Integrated Approach To Low Vision Patients

Спрямо намалението на зрението на по-добре виждащото око след корекция се различават два основни вида зрителен дефицит – слепота и слабо виждане. Low vision е лице с ниско зрение, което има визус дори и след лечение и корекция по-малък от 6/18 или зрително поле по-малко от 10 градуса. Low vision пациентите са обект на интердисциплинарен подход. Такъв екип включва група специалисти, които споделят общи идеи офталмолог low vision специалист, оптометрист и оптик, тифлопедагог, социален работник и психолог.Целта е да изясни ролята на low vision специалистите в интегрирания подход на слабо зрящиЗадачи: 1. да се създаде алгоритъм за работа на офталмолозите low vision специалисти; 2. да се извърши анкета със специален въпросник и да се обобщят резултатите; 3. да се създаде модел за интегриран подход при слабо зрящи.Материали: Литературни източници, научни публикации по въпросите за слепотата, нормативни документи и резултати от анкетата.Методи: Комбиниран подход между количествени и качествени методи. Исторически метод анализ на информацията от литературните източници. Статистически и социологически метод обработка на две анкети.Основни резултати: Слабо зрящите в 75% до 95% могат да бъдат зрително рехабилитирани с оптични средства. Това обосновава нуждата от въвеждане на алгоритъм за работа на офталмолога low vision специалист. В него трябва да се наблегне на видовете средства за зрителна рехабилитация и да се уточни алгоритъмът за определяне на увеличението на помощното средство.Заключение: Ако слабо зрящият човек има възможностите като зрящите хора, той е в състояние да бъде нормален член на обществото. Точно към това са насочени усилията на участниците в интердисциплинарния екип. Това е моделът на интегриран подход – силна сплав между отделните професионалисти, здрава колаборация между институциите.Introduction: Judging by the reduction in vision of the better seeing eye with optic correction, there are two types of visual deficits - blindness and poor vision. A low vision person is an individual who has a vision of less than 6/18 and a field of vision less than 10 degrees even after treatment and correction. Low vision patients are subject to an interdisciplinary approach. Such an integrated care team can be defined as a group of medical professionals. It would include an ophthalmologist, who is a low vision specialist, optometrist and optician, pediatrician, social worker and psychologist.Aim: The aim of this article is to clarify the main role of the ophthalmologists, who are low vision specialists in the integrated approach of patients with low vision.Tasks: 1. To create a work algorithm for the low vision specialists; 2. To conduct a survey using a questionnaire and summarize the results; 3. To create an integrated approach model for patients with impaired vision.Materials: We have used literary sources, normative documents as well as the results of a conducted survey.Methods: The method used is a combination between quantitative and qualitative methods.Results: A total of 75% to 95% of the low vision patients can be visually rehabilitated with optical correction. In order to begin a visual rehabilitation, it is necessary to take into account the degree of reduction of vision and the visual reserves. All this justifies the need of introducing a work algorithm for the low vision specialist. This algorithm should emphasize on the types of ophthalmic rehabilitation aid as well as determine the required enhancement of the aid devices.Conclusion: One thing is certain if low vision individuals have opportunities for education as sighted persons, they would be able to develop their potential and be useful members of the society. This is the main goal of the interdisciplinary team when working with visually impaired patients. This is the model of an integrated approach a strong connection between individual professionals and a collaboration between institutions

Investigation of the functional vision of low-vision children after long-term visual rehabilitation

