disclosure statement of financial interest · disclosure statement of financial interest i, c....
TRANSCRIPT
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Disclosure Statement of Financial Interest
I, C. Stellingwerf, DO NOT have a financial interest/arrangement or affiliation with one or more organisations which could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
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Visuele problematiek in de werkomgeving
Nynke Stellingwerf, Willemien van de Werken Koninklijke Visio, Haren en OMCNoord/Hanzekliniek Groningen April 2017
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Inhoud
Wie zijn wij ICF Veel voorkomende oogaandoeningen op
‘t werk En de functiestoornissen
Van belemmeringen naar mogelijkheden (Adviseur visuele problematiek bij arbeid)
11-5-2017
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ICF..
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Keratoconus, corneadystrofieen
11-5-2017
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Keratoconus
Instabiele refractie Irregulair astigmatisme, myopie Vervorming, lichthinder Geen bril maar harde lenzen Gaat vaak lang goed
Progressie voorkomen met crosslinking Anders corneatransplantatie
11-5-2017
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Cataract
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Cataract - staar
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Cataract
Verlaagde visus en contrastzien Verhoogde lichtverstrooiing
Operatie Herstel definitieve bril 4 weken na operatie
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Glare - verblinding
11-5-2017
cave
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Glaucoom
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Glaucoom
Ongemerkt gezichtsveldbeperking: - Filling in Visus blijft lang normaal Afname contrastgevoeligheid
Behandeling vertraagt proces Bij symptomen geen verbetering te
verwachten
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Verlaagde contrastgevoeligheid
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Filling in
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Onderdiagnostiek
11-5-2017
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Maculadegeneratie
11-5-2017
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Maculadegeneratie
Verlaagde visus Normaal gezichtsveld (centraal scotoom) Droge MD: geleidelijk achteruitgang
Natte MD: mogelijk stabiel met
maandelijks injectie (anti-Vegf)
11-5-2017
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Metamorfopsie
11-5-2017
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Epiretinale fibrose of “pucker”
11-5-2017
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Serosa
Middelbare leeftijd Mannen Stress Self limiting met rest Evt laserbehandeling
11-5-2017
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Diabetische retinopathie
11-5-2017
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Diabetische retinopathie
Verminderde visus bij oedeem Verminderd gezichtsveld na pan-laser Bij oedeem behandelen met laser en
anti-Vegf (lang traject) Laser heeft gevolgen voor visus en
gezichtsveld, en zicht in het donker
11-5-2017
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Retinitis pigmentosa
Zeldzaam, vaak erfelijk, vroege en late vormen Begint met nachtblindheid Daarna gezichtsveldbeperking Visus vaak lang gespaard Progressief en (nog) geen goede
therapie Soms combinatie met slechthorendheid:
Usher
11-5-2017
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Nachtblindheid
11-5-2017
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Floaters en netvliesloslating
11-5-2017
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Netvliesloslating (ablatio retinae)
Acute gezichtsvelduitval Visusverlies als niet snel behandeld
Na operatie gezichtsveld terug Visus niet altijd weer goed Bij operatie met gas weken slechtere
functie (cave vliegen, bergen etc)
11-5-2017
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Floaters (mouches volantes)
Veel voorkomend Meestal onschuldig Wel hinderlijk Soms voorbode van netvliesloslating Ook bij uveitis, bloedingen
Opties: goede refractie Evt laser of vitrectomie
11-5-2017
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Computervisie syndroom
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Computervisie syndroom
Geirriteerde, pijnlijke ogen Visusklachten (focussen, dubbelzien) Oogoppervlak klachten (waterig, droog,
geirriteerd, contacctlensproblemen) Pijnklachten rug nek schouders
(gedwongen houding multofocale glazen)
11-5-2017
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Droge ogen en blepharitis
11-5-2017
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Oorzaken
Meestal presbyopie (of andere ohk oorzaak) Combinatie met hoge eisen – veel in
dezelfde houding
11-5-2017
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Oplossingen
Leesbril / computerbril monofocaal Bril af Bifocale bril, Trifocale bril Monovision Multifocale IOL of contactlens Kunsttranen
Bewustwording, afwisselen werk/pauze
11-5-2017
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Computerbril
11-5-2017
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Kleurenblindheid
8% van de mannen, aangeboren Soms slechtziend (verworven) Meeste banen weinig problemen Te weinig aandacht websites
11-5-2017
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11-5-2017
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Gezichtsvelduitval door NAH (30%)
11-5-2017
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Visuele klachten NAH (70%)
11-5-2017
Verminderde visus, contrastzien, accommodatie, convergentie Oogbewegingsstoornis Nystagmus Veranderde lichtgevoeligheid (94%!) Zowel meer licht nodig als meer lichthinder Kleuren minder helder (21%) Moeite met dieptezien (21%), stereozien Diplopie (al of niet bij beweging) Visuele illusies en hallucinaties Visuele perceptie stoornissen
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Revalidatie bij Visio
Intakegesprek Onderzoek optometrist (of oogarts, orthoptist, (neuro)psycholoog) Multidisciplinair overleg Advies/ training mobiliteit (incl advies naar CBR), ICT, lezen, psychologische begeleiding, maatschappelijk werk, Groepen voor bv vrije tijd, uitleg omgeving Advies arbeid
11-5-2017
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Leeshulpmiddelen
11-5-2017
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ICT
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Basisverlichting en taakverlichting
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Hulpmiddel mobiliteit
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