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Role of Low Vision Specialist for Students with VI

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Presented by Dr. Joshua Robinson (Vanderbilt University Medical Center & Vanderbilt Eye Institute) on 9/21/2022 TN VIVA 2022-2023 Session Description: Dr. Robinson is an assistant professor in the Department of Ophthalmology and Visual Sciences at the Vanderbilt University School of Medicine and serves as Director of Low Vision Rehabilitation at the Vanderbilt Eye Institute. He will give an overview of the role of a low vision specialist as a member of an interdisciplinary team supporting students and young adults with impaired vision. Topics will include the differences between an optometrist, ophthalmologist, and low vision specialist as medical professionals supporting students with visual impairments, as well as opportunities for collaboration between teachers of students with visual impairments (TVIs) and Orientation and Mobility (O&M) Specialists, among others.

Show Transcript

okay so thank you all for attending today's session of our Tennessee Viva series and we're very excited to have to have dr. Josh Robinson here from vumc it low vision specialist you're so I'm going to let him introduce himself but just know all of you have it in just a minute I'll put in the chat the link to the post-event survey if you need a certificate or a c b r a p credit and the opening code if you need a CDL AP credit is going to be low vision I would pass it over to you be here like she said Josh Robinson I'm an optometrist and faculty member here in the department of Ophthalmology at the UFC I direct the low vision rehabilitation service you're at Vanderbilt Eye Institute on Medical Campus and we'll talk more about what that means thanks everyone for being here I'm happy to field questions kind of in the midst of my slides are at the end whatever whatever works as can be pretty casual I don't think that I'll have an overabundance of material to present to your group so feel free to chime in or a dollar raise your hand or whatever function you when I use to ask questions if they come up basically today I'd like to work through some slides disgusting what I do and how it relates to what you all do or will do in some capacity of like to answer these questions regarding the roles of different Eye Care Professionals is kind of clarifying delineate between those titles talk about what we mean when we reference low vision in and low vision Rehabilitation a type of clinical work that I do discuss where my work Falls kind of in the Eye Care Continuum or in the landscape of Eyecare regarding those Medical in I care and then discuss the ways in which I collaborate with other individuals in the vision impairment and vision Rehabilitation Realms to put together a comprehensive plan for the patients received and individuals who are caring for so hopefully be able to clarify these four questions amongst others over the course of the next like I mentioned I'd like to Heart by Glee what Mikey is simple review for for most of you delineating between one of the two primary sources of eye care in the US. Them ologist in the optometrist I passed out from this tear just kind of indicating the sort of backgrounds that both of these individuals half again I'm an optometrist on a doctor of Optometry meeting I've changed undergraduate degree in my case in Biochemistry completed four years of optometry school my doctor about Thomas G degree which is four years of intensive work primarily in the area almost exclusively in the area of Eyecare Anatomy physiology disease and treatment but also optic and light and lenses and lending it all basically altogether lending itself to coming out of school and being able to if desired go straight into Primary Care Optometry practice other than optional residency that is typically one year after optometry school in my case I completed residency back in Chicago in low vision Rehabilitation and ocular disease and probably probably 10 to 15 per cent of grass waiting Doctors of Optometry complete a residency there's some parallel on the left side of the screen with ophthalmologist except for those individuals MD's or in some cases are our medical doctors who have attained four-year undergraduate degree typically and then had four years of medical school where they got a broader exposure to all human anatomy physiology and disease system and then decided to pursue a four-year off the call G residency on top of that and then have an optional Fellowship in subspecialty Ophthalmology areas like this real retinal disease corneal disease in our case we have all of them. call Ma ocular oncology Pediatrics in your business and so there's some parallel between these two Les ultimate ultimately ophthalmologist come out of their Ophthalmology residency and can go into private opthamology or academic Ophthalmology or can pursue an optional Fellowship so they're four years of Ophthalmology residency is somewhat akin to my 4 years of optometry school accept the results as they have the background of medical school and can can practice invasive surgery once they're all through that so hopefully this is helpful all your s*** to delineate between these two ophthalmologist in the model that will discuss in a bit are typically the ones and co-managing location cases with so most all of my patients have most often an ophthalmologist medically following and managing their eye disease or their neurologic disease that's caused their Vision in Garnett square is I'm on the other side of the fence and the functional ramifications of of their condition and trying to provide rehabilitative intervention and devices and training to help people overcome the the reality of their vision loss so I deleted a couple times too low vision just to provide a a definition I used to sort of has a loose working definition this is from Nei and I'll just read it word for word the national Eye Institute to find location as quotation impairment which is not correct do medical intervention or traditional ophthalmic lenses and which interferes with one's ability to perform activities typical of their daily life so that's a pretty loose definition that doesn't