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April 2018

Low Vision Day: a real

Low Vision Day: a real eye-opener BY SUSANNE BRADLEY How do you tell someone they’re losing their sight? What can you do to really help a low vision patient? How do you explain the often-complex web of support and technology available? These, and many other important questions were the focus of the School of Optometry and Vision Science (SOVS) Low Vision Day on 1 March. The day included lectures, workshops and a panel discussion where students had the opportunity to talk directly with low vision patients and ask them questions about their lives and the help they had or hadn’t received. Nick Lee, New Zealand Optometry Student Society (NZOSS) president, said it was the first time many students had had an opportunity to be exposed to true low vision patients. The day provided a safe and encouraging learning environment and the students he spoke to really appreciated the opportunity to talk openly to patients who had low vision and were comfortable with and open about their condition, he said. “Previously, it felt like there was a certain negative stigma surrounding low vision patients, but everyone who volunteered their time was just happy to be helped and helped our learning too.” Samantha Simkin from the Blind and Low Vision Education Network NZ (BLENNZ), started the day with a talk about BLENNZ’s role helping low vision and blind children access education. Low Vision Day team Claire MacDonald, Sam Simkin, Michelle O’Hanlon, Shireen Ali and Katy Webber Ophthalmologists, optometrists and teachers can refer to BLENNZ. As there are different levels of support available, it’s important to refer even in cases when the child is perhaps not fulfilling all the criteria, said Simkin. Katy Webber, a counsellor with the Blind Foundation (BF), talked next about how BF can support adults and children alike, with different practical and emotional aspects of their life, to work towards a more independent and fulfilled life. Webber said the perception that BF is only for adults is wrong, BF and BLENNZ work together with the age group 0-21, but where BLENNZ’s focus is on education, BF focuses on supporting the individual in their daily life. So, it’s important to always make two referrals, one for BLENNZ and one for BF, she said. Low vision patients Trevor Plumbly (see Blind ignorance, this page), Susan Grimsdell, Camille Guy and Michael Lloyd made up the much-anticipated panel for the day’s discussion session. From sharing their life stories and answering the many questions put to them by the audience, it was clear life with low vision isn’t all bad, but it certainly has its challenges. “It doesn’t stop me from doing the things I want to do, I just need to find another way to do them,” explained Lloyd. The discussion covered everything from good and bad optometry visits, with most saying ‘telling it, how it is’ was the preferred way to receive and deliver bad news, to how public spaces could be improved to better support our low vision community. The three afternoon workshops were practical, providing insights into adaptive technology, how to best communicate with patients with low vision and how to use electronic devices designed to assist patients with low vision, orientation and mobility. The latter included role-play testing techniques for correctly performing sighted-guide assistance. The day ended with a WELCOME TO OUR NEWEST DIRECTOR Dr Logan Robinson, MB ChB, PG Dip Ophth BS (Distinction), FRANZCO An experienced cataract surgeon with an enthusiasm for vitreoretinal surgery, Logan, completed a medical degree in 2003 at the University of Otago and completed a Postgraduate Diploma in Ophthalmic Basic Sciences (with distinction) in 2008. Continuing his professional development via a fellowship in vitreoretinal surgery at Wellington Hospital, Logan then moved to the UK, completing a second vitreoretinal surgery fellowship at the Manchester Royal Eye Hospital. Returning to Christchurch in 2015, Logan took up a position as a consultant ophthalmologist at Christchurch Hospital and subsequently joined us at SES. Away from work Logan enjoys spending time with his young family and is an avid sports fan, enjoying mountain biking, golf and fishing. From everyone at SES, ‘Welcome aboard Logan’. 