# Low Vision Rehabilitation/Jane Beech part 2

You have already seen Mrs Beech (aet 78 years) who had been referred to you at See Well Australia by her ophthalmologist. She had been diagnosed with atrophic AMD in both eyes and her condition has been stable for about 2 years now. Her main complaint was and still is difficulty seeing the television and seeing faces.
You have provided her with training in eccentric viewing and she has found this to be successful. She has now returned to discuss the issues she is having with activities of daily living (ADLs) such as cooking, managing money and finances, using the telephone, telling the time etc. There is an overarching question you will need to answer, and scenario with supporting information to help guide your understanding and formulate your answer.

## Question

What strategies can you recommend for Mrs Beech in light of the difficulties she is reporting? Consider all aspects of her complaint and integrate this with what you know about the physical and psychosocial impact of her eye disease. Use the scenario and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions.

## Activities

At Mrs Beech's last visit, you gathered the following information:
POH: R and L cataract extraction/IOL implant (1999) Current glasses (bifocals): R) +0.50/-1.25x33 L) 0/-0.75x45 add +3.00 SH: Lives alone but daughter is close by. Cognitively alert, used to read and crochet. No major physical issues apparent.
Your initial assessment was as follows:
VA c bifocals: R) 6/120 L) 6/120 BEO with light = n80 pt
Subj Refn: R) +0.75/-1.00x35 = 6/95 L) =0.25/-1.00x45 = 6/120 Add +3.00 = n80 BEO with light
Bjerrum VF: as shown here.
It has been 4 months since you saw her last. Her vision is unchanged today.

### Task 1

Before you can help Mrs Beech further, you need to find out how. Start by watching this video Modification of the Environment for Patients with Low Vision and then the following playlists:
* Kitchen & mealtime tips
* Tips for managing money
* Tips for daily tasks
Additional resources: Modification of the Environment power point Eperjesi F, Maiz-Fernandez C & Bartlett HE. Reading performance with various lamps in age-related macular degeneration. Ophthal. Physiol. Opt. 2007 27: 93–99

### Task 2

Refer to chapter 12 from Scheiman M, Scheiman M & Whittaker SG. Low Vision Rehabilitation: a practical guide for occupational therapists. 2007. Slack Inc. and answer the following questions about Mrs Beech.
1. Mrs Beech is having some difficulty at home with ADL. What advice can you give her in terms of organizing her space or the areas where she performs various tasks (i.e. where she reads, eats, does crochet work)?
2. Mrs Beech is still capable of paying her own bills and she is adamant about remaining independent. She needs to be able to: a. Read who the bill is from, the amount due and the date payable b. Write a cheque for the correct amount c. Address and envelope
What items/strategies can assist her with each of these tasks?
3. Fiercely independent, Mrs Beech likes to do her own shopping. She shops for groceries, personal items and occasionally clothing. She catches the bus to Chadstone on her own. What advice can you offer her for: a. Handling money b. Telling the time at home and while out (she needs to know when her bus is coming)
4. Mrs Beech has a sister in Bendigo, she likes to call her weekly because they don’t often get to see each other now. She complains of some difficulty seeing her personal telephone directory and also the numbers on her standard Telstra phone. What advice can you offer her?
5. Although she gets Meals on Wheels 3 times a week, Mrs Beech prepares all other meals on her own. You notice she has some food stains on her jumper and she complains of some problems with cooking. She informs you that she only cooks things she knows and never tries new recipes. What do you tell her?
6. Due to recent arthritis and some mild hypertension, Mrs Beech has been prescribed medication by her GP. She has some trouble dosing correctly and remembering whether she has taken her tablets. She has been known to take a double dose. What can help?
7. Mrs Beech also has difficulty with the following things: a. Seeing the buttons on the CD player b. Setting the temperature on the oven c. Seeing the dial on the washing machine Suggest strategies for dealing with these issues.
8. Mrs Beech’s daughter is very worried about her and feels she is at the stage of considering supported accommodation options. What psychosocial factors do you think Mrs Beech is facing in light of these considerations?