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Are you one of those people that has been told “sorry, but there is
nothing more that can be done to improve your vision.” If you are or
you know somebody that has a vision loss, here is some good news for
you. The eye care field has a little known specialty called “Low Vision
Rehabilitation.” It is currently one of three focus areas for the
National Eye Institute’s National Eye Health Education Program
(NEI/NEHEP). The reason why this eye care specialty is gaining so much
public attention is simply because it offers solutions and
opportunities for the visually impaired to regain vision. Vision loss
is now a growing problem with the aging of America. Too many seniors
are accepting vision loss as a part of the aging process without
exploring opportunities to maximize remaining sight and other senses.
Low vision rehabilitation is a “treatment modality” just like eye
surgery and eye drug therapy. It represents the continuum of eye care
when vision loss cannot be avoided. The good news is that low vision
rehabilitation represents “hope supported by science” for people with
vision loss.
One reason why low vision rehabilitation has been a well kept secret
is because it is practiced by a limited number of eye doctors. Today,
low vision rehabilitation is part of the professional training of both
optometrists and ophthalmologists. Eye doctors are encouraged to
recommend low vision rehabilitation to any individual that has vision
loss that cannot be restored by eye surgery or conventional glasses.
Naturally, people are always seeking “the cure” for any vision loss but
cures are not always possible. What is possible is learning how to live
with reduced vision. What’s exciting is the special types of glasses,
devices and technology that can significantly improve visual abilities
if an individual is willing to reinvent themselves. In other words, a
person with vision loss can receive rehabilitation to learn how to use
their eyes differently with outcomes that could include a return to
reading, writing, seeing faces, watching T.V., playing cards and even
driving. One must keep in mind that the term rehabilitation is a
process that requires time and professional guidance. New skills are
not gained overnight rather with persistence and determination.
Nonetheless, the rewards from rehabilitation far exceed the feelings of
depression, frustration and anger from the prospects of losing
independence.
So what’s involved with low vision rehabilitation? Perhaps the best
program models involve a multi-disciplinary approach involving a
trained low vision rehabilitation doctor, rehabilitation
teachers/therapists or occupational therapists, counselors,
assistive/adaptive technology specialists and orientation and mobility
specialists for starters. The low vision rehabilitation doctor works in
conjunction with the referring eye doctor. The low vision
rehabilitation doctor provides a clinical examination of remaining
visual abilities with an emphasis on function and provides the
important individual’s prescriptive rehabilitation plan. This is the
“game plan” to be utilized by all the other vision rehabilitation
professionals to help the visually impaired individual reach his or her
maximum potential. While the rehabilitation doctor supervises the
rehabilitation process, each member of the rehabilitation team plays an
important role in the outcome of the rehabilitation process.
Rehabilitation teachers/therapists and occupational therapists provide
adaptive training utilizing prescribed low vision glasses and devices.
These teachers/therapists and therapists provide valuable insight to
establishing the proper environmental adjustments and techniques to
address activities of daily living. Teachers/therapists and therapists
are guided by the rehabilitation doctor’s recommendations which are
incorporated to return independence to people with vision loss.
Assistive/adaptive technology specialists can offer insight utilizing
technology such as CCTV Systems (reading machines), enhancement
software that can enlarge font size or provide voice output, scanners
and much much more. O & M specialists (orientation and mobility
specialists) provide valuable insight and instruction for safe travel
and mobility needs. Counselors’ help people overcome the naturally
occurring feelings of depression and provide strategies for coping over
the loss of vision. Counselors often lead support groups that provide
opportunities to learn from other people how to meet the challenges of
a vision loss. The above mentioned rehabilitation team can truly be a
“dream team” for a person without direction living with vision loss.
Participating in a low vision rehabilitation program requires time,
a desire to better yourself, money and it helps to have a loved one
accompany you. Typically, low vision visits can take more than two
hours. Low vision doctors take their time and spend time providing
necessary patient education. Most low vision doctors need one hour to
educate, examine and prescribe low vision rehabilitation.
Teachers/therapists, therapists and assistive/adaptive technology
specialists typically work in fifteen minute increments and often an
initial visit takes thirty to sixty minutes. Orientation to
assistive/adaptive technology can take another hour. Training with an O
& M specialist can also take a significant amount of time depending
on travel needs and visual abilities. Finally, counseling can also
involve well spent time depending on issues related to vision loss. All
this time is like the time one spends going to school rather than most
people’s concept of a quick visit to the eye doctor’s office. As they
say, when you’re having fun, time flies! If you are learning how to
return to living and restoring happiness to your soul, the time is the
therapy you need. The money part can be challenging also.
Unfortunately, Medicare (CMS) does not pay for low vision prescription
glasses, devices or technology. Medicare does provide some coverage for
low vision rehabilitation services. Sometimes help can be attained for
those in need from the Department of Human Services, sometimes from
service clubs and sometimes special grants may be available to
subsidize people who would benefit from low vision rehabilitation. Most
low vision glasses, devices and technology is affordable. Although the
cost for necessary low vision tools may at first seem expensive, when
considering gained abilities and their impact on the quality of one’s
life, the expense is truly justified. As one low vision patient told
me, “all my low vision glasses, tools and technology don’t come close
to the cost of my last car and I had no trouble justifying that
expense!” People must invest in their independence.
