Bob’s eye doctor: (Ophthalmologist) has diagnosed him with left sided bilateral homonymous hemianopia (half field loss in each eye on left side) directly related to his right-sided brain injury from a stroke.
His doctor mentioned the issues which Bob has with his mobility, due to this un-resolvable loss in the left half of each eye’s visual field. He has had assistance from Guide Dogs Victoria for this problem, with the recommendation that he uses a white cane to assist his mobility. The field loss meets mid-line of vision, so Bob is unable to read sentences.
A Bob was under the age of 65, he was assessed by our Orthoptist through his funded hours provided by the National Disability Insurance Scheme.(NDIS)
Bob has stipulated he has the following goals.
GOAL 1) To be able to study a Certificate 2 in Horticulture (through local T.A.F.E. facility), despite significant vision loss related to his stroke and functional vision problems relating to his acquired brain injury.
For Goal 1, the aim of exploring electronic versus optical aids was pursued.
GOAL 2) To be able to read recipes at home despite significant visual field loss (side vision loss). Bob has stated that he lives alone since his wife passed away, so is responsible for cooking. He must cook healthy meals to be able to maintain his blood sugar levels. Traditional optical magnifiers explored in the past are no longer useful to him, as his vision has deteriorated further especially in the last 3 months.
To address Goal 2, the strategy of exploring adaptive technology was pursued.
Visual Fatigue is experienced by Bob, particularly with reading and using the computer. He finds it very difficult to maintain focus at all and struggles with reading complete words or short sentences.
OTHER HEALTH CONDITION(S) RELEVANT TO VISUAL FUNCTIONING
Diabetes
Bob has also been diagnosed with Diabetes. Diabetic Retinopathy has not currently been diagnosed, but is very much a possible complication of having Diabetes over many years, so there is the likelihood that Bob may suffer with further vision loss in the future, despite well controlled blood sugar levels.
Due to the likelihood of further vision loss due to Diabetes, it is recommended Bob’s CCTV have the feature of text to audio output as something that may be added if necessary. The link below provides a brief outline of diabetic retinopathy ad how it impacts on vision, due to damage to the retinal blood vessels.
Acquired/Traumatic Brain Injury (post stroke)
Those with acquired and/ or traumatic brain injury (A/TBI) have a much higher incidence of binocular vision dysfunction and accommodative (focusing) disorders as well as issues of balance and a host of perceptual anomalies including a shifted concept of mid-line.
VISION FINDINGS from Orthoptic assessment
Distance Vision: (Uncorrected) Right eye 6/36 Left eye 6/24 part.
This means: what the normal eye sees at 24-36 metre’s distance: Bob can only see, if standing at a 6m distance from the same sized object. Distance vision did not improve significantly using the ‘pinhole test’. This confirms that Bob’s distance acuity is un-correctable with prescription glasses.
The combination of reduced fields in each eye and reduced distance and near acuity make Bob vision impaired, thus requiring adaptive technology to allow him to see for near and far.
Near vision:
(with reading glasses) N14-18 BEO (preferring large print N20: as used in large print books) for comfort. Bob has reduced near vision despite wearing a recent glasses prescription.
Prefers this size print.
Range of accommodation: (range of focus)
Bob has a limited range of accommodation, which, in combination with the above vision loss and his ABI, explains why he experiences visual fatigue after very short periods or reading and would benefit from an electronic rather than a traditional optical magnification device.
EYE MOVEMENTS
There was no squint or indication of any tendency for the eyes to drift inwards or outwards when Bob’s eye movements and co-ordination were briefly examined.
The reduced range of accommodation, however, will lead to easy visual fatigue, hence enforcing the need for an electronic rather than optical magnifier, as an electronic magnifier (CCTV) can be used at a further distance from the eyes, suiting his limited range of accommodation.
OUTCOMES
Bob has explored a range of both optical and electronic magnification devices to relieve his visual fatigue. Optical magnifiers only enhanced the visual discomfort he experiences with closely positioned objects, as (due to the narrower field of view) he must move the magnifier a lot and still failed to see all parts of a word on a page.
It was therefore recommended that a larger CCTV in additional to extra scanning training were the most appropriate solutions for Bob’s situation. Both of these recommendations were approved through NDIA, following a detailed Orthoptic Specialist Assessment Vision Report.