have the specificity of a legal blindness as the federal government with Define legal blindness sort of title it is more open to the case and the individual and basically this is my soda my criteria when people ask who can beer Vision Clinic at Vanderbilt I asked do they have vision loss that medicine can't fix and that typical glasses and contact lenses can't correct and it's getting in the way of them living their life or doing whatever is send text to their Identity or their ability to maintain quality of life and so this applies to five-year-olds and it applies to 95 Peralta they may have very different needs but I see all of that and we'll talk a little bit more about the specifics what's caused some of this vision loss in the ways in which we intervene and collaborate try to help individuals with permanent vision loss some of the more common causes a list on this slide obviously this is not exhaustive the top three are really the The Big Three I would say and related macular degeneration statistically is probably the most common condition that I see it in my clinic and to an extent these top three are all age-related diabetic retinopathy while while. these can occur in younger individuals to pick least the duration of diabetes diagnosis that predicts severity of retinopathy and so in this group that's your with us today probably not as much it's on those top three even though they're specifically the most common causes that I'm seeing in my clinic you're probably more exposed to early-onset I disease inherited retinal diseases that may come on in adolescence or other congenital optic nerve or other eye movements or pigmentation disorders that reduce visual Acuity and would affect a kid trying to get through 2nd or 3rd grade or a teen trying to have a driver's license or a young adult something to do move away from home and live independently and seek employment and and in general be independent and so in general these are some of the more common diagnosis that cause vision loss in the case that I'm seeing try to focus in a little bit more on on The Chew that maybe you're more pertinent to this group do you know what location is now I've mentioned again low vision Rehabilitation which is the name of the service that I provide you exclusively here at Pei seeing any comprehensive routine cases everyone I see is has met those criteria they have Vision lost that medicine and glasses and contacts can't fix and it's interfering with their ability to do something that they would like to be able to do better I am so when I'm putting together these individualize plans it's important to note will elaborate a little bit more on this later that it's a multidisciplinary effort it's not a one-stop-shop where I see a patient for 60 minutes and then I I'm out the door and say good luck it's very rare that I'm not involved in some sort of interaction with some of the other professionals with whom I worked to help train patients either on the doctor's tools that I'm providing and prescribing or bility skills are on daily living skills but in general and putting together an individualized plan that combines tangible tools and Rehab training to help someone maintain their quality of life to remain independent to reach whatever their goal with weather at currently in their life and ultimately trying to allow people who boss station or who don't have 46 vision and have never known perfect vision make sure those people don't have to focus on and be Define I was lost and what they don't have but allowing them to realize and use what they do have is fully as possible add a low vision specialist you know and in my case in Optometrist and in most cases optometrist are very few MGS in this country who are practicing primarily low vision although there are a couple the vast majority of us are residency training to get in this subspecialty field there's an fortunately not nearly enough of us and not early enough Optometry students are graduating and going into low vision residency programs to care for the dramatically increasing numbers of individuals who are impacted specifically with age-related eye diseases as the when is the demographics sort of shift toward older and older ranges in this country thanks to sort of the baby boomer generation and those there after age related macular degeneration glaucoma are not going anywhere if anything they're going to increase in frequency and prevalence until they can solve medically and reverse those conditions is going to be more and more need for people like me and there's effort being made in the colleges. common tree in it and in other rounds to try to make sure that there's an awareness of that sort of a shortage of of individuals providing the sort of work that's a weed in my case I exclusively search for people who have permanent Vision impairment we're working to develop those individualize plans that I mentioned on a previous slides and again collaborating with other professionals like yourselves try to best meet a patient's needs whether they're an adult or a child or teenager you know any other label you want to put on someone doesn't matter that's the effort that I'm providing every day in the clinic you're probably familiar to an extent with some of the complaints are the challenges that are free Vision impairment there's an image here on the right which was meant to be a simulation of age-related macular degeneration this could have 50 to any number of other sort of central vision deficits sometimes diabetic eye disease where is condition like a stargardt or a cone dystrophy that impacts primarily to center of division and makes or a blind spot or haziness or Distortion that standard contacts and glasses can't fix you can imagine with this type of vision I just pulled it maybe to read printed materials like books and mail and bills labels at the store price tags expiration dates a lot of the screens that we looked at in a row without a knowledge of an access to enlargement software or accessibility features looking at once phone or their computer when the middle portion of your vision apps that can be really challenging and of course this pertains to school work which is probably some combination of digital and print it on paper