Providing Rehabilitation to People Who Have Restored Vision Through a Retinal Implant

1
Providing Rehabilitation to People Who Have
Restored Vision Through a Retinal Implant

• Duane R. Geruschat Ph.D. CLVT, COMS

2
Disclosure

• The presenter is a collaborator with
• Second Sight Medical Products
• Supported by
• R01 EY021220 to Gislin Dagnelie, Ph.D
• University of Pennsylvania/CHOP

3
Background Information

• I am an EXPERT!!

4
What is an Expert?

• An expert is a person who has made all the
  mistakes, which can be made, in a very narrow
  field. Niels Henrik David Bohr (1885-1962)

5
This Is Real

• FDA approved the Argus II for commercial use in
  the US in February 2013
• Medicare approved payment (inpatient and
  outpatient settings) effective October 1, 2013

6
Clinical Sites 2013
Ann Arbor, MI Atlanta, GA Baltimore, MD Chicago,
IL Cleveland, OH Dallas, TX Durham, NC Los
Angeles, CA Miami, FL Nashville,
TN Philadelphia, PA San Francisco, CA Toronto On
7
You Will Be Involved
Clients will hear/read and contact you for
information
8
Goals For This Presentation

• What type of functional vision and activities
• Patient profile
• Providing rehabilitation instruction
• Best Candidates
• Challenges using prosthetic vision

9
What type of functional vision?
10
(No Transcript)
11
(No Transcript)
12
Simulation of Argus II

• Filter simulation video

13
Counting bowls
14
Walking A Line
15
Counting white parking lines
16
What These Videos Mean?

• The Blind Can See
• Low Visual Acuity
• 20 Degrees of Visual Field
• Takes time to process the image
• Ultra Low Vision

17
Patient Profile

• RP severe visual impairment
• Average years since blind 15
• Lived as person who is blind
• Re-introduction of vision
• Sequence of vision loss
• Sighted
• Low vision
• Blind
• Ultra low vision

18
Patient Profile

• Psychological dynamic
• Approach is different
• Technology is unique ultra low vision
• Sequence of life events

19
Principles of Patient Care

• Patients have varying levels of skills with
  non-visual strategies
• Many tasks can be completed with non-visual
  alternatives
• More successful patients seem to have good
  blindness skills
• Technology which enhances good blindness skills

20
Rehabilitation

• In Clinic rehabilitation
• Community based rehabilitation

21
In Clinic Rehabilitation

• Goal is to Teach
• 1 Components of system
• 2 Manipulation of controls
• 3 Basic visual skills

22
Argus II System
23
In Clinic Rehabilitation

• Goal is to Teach
• 1 Components of system
• 2 Manipulation of controls
• 3 Basic visual skills

24
Video Processing Unit (VPU)
25
Filter video if it can work
26
In Clinic Rehabilitation

• Goal is to Teach
• 1 Components of system
• 2 Manipulation of controls
• 3 Basic visual skills

27
Eye - Head - Camera Maintaining Alignment and RF
Link
28
Argus II Instructional Kit
29
What is the Best We Can Expect?
30
What is the Best We Can Expect?
31
Community Rehabilitation

• Goal is to Reinforce and Teach
• Components of system
• Manipulation of controls
• Basic visual skills
• Teach INTEGRATION OF VISUAL SKILLS

32
Community Rehabilitation

• What to do on day one?
• You know how to do rehabilitation
• Do what you always do
• This is a new and unique technology but its
  still blind rehabilitation

33
Community Rehabilitation

• What to do on day one?
• Good assessment of functional abilities without
  Argus II
• Functional vision assessment
• Set goals

34
Community Rehabilitation

• Apply good low vision rehabilitation techniques

35
The Visual Environment is Important
36
The Visual Environment is Important
37
The Visual Environment is Important
38
Contrast is Important
39
Community Rehabilitation

• Good assessment of blindness skills
• Environmental considerations
• Argus II is a supplement, an enhancement to good
  blindness skills

40
Visual Integration

• ADL
• Sorting Laundry
• Setting Table

41
White Plate Black Background
42
Black Plate Black Background
43
Black Plate Black Background
44
Visual Integration

• Orientation and Mobility
• Crossing Street
• Midblock bus stop
• Turning house lights off

45
Crossing the Street
46
(No Transcript)
47
Midblock Crossing
48
Lights and Windows
49
Visual Integration

• Quality of Life
• Fireplace
• Television
• Just feeling sighted again

50
Visual Integration

• Development of visual memory

51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
Case Studies

• Finding foyer light of apartment complex
• Turning lights out at night in home
• Fireworks
• Christmas trees
• Fireplace
• Full moon
• Detect people

55
Good Candidates

• Clear goals
• Observable and measurable
• Some level of independence as a blind person
• AND - OR
• Quality of life

56
Unexpected Learning
57
Personal History

• Ordering effect
• Its very difficult to improve
• independence when a person is
• Already independent
• Look to enhance independence
• Different way to function but may not
• improve independence

58
The Challenge of Integration

• Cochlear implant
• Electronic Travel Aids (ETA)
• Laser Cane
• Sonic Guide
• Give information but is it useful?
• Can it be integrated with other sensory
  information or does it compete?

59
The Challenge of Integration

• Electronic Travel Aids (ETA)
• Use only for specific situations
• Example Foyer Light
• Crosswalk lines

60
Mike May Crashing Through

• I feel like I have to close my
• eyes to hear people

61
Quotes from Crashing Through

• Touches things in order to see them
• Context and expectation are everything
• Like listening to a foreign language
• Sees things that are in motion
• Closed his eye and the world went still

62
The Challenge

• Integrating ultra low vision with
• other sensory information

63
Closing Thoughts

• Argus II can improve independence
• Often enhances independence

64
Thank you for your time and interestDuane R.
Geruschat Ph.D.
65
(No Transcript)
66
Watch Carefully You May See A Giraffe