128 Kilmore Street, Christchurch, New Zealand PO Box 21023, Edgeware, Christchurch 8143 t: +64 3355 6397 f: +64 3 355 6156 e: info@southerneye.co.nz www.southerneye.co.nz refraction clinic, offering students an opportunity to perform a low vision refraction test. Student Andrew Kim said this part of the day was one of his highlights and a valuable experience. Melissa Zhu said it was one of the most rewarding and challenging practical learning sessions she’d experienced. “As students, we mostly encounter patients with no pathology or patients who have pathology but are sufficiently sighted enough to come to our clinics. The duty of telling someone they will lose their driving and independence was a topic on a lecture slide I had once thought was far, far away. It was easy to avoid. (So) I felt most challenged by the hard truth that there are simply no cures yet to restore vision in some patients. “This led to a sense of collective awkwardness when we faced our volunteers in the clinic; as if we have, somehow, failed to do our jobs. However, by talking to the volunteers both in clinic and in the panel, I have come to see people living fulfilling lives with their vision problems. This was the Blind ignorance BY TREVOR PLUMBLY* Sight loss, I discovered, is such a gradual process that it’s generally detected by others before the victims themselves. Certainly, the indications I had came at me, rather suddenly. I was sitting down, quietly enjoying a cup of tea, when my wife Pam said: “we really need to talk”. Now anyone with any experience of married life or full-time employment, knows that when someone says that, good news is not about to follow. The conversation started innocently enough, along the lines of, “do you realise how often you’re bumping into things lately?” I put on, what I hoped was a pensive, reasonable expression, waiting for the final verdict and sure enough it arrived. “You need to get your eyes tested again, but go to someone a bit more high-tech than old Charlie.” I thought that was a bit harsh, Charlie had done my glasses for years and never given me any grief. Anyway, if there was bad news out there why go looking for it? I tried the usual, “I’ll think about it” and “as soon as work eases off a bit”. Occasionally this ploy works, but not this time and a couple of days later off I went, feet dragging, to the high-tech optometrist (HTO). Mentally debating the difference between an ‘HTO’ and a normal optometrist, I decided it was probably the size of the bill. The HTO looked more like a cemetery for posh spectacle frames than a place to get your sight fixed. The decor was a floor to ceiling sort of glaucoma grey which matched the hair colour of the chirpy, competent looking women behind the counter. My optometrist was a really pleasant young Australian woman who shuffled and dealt the test lenses with all the panache of a Las Vegas croupier. Whilst I gained confidence from this dexterity, she obviously wasn’t satisfied. She followed up the first act by shining a magnifying torch into my eyes muttering ‘Hmm’. It’s a personal opinion of course, but a ‘Hmm’ coming from anyone in the medical game has got to be one of scariest expressions in the English language. Its only got two meanings; a) “I haven’t got a clue what’s wrong with you”; or b) “I don’t want to be the one to tell you.” We talked about my vision and I mentioned having problems driving at night. She trumped this by saying, “I don’t think you should be driving in daylight either and you definitely need to see a specialist.” Not really what I wanted to hear. Seeing a specialist implied that what I had was beyond her ability, and then there was the cost. With Charlie, it was in and out with glasses for around $300 but this little number was looking like $600 plus, with the specialist in the game, I was starting to feel like I was involved in some sort of optical pyramid scheme. The specialist oozed professional competence. He sat me in front of an ancient-looking machine, explained the process, gave me a buzzer and said, “press this when you see the lights.” After a while he said, “when you’re ready,” and then, with a Students testing sighted-guide techniques with their blindfolded partners – Yasmeen Musa, Melissa Zhu, Tish Peat, Susan Cordery and Amelia Hardcastle highlight of my day,” explained Zhu. “The most important message to me was that we, as practitioners, cannot carry a misguided idea that low vision’ is a euphemism for the traditional meaning of ‘blindness’, and therefore an end to a person’s productivity in society. We must treat the subject with sensitivity but not taboo, as our role is to help our patients do the best in life with their own vision – whether that means spectacles, surgery, CCTVs or a referral to the Blind Foundation.” ▀ See p21 for more on low vision and the world of retina. touch of insistence, “when you see the lights.” Anxious to please, I finally spotted one and jabbed the button in triumph. He didn’t cheer, but I thought I detected a bit of relief in his expression. From there we moved into the surgery, which really looked as if it could do the biz: bright lights, lots of neatly laid-out implements that looked essential and expensive, with a patient chair that could have been salvaged from a space shuttle. He did the old shuffle and deal with the test lenses, not quite with the flourish of the optometrist, but more measured, as if he was catering to the high rollers. I eased back in the astronaut chair with all the confidence of someone getting their money’s