in both regards to work can be made more difficult by central vision loss as Ken seeing the board and what's being written or presented or projected in a classroom setting or identify faces of someone who comes in the room or being able to pick out a face in a crowd or or make eye contact with presenter in a meeting or in a school setting all of these things can be impacted by central vision lost it in a way that we're trying to account for an address in the plants that we're developing there's also a lot of impact on activities of daily living an individual perhaps who lives alone or doesn't have a lot of support at home should be able to do some of these things for themselves there's a different simulation on the right here which is more 8 retrovision lost this would make something like a moderate to severe case of glaucoma or retinitis Pigmentosa or some other inherited or acquired retinal or ocular nerve conditions that cause cancer and can make it difficult to be aware one surroundings to get around safely could use some of these things that are listed on the slide like preparing and consuming meals taking care of oneself grooming cleaning or taking care of the home getting around safely on foot or behind the wheel if that's the case and being able to manage one's finances these this list in the one on the previous slide again or not non-exhaustive there is any number of other daily living activities and independent videos of daily living that are impacted by vision loss or trying to understand and educate patients on why they see the way that they see but also how we can help to work around and address and account for those differ what is in allowing them to maximize the vision that they do have and use it to their best ability Dimension that the plans that I'm developing do often include tangible tool so beyond glasses and contacts this is where we really get into some of the low vision Rehabilitation I suspect that some or all of these may be familiar and we'll just blow through a few slides just touching on on each of these and all the way into work that we're doing before we get into some of the collaboration and some of the some of the other types of professionals who were utilizing at least plan to Optical magnifier is our long-standing kind of stay in the realm of vision rehab you may have seen or worked with children who use a dome or handheld AR magnifier like these that are meant to provide angular magnification to make printed material typically look larger overcome something like a blind spot in the middle of the vision or generalized blurriness efficiently serve when when people hear magnifying glass or magnifying lens specifically where the mines goes they come in different sizes shapes strengths forms that allow for one to use them in different ways or allow them to be more or less portable some have light built into them which is often very helpful to bring out contrast but in general these are pretty well understood optical devices that were typically often prescribing especially for some of the kids who we see based on their level of vision and what their target reading material is like similarly will use Optical magnification at a distance in the form of either a handheld binoculars stove on the left which is focusable and allows for distance spotting or sometimes a hands-free spectacle out of telescope like his picture on the right here this one specifically in vioptix format meaning the scope is mounted up above the line site something like this can be used in Mobility you could walk around with this on because the patient in Siri has enough field of view beneath the telescope to still spot their steps and make sure they're not going to run into something this is the type of tool that is most often used in classroom no high school or college settings and is the only type of telescope in bioptic format is what I'm saying that allows for drivers in some cases to maintain insurance agent meet State criteria for standard license has some States including Tennessee allow for bioptic licensure in which a patient obtains a device like this and gets an extensive amount of training with it and ultimately has has a restriction on their driver's license stating that their bioptic telescopic driver and that they must use this device when behind the wheel digital magnification remains a big part of what we're doing in my cell and some of the technology vendors between my work use devices like these the one on the left a desktop unit large-screen topaz I think this might get 24in this is just an example video magnification or CCTV closed circuit television or reading machine as some people would say that allows for adjustable levels of magnification and contrast brightness of printed material that's placed the nice on that egg white ray again you probably been in Costa d'Este and similar tools potentially something like the Ruby XL on the right which is at 5 in portable device that functions much the same way that that a desktop device would except for its portable and it's smaller obviously less screen size Adventures by allows sometimes for students or adults to put it in a backpack or a bag and take it from class to class to take it from meeting to meeting again it's meant to be sat on top of printed material to allow for enlargement easier reading app. essentially an under-appreciated aspect of what myself and sometimes occupational therapist and working with our are implementing for patience is Task Lighting in understanding the importance of Direct close doximity task lighting with an appreciation for the angle of the light and making sure the inducement of glare is not an issue thrown a few images of some of the more commonly used pass lights that were using a v e i on the disc Slide the art light which is foldable in portable the Larry light switch incredibly portable and magnetic clip-on bright LED lights that can fit in the pocket or on a tool belt or in a backpack or something larger that stands a spike on the right if someone needs to be completely hands-free and have the ability to use a gooseneck lamp that they can pull down close to their reading and writing material good direct task lighting to bring out contrast to avoid glare and