# Low Vision Rehabilitation/Thelma Scope
## PART 1

Your first patient at See Well Australia is Mrs Thelma Scope. Through working with Mrs Scope you will come to understand the concept of low vision and the impact of eye disease when treatment is no longer an option. You will be exposed to the roles and approaches of a range of professionals who might work with a patient with vision impairment. You will be challenged to determine your role as an Orthoptist in this multidisciplinary environment.
There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer.

## Part 1 Question

How does low vision differ to legal blindness and what are the various definitions used to describe vision loss and what is the socio-economic impact of vision impairment? Use the scenario and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions.

## Part 1 Activities

Task 1
Watch the What is Low Vision? lectorial where you will find out about your new patient Mrs Thelma Scope.
Consult the resources below in addition to finding your own resources to answer the Task 1 questions. When answering the questions, think about what you know so far about Mrs Scope. Discuss and compare your answers with the students in your group.
* Terminology in Eye Health
* WHO | Visual Impairment and Blindness factsheet
* Oxford Dictionary
Questions - Task 1
* Why is it important to a patient that we define disability or vision impairment?
* How does the World Health Organization (WHO) define ‘low vision’
* According to the WHO definition, can you classify Mrs Scope as having ‘low vision’?
* What is the definition of ‘impairment’? How does this definition specifically relate to vision?
* Do you think Mrs Scope has an ‘impairment’? Discuss.
* Define ‘disability’ and explain how this relates to the sense of vision.
* Do you think Mrs Scope is disabled? Explain why/why not.
* Define ‘handicap’ and explain whether this definition can be applied to Mrs Scope.
* Do you think you have enough information about her case history in order to classify Mrs Scope as either having impairment, disability or handicap? What other information would you need?
Task 2
Referring to the Eye Research Australia (Clear Insight) Economic Impact and Cost of Low Vision in Australia publication, answer Task 2 questions. Don't forget to consider your patient Thelma when answering the questions.
Questions - Task 2
* Of a composition of the total cost of vision disorders in 2004, what is the total cost of suffering? What do you think “cost of suffering” means? Explain your answer in the context of Mrs Scope.
* On page 4 of the report it states: “the share of pharmaceutical costs has increased to 11.4% of the total and of ‘other health practitioners’ to 10.6%. Why would this be so? What would contribute to this?
* There are significant indirect costs associated with vision impairment. In the context of Mrs Scope, explain how each indirect cost could impact on her life.
* Mrs Scope is 73 years old and she is expected to live quite a few more years, especially as she is generally healthy. What are the most likely reasons that her vision impairment would prevent healthy and independent ageing in her case?
* What are the top 3 causes of blindness in people aged over 40 in Australia?
* What age groups are most pre-disposed to each of the 3 causes you selected?
* What are the projected forecasts for visual impairment and blindness in Australia for the future?
* Why is addressing vision impairment a serious issue in this country?

## Resources and help

* Focus on Low Vision is an excellent publication by the Centre for Eye Research which will be useful to complete all the topics in this enquiry. You should refer to it often.

## PART 2

So far,Thelma Scope helped you to understand the concept of low vision and the impact of eye disease when treatment is no longer an option. Now, Mrs Scope will expose you to the roles and approaches of a range of professionals who might work with a patient with vision impairment. You will be challenged to determine your role as an Orthoptist in this multidisciplinary environment.
There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer.

## Part 2 Question

How does the orthoptist fit into the low vision rehabilitation team and what other professionals are involved? Use the scenario and resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions.

## Part 2 Activities

Task 1
Mrs Scope is reporting difficulty with a range of activities of daily living, including: reading, managing her finances, walking about outdoors, shopping, cooking and using the telephone. In addition, she has become fearful of leaving the house, is increasingly losing her independence and becoming reliant on others.
Do some research on each of the following professions to determine the assistance they provide for Mrs Scope.
* Low Vision Therapist
* Occupational Therapist
* Orientation and Mobility Instructor
* Physiotherapist
* Social Worker
* Special Education Teacher (Vision Impaired)
These two YouTube movies might also help: Low vision occupational therapy Orientation and mobility
Other resources & links
Statewide Vision Resource centre Who does what in vision care Better Health Channel - Orthoptists

## PART 3

This topic looks at how to manage patients with low vision and why they do or do not access appropriate services. There is an overall enquiry question you will need to answer, and scenario with supporting information to help guide your understanding and formulate your answer.

## Part 3 Question

Why do people with low vision not access, or have difficulty accessing services that could help them?
Use the scenario you already know (Mrs Thelma Scope) in addition to the resources below to formulate your own response to this question. You are looking for reasons as well as proposed solutions. Share your findings within a multidisciplinary team, collate what your team things are the best 3 responses and formulate a single response for the team.
This topic is intended to guide your understanding of the the value of low vision rehabilitation to expose you to the reasons why patients do not access low vision services, whether intentional or unintentional.

## Part 3 Activities

Through your patient, Mrs Thelma Scope, you have come to understand what the difference is between low vision, vision impairment and legal blindness. You have also considered the psychosocial and financial/economic impact of vision impairment. Next we will consider the key elements are of a low vision assessment and the principles of low vision rehabilitation. Once again, Thelma Scope's case study will assist your understanding of these concepts.
Task 1
Watch the playlist related to Principles of Vision Rehabilitation and read the following articles:
* Markowitz SN. Principles of modern low vision rehabilitation. Can J Ophthalmol 2006;41:289–312
* Vukicevic M. Functional vision assessment. Aust Orth J 2008; 40(2).
These readings are essential to your understanding of the principles of low vision rehabilitation.
Task 2
Working with the members of your group, read the following two articles and answer the questions below.
* Matti AI et. al. Access to low-vision rehabilitation services: barriers and enablers. Clin Exp Optom. 2011; 94: 2: 181–186
* O’Connor PM et. al. Access and utilization of a new low-vision rehabilitation service. Clin Exp Ophthal. 2008; 36: 547–552
Questions - Task 2
* What is the definition of “low-vision” according to O’Connor?
* How does Matti define “low-vision rehabilitation”? Does this differ from what your perception of it had been? Explain.
* How many patients access low-vision services in Australia and what factors stop them from doing so?
* Describe the differences in the provision of low vision services across Australia and across different agencies, as indicated in the article by Matti.
* Briefly describe the referral process/patient journey as described by Matti. What criticisms/comments do you have about this process? How could it be improved?
* In the studies by Matti and O’Connor what are the main barriers that inhibit low-vision patients from accessing services?
* What do you think could be done to help improve access to low-vision rehabilitation services in Australia?