The International Vision Rehabilitation Standards arrive in Morocco

The International Vision Rehabilitation Standards arrive in Morocco

The curricula developed on the basis of the international standards for vision rehabilitation, published by the National Low Vision Centre, take a further step forward on the international scene. Dr Filippo Amore, director of the National Low Vision Centre, and Dr Margherita Guidobaldi speak about this new achievement.

The International Rehabilitation Standards are the result of an international consultative process that lasted 7 years and focused on establishing international vision rehabilitation standards concerning the provision of services and the training of dedicated staff.

Through such process, which started back in 2013, international experts in the field reached an agreement on the curricula for human resources engaged in vision rehabilitation, including ophthalmologists, orthoptists, psychologists, child neurologists, O&M instructors, and teachers.

Following international consensus, differentiated rehabilitation paths were designed for children and adults, both in terms of rehabilitation procedures and the training of dedicated human resources (healthcare and non-healthcare professionals). Such differentiation also took into account the economic and development settings of individual countries.

“As a WHO collaborating centre for vision rehabilitation, we have transferred the training model described in the Standards to this first training experience in Morocco, which was held from 17 to 20 October 2022,” explains Dr Filippo Amore, director of the National Low Vision Centre. “Morocco is already one of our collaborating countries. For this reason, it was deemed as a suitable candidate for the implementation of the rehabilitation curricula and the launch of two vision rehabilitation initiatives.”

IAPB Italy contributed to the establishment of a vision rehabilitation centre at the Prince Moulay Abdallah public hospital in Salè, by providing optical and electronic devices, as well as eye tests for eye examinations. Orthoptists from the Moulay Abdallah hospital participated in the training course, along with some operators from the private eye care centre of the Hopital Universitaire International Cheikh Zaid in Rabat. This way the language of vision rehabilitation could be shared and standardised.

The meetings were conducted by Dr Margherita Guidobaldi, orthoptist of the National Low Vision Centre.

The aim was to create an eye care centre  corresponding to the “Primary Plus” level of the International Rehabilitation Standards, where operators can perform refraction tests and possibly prescribe a rehabilitation aid.

·         How was the training organised in Morocco?

The training was split into two phases, a theory part that was taught remotely and a practical session on site. For the theory section, along with Dr de Rossi, we prepared lessons in the form of slideshows, that we shared with our Moroccan colleagues ahead of my arrival. The lessons dealt with the definition, characteristics and causes of low vision, the assessment of distance and near visual function, and aids and their use. Once we arrived in Rabat, for the first two days we worked with the aids that had been donated to the hospital. Each participant had the opportunity to test the enlargements of the optical systems, understand how the handheld electronic video magnifier works and check the shades of the photo-selective filters. After that, I presented some clinical cases and together, we worked out individual rehabilitation paths based on the needs and visual functions of each patient.    

·         This meeting aimed to standardize rehabilitation procedures. Have you encountered any difficulties with your colleagues? What did you need to focus on the most?

I mainly focused on low-vision patient care (the admission to eye care services of low-vision patients) and on the near vision acuity assessment, performed with a Leat Reading Chart (BAL Chart, in Arabic). These are specific tests used in low vision centres, which are important to decide upon the type of aid and the lens power to be prescribed.  

Since participants had no experience in this field, we also agreed to have online meetings for the following four months, in order to support them and discuss the rehabilitation paths they proposed to patients.

·         Have there already been any results after the training meetings?

Two days before the end of the training, a patient with glaucoma was rehabilitated. Trainees analysed the requests and difficulties of the patient and assessed his distance and near visual function. Then they prescribed filters both for indoor and outdoor environments. The patient immediately noticed improvements, perceiving more contrast in indoor environments and less glare outdoors. As an aid to read from a short distance he chose a magnifying glass.

·         What are your impressions about this first experience of training abroad?

 

It was an important experience. It certainly needs to be perfected, but it was a great start. There is a strong desire to help, we are satisfied and strongly believe it is useful to continue the project in other countries as well. 

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Italian classification and quantification of Visual Impairment

Cieco con accompagnatore

The Italian Law of 3 April 2001, no. 138, established a classification of visual impairment that takes into consideration not only residual vision, as the previous legislation did (Laws no. 66/62, 382/70, 33/80, 660/84), but also the residual binocular visual field. This classification identifies five levels of visual impairment: total blindness, partial blindness, severe visual impairment, moderate visual impairment and mild visual impairment.