to help someone read printed materials more easily a much bigger Factor than a lot of people realize and some of the other kind of low-tech adaptive AIDS at myself in the OTS and probably some TV eyes and vision rehab Specialists are you sing include some of the stuff on this page again there's many more than this but consideration again for filters and how they interact with lights writing guys like to check writing guide on the top right image tactile and high contrast bumper stickers can be helpful things large prints in general paper books cards music on talking devices like watches and clocks anything else that can help bring out contrast help to illuminate can be implemented in different ways for both classroom and home used to help counteract the effects of vision impairment and yet there's mentioning more and more just like in in kind of our daily personal lives knowledge is becoming a bigger part of what we're doing it's becoming a bigger part of what's being done in the classroom the smart devices a few of them pictured here are are everywhere we probably all have at least one they contain Dalton accessibility capabilities that allow for digital text size enhancement brightness and contrast alteration sometimes optical character recognition so the ability to have something that's on the screen read aloud so that vision is not even involved processed or the ability to use the devices camera if it has one to take an image of Prince outside the device in the real world and have that read aloud is really numerous capabilities and I've listed some of them on the coming slides. just just to kind of gloss over to be aware of the fact that IOS operating system on your Apple devices or the Android operating system on Android devices have built-in features that really incredible accessibility of the content that's on the device and sometimes content outside the device and so your first and foremost Siri a lot of people don't right off hand maybe think of Siri as an accessibility feature but I mean a lot of patients who don't really realize the power of what they're carrying around in their pocket or in their purse because of the capabilities that something like Siri or Cortana has to be able to speak your device and prompt it to do 6 or how things read aloud or have found a Siri look up information there's just there's a lot of functionality and Siri that some people are taking advantage of and don't even know or realize just how powerful it is or may be there taking advantage of it and need a little boost from myself and the others I'm working with to help them understand you know the capabilities of their device so there's numerous other built-in accessibility features on iOS there are parallels an Android accessibility Suites allowing again for size enhancement contrast alteration or enhancement text to speech capabilities just in general really really flexible accessibility compared with Prince on paper digital technology will continue to become more accessible and be more and more part of what we're doing in low vision Rehabilitation and in the classroom in general and for the adults it's worth mentioning also we're not going to go through all of these that you're some of the more commonly used visually accessible applications for both IOS and Android some are available in both summer available on only one most of these are totally free and I think a slide like this is worth maybe going back through if you're not familiar with all these and checking some of them out I'll be happy to share the slides with Rachel as if someone is here today wants to revisit these but there's some really nice ways to use a mobile device that someone may already possess and acquire a free application that you can download that device to allow for better day today Independence accessibility and these are just a few of the many many apps that are out there continue to be developed at a rate that is hard to keep up with thankfully for individuals to cific Lee with vision loss so we know what low vision is we know kind of where it fits in the in the framework of eye care in general and what low vision Rehabilitation is I've mentioned low Tech schools high text rule some of the tangible things that were implementing a plan this is synopsis of of the team you know what the top that low vision specialist that would be the clinician like myself who sort of meeting with patients face-to-face and trying to figure out who they are or what their needs are what their goals are and putting together a play I'm kind of drawing a road map to how we're trying to help that person reach those goals and so it involves those tangible tools but it also in most cases involved at least one or multiple of these other individuals with whom are collaborating so I can National therapy I'm using very heavily both in office here at the ER but also in a home health setting for individuals who are considered Homebound and who would benefit from having OT work done in the home we're working with counseling and social work on an as-needed basis to try to get people the psychological support that they may need to work through their grieving process of vision loss if there's someone who had vision and has now lost Vision that process can be very difficult trying to provide support through that process or realize what other resources kind of in the healthcare realm could be needed in that case comes down to involving counseling and Social Work we've taken it upon ourselves to run a month support group meetings that we have over soon we're a bunch of my patients from all walks of life get together and chat and hear from guest presenters in the areas of being accessibility and services individuals with vision loss or just just listen to guest speakers who have a particular story that they want to share about their own Journey with vision loss or or what they've been able to accomplish that's been a really successful Forum in which someone patients get to hear from other people who are dealing with things similar to what they're dealing with because vision loss can be so isolating socially and a lot of people understandably don't feel that their family and their loved ones in the co-work really get it because I'm