PART I
Communication During Assessment of Vision of Deafblind Person
Deafblind Patients in Departments of Ophthalmology
The total number of deafblind individuals is relatively small and they are not accustomed to asking for services since they often have no information about the availability of services. It is therefore hardly surprising that many physicians have never met a deafblind person. If they have encountered such a patient, the focus of treatment centred on his disease, and not on the patient as a person.
Most ophthalmologists and audiologists do not recognize deafblindness as a special problem, and this often becomes the greatest difficulty related to medical services for the deafblind population: their hearing is assessed by one group of professionals, their vision by another group and these two groups of specialists usually do not meet to discuss deafblindness.
The loss of both distance senses is a specific problem causing unique rehabilitation needs in communication, mobility and activities of day living (ADL). Therefore there should be at least one, preferably two, professionals in each university eye department and ear, nose and throat (ENT) department or speech and hearing department, well educated in the problems related to deafblindness. They will not see deafblind patients very often, because in the great majority of cases the progression of the disease is very slow and the need for reassessment is rare.
During vision assessment of deafblind patients the following tests are employed:
- traditional clinical tests
- clinical tests modified to facilitate communication
- complex test situations in clinical or experimental laboratories.
In general, most of the tests that are used in the visual assessment of the normally hearing visually impaired are applicable to the examination of deaf persons, too. The selection of tests varies in individual cases, depending on the disease, the degree of visual impairment, and the language level.
The assessment usually has two goals: a further clarification of the clinical diagnosis of the eye disorder, and an in-depth analysis of the type of vision loss for rehabilitation purposes.
Basically we have to assess the following functions:
- Oculomotor functions, including accommodation
- Visual field
- Visual acuity
- Contrast sensitivity
- Color vision
- Adaptation.
We should also assess the quality of motion perception and rod-cone interaction in all diseases that may cause abnormal perception because of diffuse retinal lesions.
Before visual assessment of visually impaired, deaf or hard of hearing persons can be executed properly, both the ophthalmologist and the interpreter have to learn how to communicate in this rare situation where vision is being used for communication at the same time as it is being assessed.
The third subject in the assessment, the patient, needs additional new information as well. For them there is the text on "Eyes and Vision". By educating all three persons involved in the assessment of vision we may get better results in the future.