Perhaps the most important issue is the individual’s willingness to
participate and willingness to try new approaches. The saying “you can
take a horse to water, but you can’t force the horse to drink” sadly
sometimes applies to people with vision loss. It is truly hard to cross
the bridge of accepting a vision loss and some people become stubborn
to change. Some will openly say “if I can’t be exactly as I was before,
I’m not interested.” Fortunately, most get tired of cutting their nose
off in spite of their face and begin to realize that improvement is the
next best thing to cure. So as you can imagine the psycho-social
aspects of the rehabilitation process are just as important as the
medical aspects. People naturally seek glasses that look normal and
want to do things in a normal fashion. Sometimes this is not possible
and people must learn to do things differently. Doing things
differently is still doing instead of not doing. Attitude plays an
important role in rehabilitation. People with positive attitudes seem
to achieve the most out of their rehabilitation program. Many consider
themselves “the Goodwill Ambassadors” of people with vision loss rather
than victims of vision loss. Having a loved one present during the low
vision rehabilitation program is also very helpful because it provides
an extra set of ears hearing and eyes witnessing what needs to be done.
This “coach” becomes a valuable support system going home with the
visually impaired individual to further advance the visual
rehabilitation program and this even helps provide welcomed therapy to
the coach who begins to see a positive direction for their visually
impaired loved one.
All of our lives we are use to going to the eye doctor to get that
“perfect pair of glasses” that will help us see at any distance near or
far. When suddenly those glasses don’t exist we typically aren’t ready
for any alternatives. People with vision loss will probably require
multiple glasses and devices to meet their every visual need. Like an
apprentice carpenter with an empty tool box, the low vision
rehabilitation program helps to identify the necessary tools to restore
vision once lost. It should be pointed out that some types of vision
loss cannot be significantly restored, but that doesn’t mean other
senses can’t take over to return independence. In fact, most people
with vision loss benefit enhancing all senses not just the visual
sense. Many people with vision loss can be helped with high plus
reading glasses, prescription magnifiers, telescopic glasses and
special absorptive filters all prescribed by low vision rehabilitation
doctors. These valuable tools all require training and a spirit to
adapt to a new method of seeing. Many people who experience this new
type of sight are very excited and feel a sense of relief with the
return to seeing what they want to see. Typically, a low vision doctor
will spend multiple visits as does the other vision rehabilitation
professionals to accomplish best results. People with vision loss
continue their on-going comprehensive eye care with their specialist
and are co-managed with the low vision rehabilitation doctor annually
or as indicated.
So where do you find low vision rehabilitation programs? Begin by
asking your eye doctor where he or she recommends your referral. Some
private practicing eye doctors are very skillful in low vision
rehabilitation and can make additional referrals when indicated.
Schools of Optometry and Residencies of Ophthalmology are typically
good sources. The American Optometric Association and the Academy of
Ophthalmology are also good sources. The National Accreditation Council
(NAC) for agencies serving the blind and visually impaired is also an
excellent source to locate accredited low vision rehabilitation
programs. Many major cities have “Lighthouse” agencies serving people
with a vision loss and contacting local governmental Department of
Human Services can also be helpful. Sometimes just asking your friends
and your neighbors can also get you in touch with excellent
rehabilitation programs. Beware of programs that do not include low
vision rehabilitation doctors.
If you like to surf the web, there are many good websites to check
out. Some websites are eye disease specific while others may be broader
based with information and assistance on a variety of topics relative
to people with vision loss. Examples of websites available might
include the National Eye Institute/National Eye Health Education
Program, the Foundation Fighting Blindness, Prevent Blindness America,
the American Foundation for the Blind, AMD Alliance International,
Lighthouse International, Deicke Center for Visual Rehabilitation and
many many others. There are also many support groups. There are also
many manufacturers of low vision devices and technology that can
provide good information like Optelec, Enhanced Vision Systems, Designs
for Vision, Eschenbach, Coil, Walters and again many others. The
American Optometric Association’s Low Vision Rehabilitation Section is
another excellent source of information.
What needs to be done to improve opportunities for people with
vision loss? There is no doubt that we need to change “the culture” of
our society and professionals regarding their view of what can be done
for people with vision loss and what important contributions people
with vision loss can make to society. As a low vision rehabilitation
doctor with twenty-five years of experience working with people with
vision loss, I have personally witnessed exceptional abilities
developed despite vision loss. I have witnessed visually impaired
children competitive in the classroom thanks to the appropriate tools,
technology, training, support and human spirit. These abilities have
brought tears of joy to the parents and grandparents of visually
impaired children with the realization of a meaningful life ahead. I
have witnessed job opportunities realized despite vision loss. Again, I
have witnessed tears of joy from family members who depend on such
successes. I have seen people able to participate in all the important
aspects of life without vision loss holding them back. Vision losses
don’t determine how happy or how successful an individual will be, the
individual along with some good rehabilitation can determine that. So
society needs to see the whole person and not only a person’s vision
loss. Doctors must not feel vision loss without cure is a failure. They
must continue to seek cures, but in the meantime, devote equal
attention to maximizing visual abilities and other senses. Our
government and specifically, Medicare, and third party insurance must
support low vision rehabilitation and the necessary tools to reach
favorable outcomes just as support is provided currently for other
rehabilitation efforts. We need to encourage more doctors to be
actively engaged in low vision rehabilitation as well as other vision
rehabilitation professionals. We should challenge barriers imposed for
awareness, access and participation in low vision rehabilitation for so
many Americans in need.
I personally think the future for people with vision loss
is very hopeful. I believe more devotion to research for
both cures and better rehabilitation will yield new advancements
and better vision for the visually impaired. It amazes me
that despite vision loss rated as the third worst fear of
Americans and with the growing number of people with vision
loss in America that our society isn’t demanding more
attention to legislation to “change the culture”
in America to make good vision a priority today. We should
also continue to support low vision rehabilitation and blind
rehabilitation to people with vision loss. Employment opportunities
for the visually impaired and blind is another area that
needs more attention. Perhaps, my many friends in Senior’s
Coalition can champion this important and worthy cause with
me.
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