not walking in their shoes providing that sort of community and a place for people to ask their questions and feel like they're not the only one to be really valuable and certified rehab Specialists on campus at Bill Wilkerson Center and they run driving rehab program not just for impaired individuals but for other neuro cases or joint Replacements, send them a fair number of patients whether they're going to be bioptic drivers are not to try to assess functionally driving ability behind the wheel maybe it's someone who meets legal criteria to maintain a license but for whom there are concerns relative to their vision loss or other concern that may render them an unsafe driver that's a really valuable program and I'm off and collaborating with also off and communicating with vocational rehab through the state of Tennessee vocational rehabilitation or Voc Rehab has both vocational programs and also Independent Living programs for for Tennessee into don't have a vocational goal made either the retired or considered a homemaker but they're still having difficulty remaining independent at home what did I live with someone or not and utilizing no Services can I can pull in trainers and counselors to help Implement some of the strategies that were starting to develop in the clinic but Implement them in call Setting or in the workplace setting so that a patient can best use their tools and their skills to accomplish their goals despite their vision loss and then probably the two maybe most important Focus for this specific audience certified orientation and Mobility specialist and teachers of students with visual impairments and we'll go into a little bit more deaths on both of those in the next two sides I got this information require probably Unix status may be totally review but I think it's important to review these sorts of things and understand how someone in my role is interacting with with these individuals so a certified orientation and Mobility specialist rcom asked is one who trains page he just I'm safe and independent travel skills the orientation part of their title referring to the question where am I in space what's around me and where do I want to be where do I want to go so how do how do I appreciate and understand what sort of obstacles are around me what sort of moving pieces or people may be around me and what's my target and then the mobility half of that title refers to the process of moving safely from where I'm at to where want to go so how does that occur in a safe efficient and effective manner so he's coms individuals are training sometimes sighted guide techniques where someone with vision impairment is travelling or traveling with someone with Vision impairment or they're teaching independent Mobility skills without a side of guide like trailing along the wall or railing how to navigate up and down stairs safely and at some point in a lot of these cases they're introducing white-cain skills so the long white games that are typically collapsible that individuals use for awareness of their surroundings as they're approaching a threshold or just traveling independently in a busy or unfamiliar environment utilizing a white cane in some cases not only as a as a Mobility sort of tactile feedback device but as a social indicator to people around them giving giving sort of justification reason why someone might need to give that individual a little extra space to move through a doorway or threshold this is not always someone who who's training evolved to the point of providing a guide dog often times that ends at white teen skills but certainly the coms or myself after someone has demonstrated good safe independent can travel skills May connect an individual with a with a guide dog school to better whether that's the stuff that would be useful their independence and the certified Onan specialist will often travel and they'll do training in a patient's familiar environment with Community or in their home or outside their home on there property in a school setting in a work environment whatever is true and real to that patients daily experience is typically where they're providing or at least initiating the service and then sort of graduating and moving on to less familiar areas to really put skills to work the other of those final two specialist the TV I think it's probably that probably covers most of you so I don't have to tell you what what TV is due but I'm working with some Austin in providing clinical justification and input into education plans that's going to be implemented in the classroom and so TV I stand working with visually impaired students I'm off and collaborating with them to provide feedback and information regarding a patient's diagnosis Vision prognosis and some of the things we loose considerations that I'm mentioning that are worth kind of implementing or at least digging Prince you in a formal sort of educational setting to develop what needs to be in an IAT or a 504 plan and to promote allowing us to unit to be able to keep up with stand and you stay on level with their peers despite their vision loss I think in general at ages from birth 21 years is sort of the range in which TV eyes are working with students or patience is this sometimes these aren't even students there's some young adults to sort of graduated high school and moving on potentially eventually to to a vocational rehab or some other program to to seek better Independence and employment but in that 18221 range I know that some pdi's continue to work with their students for their patience get to bridge that Gap in and make sure that the things that have been implemented in the classroom and transition nicely to whatever the next step is whether it's higher education or just general Independent Living skills or location of fursuits and so I'm putting together plans with a lot of different moving pieces and trying to figure out what tangible and intangible tools and resources are best going to serve an individual with vision loss this is little bit looping back to the very beginning of this process but at some point someone has referred all of my patients to me and in the vast majority of cases it's an eye care provider a medical doctor or doctor of Optometry who