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• 2.10.1 Understand the significance of mental and physical co-morbidity in visual impairment and the benefit of co-management approaches to care
• 4.2.1 Understand the use of eccentric viewing and steady eye strategy in those struggling with the high magnification and restricted field of standard magnifiers and how they can be combined with typoscopic strategy to improve line scanning and pick up
• 6.1.9 Understand the significance of dark adaptation changes and their measurement in the assessment of age related maculopathy
• 7.1.7 Understand the significance of steady eye strategy in those with severe field loss and its use in their adaptation to their new visual environment

Dark Adaptation

Age-related Macular Degeneration is the leading cause of vision loss in the elderly. It affects more than 600,000 people in the UK, with an estimated 1 in every 3 of us over the age of 65 displaying some degree of the disease. As with any degenerative condition, earlier detection helps in the ongoing management of the patient.

Dr Ian Murray, a senior lecturer at the University of Manchester, has conducted extensive research into dark adaptation and retinal changes in early AMD. Dark adaptation has been shown to be selectively impaired in patients with early stage AMD, even in those with normal visual acuity. Dr Murray explores the implications of this research, and whether it will impact our work in primary eye care any time soon.

Depression and Low Vision

Almost two million people in the UK are living with sight loss. Visual impairment is more common in older people, and the effects are often compounded by other age-related health conditions. Sight loss is associated with an increased chance of developing other health issues ranging from broken bones due to falls, to depression caused by feelings of isolation.

In a recent collaboration between the charity Guide Dogs and Cardiff University, Dr Tom Margrain led a study on the prevalence of depression in the visually impaired and what’s being done about it. Gwyneth Morgan, Community Optometrist, Life Fellow and Past President of the College of Optometrists, talks to him about the study, and its implications.

Comorbidities and Low Vision

Depression is a big concern for older visually impaired people and can compromise health and rehabilitation outcomes. Dr Helen Court, optometry tutor at NHS Education Scotland, observed that in many previous studies of visual impairment as a comorbidity, the evidence often relied on anecdote or self-reporting.

Dr Helen Court discusses her cross-sectional analysis of comorbidities associated with visual impairment with Dr Janet Pooley.

Eccentric Viewing

Sight loss has an impact on every aspect of individuals’ lives. Where there is central vision loss from macular damage, techniques have been developed to help patients adapt to using their still healthy peripheral retina. Other techniques, such as steady eye strategy, help patients with field loss that affects normal visual scanning.

Anthony McGrail speaks to Professor Chris Dickinson to find out how useful such visual training can be.

Medicines Use Review

Optometrists need to know about the medications that patients are using. Where there are concerns about their understanding, or perhaps issues of compliance, optometrists often refer patients back to the GP. A Medicines Usage Review is an advanced service, offered by NHS pharmacists, that provides an opportunity for patients to discuss their medicines with a qualified pharmacist.

Bobby Sira, a Consultant Pharmacist with close to 20 years experience in the industry, tells optometrist Philip Morgan about the importance and function of these reviews in clinical practice.

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