As vision loss affects many areas of one's life, rehabilitative strategies focus on the whole person, including reading, activities of daily living, safety, continued participation in community, and well-being.
What help is available for my patients?
Amy Watts, OD Director
Vision Rehabilitation Service, Mass. Eye and Ear
"Patients with any level of vision impairment can benefit from a low vision assessment. During the initial consultation, a doctor of optometry who specializes in low vision rehabilitation will assess the patient’s visual function as well as her unique characteristics and goals. Tests of visual function may include visual acuity (near and far), continuous text, critical print size and reading speed, contrast sensitivity, macular perimetry, and peripheral visual field. Rehabilitative strategies are determined based on the patient's capabilities and goals.
Magnification is a cornerstone of reading rehabilitation. Patients learn how to use traditional devices—such as prism half-eye glasses, electronic hand-held and desktop magnifiers (CCTVs)—as well as newer technologies—such as head-mounted video displays. Patients will receive instruction at an outpatient office, as well as at their home and work setting.
Evaluating the patient in the home and work setting is very important in addressing limitations in activities of daily living. Patients learn how to reduce glare and increase contrast with proper lighting, as well as how to use tactile markings for setting oven temperatures for cooking, kitchen organization, and appliance use. Patients also learn tips and techniques for self-care and for participating in recreational activities.
Following a home safety evaluation, patients learn fall prevention strategies and can develop a plan to mark their medication bottles or use a medication organizer.
Vision rehabilitation also addresses mobility and independence, so that patients may continue to remain active in their communities. Transportation alternatives are addressed when patients cannot drive so that they can continue activities they value—such as voting and attending religious service.
Losing vision is a difficult psychological process that requires new coping strategies. Vision loss impacts not just the patient, but also their family members. Jobs and career plans are affected. Vision rehabilitation should offer options to address the need for emotional support with resources, education, support groups, counselors, and social workers."
How can we measure quality and outcomes for vision rehabilitation?
Kevin Houston, OD, MSc
Vision Rehabilitation Service, Mass. Eye and Ear
Director, Vision Rehabilitation Service, Spaulding Rehabilitation Hospital
"Physicians today want to use the best available data to diagnose, treat, and rehabilitate patients. Since 2010, Mass. Eye and Ear has led the medical community nationwide in developing and reporting ophthalmology outcome measures in its annual Quality and Outcomes Report.
At Mass. Eye and Ear, we use two patient-reported outcome measures of vision-related quality of life: the National Eye Institute Visual Functioning Questionnaire (VFQ-25) and the Impact of Vision Impairment (IVI) Questionnaire. Patients who have used our rehabilitative services have reported overall improvements in vision-related quality of life, with greatest improvements in mental health, mobility, and well-being.
For our next Outcomes report, we will use another measure: the Psychological Impact of Assistive Devices Scale. This scale should allow us to determine which devices have the greatest impact on improving vision as well as to investigate potential predictors of success, such as age, diagnosis, or additional in-home training with an occupational therapist. As more measures are developed and validated, such as the virtual reality functional assessments under development at Mass. Eye and Ear, we will apply them to clinical practice and evaluate their efficacy in future Outcomes reports to ensure the best care possible."
What does the future of vision rehabilitation look like?
Joseph Rizzo III, MD
Director, Neuro-Ophthalmology Service, Mass. Eye and Ear
Co-director, Harvard Ophthalmology Mobility Enhancement and Vision Rehabilitation Center of Excellence
" Emerging biological and engineering technologies are allowing us to help patients as never before. Patients who receive vision rehabilitation services at Mass. Eye and Ear are given information about clinical trials and future possibilities that might offer hope for visual improvement."