TOTAL BLINDNESS

Cieco con accompagnatore
Cieco con accompagnatore
Those who are affected by complete vision loss in both eyes.
Those who have a mere perception of light and shadow, or of hand motion in the best eye.
Those who have a peripheral binocular visual field residual lower than 3%.

PARTIAL BLINDNESS

Those who have a visual acuity no greater than 1/20 in both eyes or in the best eye, even with the best correction.
Those who have a peripheral binocular visual field residual lower than 10%.

SEVERE VISUAL IMPAIRMENT

Those who have a visual acuity no higher than 1/10 in both eyes or in the best eye even with the best correction.
Those who have a peripheral binocular visual field residual lower than 30%.

MODERATE VISUAL IMPAIRMENT

visita_oculistica_anziano-web.jpgThose who have a visual acuity no greater than 2/10 in both eyes or in the best eye even with the best correction.
Those who have a peripheral binocular visual field residual lower than 50%.

MILD VISUAL IMPAIRMENT

Those who have a visual acuity no greater than 3/10 in both eyes or in the best eye even with the best correction.
Those who have a peripheral binocular visual field residual lower than 60%.

Information document by the International Agency for the Prevention of Blindness – IAPB Italy

Low Vision Rehabilitation

ipovedente fa riabilitazione visiva
ipovedente fa riabilitazione visiva

WHAT IS LOW VISION REHABILITATION?

Low vision is a condition of greatly reduced visual capacity, irreversible and bilateral (it affects both eyes), which conditions and limits the autonomy of an individual, compromising the performance of normal daily tasks. Unfortunately, vision loss cannot be regained; however it is possible to learn how to maximize the use of the retinal zones that are still functioning. This goal can be achieved through vision rehabilitation, which consists of a personalized path that – through an appropriate classification of the visually impaired person – allows the preservation of the residual vision (optimizing its use). In this way, a person can overcome some “disabilities” and maintain or recover their social life, communication and planning abilities, improving their quality of life.

WHEN IS IT NECESSARY?

Vision rehabilitation is a path that should be undertaken by people with low vision regardless of the cause and the age of onset.

WHAT DO YOU HAVE TO DO?

The first step of vision rehabilitation is the classification of the visually impaired person, with particular attention given their requests, needs and psychological difficulties related to their visual impairment. This phase requires the intervention of several professional figures with specialized competences i.e. a psychologist, an ophthalmologist and a rehabilitating orthoptist. The actual rehabilitation period then follows with a series of meetings in which the visually impaired person learns to make the best use of aids, identified to meet their requests (optical, electronic and computer aids). Sometimes home-based hand-eye coordination exercises are also assigned with appropriate checks in subsequent meetings. In the future it will be possible to do exercises from home using a computer equipped with special software.

In some cases it may be necessary to use visual stimulation (biofeedback), which is practiced using an instrument called a microperimeter.

HOW LONG DOES A REHABILITATION SESSION LAST ON AVERAGE?

riabilitazione-visiva-polo_nazionale-oculista_e_ortottista-web-ok-photospip4542676d9f63ad3018df77e2de2a8bc4.jpgVisual rehabilitation sessions can require a varied amount of time (but usually a single session doesn’t last for more than an hour) depending on the visual condition of the individual, their requests, age, the characteristics of the aids, etc. In the case of visual stimulation through biofeedback, the sessions last for half an hour on average.

HOW OFTEN IS IT NECESSARY TO GO TO A SPECIALIZED CENTRE?

The frequency of visual rehabilitation sessions is variable. On average 4-5 meetings (1-2 times per week) may be sufficient to learn how to use the optical, electronic and/or computer aids. When necessary visual stimulation techniques may be used, in which case, some cycles of treatment are practiced, (usually 10-15 minute sessions, twice a week), possibly to be repeated over time after a period of observation.

WHAT RESULTS CAN BE OBTAINED?

During visual rehabilitation the still functioning retinal areas are identified and exploited. The objective of a rehabilitative program is to enable the visually impaired person to utilize these areas as much as possible, so as to improve their visual perception and quality of life.

How to book an eye examination for your child

Bambini al Polo Nazionale

DIAGNOSTIC AND VISION REHABILITATION CENTRE
FOR CHILDREN WITH MULTISENSORY DEFICIT
(CE.DI.RI.VI.)

Appointments are scheduled at the Agostino Gemelli University Polyclinic Hospital in Rome, in cooperation with the National Centre for Vision Rehabilitation of the IAPB Italy. The service is reserved for children affected by multisensory deficits, in particular for infants aged between 0 and 3 years old

Bambini al Polo Nazionale
Bambini al Polo Nazionale

Useful phone contact: +39 06 87763115, available from Monday to Friday (8:30 a.m. to 1 p.m. CET). It will be requested to the parents to send the documents about their child specifying the pathology and the reason of the examination (e-mail: polonazionale@iapb.it). Later on they will be contacted to schedule an appointment.

