1 / 20

Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy

Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy. Kasey Suckow, OD Resident: Ocular Disease / Low Vision Rehab Hines & Jesse Brown VA Chicago AAO Meeting Tampa 2007. Homonymous hemianopia. Common etiologies Stroke (most common 1 ) 8.1% over 65 2

oakley
Télécharger la présentation

Homonymous Hemianopia: Rehabilitation with Scanning and Expansion Prism Therapy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Homonymous Hemianopia:Rehabilitation with Scanning and Expansion Prism Therapy Kasey Suckow, OD Resident: Ocular Disease / Low Vision Rehab Hines & Jesse Brown VA ChicagoAAO Meeting Tampa 2007

  2. Homonymous hemianopia Common etiologies • Stroke (most common1) • 8.1% over 652 • 20-30% with VF defects3 • Traumatic Brain Injury • Signature injury • Lesions along visual pathway 1. Zhang, Xiaojun MD, et al. J Neuro-Ophtho September 2006: 180-183. 2. Neyer, et al. Prevalence of Stroke 2005. JAMA. July 2007: 279–281. 3. Rossi PW, et al Neurology 1990;40:1597-9

  3. Therapy • Therapy goals: • Increased Awareness • Increased Visual Field • Therapy Options • Scanning Therapy • Prism Therapy • Yoked prism • Expansion prism

  4. Scanning Therapy • Never go where your eyes have not gone • Critical for orientation and mobility • Pt safety

  5. Basic Movements • Head Posture • Turn towards side of defect • Field shift • Eye movements • Constant scanning • Systematic movements • Walking

  6. Scanning and Turns • Turning into defect • Stopping in place • 90 degree turn • Scan into defect • Looking up and down

  7. Complex environments • Combining all individual skills. • Coordinated, intentional movements • Encourage pt to take their time

  8. Expansion Prism Therapy4. Peli, Eli MSc, OD, FAAO. Optometry and Vision Science. Sept 2000 453-464. • Increased field of view • Peripheral prism • 8 x 22mm segments • 40 Diopter fresnel • Monocular fit • Superior and inferior • Peripheral diplopia • Clear single central vision

  9. Field Expansion4. Peli, Eli MSc, OD, FAAO. Optometry and Vision Science. Sept 2000 453-464.

  10. Expansion Prism Therapy4. Peli, Eli MSc, OD, FAAO. Optometry and Vision Science. Sept 2000 453-464. • Monocular fit (on side of VF defect) • Upper segment first • Demonstrate increased field • Training • Cleaning and care • 2 wk adjustment • Lower segment • 2 wk adjustment • Prism ground into lens

  11. Pt EducationA.R. Bowers, et al. IVOS September 2006;47: E-Abstract 3489 • Viewing through carrier lens • Increasing peripheral awareness

  12. Increased awareness

  13. Prism AdaptationA.R. Bowers, et al. IVOS September 2006;47: E-Abstract 3489 • Image jump • ~10-15 degrees • Adaptation • 75% acceptance rate

  14. Case #1 • 67 WM with hx of recent stroke • HH confirmed with HVF • VA: 20/25 OD, 20/20 OS • No head turn/abnormal posture • Functional complaints: • Bumping into people/objects on his left • Difficulty avoiding objects on left • Problems shaving left side of face • With actual act of shaving • Difficulty cooking

  15. Therapy and Response • Scanning therapy following previously listed steps shows increased performance and subjective improvement. • Expansion Prism Therapy also has positive subjective results with both upper and lower prism. • Pt notes increased awareness and avoidance of objects on left side.

  16. Case #2 • 74 WM with history of head trauma (gunshot wound 50 yrs prior) • HH confirmed with HVF • VA: 20/40 OD, 20/32 OS • Left head turn • Significant fall history • Functional complaints • Pt did not have any complaints, but interested in prism therapy for increased left awareness.

  17. Therapy and Response • Scanning therapy shows pt is proficient and has developed good compensating skills. • Pt notes improved awareness of field, but not enough improvement to warrant permanent lenses, and preferred habitual Rx alone.

  18. Case #1 Relatively recent loss No head turn Poor scanning strategies Several Functional complaints Case #2 Long term loss Left head turn Good scanning strategies Few functional complaints Differences between Pts

  19. Conclusions • Benefits of Scanning and Prism Therapy • Safety • Street crossing • Fall prevention • Orientation and Mobility • Increased Confidence • Each pt unique • Consider patient goals and motivation • Successful rehabilitation involves therapy with or without prism.

  20. Acknowledgements • Steve Rinne, MA Low vision research therapist • Amy Wurf, MA Low vision therapist • Joan Stelmack, OD MPH

More Related