Low Vision Rehabilitation
Life is experienced through the senses - the sound of a loved one’s voice, the warmth of a touch, a scent or flavor that evokes memories. Perhaps the most vivid source of sensory information is the sight that colors our world, shows us its depth and activity, and serves as a gateway to the information in written words, pictures and the unspoken language of human interaction.
For many of us, sight is the sense we would miss most keenly. Though science has made great strides in restoring and protecting vision, even with the best treatment, there are still patients whose vision remains only a shadow of what it was or might have been.
However, that doesn’t mean nothing can be done to help people with limited vision reclaim their independence and improve their quality of life.
“Being able to read again is the most common goal our patients want to achieve,” Dawn DeCarlo, OD, director of the Center for Low Vision Rehabilitation at UAB Eye Care said. “For example, to someone with age-related macular degeneration, a simple illuminated magnifier that costs less than $100 that allows them to read a medicine bottle and the directions to microwave a meal can mean the difference between being able to age in their own home or having to go into assisted living, which they may not be able to afford.
“Another common goal is being able to drive again. We live in a society where so much depends on being able to get where you need to go, which is particularly difficult where public transportation is limited,” DeCarlo said. “With the help of a spectacle-mounted telescope, patients with some types of visual disorders can see well enough to drive again, which restores their freedom and autonomy, and may allow some of them to continue in their career.”
The center is one of only two low vision rehabilitation clinics in Alabama and serves hundreds of patients annually from across north and central Alabama and surrounding states. In addition to the diseases of aging, stroke and complications from systemic diseases or trauma, disorders such as retinitis pigmentosa, visual conditions related to albinism and congenital eye disorders bring patients of all ages to the rehabilitation center.
“I’ve seen patients as young as four months and we had a 105-year-old lady who wanted help with visual limitations that were keeping her from doing what she wanted to do,” DeCarlo said.
For DeCarlo and fellow clinic optometrist Lynne Stevens, OD, the first step in vision rehabilitation is evaluating patients and determining which tool can be most effective in addressing their condition and helping them achieve the goals that are important to them.
“If they haven’t been receiving eye care and need new glasses, we take care of that. The other tools that might be helpful aren’t necessarily complicated or expensive. Low cost tools can make a big difference, which is helpful, since refraction isn’t covered by most health coverage, and many of our patients are on a fixed income and can’t afford a major expense.
“In some cases, we teach patients to use other parts of their retina to see past scar tissue. Sometimes they need more lighting or a glare filter. For some patients the issue isn’t making things larger, but making them smaller. If they have a small central field of vision, magnifying makes the problem worse by showing them bigger pieces of less of what is there, so they need a different approach.”
For school-age children, the first issue that needs to be addressed may be an accurate assessment of what their visual abilities are so teachers and parents will have a better understanding of what they can do and how to help them.
“We do a detailed battery of tests and write a comprehensive report for teachers so the child’s vision can be taken into account in the learning environment.”
Sometimes patients are referred for specialized occupational therapy to help them deal more effectively with the visual aspects of everyday activities. Occupational therapy for vision problems wasn’t covered by Medicare until recently, and therapists trained to work with visually impaired patients aren’t available everywhere. However, they can offer a great deal of help in reducing or eliminating barriers, and teaching patients how to better manage their health.
“For example, if we have diabetics who can’t see well enough to measure insulin or check their blood sugar, we can teach them to use alternate methods. Our occupational therapists can also teach them to prepare the healthy meals they need, even if they don’t see as well as other people.”
Examining low vision patients, evaluating complex health issues, determining the most effective tools, and teaching patients to use them typically takes longer than an average eye exam. Fortunately, support from foundations and charities has helped to keep rehabilitation services affordable. For patients who need glasses or specialized devices they can’t afford, the center has been able to find grants from charitable organizations.
“Sight Savers of America, the Eyesight Federation of Alabama, and charities such as the Henry U. and Henry G. Sims Memorial Foundation do so much good work helping people who have vision problems improve their quality of life,” DeCarlo said.
Many more people could be helped if there was a greater awareness of low vision rehabilitation and what it can achieve.
“Some older patients think the restrictions of limited vision are just part of getting older,” DeCarlo said. “Physicians know that eyes are the windows into seeing what is going on in a patient’s systemic health, but many aren’t accustomed to thinking in terms of rehabilitation for patients with vision problems that can’t be corrected by other forms of treatment.
“The center receives referrals for many patients from their optometrist or ophthalmologist, and some patients refer themselves. We’re also seeing quite a few referrals from neurologists and other specialties where rehabilitation is a customary part of follow-up care,” DeCarlo said.
“We’re working on outreach and education to improve awareness of the potential for rehabilitation to help patients do the things that matter to them. If there is one thing that is important to your patients that low vision is keeping them from doing, it’s time to refer them for an evaluation.”