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Vision Rehabilitation

LOW Vision is the major challenge facing eye care and rehabilitation professionals in the 21st century. Very less has been done for the habilitation of these less understood mass of population who need specialized care and services to live and work independently and effectively.

Joseph Eye Hospital is currently developing potential resources to meet this inevitable need in ophthalmic care through its unique wing – the Low Vision Enhancement Centre – a package of Low Vision and related services.

Milestones

# Slowly, it gained momentum and services were expanded.

# In June 2001, the centre for Rehabilitation was started.

# In December 2001, Low Vision personnel underwent training and the resources of the centre were strengthened.

# Training and networking offshoots were developed in 2002.

# Outreach activities began in 2003.

ALL ABOUT LOW VISION

Persons with low vision are those who have limitations in seeing at a distance, but are able to see objects and materials within a few inches or at a maximum of one foot away. Some of them may be having restricted field of view that may prevent them from perceiving a whole picture of the environment or objects.

Look out for the possible problems in low vision. You have some clues here:

* Blurred vision

* Close viewing distance

* Difficulty in reading small print

* Problem with low contrast text

* Inability to read in dim light

* Stumbling over obstacles on the way

WHEN DOES THIS HAPPEN?

Some of the eye conditions that may affect vision severely that tends to make the person low vision are cataract, glaucoma, corneal opacities, retinal detachment, macular degeneration, optic nerve atrophy, retinopathy of prematurity, etc.

HOW CAN YOU HELP?

When you come across a person with any degree of these problems, even if he or she can hardly see anything, direct the individual to an eye specialist nearest to your locality. A timely referral may go a long way in changing the entire life of the person.

WHAT WE DO

When a client comes to us, we route him through a sequence of steps, wherein he is first seen by an ophthalmic assistant who does a preliminary examination to estimate the level of vision in the individual. The eye doctor or ophthalmologist then makes a detailed investigation to rule out the problem. Necessary treatment and suitable glasses is given. This is followed by a thorough check of the person’s ability to do relevant practical activities. The Rehabilitation that follows will be individualized and comprehensive. To put it in a nutshell, low vision intervention aims:

* To diagnose the cause of low vision

* To provide necessary treatment

* To enhance visual functioning through assistive devices

* Provide additional guidance to improve quality of life

* Promote maximum use of residual vision

FACILITIES

The centre is equipped with sufficient infrastructure for examination and training with updated tools for testing purposes. The recent developments in the field have been incorporated into the routine functioning of the centre. The human resources is constituted by a team of qualified and specialized personnel belonging to various disciplines such as Ophthalmologists, Ophthalmic technicians, rehabilitation professionals and field staff.

Hence the combination of medical and rehabilitation care in a comprehensive manner is the unique feature of our centre.

DEVICES

Apart from conventional glasses that enhance sight, we offer suitable low vision devices that make reading easier through magnifying techniques. These devices are available in various forms in low and high powers to suit the individual requirements.

SERVICE DELIVERY

At the Low Vision Enhancement Centre, a wide range of clients benefit from clinical and rehabilitation services. The clients through the Outpatient Department, those referred from other clinics, the school children and persons from Rehabilitation Centres and Community Based Rehabilitation Programmes are a part and parcel of our wide network of beneficiaries.

Of late, Infants and multi-handicapped children have become the centre of our focus. In these children, we employ individualistic approaches of assessment and training. We assign the parents, care givers and teachers the main role to assist and monitor the visual development of these children.

We also reach out the needy population in the community through the outreach programme of our centre. A team of low vision personnel visit schools and organizations to carry out the screening for low vision and provide the necessary intervention at the doorsteps of the clients. This also helps to promote awareness in the society. It is surprising to find that more than 40% of the children in blind schools and Integrated Education Programmes have useful vision that has remained neglected.

VISION REHABILITATION

While vision rehabilitation cannot restore lost sight, it can help a person to make maximum use of residual vision even after all possible ways of treatment fails to correct the limitations of reduced vision. It can equip you with techniques to maintain an independent lifestyle. It involves:

* Counseling

* Clinical evaluation

* prescription

* functional evaluation

* vision training

* training to use devices

* manipulating the environment

* follow-up

1. Counselling- explaining the visual problem, prognosis and scope of intervention strategies.

2. Clinical evaluation- making a diagnosis of the visual condition and testing visual ablilities such as distant vision, near vision, field of vision, binocular vision, colour vision etc.

3. Prescription- correcting the refractive error with glasses and assisting near vision tasks with magnifiers and distant viewing with telescope.

4. Functional evaluation– to practically assess the individual using his vision for functional purposes such as reading, writing, mobility etc

5. Vision training- this is the major stage of intervention wherein the person is encouraged to use his residual vision through training of various skills like scanning, depth perception, visual discrimination, eye-hand coordination etc

6. Training to use devices- the well refined visual abilities are not utilized to teach the person to use the optical and non-optical devices recommended for him.

7. Modifying the environment to enhance lighting, contrast, position etc to improve visual performance

8. Review- apart from these, the clients are reviewed periodically based on individual need, while a school visit is made in case of those children requiring classroom interventions.

CLASSROOM INTERVENTIONS

Each low vision child has a different need. By helping the parents and guiding the teacher in finding ways and means of solving classroom difficulties, a much better performance could be expected of the child at school.

* Allow the child to sit in the most suitable position, either in the front row centering the blackboard or near the window.

* The child’s place must be such that he or she doesn’t struggle due to glare on the board or other teaching materials.

* The teacher also needs to position herself in a place where the child is able to perceive her expressions and lip movements.

* Make sure that the child is using the prescribed devices.

* The child must be ensured with sufficient lighting over the task area.

* The blackboard should be kept clean in order to give maximum contrast for the writing area.

* Monitor correct use of non-optical stands and typoscopes and look out for need for any further interventions.

* Give ample time and rest periods for optimal functioning.

TRAINING

The most effective method to carry and expand the spectrum of services is to empower existing manpower in the field with knowledge and skills to carry out low vision work in the respective communities.

So far, we have trained community level workers, teachers, special educators, rehabilitation and eye care professionals from various programmes.

FUTURE PERSPECTIVES

Our services are being expanded steadily and will soon be covering a larger population with a wider range of services. They would be made more viable and accessible that even the nearby states and neighbouring countries will be able to avail the benefits. Outreach will be the major concern in the coming years. Manpower training will be carried out at all levels and in a more phased manner.

Vision is a beautiful gift. Let us kindle this light in the lives of the differently abled low vision and add a ray of smile lit with a sense of indomitable triumph and success.

Vision Rehabilitation

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