Future doesn’t have to be unclear for patients with low vision

Excerpted from page 48 of the January/February 2018 edition of AOA Focus

A Budapest, Hungary-based study in the October 2017 issue of BMC Geriatrics looked at the link between patients' health expectations and their actual health outcomes. And the findings suggest informal care and happiness are central in patients' health expectations.

"AMD patients requiring others' help for self-care have worse HRQOL (health-related quality of life), expect shorter life and lower HRQOL for future ages. Patients' happiness in general has a deterministic role as well, both in current health status utility evaluation and subjective health expectations," the researchers say.

"These two patient-related factors (informal care need and self-reported happiness) might be of relevance also in chronic diseases other than AMD, and we encourage considering them in further health expectation studies," they add. "Results of our empirical investigation highlight the importance of including issues of long-term expectations in patient-clinician discussions in AMD care, to have a better knowledge and understanding of their perspective."  

'A complicated life situation'

February is Low Vision Awareness Month and doctors of optometry have considerable vision rehabilitation resources to see patients through declines in their vision when their visual impairments can't be improved by medical and/or surgical options or with conventional eyewear or contact lenses.

Paul Freeman, O.D., and Eli Peli, M.Sc., O.D., have decades of experience working with patients with low vision.  

Dr. Freeman has served residents of the Pittsburgh, Pennsylvania, area since 1974. He is past chair of the AOA's former Vision Rehabilitation Section and author of "The Art and Practice of Low Vision."  

Dr. Peli is professor of ophthalmology at Harvard Medical School and the Moakley Scholar in Aging Eye Research at the Schepens Eye Research Institute, Massachusetts Eye and Ears, in Boston, Massachusetts. He co-authored "Driving with Confidence: A Practical Guide to Driving with Low Vision."  

"It should come as no surprise that a chronic health condition that presumably will not get better and, in fact, could get worse, and which impairs function and creates a disability, can negatively affect projected quality of life," says Dr. Freeman, referring to the study.  

Adds Dr. Peli: "This is a complicated life situation."  

A dose of empathy and truth

The challenge, Drs. Freeman and Peli say, is getting patients to see that the future doesn't have to be bleak. People with low vision can be taught a number of techniques to perform daily activities with their remaining vision, if they are open to treatment.  

For starters, Dr. Peli listens as patients spill out their frustrations.

 "I empathize with them," Dr. Peli says. "In most cases, they realize they're not going to get better. I make them understand that I care about their problem and that we can deal with it one way or another. It's a life-changing situation. It's normal to be upset about this. It's even healthy to be upset about it.  

"Then I tell them what is possible and what we can do," he adds. "I let them know we can deal with it one way or another."  

Further, Dr. Peli answers their questions, but he also asks his own in order to appreciate what is meaningful in patients' lives:

• Are you still driving?
• Do you live alone, or do you have family who support you?
• What's your daily routine?  

Low-vision rehabilitation is integral to helping patients toward the goal of independence, doctors of optometry say, by using optical, electro-optical, non-optical, and environmental modification treatment.  

"The presentation of these options is important, as in many instances, this puts the patient back in charge of making a potentially life-altering decision-resuming the ability to be self-reliant and maintaining as much independence as can be had, given other comorbid conditions," Dr. Freeman says.

"However, to get to that point, the patient has to be an active participant in potentially learning new ways to achieve that goal."

Enter doctors of optometry.  

Communication between the doctor and patient is extremely important. "By informing patients of the continuum of care, which will help a person maintain independence, the goal identified by the authors of the study, 'including issues of long-term expectations' ... can be met and hopefully will help these patients achieve some level of self-reliance for as long as they have the desire to do so," Dr. Freeman says.  

Join the AOA Vision Rehabilitation advocacy network

Interested in helping the AOA advocate for better Vision Rehabilitation (VR) policies, regulations and laws? The AOA Vision Rehabilitation Committee provides leadership and expertise for AOA's advocacy initiatives. Get involved, access VR resources and be listed in AOA's Find a Doctor search tool as a practice with a special emphasis on VR.