The doctors at Edmonds Eye Associates have been leaders in the field of vision rehabilitation for over thirty years. There are two broad areas rehabilitation; The first is for geriatric central vision loss primarily from Age Related Macular Degeneration or other disorders of central vision, such as diabetic retinopathy or optic atrophy. The second area is for other vision problems such as visual field loss, eye movement disorders or perceptional vision problems as seen in stoke, neurologically disorders or acquired brain injury.
For Central Vision Loss:
The Edmonds Rehabilitation System for central vision loss has evolved from the doctor’s personal work in the field of clinical Low Vision at the Wills Eye Hospital and the Lankenau Hospital in Philadelphia, Pennsylvania. These clinical settings have provided a preponderance of geriatric macular degeneration patients referred for low vision service by retina specialists and other tertiary eye care providers. This population often presents without well define goals or specific desired tasks. The medical eye condition is often fresh and may be unstable. They basically want to “see better” or function at a higher level.
The geriatric macular degeneration community has largely been frustrated by the decline in their visual function and by the lack of a positive outlook by their eye care providers. Many have had cataract surgery followed by laser or other treatments yet have not achieved the desired outcome. Others have been seen by traditional low vision clinics and have multiple low vision devises but no real understanding of their vision deficit or a meaningful framework in which to use their menagerie of aids.
Experience has shown that geriatric patients are easily confused by multiple Low Vision Aids and complex management plans. A concise, upbeat, success oriented program of simple eccentric viewing training or vision rehabilitation, rolled out over a 3-6 month course will allow the patient to grasp the nature of their vision problem and let them slowly adjust to their disability. Once adjusted, the patient will be much more willing to consider multiple aids or ancillary services to manage their life.
These tips will be helpful in the management of these patients.
- Always remain upbeat and firmly in control of the exam and management plan.
- More than fifty percent of each office encounter revolves around patient education and counseling education.
- Almost every patient will benefit from a course of vision rehabilitation prior to the final optical management plan.
- Educate and Re-educate on the principle of adjusting the size of the scotoma or “blind spot” with relative distance magnification.
- Always set rehabilitation program above the patient’s threshold to assure the greatest chance of patient compliance.
- The purpose of a monocular microscope is to optically shrink the blind spot by reducing the focus distance rather than to provide magnification. The shorter the focal distance, the smaller the blind spot. Small blind spots allow the brain a chance to adjust to the vision loss and are the key to the rehabilitation process.
- The patient must be educated to use the close working distance as a tool to allow the brain to identify and adjust to the damaged area of the retina or optic nerve pathway. The final optical management plan may or may not include the close focus distance of the monocular microscope.
- Provide positive reinforcement for each accomplished page of distance acuity or line of near text.
For complex loss of visual function from assorted Neurological problems:
The management of patients with eye related Neurological problems for the Doctors at Edmonds Eye Associates has evolved from the care of critically injured in-patients at Magee Rehabilitation Hospital in Philadelphia. Dr. Scott Edmonds has anchored this program and has brought much of the long term rehabilitation to Edmonds Eye Associates. In 2014, Edmonds Eye Associates opened a new rehabilitation suite on the ground floor of the Edmonds building in Drexel Hill. In 2015, these services were added to the Edmonds Eye at Wills Eye Hospital. In the fall of 2016, Edmonds Eye Associates joined with Jefferson Hospital, the Rothman Institute, and Wills Eye at the Jefferson Comprehensive Concussion Center at the Philadelpha Navy Yard. One of the new suite’s key tools the Sanet Vision Integrator.
This unique touch screen based program allows brain injured patients to re-learn to coordinate their visual system with touch and body movements. Daily tasks require fast and accurate eye hand coordination and this tool measures and trains this critical function.
Another new tool in the rehabilitation of brain injury is the NeuroTracker. This therapy program trains and resets the motion cognitive centers in the brain to reorganize vision based motion information.
Other tools to improve eye movements in the areas of teaming and tracking are used by the optometry staff along with our Occupational Therapist and other vision therapists. Some of this training is provided on traditional vision therapy platforms as shown below:
a. Brock’s string
b. Marsden ball
c. Stereo hectograms
Program’s are customized for each patient based on their injury and in coordination with a team of neurologists, physiatrists, physical therapists, occupational therapists and other providers.