is following in Monett a patient's medical eye condition and that condition has gotten to the point where they can't know fortunately can't help them functionally any further with their annual updated eyeglass or contact lens prescription and so they're referring to someone like me to put you these plans to help these individuals in a really look their best life in some instances there's other modes medical professionals who are referring patients most commonly neurology but sometimes primary care physician spending on the diagnosis some of my pay Salford and they call in because because unfortunately they've been told by their doctor no quote there's nothing more I could do for you which medically may be accurate but shouldn't be the end of that discussion and it's an ongoing process try to educate providers in the community and Nationwide of the importance of low vision Rehabilitation and a timely referral to some patients get fed up with hearing that there's nothing more that can be done and they go online and they find name or someone in my capacity and self-refer that's fine and we're typically following up with that patient's primary eye care provider to make sure we've got notes and some background on them before they come in sometimes I'm getting referrals or request for clinical evaluation screw School District are from a tvi and in those cases weird than seeking all the pertinent information to get a patient or a student in to be seen and then providing as much detail as we can in a letter back they're requesting individual or District regarding diagnosis prognosis Vision currently and also some recommendations to be considered in development of those educational plan for the classroom which is sort of a unique set up here at the eye is worth mentioning Dave is an acronym standing for providing access to the visual environment and this is a state Grant funded program that's been around for almost 25 years continuously funded every year until last school year where there was sort of a gap and it was dropped by one department at the state thankfully this school year that's just begun a different department at the state and picked it up and threw this project were able to see Statewide I think up to 120 students who meet a certain threshold of vision impairment and provide support to the student family and hopefully they're TV I if they have one who's working directly with them in the form of an evaluation some low-tech optical devices and trying to bridge the gap between getting those devices from the clinic into the hands of the TV or whoever's going to after them any educational setting and so projects paved is back up and running with thrilled we've got one soon-to-be 3TV eyes on the staff who cover sort of Middle East and West Tennessee and if there's ever a case that any of you have seen and there's a desire to get them in to be seen either in just our standard clinic or to see if project baseball station maybe you should be aware of those as options and you can make a referral through the eye through the main number or I got my contact information on the final side of this presentation is if anyone needs to get in touch and then finally I'm in a similar capacity but for my non adolescent patient sometimes a Voc Rehab counselor is referring for again functional Vision evaluation and prognosis and also loose recommendations about the types of tools training devices that could be implemented in their Voc Rehab case to help them either obtain or maintain employment or if it's through the independent living arm of voc rehab tools and skills for Independence at home it's so that counselor is done hopefully you helping to implement the clinical plans that I'm drawing up and there's a dialogue that goes back and forth to try to make sure that there are realistic steps involved in that those steps are ultimately allowing the patient to reach the goal. That has been set forth a lot of information probably a lot of review I guess hopefully I think it's important in summary these are sort of the take-home points that I think are important to realize through my role is as a low vision rehab specialist people strictly with permanent vision loss that medicine and standard lenses can't simply fix the nature of the comprehensive plans we're developing involves both tangible tools and training but more so I think why is on collaboration in being able to communicate with and involve Professionals in other aspects of the rehabilitative plan to help equip patients to do their absolute best meet their goals be successful and again not be Define by or not have to fixate on what Vision they don't have but to help some help Empower them to use what they do have is fully as possible I'd be happy to take any questions or have a discussion if there's anything that would be desirable to review I'm happy to open it up to anyone at this point thank you very much. Just anyone any questions I'm one of the imini Covington. we see is that parents will come in with a report from you guys and they will be very specific and asking for what you list do you think it's really hard being a high school kid with use or is that enough environment and I guess I'm wondering is do you think there's a way that we can collaborate with what you're recommending and what the school districts are currently using so that maybe we could send you guys kind of a here's what we've got an that might help guide at more so the parents aren't so angry with us I don't know how do I know you do question for Amy so we're all on the same page when you say stuff is recommended through the clinic that the school doesn't provide do you mean like brand name items or types of General accommodations maybe the combination of the two oh you're fine I'm out of them so sometimes it'll be specific sometimes it'll be simple or simple as telescopes that that you know you might suggest and then the parents want to know why I do that kind of a Whataburger using now all of as you pointed out in your presentation or things were using I do have kid to driving with bayoptiks that's amazing we also love different devices I don't know Alan I mean you have almost a list of everything that were all kind of using days Clover book The