Guest Editorial

A Service Destined to Grow

Our patients will increasingly need low vision rehabilitation.

By Frank J. Weinstock, M.D., F.A.C.S.

Ophthalmic surgery is exciting and capable of amazing success in restoring vision. However, not everyone may be helped by medicine and/or surgery, which means that a small but significant number of our patients will fall in the category of the visually impaired. Many of these patients are told directly or indirectly that "nothing more can be done" without being informed that assistance for their remaining level of vision might be available.

Their Numbers are Growing

Over the next two decades, the number of visually impaired Americans over age 40 is expected to increase from 3.3 million to 5.5 million, according to the National Eye Institute. Injuries and the lack of mobility caused by low vision will cost the government about $4 billion a year in benefits and lost taxable income, according to the Health and Human Services Centers for Disease Control and Prevention. The cost could be significantly reduced if help was given to the visually impaired.

Lectures about low vision at the American Academy of Ophthalmology (AAO) have increased from one course in 1965 to a multitude of courses and seminars at the recent AAO meeting in New Orleans. In addition to the formation of the Visual Rehabilitation Task force and the SmartSight initiative by the Academy, academic and commercial entities are increasingly delving into the development of advances, both in gene therapy and in surgical methods of attempting to improve vision.

Take the Initiative

Our goal must be to help patients with poor vision to adapt to life and be productive. This may be as simple as handing them the important AAO Smart Sight materials, which are available for both you and your patients on the Academy's Web site at http://one.aao.org/CE/EducationalContent/Smartsight.asp. Or it may require intensive examination and evaluation (in our office or at a specialized facility), followed by efforts to maximize the remaining vision with the available resources for visual rehabilitation.

The challenges for us, as ophthalmologists are:
► Continue to decrease the potential numbers of individuals with vision impairment via advances in medicines and surgery to preserve, improve and maximize the remaining vision.
► When patients are diagnosed with low vision, it is essential that they are not simply followed up year after year with "routine eye exams" that don't address their individual situations. They must be referred for the assistance that will result in a productive individual.
► When these modalities do not work, be proactive and discuss the low vision situation with the patient and his family as early as possible. Discover the patients' needs and help them to achieve their potential. Begin with a simple refraction and various types of magnification via higher add glasses. Then continue on to magnification devices that are available in both stationary and portable form.

We must inform patients about the availability of large-print reading materials, reading machines, specialized lenses and other advanced modalities that could help. Materials on tapes, CD's and DVD's, as well as compressed speech machines, should be discussed with patients. Beyond this, make more advanced low vision rehabilitation services available to your patients via your office or refer them to a low vision rehabilitation specialist or center.

In addition, we must encourage insurance companies and the government to assist in making this help available to all of our patients in need, especially younger and working-age individuals, as well as those that do not read English.

We must get ourselves as well as optometrists who are concerned with vision to make our patients the recipients of compassionate care and make the latest advances in visual rehabilitation available to them. We must also promote a multidisciplinary approach and cooperation with optometry, occupational therapy, physical therapy and opticianry. The "low vision rehabilitation wave" is coming, and we owe it to our patients and the public to be ready. OM