As primary eye care providers, optometrists play a key role in preventing, identifying and treating vision loss in the general population. To effectively assist patients with visual impairment, optometrists not only need to be competent clinically, but must also display compassion and patience. Never tell a patient, “Nothing more can be done.” (1) Though it may be true that there is nothing more that can be done for the eye, there is almost always something to be done for the patient, e.g. low vision rehab/blind rehab services. The following are five tips I find most useful when working with visually impaired patients.
#1: Patient Education
One of the most important aspects of assisting low vision patients is education. Patients must understand the prognosis of their condition and should have a basic grasp of the pathophysiology of their visual impairment. For example, patients with age-related macular degeneration will never go completely blind, and they should know that their peripheral vision will not be affected (unless they also have glaucoma).
#2: Positive Attitude
When examining visually impaired patients, optometrists must display a positive attitude and be flexible with the examination process. Doctors should also encourage and motivate patients by designing the examination so that patients can perform successfully. For example, a special low vision acuity chart with larger letters and numbers (Feinbloom chart) should be used at the distance where patients can see best (not necessarily at 20 feet). The bottom line is that the normal eye exam sequence, refraction, and eye health testing should be modified to highlight all of the abilities that the patients still retain.
#3: Family Involvement
Besides the optometrist’s role in assisting the patients, family plays an important role in providing physical, emotional, and social support, and family is often very strongly involved in low vision rehabilitation services. Thus, it’s important to get the family involved! Family provides two important types of support for the patients: instrumental and emotional. Instrumental support is through assistance with everyday activity, while emotional support is through encouragement and comfort during tough times.
#4: Support Groups
Although little can be done to reverse the effect of visual impairment, patients may benefit from psychosocial interventions such as support groups. In a support group patients can interact and be amongst people who understand what they are going through. Support groups may build camaraderie as well as let patients know they are not alone. Studies show that social support increases self-confidence and lead patients to have decreased emotional distress (2).
#5: Be a Patient Advocate
Optometrists are often the liaison between patients and other health care professionals and resources. We need to appropriately refer patients to occupational therapists, orientation and mobility therapists, social workers or the Department of Rehabilitation when warranted. Overall, being an advocate for the patients is the key to managing low vision cases.
In conclusion, visual impairment is not a life sentence and this concept must be conveyed to the patients. With proper low vision device training and support, many patients can live a life with few limitations.
References:
- Tanton, JH. Nothing More Can Be Done. A Fable of Our Time. Low Vision and Vision Rehabilitation. Volume 7, 2, June 1994.
- Bambara JK, Wadley V, Owsley C, Martin C, Porter C, Dreer LE. Family Functioning and Low Vision: A Systemic Review. Vision Impair Blind. 2009; 103(3): 137-149
