SEE BAD FEEL GOOD
REMEMBER:
Even if you are old
Even if you dont believe it is possible
Even if life seems like a dead end
Even if you have lost your dreams
You can regain something to do, somone to love and a new
project to look forward to…
Krister Inde, MA in spec ed
• Innovator of low vision rehabilitation in Sweden
and in Jordan…
• ”Low Vision Training” 1975
• “See Bad Feel Good” 2003
• Eccentric Fixation and Use of Low Vision – See
More, 2005,
• Lund University – Linneaus Uniersity- Indenova
Inc.
• Leber’s Disease with CFL since 1967 with 0,05
Come and visit us in Sweden
What is a low vision clinic
•
•
•
•
•
Correct information
Services offered – to whom?
Staff – what professionals?
Organisation – where in the world?
Core business – what are the needs to be
offered to whom and where and at what
costs?
The Four LV Groups + 1 extra
• Central scotomas and
VA <20/200 (<0.1)
• Abnormal nystagmus
• Peripheral restrictions
• Low visual acuity and reduced visual
acuity 20/200 –20/60 (0.1-0.3)
• Visual field restrictions and perceptual problems due to
Stroke
All Methods…to be used or not?
• Nova Vision – to make dead parts come alive?
• Visio Coach – train saccadic eye movements?
• ”To See is not Enough” – Gunvor Birkeland
Wilhemsen. - Synanamnes is great!
• DynaVision trains neglect and attention in all
directions
• NeuroVision Tech - trains sideways clinically
and in real situations for better life Q?
• Treatments with Prisms by Boston research?
Every other patient needs it?
• Danish Optomtric Behaviouism in addition?
Sweden 9,2 million inhabitants
Regional centers
• 34 Low Vision Centers in
the 27 regions
• The largest one has more
than Low Vision center
employees 83
professionals
• Referrals by
ophthalmologist
• VA 0.3 and lower
• Service is almost free!
Low vision center in Jönköping
• Started 1976
• Staff:
–
–
–
–
1 optometrist
4 low vision therapists
2 social workers
Ophthalmologist
consultant
Low vision center: Patients
• The province
population about 400
000
• 400 new referrals
every year from
ophthalmologists
• 3500 visits
• Always try with optical
devises and training
Low Vision Therapy
• Started early 70th by
Örjan Bäckman and
Krister Inde
• 1975 the book “Low
Vision Training”
where published in
English 1979..
• First LVC in 1973 –
role model from
Copenhagen 1960
and New York 1953
Special service
• Appr. 350 Home Instructors
• Seven Labor Market Offices
• Six places for Rehab Courses for LV
Seniors
• Special Education Institute
- service for low vision and blind
children
- education of teacher and parents
University of Kalmar Sweden
• Optometry School at
Kalmar University
• From this year
Linnaeus University –
www.lnu.se
• Vision Enabling lab.
• Research with
optometrists as
doctoral students
OPTOMETRIC REHABILITATION
• Since 2004
• 7,5 points
• Webbased for optometrists and low vision
theraprists
• Low vision Optometry, Pshyckology,
Team, Low Vision Training and Devices
• Pracitce, Interviews
• Three Meetings and web contacts
Finansiärer
Ett projekt finansierat av:
• Synskadades riksförbund
• Norges Blindeförbund
• Dansk Blindesamfund
• Center for Syn og Kommunikation, CSK
• Ekhagastiftelsen (logga)
• Ett tiotal optik- och hjälpmedelsleverantörer med
Multilens som huvudsponsor. Stort tack!
AMD - AGE TELATED
MACUAR DEGENE-RATION
It can be considered a
pandemia…1 of 3 over 75!
e
Help in different stages of
AMD, particularly
dry AMD
FIRST STAGE –
Reduced vision
– skaffa bättre läsglasögon
(högre addition) och en belysning som
gör att du använder det bästa som
linsen och näthinnan kan åstadkomma
mitt i ”apoptos-problemen”
0,7 – 0,4
Help in different stages of
AMD
SECOND STAGE –
Low vision
– öka förstoringen och kompensera den lägre
tapptätheten i kombination med bra belysning
0,4 – 0,1
Help in different stages of dry
AMD
THIRD STAGE
No macular vision – central
scotoma
BRA - Best Retinal Area
– När merparten av Makula inte längre
fungerar, då måste man hitta sin BNP, Bästa
NäthinnePlatsen
(på engelska BRA, Best Retina Area)
SEEnior – a New
Scandinavian Global
AMD Rehab Program
– also in Israel?
