For low vision specialists and those who consult them
Aaopt review 2/2: Nyctalopia
November 19, 2009Posted by on
As I mentioned in my previous post, one of the highlights of the low vision programme at the American Academy of Optometry meeting last week was a special evening session on Nyctalopia.
The first speaker was Dr John Musick who spoke entertainingly on the identification and management of people with night vision problems.
He emphasised the difficulty of identifying poor night vision as people often assume everyone can’t see in the dark. He suggested asking ‘have you ever seen the stars?’ as a screening question. He also stressed the need for referral to an ophthalmologist who specialises in hereditary retinal disease rather than a general ophthalmologist given the rare nature of some of these conditions. He mentioned the importance of referral to orientation and mobility experts, and to ensure that people had a ‘caring community’ for support: be it family, friends or colleagues. He touched briefly on the need for occupational counselling, given the typical age of presentation of people with nyctalopia (age 10-20).
Next, Dr Roanne Flom gave an excellent overview of low vision rehabilitation for people with poor night vision. This ranged from the importance of arranging a workplace evaluation (she cited warehouses in particular as being dim environments to work in); to ensuring good task lighting (she demonstrated various head mounted led systems which can be used when walking). She also discussed the use of dark adaptometry, glare testing and night vision camcorders in people with nyctalopia. My favourite clinical pearl from this talk was ‘you can spot people with poor night vision as they come in with a torch and dark glasses, as the range of optimal illumination is so critical.
The final speaker was Dr Byron Lam from Bascom Palmer in Miami. He gave an overview of gene therapy, stem cell therapy, retinal implantation and dietary supplements in retinal disease. His talk was good, but not as impressive as Alan Bird’s award lecture on similar topics at this year’s ARVO. A salient point made by Dr Lam was the importance of counselling people appropriately before they enter a clinical trial, as that could well be their only chance of entering a study: participation in a previous treatment trial is often an exclusion criterion for entering future clinical trials.
In all, it was an excellent and interesting symposium on a frequently ignored topic.