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HEARING AND

VISUAL
IMPAIREMENT
Prepared by

Ms. Jyoti kundu

VISUAL
IMPAIRMENT

DEFINITION
Visual

impairment is defined as the


limitation of actions and functions of the
visual system
The National Eye Institute defines low
vision as a visual impairment not
correctable by standard glasses, contact
lenses, medication or surgery that
interferes with the ability to perform
activities of daily living.

CLASSIFICATION OF VISUAL
IMPAIRMENT
Low

visual acuity means vision between


20/70 and 20/400 with the best possible
correction, or a visual field of 20 degrees
or less
Blindness is defined as a visual acuity
worse than 20/400 with the best possible
correction, or a visual field of 10 degrees
or less

Legal

blindness in the US means visual


acuity of 20/200 or worse with the best
possible correction, or a visual field of 20
degrees or less.
Visual acuity of 20/70 to 20/400 (inclusive)
is considered moderate visual impairment
or low vision

COMMON VISUAL PROBLEM


Hyperopia: Can see objects farther away but not close one.
Eye ball is too short.

Myopia : Can see objects close away but not farther


Eye ball is too long

Astigmatism : Produces images similar to looking at carnival


mirror
o

Color blindness : Decrease ability to disntinguish colors.


Usually genetic cause but can be caused by nerve
damage
Problem with cones cells

CAUSES

Injury to the eyes


Injury to the eyes while playing or at work or due to accidents
may result in vision loss and impairment.
Particularly injuries to the cornea are the commonest cause of
vision loss.
Inherited conditions of blindness and vision impairment
Retinitis pigmentosa is the most common cause of inherited
blindness.
Infections of the eyes
Sometimes if the mother has had a viral infection like German
measles that is transmitted from the mother to the developing
fetus during pregnancy the baby may be born with blindness or
visual impairment.

Diabetic retinopathy
Diabetes affects the small blood vessels in the retina.
When damaged this leads to impairment of vision.
Glaucoma
This condition results due to raised pressure within the
eyes. The increased pressure impairs vision by
damaging the optic nerve.
Age related Macular degeneration
Age related Macular degeneration or AMD that is a
progressive loss of the visual acuity due to damage to
the macula that is the most sensitive part of the retina.
The risk of AMD rises in those exposed to excess
sunlight and those who smoke excessively.

Amblyopia
This is basically impaired vision in one eye due to lack of its
use in early childhood.
Cataract
Clouding of part or the entire lens of the eye.
Normally, the lens is clear to let in the light that focuses on
the retina. Cataracts prevent light from easily passing
through the lens, and this causes loss of vision.

AIDS related visual impairment


This is usually caused by viral infections of the eyes called
Cytomegalovirus or CMV retinitis.
Cancer of the eyes

Retinoblastoma is the most common eye cancer of children.


There are between 300 and 400 new cases diagnosed annually

SIGNS AND SYMPTOMS


Headache with reading and writing
Leave small words while reading
Blinking of eye
Frustation due to inability to read
Eyes can be watery and swollen
Covering one eye while reading or doing work

DIAGNOSIS
Diagnosis begins with complete history and family
history of visual impairment in the patient.
External examination of the eye including lids,
conjunctiva, cornea, iris, lens, etc. are the next
step
Snellen test
The Snellen test is also known as the visual acuity
test.
Usually a chart called the Snellens chart is used.
It contains progressively shortening random
letters and numbers and is placed 6 meters away
from the patient.

Visual field test


Visual field is the range of vision that a person
can see without tilting or turning ones head.
This measures the peripheral vision of the eyes
Tonometry test
This test uses specialized instruments to
determine fluid pressure inside the eye to
evaluate for glaucoma
Ocular Motility Assessment
This tests if there is squint of other problems in
the movement of the eyeballs

TREATMENT
Control of diabetes This prevents progression of
diabetic retinopathy and resulting visual impairment
to some extent. However in advanced cases this may be
of little help.
Cataract surgery In cases of visual impairment
due to cataracts, surgery may be opted. Usually an
artificial lens is placed within the eye as a replacement
of the damaged and clouded lens. This, more often
than not restores vision.
Magnification systems This is achieved using
appropriate lens, reading telescopes or surgical
systems etc. Hand magnifiers may also be offered. For
improvement of visual fields prisms and mirror
systems may be prescribed.

Glaucoma medications in eye drops are


prescribed to control glaucoma. These may
contain drugs like Latanoprost, tafluprost,
travoprost which are prostaglandin
analogues.The drugs may include Beta-blockers
like betaxolol hydrochloride or carbonic
anhydrase inhibitors dorzolamide and
Sympathomimetics like brimonidine tartrate.
Glaucoma may also be managed surgically using
open microscopic surgery, laser corrections, etc.
At present there are no cures for
age-related macular degeneration(AMD)
especially of the dry variety.

