NLIGHTENMENT VISION REHABILITATION
A Guide to Helping Your Low Vision Patients by Elisa DeMartino
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n the next 10 years or so, we’re going to see a growing number of visually impaired individuals — particularly in the aging baby boomer population. However, low vision also disproportionately affects other vulnerable people, such as those with low-income, smokers, diabetics, and people with chronic diseases. In a knowledge-packed, on-demand session on the first day of the American Academy of Ophthalmology (AAO) Virtual 2020 — held on November 13, 2020 — four experts outlined the importance of incorporating the needs of low vision patients into your practice.
Recognize the impact of vision loss Dr. Marc D. Bona introduced the topic by calling to attention the importance of visual impairment treatment in ophthalmology. He sought to increase ophthalmologists’ understanding of vision rehabilitation and how to approach the issue with patients. A patient-centered approach is crucial because people have different demands and will tolerate varying degrees of vision loss. Dr. Bona also pointed out that low vision makes someone twice likely to fall and four times likely to experience a hip fracture — along with that, a tendency for activity restriction, increased depression, and social isolation. They may also have difficulty driving, working, or even just carrying out simple daily tasks. “Developing strategies to overcome these barriers is a key part of the vision rehabilitation process,” Dr. Bona stressed, going over what ophthalmologists can do in their process of diagnosing low vision, educating patients, and directing them towards appropriate rehabilitation.
Understand the benefits of a low vision test Dr. Donald Calvin Fletcher — with over 30 years of low vision practice in his Wichita office — covered several of the same points but elaborated on testing technique. He is, in particular, a proponent of the SK Read test, explaining that the jumbled words can identify a pattern of mistakes where patients’ vision compensates. For instance, if the patient has a scotoma to the right, they may see the word “saved” as “save”. Another main focal point in his presentation was the need for better training with assistive devices. “Too often, we think about low vision rehab being, ’oh, give the person a magnifier [and] we solve all the problems for them’ — not the case.” He elaborated by telling a touching story of a patient who had loved to bowl but stopped since becoming visually impaired. His therapist accompanied him to the bowling alley and demonstrated how to use the magnifier. “With that little magnifier,” Dr. Fletcher explained excitedly, “he felt like he could be part of his social network again. He could push the buttons and be with the guys. And that was significant to him.”
Outline strategies for helping your patients Michelle Eileen Buck, OT and CLVT with the Henry Ford Health System, continued to outline in detail what specific tasks become impossible for low vision patients. She provided simple tips to incorporate, such as increasing lighting, minimizing glare with visors or light-colored sunglasses, and maximizing background contrast by, for instance, choosing a colored cutting board during meal prep. She also reviewed vision technology,
audio technology, and transportation alternatives while offering a final plug for low vision support groups. “Interacting with others who are going through the same circumstances will give low vision patients the opportunity to ask questions to the group and get new ideas and strategies about how to manage everyday tasks,” Dr. Buck shared.
Plan different models of care in low vision rehabilitation The session was brought to a close by Dr. Anne Riddering, OT and CLVT with 25 years working in rehabilitation with the Henry Ford Health System’s Center for Vision and Neuro Rehabilitation. She narrated a brief history of vision rehabilitation from the 1920s until now. Afterwards, Dr. Riddering got into some numbers, predicting that the amount of elderly and legally blind people in the United States would double between 2015 and 2030. She pointed to three studies that emphasized the prevalence of multimorbidity in vision-impaired people. After stressing that vision rehabilitation is a prevention tool for falls, lack of independence, problems taking medication, and depression, Dr. Riddering provided some final encouragement. “Studies examining outcomes have shown that after participating in visual rehabilitation programs, subjects show improvement in the following areas: visual abilities or function, including reading and mobility tasks, self-esteem, quality of life, and general health. We don’t just save eyes, we save lives,” concluded Dr. Riddering.
Editor’s Note: A version of this article was first published in CAKE & PIE POST AAO Edition (Issue 2, page 4).
| Dec 2020/Jan 2021
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