Waiting for the miracle: low vision rehabilitation

Vision rehabilitation continuum varies by doctor, model, and resources of the practice. What is important is to provide the patient with a range of options so that he or she may maintain the best quality of life after any vision loss. At a minimum, the AAO has established a SmartSight pamphlet to be distributed to all patients with a visual acuity beyond 20/40. The pamphlet lists information, services, and resources located largely on the East Coast in partnership with Lighthouse International in New York.

Without question, ophthalmologists have made tremendous positive impacts on the vision of many people around the world. That fact has become more evident as research and technology unveil new knowledge, techniques, and innovative procedures to benefit the visually impaired.

From the patient's perspective, losing his or her vision dramatically or gradually can be a traumatic and life-altering loss. To give the patient hope of experimental therapies in the future may keep the patient motivated for a while, but it does nothing to address how to live with the vision he or she has every day.

According to the American Academy of Ophthalmology's (AAO's) Vision Rehabilitation for Adults Guideline 2007, "Ophthalmologists have a minimum responsibility to recommend vision rehabilitation as a continuum of their care and to provide information about rehabilitation resources for patients with vision loss that impacts function."

Large private agencies and centers often provide a wide variety of services. On the West Coast, there are agencies such as the Braille Institute regional centers that provide services such as activities of daily living (ADLs) and orientation and mobility (O&M) training. The Center for the Partially Sighted in Los Angeles, founded by Samuel Genensky, who pioneered the use of closed-circuit TV (CCTV for video magnifiers) technology for low vision, also has staff to assist in the psychological aspects of vision loss.

At large medical centers across the country, such as the Casey Eye Institute, the Jules Stein Eye Institute, and the Mayo Clinic, there is a built-in relationship between ophthalmologists and low vision optometrists, to provide patient continuity.

Resource centers

Increased use of occupational therapists (OTs) on staff or ad hoc, due to the Medicare billable aspects of occupational therapy training, is helping to integrate low vision functional assessment with eccentric viewing (EV) training, ADLs, and assistive technologies at learning institutions with low vision centers, such as with Rebecca Kammer, OD, at the Southern California College of Optometry, Fullerton, or at the University of California, Berkeley, School of Optometry low vision clinic with Robert Greer, OD.

Kaiser Permanente, one of the largest HMOs in the country, is expanding its low vision centers to match the needs of its members, to provide more services, including a possible optional low vision provision to their health plans. The Veterans Administration has large regional Blind Rehabilitation Centers and is expanding its low vision centers throughout the country to keep pace with aging veterans' needs as well as the growth in head trauma-related vision loss in more recent vets.

Smaller group, individual, or remote practices can refer patients to resources, too, to provide that continuum for the patient. The functional examination can be conducted by low vision specialists, such as Ronald Cole, MD, in Sacramento and Don Fletcher, MD, in San Francisco. Although Drs. Cole and Fletcher employ slightly different assessment techniques employing a grid sheet and laser pointer, they follow similar approaches to EV training using an OT for rehabilitation.