By Rashid M. Taher, MD, and Marc Jay Gannon, OD
May 1, 2019
Referring patients begin a process of vision rehabilitation.
Forging a partnership with a low-vision specialist can benefit both retina specialists and their patients. Here we share 5 tips that have helped make our long-standing working relationship successful and one that has changed the lives of hundreds of their shared patients.
The job of the retinal physician is to treat patients’ medical condition, cure it when possible, and stabilize and retard its progression. What they must always consider is why patients would subject themselves to surgery or the trauma of getting an injection directly into their eye. The simple answer is that patients want to see. They want to participate in those activities that make them feel vital, happy, and authentically themselves. Even if the condition is cured or stabilized, without restoring sight, clinicians have missed the mark as far as patients are concerned.
There are 2 main categories in low-vision rehabilitation: those services that are adaptive or compensatory, and those that are visually restorative. The difference is one method teaches people how to be blind, the other teaches them how to see.
With adaptive and compensatory strategies, the patient is trained to adapt to their vision loss and compensate with another sensory modality. An example of this would be marking the dials on an oven with bump dots. In this way, a patient could feel the dots placed on the dial and on a predetermined temperature on the oven lining up when the dots come together. This would enable them to know the oven was on and set to a specific temperature. This is a survival skill for the blind, enabling a patient who could not set the oven and cook to accomplish this activity of daily living.
In a restorative approach, patients have their vision assessed to determine where they have residual areas of vision. These would be evaluated as to size, location, and sensitivity of the individual sites. If an area is found, a telemicroscopic system may be created and a program of therapy instituted to teach the patient to view properly through the scope to regain visual function. These patients could then go into any kitchen with the telemicroscope and see the dials on the oven and visually set the temperature. They would not be limited to only using stoves that had been marked — they could use any stove, like any other sighted person.
There is a wide variety of low-vision services:
When choosing a low-vision specialist for your patients, look for those who have the greatest access to a wide range of devices and services. They will prove to be the best in providing your patients with the most comprehensive and functional level of vision restoration.
Low vision devices come in a wide range of design and function:
One of the greatest fears humans share is the loss of sight. Loss of sight leads to loss of the ability to perform activities and often results in dependency on others and feelings of isolation, inadequacy, depression, anger, as well as other psychological symptoms of vision loss.1 Loss of sight can be terrifying and at times even result in loss of life, either accidently or intentionally. In 2006, a global outreach campaign to raise awareness of the little-known psychological effects of AMD was launched. The campaign aimed to demonstrate that basic support to improve AMD patients' quality of life — early access to medical expertise, diagnosis, treatment, and low-vision programs, including counseling — is vital.2,3 When the vision team restores functional vision, there are wide-reaching positive effects in all of these areas.
Eye care clinicians might not think of these interventions as lifesaving, but often they are. When retina specialists send patients to a low-vision specialist, they provide the continuum of care that improves patients’ visual and psychological outcomes, self-esteem, safety, and confidence.
The American Academy of Ophthalmology (AAO) promotes referral to low-vision specialists and has created materials to educate ophthalmologists on vision rehabilitation.4 In a video created by the AAO’s vision rehabilitation committee, AAO CEO David W. Parke, MD, emphasizes the importance of referral for vision rehabilitation for patients who are starting to lose their vision. He adds that starting the process early better enables patients to involve themselves in vision rehabilitation.4
Many patients ask for assistance and demonstrate a desire for help. They yearn to enjoy the better quality of life, safety, and confidence that restored vision function may provide for them. Many are told, “There is nothing more that can be done.” This is not the case anymore, and it is the vision care team’s duty to provide patients with a better continuum of care.
Acuity is a potential rule of thumb for considering a patient for referral. Patients who are demonstrating acuities of less than 20/60 in their better eye are logical candidates, but patients with acuities better than this may still be having problems enjoying those activities that permit them to be fulfilled and independent. On the other end of the scale, patients who may only demonstrate hand motion centrally may have eccentric islands of vision that may have them reading 1M print, and seeing the faces of loved ones, with proper assessment, instruments, and therapy.
Ophthalmologists can feel defeated when treating patients who continue to lose vision. However, sometimes, vision cannot be saved. Retina specialists can get so caught up in the medical solutions for saving vision that they fail to remember what’s most important to patients. To the retina specialist, success is a stable eye. To patients, a stable eye is a necessary tool for their goal: seeing.
Vision rehabilitation is the standard of care for patients who have lost functional vision. Ophthalmologists have the ability and power to make a great difference in the lives of patients. Referral to a low-vision specialist empowers retina specialists to help patients improve their quality of life.