worth. When the magnifying light elicited another “Hmm” I wondered if it was some sort of diagnostic code for unrecorded ailments. But no! He rolled back his chair and said, “You’ve got RP.” I chewed on this medical morsel for a moment before asking, “Is that good?” He then treated me to a short, honest opinion on the joys of retinitis pigmentosa. Briefly, I could lose my sight or some of it, I could lose all or some of it quickly or slowly and it was inoperable. Not what I wanted to hear. See what I mean about going out and looking for trouble? Somewhat poorer and not exactly buoyed with hope I left, clutching an appointment for the Dunedin Eye Clinic. The clinic was all business, lots of fellow patients dotted around the waiting area, half-hoping and half-dreading the appointment and the result. The staff here are frontline troops, a mix of eager younger types and urbane, battle-worn professionals who’ve seen it all before, and if the line outside is anything to go by, they were going to see a fair bit more of it. Similar tests, same diagnosis, same prognosis, but good, helpful advice on what to expect and how to cope with it. Top marks all round for the public health system. I left quite upbeat and halfconvinced there wasn’t that much wrong with my sight anyway. But on reflection I guess it was more wishful thinking and a natural reluctance to face the reality of life. NZ Optics is pleased to welcome Trevor Plumbly as a new contributor. Trevor will share more about his life on the ‘dark side’ or as a ‘white caner’, as he also likes to be called, in future issues. *Trevor Plumbly is a retired arts and antiques dealer, diagnosed with retinitis pigmentosa 15 years ago. Originally from Tunbridge Wells in England, Plumbly, together with wife Pam, formerly owned Plumbly’s Auction House in Dunedin. In the 1980s, he was one of the antique experts in the popular television programme, Antiques for Love or Money, and became a well-known face in Dunedin as a result. In 2008, when sight loss put a stop to the antiques dealing, Trevor and Pam decided they wanted to be closer to family, so they sold up and relocated to Auckland. This is his first column for NZ Optics. 6 NEW ZEALAND OPTICS April 2018

Greenlane ups low vision services The low vision (LV) clinic at Greenlane Clinical Centre has recently welcomed two new optometrists to its team. Deepa Kumar and Deborah Chan, have joined Sandy Grant, LV clinic coordinator and therapist, to provide a multi-disciplinary low vision service to patients referred by eye health specialists, general practitioners, the Blind Foundation and other ADHB departments. The most common referrals are for patients with macular degeneration (MD) and glaucoma, although the clinic will accept anyone with functional vision issues, said Grant. Patients seen at early stages of MD often identify reading, handwriting and glare issues as their main difficulties, while patients with glaucoma, retinitis pigmentosa, hemianopias or monocular vision may experience mobility and reading issues. Other visual concerns highlighted in the assessment are also addressed through LV strategies such as eccentric viewing, low vision aids, both optical and non-optical (eg. magnifiers, task lamps, signature guides), basic training with aids or sighted-guide, information, peer support or referrals, such as Blind Foundation membership. Early intervention often alleviates many patients and helps the patient develop coping mechanisms, said Grant. The low vision clinic runs Tuesday and Thursday afternoons and on average about four patients per clinic are seen. Wednesday afternoons is a therapist-only clinic, though Grant said she hopes to add another fullservice clinic in the near future. Patients referred to the clinic are interviewed first by Grant and then the optometrist, who refracts the patient and determines magnification requirements. Follow-up appointments are often required, or patients can self-refer back should they feel their vision has deteriorated. Originally from Canada, and trained in rehabilitation teaching, orientation and Greenlane low vision optometrists Sandy Grant and Deepa Kumar mobility, Grant came to New Zealand in 1992 to work for the Blind Foundation. “As the clinic coordinator, I love the interaction with patients and in playing my part on the LV team. “It’s rewarding work, encouraging and demonstrating what is possible to patients through a variety of strategies, low vision aids, appropriate support, referrals to enable the patient to approach their low vision with added confidence, motivation and a boost in self-esteem.” Grant said she’s excited about the recent expansion of the clinic and is looking forward to providing more patients with a range of services to start them on their journey to living successfully with low vision. The LV clinic at Greenlane also recently made a sizeable donation of older model (and never used) magnifiers to