Gordon Ilett Optometrist [email protected]. Disclosure Partner Linklater Warren Optometrists Trustee SeeAbility Co-Director Special Olympics Opening.

Visual Health in Learning DisabilityNHFN Birmingham

Gordon IlettOptometrist

[email protected]

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