# Low Vision Rehabilitation/Jane Beech - part 1

Mrs Jane Beech is a new patient you will be seeing at See Well Australia. Through working with Mrs Beech you will integrate your understanding of the impact of central field loss with the concept of eccentric viewing training as a management strategy. There is an overarching question you will need to answer, and scenarios with supporting information to help guide your understanding and formulate your answer.

## Question

When is eccentric viewing training an appropriate strategy for the management of central field loss and how is a training program implemented? 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

Mrs Jane Beech, aged 78 has been referred to you at See Well Australia by her ophthalmologist. She has been diagnosed with atrophic AMD in both eyes and her condition has been stable for about 2 years now. Her main complaint is difficulty seeing the television, seeing faces and she wants to be able to improve her vision generally.
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 is 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. (NB: Double click on the field for higher resolution)

### Task 1

Your mentor at See Well Australia suggests that Eccentric Viewing training might be useful for Jane. Do you know anything about Eccentric Viewing? Find out more by watching the Eccentric Viewing playlist. Find the Eccentric Viewing power point slides here.

### Task 2

Consider the following questions:
* Is Mrs Beech a good candidate for Eccentric Viewing (EV) training? Justify your answer by describing the criteria a patient needs to meet for training.
* Based on her Bjerrum visual field, what would be the optimal Trained Retinal Locus (TRL) and why? Mark the best area on the field above.
* What other methods could you use to establish the TRL if a Bjerrum was not available to you?
* Now that you have chosen the best TRL, in which direction will you tell Mrs Beech to look and how far in that direction does she need to move her eyes?
* Before you commence EV training, what very important factor do you need to consider and perhaps alter?
* The first step in EV training after establishing the TRL is “awareness”. What are the methods for establishing awareness? List each and indicate whether they would/would not be appropriate for Mrs Beech.
* What kind of activities would you give Mrs Beech for practicing EV in her own time?
* What activities could contribute to her applying EV more widely?
* Based on the information you have, what is the most likely visual prognosis (i.e. near print size) that she could achieve? Justify your answer.
* How many EV training sessions are sufficient? What is the minimum and why?
* At what point would you make the decision to stop EV training with Mrs Beech?

### Task 3

Jason is 14 years old. He is also a patient at See Well Australia and she has an appointment on the same day as Jane Beech. Jason has central vision loss as a result of Leber's optic atrophy. Is it possible to train a child in eccentric viewing? The following articles will help you answer this question and the questions below:
* Fitzmaurice K. (2008) Eccentric Viewing may help children: Case reports. Proceedings of the 9th International Conference on Low Vision, Vision 2008, Montreal, Quebec, Canada July 7 – 11 2008.
* Fitzmaurice K & Clarke L (2008) Training Children in Eccentric Viewing: A Case Study. Journal of Vision Impairment and Blindness:2008; 102(3), p 160-66.
Questions - Task 3
* How would you explain the process of eccentric viewing to Jason, including the steps that your patient will take in a way that will provide understanding of the process and motivation to undertake it.
* Eccentric viewing resources are usually developed for older adults, how would you present eccentric viewing strategy to children and young adults?
* What do you think might be the physical and psycho-social issues for children and young adults who have lost macular vision?
* How could you develop an eccentric viewing training program that would not take valuable time away from Jason's education and leisure activity?