Krister Inde, Jörgen
Gustafsson, Sweden, Gaute
Mohn Jenssen, Arne Tömta,
Norway, Kirsten Kobberö, Jytte
Mejlvang, Kirsten Baggesen,
Denmark
Kalmar University, Sweden,
2008-2009
The Scandinavian SEEnior
Team
7 professionals speaking three
languages:
3 optometrists, 3 low vision therapists
1 ophthalmologist
Three Scandinavian and
Five Nordic Countries
• Denmark,
Norway, Sweden
is Scandinavia
+ Iceland and
Finland = the
Nordic Countries
• Scandinavia - 20
million inhabitants
with 69 low vision
clinics and 600
professionals
•
•
•
•
•
The Poster of
Scandinavian Low Vision
20 million Services
Scandinavians –
whereof
5% have
visual
A Role
Model?
problems in everyday life,
= 1 million that want your help, 2 of 3 over 65!
70 low vision clinics (82 employed in Stockholm, 51
in Copenhagen etc)
600 professionals (343 Sweden, 205 Denmark, 52
Norway) + Iceland (Eyes land)
All devices free of charge on loan bases
1700 CCTVs at total amount of 6,5 million USD only
in Sweden 2007. 1000 in Norway, 800 in Denmark!
Who do we see in
SEEnior?
AMD Patients, with emphasis on dry
AMD from early stages of the disease to
persons with CFL (central scotomas)
AMD in three stages:
1. When reading starts to be a problem
(+4 to +8)
2. When stronger magnification is
needed in
the macula (+8 to +24)
3. When PRL or BRS is needed
(+24 to +56) and use of CCTV
Objectives: What can the
world expect from SEEnior?
We will develop a Professional
Vision Enabling Program
including
Assessment and
Training methods with
materials for persons
and professionals in
AMD Rehab programs
Principles: AMD is an
acronym for Altering
Magnification Drastically
• The material starts at Reduced
Vision and ends up at No Vision in
the macula
• The material is designed Side by
Side for Everyday Life with respect
for Active and Passive Elderly
Persons
• It involves optometrists and private
eye doctors and ends up with low
vision professionals
• Patients understand when they have
Inventory of materials
used until now at 69
centers in Scandinavia
• What kind of materials do you use
today for AMD persons?
• Have you made any materials of
your own?
• What rehab programs are used?
• Preliminary results: No
common programs, no
standardized updated
What situations cause the
biggest problems in AMD?
1. To learn to live with the problem (SEE
BAD FEEL GOOD)
2. To learn to read at a closer distance in a
natural way
3. To assess the right magnification size and
method
4. To use and implement optical devices in
everyday life, in the shop, in the golf
course, in the garden, meeting friends in
the street…
5. To find the BRS, Best Retina Spot (PRL)
6. To learn not to drive
7. Not to feel embarrassed or ashamed of
the poor visual function
wherever whenever
BRA/PRL TEST FOR CFL
PERSONS
Where do I focus to see the objects
better?
BILD
MOVITEXT
A new concept of reading a word
document according to the earlier
described training method of reading
with PRL/CFL
MOVITEXT IS A METHOD
TO LEARN
User's Manual for SEEnior
MANUAL - 40 pages for both professionals
and very interested patients
Evaluation at
9 plus 2
centers
during
October/Nov
ember 2008
Results: Production of
reviced SEEnior
materials in five
languages
• Denmark 5,6 million
•
•
•
•
•
Finland 5 million
Iceland 0,3 million
Norway 4,6 million
Sweden 9,3 million
Appr 25 million in the Nordic
countries
• > 1,5 million with reduced vision,
low vision or no vision.
• ”Mina elever vet att jag inte
ser så bra. Därför
SEEnior materials was
published and
implemented from March
2009
Interested? Yes, we would love
to
make it in more languages!
Mer texter att testa med
Synen blir sämre med du kommer
klara dig bättre och bättre
Att läsa nära med optik
…Eller med hjälp av elektronik
Läs och lyssna
Se på TV
Spela kort
Se och sy
Sticka och virka
Skyltar som visar vägen och tiden
Tolka suddiga bilder
Se en föreställning
Njut av en utställning
Ljus i tillvaron
Vem får köra bil?
Se nära på långt håll
Se upp med nacken
En bländande tillvaro
Gå och handla
Rätt gradtal på ugnen?
Storstilat tidur
Att finna rätt och laga god mat
En norsk, en dansk, en svensk och…
Instrumenten att värdera med
• BNP = bästa näthinneplatsen
- värderas med hjälp av BNP-test
• AVANTIMETER – att värdera
förstoringsbehov I förhållande till
läsavstånd
BNP-test formelen
Fikseringspunkt på aktuell leseavstand:
Fokuseringpunkt (FP) x Arbeidsavstand m/hjm
(AA)
Testavstand (TA)
Avantimeter
Avantimeter
Avantimeter
LäsTV
Contact me and HiK, School of
Optometry, Vision Enabling Lab
• www.hik.se/senior
• www.indenova.se
• Krister@inde.nu
”De som hör av sig och skriver och klagar är
mindre välkomna än de som hör av sig och vill
förbättre och utveckla världen.”
www.hik.se/senior