ВъведениеСпоред определението на СЗО - слепи деца във възрастта от 0 до 15 години са тези с най-добре коригирана зрителна острота на по-доброто око, по-малка или равна на 0.1 (6/60). За тежка зрителна инвалидност при деца е прието коригираната зрителна острота на по-доброто око да е по-малка или равна на 0.3 (6/18). При децата с нарушено зрение е приет терминът „зрително подпомагане`, докато при възрастни - „зрителна рехабилитация`.Цел: Да се изследва функционалното зрение на деца от училището за слепи „Проф. д-р Иван Шишманов` - Варна, като се оцени ефектът от дългогодишното специализирано обучение и зрително подпомагане.Материал и методи:През 2009 г. и 2018 г. са изследвани деца от училището за слабо зрящи „Проф. д-р Иван Шишманов` Варна. На първа визита през 2009 г. са обхванати общо 23 деца, a на втора през 2018 г. - 16 деца. При първия преглед са изследвани зрителната острота и обективното състояние на очите, a при втория - зрителната острота и функционалното зрение, чрез специално разработен адаптиран въпросник. Зрителното подпомагане се осъществява чрез помощни увеличителни средства.Резултати:На първата визита са изследвани общо 23 деца от 1-3 клас, a на втората - 16 ученика. През 2009 г. едноочно намалено зрение е установено при 5 деца, a двуочно намалено зрение - при 18. На 10 деца е препоръчано зрително подпомагане чрез лупа, 6 са насочени за корекция с диоптрични очила, при 4 е била възможна подготовка само на Брайл и при 3 - няма препоръка, справят се добре. Девет години по-късно се установява, че общо 11 деца ползват лупа, като 7 от тях използват и лупа и електронен увеличител, само едно дете ползва очила и лупа, a останалите три деца - само лупа. Най-предпочитаното увеличение на използваните лупи е 5х - при 6 деца (37.5%). Трима ученика се ограмотяват само на Брайл. Оценката на функционалното зрение показва положително развити уменията за близко виждане - учениците държат правилно оптичното средство в 93.75% и разпознават лице в 81.25%. Оценката за дейностите на далече показва 100% справяне със стълби. При 50% все още се налага допълнително обучение с увеличително средство, a само в 12.5% се отхвърля изцяло помощното средство.Заключение:В нашето проучване се установи, че повечето от децата със зрителни увреждания имат остатъчно полезно зрение. Ограмотяването с Брайл често се използва в комбинация с плоскопечатния шрифт, в допълнение с увеличен или уголемен шрифт чрез оптични или електронни средства. Всички ученици от специализираното училище владеят Брайловата азбука, но близо две трети използват и плоскопечатния шрифт. Високата им мотивация за справяне с увеличително средство съвпада с добрата им адаптация и развити умения. Това потвърждава ефективната нужда от зрителна рехабилитация на колкото е възможно по-ранна детска възраст.IntroductionAccording to the definition of WHO, blind children aged 0 to 15 years are those with the best corrected visual acuity of the better eye being less than or equal to 0.1 (6/60). For severe visual disability in children, the corrected visual acuity of the better eye is less than or equal to 0.3 (6/18). For visually impaired children the term visual aid is used, and for adults - visual rehabilitation.Aim:The aim of this article is to study the functional vision of children from the school for the blind `Prof. Dr. Ivan Shishmanov` - Varna, assessing the effect of long-term specialized training and visual rehabilitation.Materials and MethodsThe children from the specialized school for blind `Prof. Dr. Ivan Shishmanov` - Varna were studied in 2009 and 2018. During the initial study 23 children were examined and in 2018 the children were 16. The visual acuity and the objective state of the eye were examined at the first visit. During the second one, in addition to visual acuity, we checked functional vision through a specially developed and adapted questionnaire. Low vision rehabilitation in the school is provided by auxiliary magnification devices.ResultsAt the first visit in 2009, a total of 23 children from grades 1-3 were examined. During the second visit in 2018, 16 students were examined. There were five children with one-eye blindness and 18 with low vision in both eyes. Ten children were recommended for visual aids through a magnifier, six were targeted for correction with dioptric glasses, for four only Braille was possible, and three did not get any specific recommendation, as they did well without aids, according to the visual therapist. Nine years later, it was found that eleven children used a magnifier, seven of them using a magnifying glass and an electronic magnifier, and only one child used dioptric glasses and a magnifier. The remaining three children used a magnifying glass. The most preferred magnification was 5x, used by six children (37.5%). Three students learned only be means of Braille. The assessment of functional vision showed positive development of near vision skills. The students held the optical devices correctly in 93.75% of the cases and recognized a face in 81.25%. The evaluation of the activities at distance showed 100% success in climbing stairs. Additional training with a magnifying device is still need in 50 %. In 12.5% of the cases the aid device was completely rejected.ConclusionOur study found that most of the children with visual impairment in the school had enough useful sight capacity. The learning of Braille was often combined with the flatbed font, in addition to enlarged or bigger-sized fonts on optical or electronic devices. All students in the specialized school knew Braille, but a large part of them also use the flatbed fonts. Their high motivation to cope with magnifying devices coincided with their good adaptation and developed skills. This confirms the effective need for visual rehabilitation also for children as early as possible

Community knowledge about the problems of blindness and low vision

Introduction:There are two main types of visual deficit - blindness and low vision. It depends on the decrease of the vision of the better seeing eye after correction. Low vision is a condition of visual acuity, even after treatment and correction, of less than 6/18 or a visual field of less than 10 degrees.The aimof this study is to investigate the awareness of blindness and low vision in the general population and among the health care professionals.Materialsand Methods:This is a questionnaire survey. The study was performed from 10 April 2018 to 10 May 2018 in Varna. We used a separate questionnaire for the two groups of participants. Тhe first group consisted of randomly chosen patients in the Eye Center and their relatives and the second included medical specialists. The statistical analysis was made with Microsoft Excel 2013.Results:The majority of respondents - 60% were between 25 and 60 years old. More than 89% of the respondents had no information about the activities of the Union of the Blind and the special schools for blind children in Varna and in Sofia. Over 33% of respondents were not interested in specialized training in visual rehabilitation, 75% did not know the prices of the devices for correction of low vision. This matter was interesting for 91% and 83% would take place a National Vulnerable Campaign for low vision.Conclusion:The awareness of blindness and low vision among the general public and the medical specialists is very unsatisfactory. This indicates the need for change of public opinion and for specialized training of medical specialists. Therefore, an implementation of a low vision algorithm is needed.Introduction: There are two main types of visual deficit - blindness and low vision. It depends on the decrease of the vision of the better seeing eye after correction. Low vision is a condition of visual acuity, even after treatment and correction, of less than 6/18 or a visual field of less than 10 degrees.The aim of this study is to investigate the awareness of blindness and low vision in the general population and among the health care professionals.Materials and Methods: This is a questionnaire survey. The study was performed from 10 April 2018 to 10 May 2018 in Varna. We used a separate questionnaire for the two groups of participants. Тhe first group consisted of randomly chosen patients in the Eye Center and their relatives and the second included medical specialists. The statistical analysis was made with Microsoft Excel 2013.Results: The majority of respondents - 60% were between 25 and 60 years old. More than 89% of the respondents had no information about the activities of the Union of the Blind and the special schools for blind children in Varna and in Sofia. Over 33% of respondents were not interested in specialized training in visual rehabilitation, 75% did not know the prices of the devices for correction of low vision. This matter was interesting for 91% and 83% would take place a National Vulnerable Campaign for low vision.Conclusion: The awareness of blindness and low vision among the general public and the medical specialists is very unsatisfactory. This indicates the need for change of public opinion and for specialized training of medical specialists. Therefore, an implementation of a low vision algorithm is needed