HEARING
IMPAIREMENT

DEFINITION

A person suffering from hearing impairment has


difficulty in perceiving or identifying sound
clearly due to auditory problems

CLASSIFICATION :

Degree of Hearing Loss Ability to


perceive sound

Mild -Difficult to identify soft sound such as


whispering
Moderate -Unable to hear clearly what others are
saying during conversation. Hearing aids are
necessary.
Moderately-severe -Unable to clearly hear loud
noises such as telephone ring
Severe- Can only hear very loud noises and
sounds such as shouting or vacuum cleaner noise

TYPES OF HEARING LOSS :There are four types of hearing loss:


Auditory Processing Disorders

Conductive

Sensorineural

Mixed

Auditory

Processing Disorders

Auditory Processing Disordersoccur when the


brain has problems processing the information
contained in sound, such as understanding
speech and working out where sounds are coming
from.

Conductive

Hearing Loss

Conductive Hearing Loss occurs when there is a


problem with theOuterorMiddle Earwhich
interferes with the passing sound to the
Inner Ear.

Sensorineural

Sensorineural Hearing Loss occurs when the


hearing organ, the Cochlea, and/or the
auditory nerve is damaged or malfunctions
so it is unable to accurately send the
electrical information to the brain.
Sensorineural Hearing Loss is almost always
permanent.

Mixed

Hearing Loss

Hearing Loss

A Mixed Hearing Loss occurs when both


Conductive Hearing Loss and Sensorineural
Hearing Loss are present. The sensorineural
component is permanent, while the conductive
component can either be permanent or temporary

CAUSES
Congenital factors
Heredity
Viral infection during pregnancy, e.g.rubella
infection
Congenital defects such as anomalies of the ear,
nose or throat
Premature birth, birth asphyxia,excessive
bilirubin, etc

Acquired factors
Excessive earwax
Eardrum perforation
Middle ear effusion or infection
Otosclerosis or ear ossicle dislocation
Sequelae of childhood diseases such as measles
and meningitis
Head or ear trauma
Prolonged exposure to loud noise
Medication that may lead to hearing damage

SYMPTOMS
Early signs of hearing loss can include:
difficulty hearing other people clearly and
misunderstanding what they say,
especially in group situations
askingpeople to repeat themselves
listening to music or watching television
with the volume higher than other people
need
difficulty hearing the telephone or doorbell

finding

it difficult to tell which direction noise is


coming from
regularly feeling tired or stressed,from having to
concentrate while listening
During

infancy:
1-3 months old No response to sudden sound such
as banging of door or ringing of doorbell.
4-6 months old Unable to locate the sound source.
7-9 months old Do not look at the person being
mentioned, e.g. Where is UncleTom?.
10-12 months old No response to their names
being called or frequently used words or phrases,
e.g. No.

During childhood:
Delayed response to sound
Cannot hear clearly what others are saying
Show difficulty in locating the sound source
Pay more than usual attention to speakers facial
expression and lip movement whilelistening
Give irrelevant answers or misinterpret
instructions
Request for repetition during conversation
Show poorer ability to understand speech ` in a
noisy environment

Tend to turn up the sound volume of television


Incorrect pronunciation
Delayed language development
Poor attention in class
Frequent use of gestures to express themselves,
e.g. pointing to what they want
Easily irritated as a result of communication
difficulty

DIAGNOSIS
Physical exam.Your doctor will look in your ear
for possible causes of your hearing loss, such as
earwax or inflammation from an infection. Your
doctor will also look for any structural causes of
your hearing problems.
General screening tests.Your doctor may ask
you to cover one ear at a time to see how well you
hear words spoken at various volumes and how
you respond to other sounds.

Tuning fork tests.Tuning forks are twopronged, metal instruments that produce sounds
when struck.
Audiometer tests.During these more-thorough
tests conducted by an audiologist, you wear
earphones and hear sounds directed to one ear at
a time. The audiologist presents a range of
sounds of various tones and asks you to indicate
each time you hear the sound

TREATMENT
Removing wax blockage.Earwax blockage is a
reversible cause of hearing loss..
Surgical procedures Surgery may be necessary
if you've had a traumatic ear injury or repeated
infections that require the insertion of small
tubes that help the ears drain.
Hearing aids.If your hearing loss is due to
damage to your inner ear, a hearing aid can help
by making sounds stronger and easier for you to
hear.
Cochlear implants.If you have severe hearing
loss, a cochlear implant may be an option for you.

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