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OPTICS/ REFRACTION/ CONTACT LENSES SESSION

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AUTHORS PROFILE: Dr. DEEPAK. C. MEHTA Currently, Prof. & Head, Dept. of Oculoplasty & LVA Clinic, M & J Institute, Ahmedabad, Recepient of WHO fellowship, USA in 1989. E-mail: deepakmehta_in@rediffmail.com

Successful Visual Rehabilitation with Low Vision Aids in Macular Pathology Patients
Dr. Deepak C. Mehta, Dr. Mahesh Chandargi, Dr. Vijay Damor, Dr. Nitin Jain, Dr. Chirag Gohil, Dr. Anand Kumar, Dr. Vikas Badada
ow vision patients with macular pathologies (heredomacular degenerations, dry and wet ARMD, macular holes, PDR) may have magnitude of symptoms like central field loss, multiple field loss, tunnel vision, contrast loss and glare, distorted images and some additional symptoms including blurred vision and defocused images. These patients may be legally blind i.e. BCVA of 20/200 or less, or a visual field of no more than 20 degrees. The number of patients with impaired sight that cannot be improved with the spectacles, contact lenses, medical treatment and/or surgery is growing. Demographic trends suggest that the number of patients with low vision is going to increase further since the main causes of low vision are age related. Large percentages of these patients are visually rehabilitated by judicious use of a variety of LV Aids. LVA clinic at M & J Institute of Ophthalmology & Western Regional Centre regularly receive low vision patients not only from all over Gujarat but also the western states of India.

Snellens chart and it is possible to equate acuities at different distances. For assessment we utilized, (1) Keelers LVA trial sets, (2) Special low vision charts 3 meter distance Snellens charts & special near vision charts, dot charts, E charts etc. Illumination was also incorporated as & when required. The following LV Aids were evaluated & dispensed judiciously: (1) Hand/ Stand Magnifiers, (2) Spectacle Magnifiers, (3) Near vision fixed focus telescopes, (4) Closed circuit television, (5) Illumination devices.

Results
Table 1: Biographical characteristics of new referrals to low vision clinic
Category Age (yrs) 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 > 80 Sex Male Female No. of pts 17 16 10 18 46 79 44 10 157 83 Percentage 7.0 6.6 4.1 7.1 19.1 32.9 18.33 4.1 65.41 34.39

Materials and Methods


Retrospective study of 10 yrs was conducted and data was carried out over 240 patients with low vision at LVA clinic, M & J Western Regional Institute of Ophthalmology, Ahmedabad. Each patient had a low vision assessment as per the prepared proforma. The visual assessment was performed over BaileyLovie LogMar chart, which has the added advantage over the conventional

Low vision clinic saw patients of almost all age group (13 to 89 yrs), however the vast majority were over the age of 50 yrs (74.58%).

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AIOC 2006 PROCEEDINGS

Table 2 : Macular disorders of the patients


Macular disorders Dry ARMD Wet ARMD Heredomacular degenerations Macular hole PDR Others No. of pts. 115 34 45 17 15 14 % 47.91 14.16 18.75 7.0 6.25 5.8

Table 3 : Binocular visual acuity of the patients


Binocular visual acuity 6/18 to 6/36 6/48 to 3/36 3/60 to 2/60 1/36 to 1/60 Less than 1/60 No. of pts. 91 79 46 22 2

Age related macular degeneration formed the major bulk of the patients (62.07%) with heredomacular degenerations, PDR and macular holes forming the remaining. For ease of interpretation, data about visual performance recorded using the Bailey-Lovie LogMAR chart were converted to the equivalent Snellen fraction and are also presented in Table 3. Patients attending the low vision clinic for the first time had a mean binocular visual acuity of only 6/60. Refraction improved binocular VA by one line or more in only 59 subjects. For this group the mean improvement in VA equated to an improvement from approximately 6/60 to 6/18. Table 4 describes the types and powers of the magnifying devices used to bring about the improvement in reading ability.

Table 4: Characteristics of Low vision Aids supplied


Description of aids Hand magnifier Illuminated hand magnifier Stand magnifier Illuminated stand magnifier Other Aids supp- Magnilied (%) fication 7 Dioptres X4 X4.7 X4 X6.4 Not applicable 20 20 30 30 11

High power reading addition 13

Discussion
LVAs are extremely beneficial in visually rehabilitating patients with low vision due to
1. Wormald RPL, Wright LA, Courtney P, et al. Visual problems in the elderly population and implications for services. BMJ 1992;304: 12269. 2. Bischoff P. Long-term results of low-vision

macular pathology. An excellent doctor-patient relationship is extremely necessary in initiating the problem solving process. Persistence and determination on the part of ophthalmologist can vastly improve quality of life of pts with macular pathology. Satisfactory visual rehabilitation in LV patients can help them to carry out fair amount of day to day activities with minor lifestyle modifications.
rehabilitation in age related macular degeneration. Doc Ophthalmol 1995;89: 30511. 3. Leat SJ, Fryer A, Rumney NJ. Outcome of lowvision aid provisionthe effectiveness of a low vision clinic. Optom Vis Sci 1994;71:199206.

References

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