rubies I can't think of a lot of runs cool. They're just from one one one kind of 11 way I'm I'm sort of connecting to this is what what I've definitely recommended over the years is when we write recommendations tities is to use device categories when we describe a recommendations in the eye peas and I'll even say you know so so save for a long time we had. Vizio book and now there's a very similar device called the the Jupiter I would refer to those in an IP as a portable video magnifier and then it you can also say like the Jupiter from 8th and that. Kind of lame describe the category of what you know we have in mind but then gives an example to really pinpoint exactly an example but it doesn't doesn't tie you then she's saying it's got to be there because then that's kind of what we do to and it doesn't appear sometimes think that they have to provide it always I mean some things are easy right if you suggest I need a dome maybe the other one thing is always tricky and schools and thank Alan is available I asked him for a lot of things I don't know I just wanted to think about it there's a way that we could do the things you tend to recommend what what things do we already have Alvin School District several commonly used it was just a thought specific as I can with those sorts of devices like technology it's easier to be pretty Broad when it comes to like the strength of a monocular telescope I mean. That recommendation you made on the basis of vision and Target vision in a way that you know I get that consider access to like a 3 x 20 monocular telescope or similar like I try to be verbally as non-specific as I can and I know that it's very different if I'm communicating with you versus someone like you know Anna County that's further out maybe has less resources or a district that just has never dealt with a kid with vision loss and so I tried it I try to be as fast as I can without paying the school into a corner and end in a situation where a parent is really angry it would be helpful I wouldn't hurt for me to know like what you specifically have access to and if I kept list I mean I don't know if that's too much of an undertaking but I for all kind of using the same thing as right now especially as technology has changed in just the past few years we've all kind of gone to this certain will let me know that they wanted sturdy and they can't break them and they are extremely functional I have multi purpose I think that's what we're really looking for for the schools in Alan's got great list what I mean I don't know how long I'm not telling you to do anything at the resource center technology-wise just have it in a frame of reference yeah and I also that would be helpful if anyone is willing to share that kind of information I try to write those letters again so that the verbage is is clinically student may benefit from access to this you know all of these points should be formally consider you no I'm not I'm not stating it as like a you must do this but as a based on the clinical picture please consider whether these may have a place plant like and maybe the answer is no for whatever reason or there's technology that takes its place and it's not really a necessity and you know I don't always see like the results of those and maybe you know I send a letter I'm hopeful that it gets at least evaluated and that the kids getting what they need and we appreciate the letters keep the letters coming by a temp to be even less specific yeah I mean I think categorizing it like Alan suggested is a great you know that you can even use the word portable sometimes if you say desktop magnifier and parents are like stop magnifier and I say but this is a fire they can take it from class to class it's to me and it's it feels really simple but when you're a parent is grieving the loss of your child's Vision that they come out of from a very different place understand yeah I will all Temps to do that I mean we can continue to like discuss two back from you and you said is better like this is great work please try to make it as effective as simple as I can make it work Jennifer Johnson has her hand up very specific question if nobody else has any more that would like benefit the whole group I'm sure your question will benefit all of us to go for it to AJ okay well I just talked to me about this yesterday and I'm about to see the student in like so I thought this is perfect he really wants to do basketball but he has high myopia and band Cara Cara that yeah yeah and is it's a - 14.75 + - 16.25 do you think injury resistant goggles that would keep him safe and he could do basketball or do you think that's too risky hold is he 11th grade Sol 17 in general there's a pretty high risk with someone with that much myopia of a retinal detachment with any kind of knocks to the head injury resistant goggles wouldn't hurt I mean they would prevent maybe a direct blow to the eye but in general or quick you know Whiplash and I'm getting knocked down even if even if there's no physical Force to the head you know if he stood in and took a charge like as a Defender and got run over yet that means anything to you know just say that just a process like the Whiplash process send potentially cause a retinal detachment ending most I care providers would agree that that's a that's a high-risk Sport and as much as that's really difficult to say no to a I would be really really hesitant to recommend that he would be able to stay, splotchy crime scene and a floater you know like a sign of some level of vision impairment obviously you know you're working with him and I don't know the big pic they're like specifics of what his vision is like and whether he would be inherently at higher risk of an injury because of that 2028 is the last I know it's real you can see well enough to play certainly but I feel better telling them your opinion because I didn't want to be like sure yet so we'll just get on the goggles and then watch out I don't know I don't know him do I maybe he get what where did you say your clinic is or which like the main campus line. listen to Hendersonville pretty sure any of my colleagues who have seen him or anyone in my field would would agree with that or not play but there's definitely