Bedside Screening for Vision – Occupational Therapy

Tags

Eye Movements, Eye Disease, Visually Impaired Persons, Vision Disorders, Blindness,  Diplopia, Vision, Binocular Vision, Monocular Visual Acuity, Visual Fields, Low Ocular Motility Disorders, Cortical Hemianopsia, Abducens Nerve Diseases, Abducens Nerve, Oculomotor Nerve, Trochlear Nerve, Visual Perception, Nystagmus, Strabismus, Smooth pursuits, Saccades, Depth perception, Stereopsis, Gaze disorder, internuclear opthalmoplegia, Parinaud’s syndrome, Weber’s syndrome, Skew deviation, Conjugate deviation, Oscillopsia, Visual tracking, Agnosia

Bedside Screening for Vision

  1. Interview: ask the patient if they perceived any changes in vision (baseline vs. new onset)
  2. Assess near and far acuity
  3. Assess the ability to sustain visual attention for 1 minute
  4. Assess smooth pursuits (smooth movements)
  5. Assess saccades (moving between targets)
  6. Assess convergence from the tip of the nose
  7. Assess diplopia
  8. Assess pupil constriction in the presence of light
  9. Assess each eye’s visual fields one at a time
  10. Observe any squinting, changes, gait disturbances, running into objects, poor pathfinding, neglect, inattention

OT Intervention Sequence

New Findings → Collaboration and education with patient and family → Update Plan of Care → Update team → Compensatory vs. Remedial intervention → Document → Reassess → Referral as necessary

Treatments

  • Eye strengthening
  • Eye coordination
  • Visual field awareness
  • Enhancing visual perception in the environment
  • Patching
  • Lens adaptations
  • Improving daily occupational performance
    • Meaningful occupation disrupted by visual deficit
    • Self-care
    • Reading
    • Device use, e.g., smartphone
    • Medication
    • Home management
    • Driving
    • Academics/Vocation

Referrals

  • Ophthalmologist: specializes in diagnoses, management, and surgery; prescribes corrective lenses
  • Neuro-optometrist: evaluates and treats the optic system. Involved in the health of the eye. Prescribes corrective lenses. Collaborates with occupational therapists and vision specialists for vision rehabilitation.
  • Optometrist: examines the eyes for prescribing and dispensing corrective lenses. Screens for certain eye abnormalities.

References

Hanna, K. L., Hepworth, L. R., & Rowe, F. (2016). Screening methods for post-stroke visual impairment: a systematic review. Disability and rehabilitation.

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.