volunteer ophthalmic services overseas (VOSO) for their trip to the Pacific Islands in an effort to support LV work on this history-making VOSO trip. We wish Naomi Meltzer and the rest of the VOSO team all the very best for this new chapter in VOSO’s evolution, said Grant. ▀ If you would like to a refer a patient to the low vision service at Greenlane Clinical Centre, referral forms can be found on the Healthpoint website or email sandy@adhb.govt.nz. For questions, call 09 3074949 extn 27641. Calling mentors The School of Optometry and Vision Science (SOVS) at the University of Auckland needs more externship mentors for their final year BOptom students. During their last year of study, each New Zealand BOptom student undertakes a three-week externship in a community-based optometry practice. Through these externships, students gain further experience in the direct examination and management of patients away from the confines of the university clinics, says Dr Geraint Phillips, SOVS senior lecturer and clinic director. “Feedback from the profession shows many optometrist mentors enjoy the exchange of ideas and information with the next generation of optometrists.” The externship period can be broken up so that the student attends more than one practice, for example, when a practice is keen on taking part, but cannot host the student for the full three weeks. Optometrist mentors supervise the student during their externship, which includes being available to check the clinical findings for every patient the student examines. Mentors also complete an evaluation at the end of the student’s externship; a format is provided with pre-set questions. Optometrist mentors are invited to become New vision-tech hub Australian low vision service provider, Vision Australia, has opened a new interactive site so people who are visually-impaired can experience the abundance of new technology available to help them today. Located in Vision Australia’s new Parramatta centre in Western Sydney, the new Vision Store and Tech Hub showcases the latest specialist adaptive technology and how more mainstream devices can be optimised and used to support people who are blind or have low vision. “Whether it’s living independently, being active in their community, finding employment or staying connected with family and friends, technology is often the key to unlocking opportunities for people who are blind or have low vision,” said Ron Hooton, Vision Australia’s CEO. “Individuals have different circumstances and goals and what we have at Parramatta is a location where anybody who is blind or has low vision can come and be exposed to a huge range of technology that can support them Honorary Teaching Fellows with the University of Auckland, a position SOVS: Calling more optometry mentors which offers full access to the extensive resources the Auckland University library offers, including all of its electronic resources (encompassing many excellent journals); use of the title “Honorary Teaching Fellow affiliated with the School of Optometry & Vision Science at the University of Auckland”; preferential and cost-reduced access to continuing professional development events within SOVS; use of the following phrase on practice websites and similar: “Our practice provides teaching services for the University of Auckland’s School of Optometry & Vision Science for their Bachelor of Optometry degree”. The School of Optometry & Vision Science is keen to welcome new and returning mentors for externships in June and July 2018. If you are interested in becoming a new or returning externship mentor, please contact Gini Parslow, practicum placement co-ordinator at v.parslow@auckland.ac.nz or phone 027 406 8543. ▀ and get expert advice about what is likely to best suit their needs.” Technology advice is provided by Vision Australia staff plus representatives from tech organisation partners, including Samsung, Apple and Google, and specialist adaptive technology providers such as IrisVision and OrCam. Other highlights of the new space include demonstration home environments, including an accessible kitchen and cooking aids (both low and high-tech solutions); a living room with TV/voice integration home devices; workplace/home study tools; Google Home to control lighting and provide audio cooking instructions; and other tools such as Samsung’s voice-controlled screen magnification tech. “Accessibility is a key consideration for people who are blind or have low vision and we’ve taken that into account with the design, layout and other features in the space,” Mr Hooton said. ▀ We’re bringing more optometry events and webinars to you MyHealth1st is revolutionising digital customer engagement for independent optometrists. Don’t miss our free events and webinars on how you can join the digital revolution and put your business growth 1st. Sign up now at: myhealth1st.co.nz/optometryevents April 2018 NEW ZEALAND OPTICS 7