Low-vision rehab covers more than physical needs

Daniel Briceland, MD, medical director, Spectra Eye Institute, Sun City West, AZ, described the impact of visual rehabilitation on geriatric function.

Low vision is defined, according to Dr. Briceland, as bilateral impairment of vision that substantially impairs the function of the patient and cannot be corrected adequately by medical or surgical therapy, conventional eyewear, or contact lenses. Low vision may present as a loss of sharpness of the visual acuity, loss of field of vision, light sensitivity, distorted vision, or loss of contrast.

Most patients with low vision are elderly, Dr. Briceland pointed out. However, patients who are children or working adults are affected equally and dramatically. In addition, low-vision services, which can be costly, are not usually covered by insurance, which can add to the debilitating psychological effects on the patient.

The toll of visual impairment on patients can be devastating.

"Low vision ranks just behind arthritis and heart disease as a cause of impaired function in patients older than 70 years. Older adults with new visual impairment face major losses of health, family, friends, and especially mobility. One-third of employees who are visually impaired reported difficulties performing their jobs, and 50% of patients who responded to a survey conducted by Lighthouse International reported that they had some or very serious problems because of loss of income as the result of visual impairment," Dr. Briceland said.

The statistics surrounding the prevalence of vision impairment are also sobering, according to Dr. Briceland. The prevalence of visual impairment is high, with 3.3 million Americans aged 40 years and older affected.

Dr. Briceland estimated that the figure will increase to 5.5 million individuals by 2020. In the United States, 240,000 new cases of visual impairment occur annually; one in 28 Americans has low vision. Individuals older than 80 years account for only 8% of the population but 69% of the cases of blindness.

In line with this, half of the cases of moderate and severe visual impairment in the United States are attributable to diseases that are prevalent among the elderly, such as cataract and extreme refractive errors. Profound visual impairment, near total vision loss, and total blindness are primarily the result of age-related macular degeneration (AMD), diabetic retinopathy, and glaucoma.

"The consequences of vision loss are severe-loss of employment, disability, depression, falls, isolation, and dependence on others. It is important that rehabilitation begin as soon as possible and that the patient is informed to the fullest extent that what may have been normal before vision loss may need to be modified to be normal after vision loss. This may include the loss of driving privileges, the need for special glasses or modifiers, and help reorganizing their environment. A quarter of individuals with vision disorders report difficulty managing their daily household tasks, 20% have problems with transportation, one-third state that visual impairment interferes with leisure activity, and 31% that loneliness is somewhat or a very severe problem," Dr. Briceland recounted.

He advised that ophthalmologists who treat patients with low vision be aware of both the patient's physical and psychosocial needs. Rehabilitation is an ongoing process with these patients, involving continual work and adaptation, Dr. Briceland emphasized.