Our Centre accepts children from 0 to 3 years old who have eye or brain problems, therefore even associated to other motor and sensorial deficit. The multidisciplinary team include several specialists who take care both of the diagnosis and child’s rehabilitation: ophthalmologist, child neuro-psychiatrist, pediatrician, geneticist, orthoptist and neuro-psychomotility therapist.

Therefore it’s possible to follow a diagnostic, assessment and rehabilitation path.

Our appointments on outpatient base (lunch is available for children who stay until afternoon).

In case of first examination, mostly for families non resident in Rome, an evaluation in more days is foreseen always in day hospital scheme (without overnight stay in the hospital).

In the diagnostic phase all professional figures before mentioned can be present; in the evaluation and the rehabilitation path the following are available: ophthalmologist (if necessary), child neuro-psychiatrist, orthoptist and neuro-psychomotility therapist.

The team is always available to welcome colleagues and teachers who follow children in the territory of residence, both during and after the examinations. When direct contact is not possible, during the examinations (with the consent of parents) some photos and videos of the activities and adviced the materials can be taken.

DIAGNOSTIC AND VISION REHABILITATION CENTRE FOR CHILDREN WITH MULTY-SENSORIAL DEFICIT (CE.DI.RI.VI.) at Polyclinic A. Gemelli, Largo Agostino Gemelli, 8 – 00168 Rome, Italy.

How to book an eye examination for an adult

Reception del Polo Nazionale

To book an examination at the National Centre for Vision Rehabilitation in Rome simply call the phone no. +39 06 36004929 and select the #2 key. The service is available from Monday to Thursday from 8:30 a.m. to 1 p.m. and on Friday from 10 a.m. to 1 p.m. and 2 p.m. to 4 p.m. (CET). Alternatively you can go directly to the National Centre at the Agostino Gemelli Hospital, L.go A. Gemelli 8 – Rome, Italy (building C, second floor). Thanks to the administrative office of the National Centre it is possible to book an eye examination for people experiencing significant visual impairment.

ACCEPTANCE

Reception del Polo Nazionale
Reception del Polo Nazionale
Upon arrival at the National Centre a secretary will provide you with the necessary documents for the payment of the service that you have booked. With these documents you are required to go to the help desk of the Ophthalmological Department at the same Hospital, which is open from 8.00 a.m. to 1.00 p.m. (Monday to Friday) and can be found on the second floor. In the case of an afternoon appointment, the payment should be made on the third floor (with the same documents). The administrative office of the centre will take documents and open a medical record.

Quality Certification

riabilitazione-visiva-polo_nazionale-oculista_e_ortottista-web-ok-photospip4542676d9f63ad3018df77e2de2a8bc4.jpg

High quality low vision rehabilitation at the National Center

The Low Vision Center at the Gemelli Hospital in Rome respects excellent standards of different aspects of its services

riabilitazione-visiva-polo_nazionale-oculista_e_ortottista-web-ok-photospip4542676d9f63ad3018df77e2de2a8bc4.jpgThe National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired has obtained and renewed an important quality certification, in accordance with the requirements of the ISO 9001:2008 standard. This highlights the high levels of its activity, particularly in the following areas:

  • preventive medicine;
  • programming and execution of rehabilitation treatments for patients with low vision;
  • epidemiological research;
  • basic research;
  • experimenting with new rehabilitation models;
  • use of advanced optical and electronic aids for low vision;
  • use of visual-functional evaluation software;
  • training and updating of healthcare professionals;
  • networking activities (with other Visual Rehabilitation Centers) and advocacy.

polo-riabilitazione-microperimetro-paz_med-2-web.jpgAs far as the quality level is concerned, external experts assessed the consistency of the policy, objectives and strategies of the National Center, with a large commitment by the head of IAPB Italy to auditing procedures, which led to a careful qualitative assessment. All this has taken place in the framework of an excellent and fruitful collaboration with the A. Gemelli Hospital. Great staff preparation, including the technicians, is an obvious guarantee for all patients. The National Centre is, among other things, a WHO Collaborating Centre on Prevention of Blindness and Rehabilitation. It started as a project of the International Agency for the Prevention of Blindness-IAPB Italy, which became reality thanks to Law no. 291/03. Inaugurated in autumn 2007, it has been running since 2008 at the Gemelli Hospital in Rome.