The field of ophthalmology is in constant evolution. Our ability to preserve and restore vision for patients with complex diseases such as glaucoma, diabetes and macular degeneration has vastly improved over the past decades. Yet, despite major advancements in both medical and surgical management, some patients’ vision loss continues to progress, often leading to permanent, irreversible functional deficits.
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The Scope of the Problem
In a recent survey quoted by the American Federation for the Blind, more than 20 million American adults self-describe as being visually impaired, despite having glasses or contact lenses, with almost half of these patients being some of the poorest in the nation.
Additionally, there are at least 3 to 4 million Americans who are considered legally blind, and given our aging demographics, there will be a predicted doubling of patients with age-related vision problems in the coming decades.
In the U.S., someone is considered legally blind if his or her vision is 20/200 best corrected (with glasses or contacts), or a constriction (tunneling) of vision to the central 20 degrees in the better seeing eye.
Patients may also be considered visually impaired even at the 20/40 — 20/70 level, however. At this stage, many patients may begin to complain of a loss of ability to perform daily living activities. Some examples of these limitations include reading, walking, use of mobile devices, cooking or other commonly performed tasks. Furthermore, these patients are generally ineligible for an unrestricted motor vehicle license, thus severely limiting independence and mobility.
Age can also impact vision. For example, many patients complain of progressive impairments in color vision and reduced contrast over time. Symptoms such as glare and light sensitivity, along with difficulty with vision at nighttime, are also extremely common. These symptoms can be just as disabling as loss of central or peripheral vision, and a comprehensive eye examination is warranted for anyone with these complaints to rule out eye disease.
Despite the many impairments and issues people face with vision loss, we are exceedingly fortunate to have many diagnostic and therapeutic options available to help.
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Low Vision Rehabilitation Services
There are a variety of services available to patients to help optimize their vision, and the care of these patients is generally best handled by a multidisciplinary team approach. This often includes many health care providers, such as occupational therapists, orientation and mobility specialists, and physical therapists working in conjunction with specially trained optometrists and ophthalmologists. These highly comprehensive services can be designed to meet individual patient needs, with services rendered not only in the office, but sometimes at patients’ homes, as well. Low vision rehabilitation services have evolved dramatically over the years, and low vision aides have advanced well beyond the traditional white cane. Specialized monitors, digital readers, mobile applications and other modern solutions to the challenges for people who are blind have been developed and continue to be innovated. Careful evaluation, along with an understanding of an individual patient’s needs and deficits, are critical in choosing the most appropriate therapeutic options and devices.
As the largest provider of vision care in the Bronx, New York, the Department of Ophthalmology and Visual Sciences at Montefiore Health System frequently treats patients with severe vision loss and major functional deficits. We are extremely fortunate to have a close partnership with Lighthouse Guild, based in New York, and the leading not-for-profit vision and health care organization. They have a long history of addressing the needs of people who are blind or visually impaired, including those with multiple disabilities and chronic medical conditions. Referrals of our patients for these critical services are being streamlined using electronic medical records, and the benefits of visual rehabilitation can be life-altering for many patients. Low vision specialists exist throughout the country in a large spectrum of practice settings.
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What to Do When You Need Help
If you or a loved one is having difficulties with vision, the first step is to reach out to an eye care professional for a baseline evaluation. Optometrists (ODs) and comprehensive ophthalmologists (MD or DO) generally serve as the first line in diagnosing and treating eye disease. Routine eye examinations should be part of comprehensive care, and your primary doctor can direct you to a health care professional who can help. Many patients may already have an eye care specialist, but have not yet been referred to a low vision rehabilitation specialist to help improve functional vision. Your eye care provider will likely have information about local and national resources, and it’s absolutely appropriate for you to ask if these services are right for you.
Online resources on the topic are also available and can be greatly helpful in updating patients to background and services. Searching for “low vision” on the American Academy of Ophthalmology website will link to a variety of articles and resources. The Lighthouse Guild website is another extremely helpful educational resource for visually impaired patients.
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Low Vision Services: Providing Hope and Improved Function for People Who Are Visually Impaired originally appeared on usnews.com
