovea – mid brain and CN 2, 3,4,6
Image to Brodman’s Area (BA) 17 & 18 (via CN2)
Temp Occipital Cortex BA39 – Structure and form
To BA 21 & 42 Wernicke’s area – phonetic representation
BA 44&45 Broca’s area - speech
MRC Cognition and Brain Sciences Unit
Process in reading a wordTo read ‘FOX’Recognise letters and order – F(1)O(2)X(3)To lexicon or brains dictionary –recognition of
familiar order of lettersSemantic system then associates features
with wordSpeech output converts word into phonetic
soundSpeech generated using motor control of jaw,
tongue, voice-box and breathing
Learning Disability and VisionNeuro-developmental
disorder causes LD so all parts of eye and visual development may be affected
Structural defects may be caused by developmental abnormalities
Developmental defects may lead to further structural damage
Behavioural changes may lead to injuries to the eye
Periventricular LeucomalaciaDamage to white matter
adjacent to ventriclesPresent in up to 25% of
pre term infantsAffects visual and
acoustic tracts as well as descending cortico-spinal tracts
Up to 60% may develop cerebral palsy
Visual impairment and perceptual abnormalities
www.pedsradiology.com
Actions NeededFunctional Assessment of all clientsDocument visual abilitiesCommission Pathways to allow extended eye
examsEnsure regular 2 yearly eye examinationsWork with Secondary Care Providers to
ensure equal accessDocument outcomes and advice given
Functional Vision AssessmentDesigned for use by
CarersSeeAbility
Functional Vision Assessment Tool
www.lookupinfo.org
Checklist 1 - Appearance of the eyes
the appearance of a persons eyes may raise concerns about their eye health
Checklist 2 - Behaviour a persons behaviour may be
related to poor vision or other eye care needs
Checklist 3 - Poor central vision
this is when a person cannot see straight ahead very well
Checklist 4 - Poor peripheral vision
sometimes a person has difficulties seeing to the sides and up and down
Checklist 5 - Sensitivity to light
some people experience difficulties because their eyes are very sensitive to light
Checklist 6 - Poor colour vision (or contrast sensitivity)
some people do not see colours very well and can find it difficult to see objects clearly against different backgrounds
Checklist 7 - Poor vision in one eye
some people have poor vision in one eye only
Eye Examination PathwaysKAB – BexleyRNIB Bridge to VisionSeeAbility Eye 2 EyeLOCSU Sight test pathwayWOPEC - Accreditation for practitioners
LOCSU Pathway
Can Eye Examinations be done?
Yes
Pathway SupportPre examination reporting –
Telling the Optometrist about me form – SeeAbility
Appropriate facilities and equipment – desensitisation visits
Funding of extended eye examinations and repeat visits
Includes domiciliary servicesFeedback forms and
reporting – SeeAbility forms or PHP/Health Passports completed
Information leaflets on Eye health and Spectacles - SeeAbility
Secondary CareRoyal College of
Ophthalmologists Guidelines
GMC GuidelinesGood Practice eg
SheffieldAdvocacy and
support
RememberAssess Visual FunctionRecord Functional AbilityOrganise Eye
Examinations Create PathwaysRecord ResultsModify Care PlansEmpower Individuals
Information & HelpSeeAbility
www.lookupinfo.org www.seeAbility.org
Paula Spinks-Chamberlain
LOCSU www.locsu.co.ukKatrina Venerus
