National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired
Our Visual Rehabilitation Team
The team of the National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired (“Polo Nazionale” in Italian) consists of various professionals with highly specialised skills and expertise These include ophthalmologists, orthoptists, a psychologist/psychotherapist and external consultants, such as an expert typhologist and an orientation and mobility instructor. If required, it is also possible to receive other specialist advice, such as from a neurologist or neuropsychiatrist.
The approach of the multidisciplinary team is holistic in nature and considers man as a whole, as beings composed of mind and body. The knowledge of the close relationship between these two different aspects of human reality requires a different clinical approach to the person who is visually impaired. In fact, there can not be a suffering of the body without the involvement of the psyche.
The person who accesses the National Centre for Visual Rehabilitation will meet the psychologist, who has the function of:
welcoming the person by listening and recognizing their subjective dimension;
exploring the patient’s emotional state, the difficulties and any psychological discomfort experienced in reference to the disease;
identifying the needs, requests and any non-expressed expectations;
examining the reasons or motivation for requesting rehabilitation;
making the visually impaired person and their his family feel part of the treatment process.
Therefore, psychological support is both individual and family related (support in the management of issues relating to disability). The support meetings are agreed and shared with the patient: they can take place concurrently with the rehabilitation process or occur on a weekly, fortnightly or monthly basis. Before the patient’s eye examination, the psychologist refers any relevant information to the ophthalmologist to encourage a more empathetic relationship between doctor and patient.
The eye examination begins with a careful collection of general and ophthalmological data (clinical history of an individual),l, followed by an accurate assessment of visual acuity and reading skills, an objective physical examination (evaluation of the anterior segment eye, ocular tonometry, fundus), a contrast sensitivity test, an evaluation of the chromatic sense and the testing of the filters, both indoors and outdoors.
The diagnostic procedures practiced are as follows:
microperimetry, which aims to:
- determine the breadth and depth of the scotoma (area of non-vision or reduced vision), the width of the scotoma and its relationship with the foveal region (central area of the retina that permits 100% visual acuity);
- evaluate the behaviour of fixation (stability and eccentricity) and the characteristics of the PRL (Preferred Retinal Point or pseudofovea point, i.e. the area of the retina used for distinct vision following irreversible damage of the macula, the central area of the fine photosensitive tissue);
- explore the functional state of the retina;
- identify the orientation of the rehabilitation program;
- search for the best Preferred Retinal Locus;
- make a prediction on a possible functional recovery;
- calculate the angle of decentralization;
- examine the binocular visual field according to the Zingirian-Gandolfo program, which is important for the quantification of retinal damage, in particular in the form of peripheral hypovision and in the mixed type, for medical-legal purposes and, therefore, for the assessment of the invalidity.
Any additional diagnostic examinations (OCT, retinal fluorescein angiography, electrophysiological tests) are planned on the basis of observed clinical reports.
MEETING AS A TEAM
Once the diagnostic procedure has been completed and full information about the patient has been acquired, the team at the National Centre meets to create a personalized rehabilitation program. The meeting is attended by all the specialists of the Centre (psychologist, ophthalmologists and orthoptists) and, when necessary, also by external consultants (such as the orientation and mobility instructor and a typhologist.
The rehabilitation program is personalized and built on the individual needs of each visually impaired patient. Cutting edge instruments and equipment are used for rehabilitation and we are in direct contact with companies in this sector. Meetings are periodically arranged with these firms, where technological updates are provided, along with presentations and demonstrations of new innovative devices (the fruits of advanced research).
READING WITH NEW VIDEO SYSTEMS
The contexts in which rehabilitation paths are devised include the following: :
- reading rehabilitation:
- training with optical and electronic aids (for example video magnifiers for low vision, telescopic systems, aplanatic lenses, etc.);
- rehabilitation for intermediate distance activities;
- rehabilitation for long distance activities;
- use of computer software;
- biofeedback with the microperimeter to stabilize fixation;
- typhlological aids.
Each phase requires a series of meetings with the orthoptist in charge of the rehabilitation, with the aim of helping each patient make the most of their functional residual vision, and identifying the most suitable optical and/or electronic aids for their individual needs. Furthermore , the orthoptist can assign “ home exercises” to strengthen and reinforce the results obtained during outpatient training.
CLOSING OF THE REHABILITATION PATH
At the end of the rehabilitation program the specialist can prescribe the most suitable aids to meet the requirements of the visually impaired person so to improve their quality of life.
The aim of the National Centre for Visual Rehabilitation is to take charge of the patient as a whole, paying particular attention to their existential difficulties and any psychological issues related to the visual state that affects, and will affect them, both from a clinical point of view (taking into account conditions such as diabetes, hypertension, heart disease) and in terms of their quality of life.
The ophthalmologist dealing with rehabilitation becomes the “central link” - with the other specialists and the clinical ophthalmologist and/or surgeon, and can monitor, and if appropriate, support the therapeutic and rehabilitative program.
Good visual rehabilitation can only be achieved as a result of a team effort and is not the consequence of just an individual work!