Inside the Eye Disease Just the Facts: A Resource Manual for the Vision Rehabilitation Professionals

Copyright © 2020 by Lucien G Prince, MD, MBA,MS-CVRT, CLVT. 787342

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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ISBN:      Softcover               978-1-7960-8397-2

                Hardcover             978-1-7960-8398-9

                EBook                   978-1-7960-8396-5

Library of Congress Control Number: 2020901068

Rev. date: 01/21/2020

Preface

The majority of Vision Rehabilitation Professionals who teach clients how to use their remaining field of view is constantly asked to recommend the right book to explain eye diseases. Although, there are several great textbooks on the visual field available, none seems to meet the standard that rehabilitation professionals require to satisfy their clients’ needs. This book is therefore the prescription that encompasses the major topics of eye disease in relation to low vision, orientation, mobility and vision therapy. This book answers all the questions about the anatomy, physiology, pathophysiology, pathology, treatment, prevention and vision rehabilitation therapy of any abnormality of the eye. This book can serve as a companion text for not only for vision rehabilitation professionals but also medical students and family members of patients. The audience includes certified optometrists and ophthalmologists; pediatric and occupational MDs and RNs; allied health personnel in ophthalmology and optometry and pharmacists. It may also be of interest to those involved in a wide range of occupations in industry, government, military and civil aviation and maritime functions. It aims to help fulfill the thirst for knowledge about functional visual impairment and blindness.

I would like to express my gratitude to my CFO Jeanine Johnson and the numerous contributors that made this text possible:

• Lachelle E. Smith, M.S., CVRT (Director of the Vision Rehabilitation Therapist Program Salus University)

• Audrey Smith, PHD (Dean, College of Education and Rehabilitation, Salus University, Professor, Blindness and Low Vision)

• Krystell D. Prince, MSc. (Clinical Data Analyst)

• Eric G. Austin (Media/Marketing)

• Jerline Aristide(Intern)

• Vision Rehabilitation Staff at EBRC (Eastern Blind Rehab Center, West Haven, CT VA Facility)

• VISIONS Rehab Staff and Management (New York, NY)

Foreword

Although blindness has existed since the beginning of recorded history, it became a major societal concern after World War II, when the hospitals were filed with visually impaired veterans. The strong, brave men and women, who had so valiantly fought for world peace and human rights, were now perceived as weak and helpless. It was at that time the rehabilitation professionals began to analyze the issues of living without sight. As of today, the majority of the population still see individuals with visual impairment as someone who has lost psychological security, basic skills, communication skills (reading, writing), and appreciation of all that is beautiful. They are also believed to have lost control over their financial occupational status and personality. However, while many perceived people who are visually impaired or blind as helpless, resentful, bitter and unhappy, some advocate that blindness itself does not create emotional disturbance. Instead, it is societal prejudices that cause emotional distress; it is the misconceptions about the loss of vision or the need for adaptive skills that causes the anxiety (Cutsforth 1951: Jernigan, 1969).

Although, there is a lot of progress in the evolution of attitudes and stereotypes towards disability and visual impairment in the U.S population, the ancient misconceptions still exist. Individuals who are blind or visually impaired are still being regarded in some part of the society as a different class of people with definite stereotyped characteristics. The loss of vision is still looked upon as punishment by many; for example, parents may feel guilty that their child visually impaired. Also, very often the parents of blind children get the impression from physicians and nurses that the child will be hopeless and helpless. This is a great dis-service because, without a good understanding of the child’s capabilities, the child will not succeed in life.