Visual Rehabilitation for Low Vision People with Socially Significant Eye Diseases / Зрителна рехабилитация при слабо зрящи със социално значими очни заболявания

The thesis is a systematic scientific study performing a complex analysis of the issue of the visually impaired. It covers the socially significant eye diseases leading to low vision, the social aspect of the problem, the visual rehabilitation and the integration of these patients. The unsatisfactory awareness of the public and the knowledge of ophthalmologists about these problems was confirmed categorically by the conducted survey. With low-vision children, it has been found that they can use most of their residual vision with the help of training, assistive magnifiers and other technologies. The most preferred magnifying device with them is the magnifier. Near vision in adults is also corrected by magnifiers, followed by electronic magnifiers. It was found that there was a statistically significant difference in reading speed "without" and "with magnification"-three times higher in all groups. Visual rehabilitation does not have an immediate effect. It is a process of diagnosis, training in the correct use and adaptation to the device, combined with trust in the team of specialists - ophthalmologist, optometrist, optician, typhlopedagogue, social worker and psychologist. There are significant barriers and difficulties in accessing visual rehabilitation of an organizational and personnel nature-limited resources, lack of trained specialists, lack of an integrated approach and multidisciplinary team. Deal with them will provide complex care based on modern standards.Дисертационният труд представлява системно научно изследване извършващо комплексен анализ по въпроса на слабо зрящите. Той обхваща социално значимите очни заболявания, водещи до нарушено зрение, обществено-социалния аспект на проблема, зрителната рехабилитация и интеграцията на тези болни. Незадоволителната информираност на обществото и познанията на офталмолозите по тези проблеми се потвърдиха категорично от проведеното анкетно проучване. При слабо зрящите деца се установи, че с помощта на обучение, помощни увеличителни средства и други технологии те могат да използват максимално остатъчното си зрение. Най-предпочитаното увеличително средство при тях е лупата. Средството за корекция на зрението за близо при възрастните също са лупите, следвани от електронните увеличители. Установи се, че съществува статистически значима разлика в скоростта на четене „без“ и „с увеличение“, като във втория случай тя е три пъти по-висока при всички групи. Зрителната рехабилитация няма мигновен ефект. Тя е процес на диагностика, на обучение в правилното използване и адаптация към помощното средство, съчетана с доверие към екипа от специалисти-офталмолог, оптометрист, оптик, тифлопедагог, социален работник и психолог. Съществуват значителни бариери и трудности в достъпа до зрителна рехабилитация от организационен и кадрови характер-лимитиран ресурс, недостиг на обучени специалисти, липса на интегриран подход и сформиран мултидисциплинарен екип. Преодоляването им ще осигури комплексна грижа

Good vision – good driver

Vision is a complex act that allows the visual analyzer to perceive and analyse objects in the environment. The teams of two eye clinics conducted a “good vision-good driver” awareness campaign in combination with a survey. In most countries in the world, drivers over the age of 65 are required to renew their licences every 2 or 3 years. The European Commission wants car drivers over 70 to prove their ability every 5 years. The aim was to analyze the relationship between patients’ visual performance concerning their self-reported driving and their subjective general health. The survey was conducted through a direct survey at St. Nikolay Chudotvorets Eye Clinic Eye Clinics from 1.06.2021 to 31.06.2022. For the period, 103 patients were surveyed, 84 male and 19 – female. The group of 50–70-year-olds was the most numerous. Uncorrected vision equal to or less than 0.3 was present in 45.6% of all 206 eyes. Almost all respondents drove a car, only 3 were not drivers, and most (50.9%) had no difficulty driving. More than 42% of the respondents found driving difficult only at night, and 6.8% had difficulty always. There is an overlap in the results of the questions of whether the patient had had a traffic accident – positive in 13.7% and whether they had ever had a stroke. The ability to drive is a multifactorial process in which vision plays an undeniable role. Visual acuity reflects the need for correction in the driving licence. The present research proves the need because it shows patients with poor vision driving and not at a young age who overestimate their general and visual objective condition