Dr. Hj. Ani, Sp.

BCVA

WHO
standard
(def)

WHO
1992
(function
al def)

6/6-6/18

Normal

Normal

<6/18-6/60

Low vision

<6/60-3/60

<3/60-1/60

Visual
disturbance
Severe visual
disturbance
Blind

Low vision
Low vision

A low vision person is a

person who has visual
disorder.

Even after therapy, operation &

correction,
best eye BCVA is still < 6/18 (0.3)
Visual field, <10 degree
But able to use his remaining sight,
to work

Examination procedure

Observe
History
Motility test
Ocular assesment
Near & far VA assesment
Refraction
Binocular vision assesment

Examination .

Contrast sensitivity
Colour vision, if needed
Visual field, if needed
Light requirement (inside & outside)
Prescribing correction lens
Prescribing LV optical device
Using accomodation & refractive error
Decide tools
Considering working distance

Three misunderstanding

VA decreased only because of ocular

pathology
Improving refractive error with
ocular pathology will not improve
VA
Improving VA less than 6/60 is not
significant, not worth it

Refractive error commonly

associated with LV

Albinism moderate/high H or M +
moderate/high astigmatism
Cataract myopic shift
C palsy
mod-high hyperopia
Corneal scar
mod-high astigmatism
Deg myopia
high myope
DM
myopic shift sugar level
Down synd mod-high myopia

Refractive error
associated.

Glaucoma myopia
Keratoconus
high irregular astigmatism
Microphthalmos
mod-high hyperopia
Monochromatism
high myopia, mod
astigmat
Pendular nystagmus moderate astigmatism
ROP high myopia
moderate: 3-6D myop; 3-5D hyperopia, 2.5-4 astigmat
high:>6D myopia, >5 D hyperopia, >4D astigmat

Eye diseases & colour

disorder
Condition

Colour confusion

Amblyop
none
Choroiditis
blue-yellow
Cone dystrophy red-green
Diabetic rpathy
blue-yellow
Glaucoma
blue-yellow
ARMD
blue-yellow

Eye disease.

Stargardts mac deg

red-green
Myopia deg
normal, if macula is
good (b-y)
Lebers HON red-green
Papilledema
blue-yellow
Retinal detachment blue-yellow
RP
B-Y, R-G,
achromatopsia

Congenital vs aquired
colour vision disorder
Congenital

Aquired

Men (x linked) men/woman

R-G disorder
B-Y or R-G
Symetry ODS asymetry
Stable change with time
Not depend on size & lighting
Normal VA decreased sight quality

Effect from some eye

disease..
Vit A def
nictalopia. Contrast
RP
nictalopia, visual field
Glaucoma peripheral sight
Optic atrophy
VA
. etc
Central vision dist near working
distance
Peripheral vision dist mobility

VA assesment

Influencing factors
Illumination
Background contrast
Different target
Different examiner
Eye condition
Consentration
Intelectual level

VA assesment

Use test tools according to age,

handicap severity

Accuracy is important
Damage level indicator
Help to decide education
Starting point to decide magnification
needed

Non optical device

Typoscope
Standard
Large print
Filter glasses, hat
Thick lining exercise book
Change reading technique
Colour

Non optical

Contrast
Illumination
Size
Distance
Class positioning
Writing guidance

Guidance to choose
magnifier

Microscopic glasses
Until + 20.00 D
For school children and adult
If he has central/paracentral fixation
For reading, sewing, writing

Microscopic glasses &

hand/standmagnifier

If > +20 D magnification needed

Guidance

Hand/stand magnifier
Eccentric fixation
For some preschool children
More than + 20.00 D
If client desperately needed

Near vision

Record
Near VA distance without tools
Better eye
Distance where he put the chart
Fixation
Test type

Decide what tools to start

Decide print size goal (1 M ?)

Near VA..

Calculate magnification needed

Decide starting magnification
Find the best magnification
Record the magnification needed,
choosen tools,
optimal working distance & BCVA

Magnification

Three magnification method

Enlargement of the object/print
Get closer
Optical magnification, use magnifier
The larger the magnification
decreased visual field
closer reading distance

Magnification..
The less light to the object
Better use
1. Least magnification
2. Enough to improve sight
3. Comfortable working distance

Prescription
consideration

Client wish ; cost, appearance

Eye competency : contrast.s, v.field
Low vision aids : treshold,
(dis)advantage

Optical & non optical

Flexibility
Available training

Four combination factors

Refr. error
( 0 to +/- 40 D)

Accomodation
(0-10 D)

Optica
l aids
( 0-80 D)

Non optical
device

Contrast sensitivity

Identified who needs more contrast

to increase VA
Can increase reading speed
Increasing c. sensitivity
Better illumination
Typoscope
Filter
Better print materials

Objective
test:
Hiding Heidi
Mr Happy
Lea symbol

Subjective test
Text in moderate
& low contrast

st increase contrast before checking magnification need

Eye problems in learning

difficulties

No/ small eye

Eye closed
No pupil
Opaque or damage
Often infected
Moving /blinking all the time
Severe squint

Behaviour

Often touch the eye(s)

Unusual head movement
Avoiding light, closing eye
Short consentration
Seldom relax
Amazing look when seing light
Poor decorum & communication skills
..etc

Eye problems.

Not recognizing people

No eye contact
Poor attention to others
Observing things very close
Prefer bright object
Often smashing objects
Prefer going with othersetc

Question about sight

What eye problems ? Squint ? Nystagmus ?

Therapy, glasses & operation history?
Does he know where the light coming from?
Does he react differently when in daylightnight?
Does he maintain eye contact ? Starring at
light?
Does he has a better sight when looking
from a certain position?

Question.

At what distance can he recognize a

toy ?
Does he reach something that he
likes?
Does he always looking for a lost toy?
Does he prefer certain colour?
Does he prefer one eye over another ?

Problems on magnifiers

No focus
Distortion
Glare
Blurred
Eye fatigue
Small visual field
..etc

What should an LV person,

friends
& teacher know about .

Simple language about

diagnosis, prognosis & cause of
LV (simulate & discuss)
Making aware that LV is not
blind and also not normal
Important to check regularly
Tools care

What should we know

Always using positive words

Training
First talk about his ability
Tools to increase VA

formular