Being the Chief Medical Officer for a Medical and Paramedical Exam Company for over 14 years, I received a full range of cases of individuals with multiple disabilities including blindness/visual impairment. These people had no idea about the severity of their eye’s conditions and thought they were going to regain their sight. They are helpless if their families do not have the financial resources to send them to a low vision or blind rehab facility. To quote one of them: "I don’t want to go to restaurants with my husband anymore, because I don’t want to embarrass him with his friends. There is a disbelief and recognition and emotions over there. Very often, nurses working in hospitals or nursing homes tend to collect medical information needed from the visually impaired or blind client’s companion instead of asking the client directly. In addition, a person may be called blind when he/she lacks common sense and stolen blind when someone foolishly allows himself/herself to be cheated. Other terms such as blind alley, blind fury, intellectually blind or morally blind, all have negative connotations affect the population with which I’m working. This presents a real challenge in the rehabilitation process. Bad pirates still wear eye patches in storybooks or movies, while physical beauty is constantly advertised over the media. The strangest assumption commonly held is that as soon as a person becomes blind or visually impaired, he/she immediately takes on all the stereotypical characteristics. To quote Helen Keller: not blindness, but the attitude of the seeing to the blind is the hardest burden to bear". Generally, the society is geared to accommodate the majority and thus the needs of these minorities are often forgotten. The society reinforce dependency of individuals diagnosed with blindness or vision loss; they assist them with service systems that make it unnecessary to compete for their survival needs. The fact is, of course that some people with vision loss can survive in our competitive society on their own, but many cannot without support.

As a Vision Rehab Specialist, it will be important that we not only educate the general public about blindness and disability, but also the blind person’s family, friends and associates. In addition, the individual who is blind or visually impaired will have to learn through training how to effectively manage negative encounters. While assisting clients in their adaptation to visual impairment, we must view ourselves as positive role models and know that the client is a person first. In other words, we must play a positive role by changing the attitudes of both sighted and visually impaired or blind clients. It will be important to encourage individual with vision loss to be taught together with the sighted whenever possible.

All these memories along with some Alumni from Salus University motivate me to come back to the vision field and finish what being already started. The personal satisfaction you obtain from assisting individuals who are visually impaired, or blind is an indescribable fulfillment.

Being a practicing Low Vision Rehab Specialist, I have a better understanding of feelings, attitudes and recognize the impact that any negative feeling might have on individuals who are blind or visually impaired. I understand that attitudes of significant others (i.e. family and friends) have the most significant impact on a client’s self-concept; families with positive attitudes most likely will help the individual who is blind or visually impaired maintain a positive outlook. To best understand the adjustment to vision loss, it is necessary first to be aware of the relationship between self-esteem and adjustment and to the concept of acceptance of loss. A good understanding of this book will give the eye care professionals the skills needed to assess clients diagnosed with visual impairment and blindness; the age at which vision loss occurred, the degree of vision loss and the coping strategies to use.

Contents

Chapter 1:

Understanding the Anatomy and Physiology of the eye

Chapter 2:

Basic Optical Principles of the Eye and Refractive Disorders

Chapter 3:

Common Disorders and Diseases of the Eye (Mostly Encountered in Low Vision)

Chapter 4:

Normal changes in the Aging Eye and Functional Implications

Chapter 5:

Traumatic Brain Injury (TBI) and Comprehensive Vision Rehabilitation Evaluation

Chapter 6:

Inside the Low Vision Exam

Chapter 7:

Special Considerations-Questions/Answers

1. Ergonomic Positions and Visual Performance

2. Prism and Functional Visual Assessment

3. Low Vision and Adaptive Diabetes Self-management

4. Developing Effective Communication Skills to Stay Connected with Friends and Relatives

5. A Visually Impaired Client in A Shopping Center

6. The AZOOR (Acute Zonal Occult Outer Retinopathy)

Chapter 8:

Psych-Social Consequences of Visual Impairment

Chapter 9:

Living Skills Cases

Chapter 1:

Understanding the Anatomy and Physiology of the eye

To understand the visual process, it is important to master the major parts of the eye, where the visual information is collected and transmitted. A thorough foundation on ocular anatomy will enable you to better understand diseases of the eye as well as the functional and educational implications of those anomalies and conditions.

Let’s start with the anterior part (front) of the eye and way towards the back or posterior part. Images of different parts of the eye are provided to help with your learning.

The eye is a spherical organ. (Approximately one inch in diameter). It is suspended in a cone-shaped, bony structure called the orbit. The bony orbits provide a safe shelter for the eyes. The eye detects energy (as photon) and transmits information about intensity, color and shape to the brain.

LIDS

The lids are a thin layer of epithelial tissue, which serves to protect the eye. The upper and lower lids are the thinnest layers of tissue in the body (see photo under conjunctiva section).

Functions:

• Protects eye from foreign bodies, dust

• Blinks as a reflex

• Nourishes cornea via its blood vessels

• Helps to spread tears

• Limits light entering the