LVA Assessment - Intro

LVA is more of a problem solving exercise than the normal exam - not one unique outcome for px (ie 6/6). The main questions to ask is

What does the px want to do and is it going to be possible (expectations could be high or low)

• Many px may want a better pair of specs but this isn't possible, may be distressed/disillusioned
• Px must agree with what you want them to do - ie be happy with it

Speed has to be adjusted to fit the patient - an elderly px is going to need more time for subjective for example. Also avoid unnecessary tests. Initially general observation of the px can reveal a lot - bothered by light, physical infirmities, eccentric viewing, guided?

LV-centric equipment includes suitable test charts, real world items, 1.00D cross cyl, large aperture lenses, LVAs.

H&S is very important

• Pxs wants and needs (may not be the same thing)
• Questionnaire is useful for learning how they get on with specific tasks (how's watching tv? Do you sit close to it? etc)
• Specifics qs for distance, near, occupation, mobility, everyday tasks, hobbies, interests, different lighting conditions, onset of impairment, difference between eyes, believed caused, person who referred, ophthal - current and past treatment, when due back there, previous LV assessment, LVAs, live alone, hopes & expectations, registered etc etc etc

Psychological Aspects

Motivation is very important - they ain't going to get anywhere otherwise - the patient must be ready and willing to accept help.

Loss of vision can be assessed using a similar model to the one used w/bereavement

1. Denial/Shock - can't be happening
2. Grief - can't do anything now
3. Anger - it's not fair
4. Depression/Apathy - why bother
5. Acceptance - it's going to be ok

Px really needs to be at stage 5 before we can proceed. There's also a self-efficacy model which works best w/gradual vision loss. It's argued that early skill-orientated intervention can prevent loss of competence and foster a sense of personal control essential to successful rehabilitation.