Taking on Low Vision

As the global population ages, the optometric profession faces the growing challenge of addressing the low vision needs of the elderly. Is this a service you provide in your clinic? This demographic shift necessitates a deeper understanding of how age-related changes in vision affect daily living and patient care. In response, optometrists can focus on tailored strategies to manage and mitigate the effects of low vision in patients. By integrating comprehensive assessments, adaptive technologies, and personalized care plans, optometrists aim to enhance functional independence and overall well-being for the aging population.

This article explores the unique challenges involved in managing the low vision needs of the geriatric community and looks at some of the innovative solutions available, emphasizing the critical role of specialized patient care in improving quality of life for older adults.

THE LOWDOWN ON LOW VISION

An estimated 4 million Americans have low vision,¹ which is a chronic visual impairment that can’t be corrected with glasses, contact lenses, surgery, or medical treatments. Low vision and blindness are leading causes of disability in US citizens.^2,3 According to one study,⁴ both low vision and blindness are expected to more than double in the next 30 years, with more than 9.5 million living with low vision.

COMPREHENSIVE CARE

As an associate in a private practice, I provide care to a diverse range of patients, from young children to seniors. What I love about primary care is the opportunity to encounter and address a wide array of patient needs. However, managing difficult cases can be physically and emotionally challenging—for both clinicians and patients. For example, despite following all recommended protocols for a patient with age-related macular degeneration, it’s absolutely in the realm of possibility that their vision will continue to deteriorate. Conditions such as these can significantly affect a patient’s daily functional vision and overall quality of life.

What do you do when your treatment strategies fail? How do you handle difficult conversations with patients? I am a visual learner, so I like to have displays or hand-outs, whether electronic or physical, to help me explain things. Getting patients to understand what is happening to them and why can sometimes make a world of difference in helping them cope with their diagnosis.

CAN WE DO IT ALL?

I firmly believe we cannot do it all—at least not to a certain standard. As much as I wish I could convince myself, I know my expertise ends when it comes to advanced care of low vision. We were all taught low vision in school and are capable of managing patients with vision impairment, but I find myself often questioning whether I am doing enough for the patient or whether my efforts are efficient for myself long term. We have a great network in my area where I can refer patients to a local low vision optometrist for help in properly managing these patients. This is another wonderful aspect of optometry that allows us to collaborate and work together on a mutual patient. There is an organization for the blind in Charlotte that offers numerous online and in-person resources beyond visual assistance, including Braille education, to help visually impaired individuals lead more fulfilling lives. There might be a similar organization in your area. As noted in the last column, technology can be extremely helpful with efficient referrals and communication.

EVOLVING METHODS OF MANAGEMENT

The integration of technology in optometry is transforming patient care in remarkable ways. Tools such as smartphone apps and even built-in smartphone settings can enhance contrast sensitivity and provide real-time assistance, while electronic magnifiers help patients read and engage with their environment more easily. These advances in technology not only improve diagnostic accuracy, but also empower patients to regain independence and achieve their personal goals.

Although I do not manage a great deal of patients with low vision, I always provide support for my patients until they can be seen by a specialist. As a low vision novice, below are some guidelines I find helpful when caring for these patients.

• Determine their underlying visual goal
• Avoid performing a refraction in the phoropter
• Always determine whether visual acuity is with eccentric viewing
• Avoid prescribing progressive lenses
• Incorporate lens tints, which can help aid visual strain or glare
• Include interdisciplinary care: occupational therapist, low vision specialists, counseling, and more
• Provide patients with resources relevant to the stage and level of their visual ability

Some of the tools we can suggest to patients range from high-plus reading glasses, magnifiers, electronic devices, wearable devices, assistive software, tablets, large print books, audible books, smart glasses, and more.

DO YOUR BEST; IT MATTERS

As our encounters with low vision increase along with the aging population, we as optometrists are leading the way in delivering crucial care and facilitating transitions to new treatment options. How crucial is this care? Offering patients access to low vision services could lower their risk of mortality, considering the fact that low vision can decrease a patient’s activity level and increase the risk of accidental falls, which is a leading cause of death in individuals 65 years of age and older.⁵ It is therefore imperative for us as full scope optometrists to embrace new technologies and personalized care strategies that can help patients maintain independence and significantly enhance their quality of life, regardless of our level of low vision expertise. Take it one step further and make a connection with a low vision specialist in your area. Or, familiarize yourself with the resources provided by the American Academy of Optometry (bit.ly/AOAvisrehab). Another option is to become a Diplomate of the American Academy of Optometry's Low Vision Section (bit.ly/AAOptLVS). Always keep striving for more in our profession and continue to find your passion!