Rehabilitation After Ocular Trauma

Rehab Goals & Assessment - Charting Recovery

Core Rehabilitation Goals:

• Visual: Maximize residual vision; prescribe optical/non-optical aids.
• Functional: Enhance independence in Activities of Daily Living (ADLs) like reading, mobility.
• Psychological: Address anxiety, depression; foster coping strategies.
• Vocational: Facilitate return to work or explore new vocational pathways.
• Team Approach: Involves Ophthalmologist, Optometrist, Low Vision Therapist, Counsellor, Occupational Therapist (OT).

Comprehensive Assessment Battery:

• Ophthalmic Examination:
  • Visual Acuity (VA): Best-corrected, near, distance.
  • Intraocular Pressure (IOP) measurement.
  • Slit-lamp biomicroscopy: Detailed anterior segment evaluation.
  • Fundoscopy: Posterior segment, optic nerve head status.
  • Visual Field testing (Perimetry): e.g., Humphrey, Goldmann.
  • Electrophysiology (if needed): ERG for retinal function, VEP for optic pathway integrity.
• Functional Vision Assessment: Evaluate performance of vision-dependent tasks.
• Quality of Life (QoL) Scales: e.g., NEI VFQ-25 to gauge patient-reported outcomes.

⭐ Early referral for low vision aids (LVAs) and vision rehabilitation services significantly improves outcomes and QoL after ocular trauma, even with moderate vision loss.

Visual Function Restoration - Sight Savers

• Low Vision Aids (LVAs): For visual acuity (VA) <6/18 to 3/60 (WHO criteria).
  • Optical LVAs:
    • Magnifiers (hand-held, stand, spectacle): For near vision.
    • Telescopes (hand-held, spectacle): For distance vision.

      ⭐ Telescopic LVAs are prescribed for distance vision enhancement.

  • Non-Optical LVAs:
    • Lighting: Enhanced illumination, glare control.
    • Large print materials, high-contrast objects.
    • Electronic aids (e.g., CCTV, screen readers).
• Management of Specific Visual Impairments:
  • Diplopia: Management 📌 P.O.S. - Prisms, Occlusion, Surgery.
    • Prisms (e.g., Fresnel, ground-in).
    • Occlusion (e.g., patching one eye).
    • Surgical correction (for stable deviation).
  • Photophobia:
    • Tinted lenses (e.g., FL-41 tints, photochromic).
    • Broad-brimmed hats.
  • Visual Field Defects (e.g., hemianopia):
    • Scanning techniques (systematic head/eye movements).
    • Prisms (e.g., Peli prisms for field expansion).
• Vision Therapy/Orthoptics:
  • Addresses binocular vision anomalies (e.g., convergence insufficiency, suppression).
  • Improves accommodative dysfunction.
  • Exercises to enhance eye teaming, focusing, and visual tracking.

Beyond Vision - Holistic Comeback

• Psychosocial Support: Crucial for managing emotional and psychological sequelae.
  • Counseling: Addresses trauma-induced anxiety, depression, body image concerns, and PTSD.
  • Support groups: Offer invaluable peer understanding, shared experiences, and coping strategies.
• Vocational Rehabilitation: Facilitates successful reintegration into the workforce and daily life.
  • Job modification: Adapting specific tasks or the overall work environment.
  • Retraining: Acquiring new, relevant skills for suitable alternative employment.
  • Assistive technology: Includes low vision aids, screen readers, and voice-activated software.
• Cosmetic Rehabilitation: Aims to restore facial aesthetics, symmetry, and patient confidence.
  • Ocular prosthetics: Custom-fitted artificial eyes provide optimal cosmesis and motility.
    • Indications for enucleation/evisceration: Severe irreparable trauma, blind painful eye, prevention of sympathetic ophthalmia, select intraocular malignancies.
  • Anaplastology: Utilized for extensive orbital or periorbital tissue defects.

  ⭐ Custom ocular prostheses offer superior motility and cosmesis compared to stock shells.

• Patient Education: Essential for promoting long-term adaptation, self-efficacy, and care.
  • Detailed instruction on self-care, prosthesis handling, insertion/removal, and socket hygiene.
  • Stress critical importance of consistent long-term follow-up appointments for monitoring.

High‑Yield Points - ⚡ Biggest Takeaways

• Early, comprehensive management is critical for visual outcome post-trauma.
• Visual rehabilitation aims to maximize residual vision with appropriate aids.
• Key Low Vision Aids (LVAs): magnifiers, telescopes, electronic aids.
• Occupational therapy facilitates ADL adaptation and vocational training.
• Psychological support is essential for coping with vision loss and trauma.
• Custom ocular prostheses provide cosmesis and socket health in anophthalmia.
• Regular, long-term follow-up detects late complications and guides ongoing care.