some inherent risk in that I'll let them know maybe you can just play like a nice little pickup game at the park or something I don't know okay okay I'm just going to pass along that information to the my dad helps me out a lot. Is there like a is it the the oh my goodness my words like that scription for the glasses is that the best thing to look at or like what's the best indicator of like likes you can really need to be careful in gym class or in your daily activities for like a retinal detachment for the details that you're seeing it would be the glasses prescription I mean the vision tells you nothing really got a lot of minus in that prescription was very nearsighted likely has an eyeball that is physically longer just physiologically and has a retina that stretched pretty thin resulting potentially in his vision loss or their vision loss but also resulting in increased tendency for a break or a tear attachment if you had to pick a number what number would you pick it all depends on the length of the eye which is a gifted by myopia double digits is like just off the top of my head that's not a hard-and-fast rule and there are there are exceptions to that but I was concerned starting at -10 and either I that's good to know thank you if I can just throw out there to to your question Jade a I wonder if they're there doctor should be part of the conversation to so that they're the ones between conversate one bike for me hearing that student I my questions like what was he being seen by a retinal specialist to monitor like does your have retinal tears as he have I don't even care about is a cutie but I want to know that they already have a visual field lot going on and just that way we're one of the team members having that conversation about how high of a risky is for a further Detachment for sure I just got a comedian and so they want me to updated by tomorrow so I had a phone call with mom last night and she was like you think you could write in those goggles and his accommodations so we can play basketball and I was like I mean I want to say yes but then I was like online forums and get a hold of his doctor but obviously I wasn't able to do that in one day and so then I saw that this session was coming up and I'm like great information and also great opportunity to ask a question before I have to go home and finalize this i t you know 48 Hours of finding out about it or like the meeting which they held two and a half months early but anyway so it seems to involve the opinion of someone who's actually evaluated the patient for sure but that is good for me to like I don't know just be able to tell him I'm like hey I'm right now not going to write this thing because here's what the deal is and it's whiskey and we can have a further conversation about this and blah blah blah but I don't feel comfortable so yeah go ahead after hearing all this so that's mainly what I wanted to get an ID like yeah is that permissible or is it really risky if it's very risky yeah so thank you we're just about almost out of time does anyone have any other questions that's why we're here I was a little curious Josh to get a quick check if you can touch on the roll or the intersection that you cots play with the work that you guys because I think at least for me personally I'm not intimately familiar with the role of the oven OT and I know it's very differently and educational setting versus a more clinical Medical Center in ER like we trust what we know and we know we know and maybe somewhat distrustful of folks doing what we proceed as efficient related tasks can you just got to speak to that what I would say front that OT involvement in my patient base is most often isolated to adult cases like that there's not a lot of cases that I can think of where there's been in Falls met with a minor except for the teens were pursuing like a bioptic telescopic license but in general I'm using the outpatient OTS that I use here at the Eye Institute are acute care neuro oties over on the florist here at Vanderbilt who spend part of their time with me and who have a background and experience in vision-related Rehabilitation and so there you just like o t is very diverse sometimes it's sort of sub specialization they are specifically addressing visual needs with some of the adaptations like noted in those slides and implementing strategies or contrast lighting tactile markings there helping to train my patients in utilizing the tools and devices that I'm prescribing introductory just simple safe around the home Mobility sorts of skills without white Keenan and formal training and there are programs for occupational therapist to be calm what the acronym is like Vision Rehabilitation certified very few of practicing OTS have that certification but ultimately as my program which is relatively DIY rose you know the hope is to implement having a full-time OT actually on staff that just has an Ophthalmology ploidy doesn't doesn't go over to the hospital to see if you care really only team to the only miners. coyotes are probably ever working with because hopefully the students who were seeing have support through their District or through their tvi to implement some of the stuff in a not totally just similar way to how coyotes are training patients adult patients in the use of tools does that help okay well we're perfectly yeah if you don't mind and then we can I'll send you a link afterwards we can post them with the recording to you so anyone can download and watch what's a recording or yeah we're perfectly at 3 so thank you all for attending I'm going to put the link in the chat again to see how it and will also email it out probably tomorrow out for anyone who can't download it right now but our closing code is specialist and Allen also put a even shop for our other upcoming sessions this year and we hope to see you guys again soon our next session is actually next Friday the 30th we'll have our first Vision educator Consortium meeting of the year and look forward to seeing you all there so if you guys use anything Josh for joining us today and I hope everyone has a good rest of the day thank you so much thank you yeah thanks for being here 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