Study: Low vision services can improve quality of life

Sue E. Lowe, O.D., and the staff at her Laramie, Wyoming, practice see every day what a recent study, from the University College London Institute of Child Health and the UK Biobank Eye and Vision Consortium, reported: even the mildest loss of vision can impact the quality of patients' daily lives.

Take, for example, Dr. Lowe's elderly patient who could no longer crochet and the cowboy who could no longer read the ear tags on cattle. Today, the elderly woman is crocheting again and the cowboy is seeing tags better, says Dr. Lowe, who is chair of the AOA's Health Promotions Committee.

Dr. Lowe, who invested in training in low vision treatments for herself and two staff members more than 25 years ago, adds, "There's no reason we should live out our lives and not be able to maintain what we do, given the low vision devices out there today."

Low vision can impact individuals' ability to earn a living, says Gary Chu, O.D., senior director of public health and community collaborations at New England Eye and associate professor at the New England College of Optometry. He also is a member of the AOA's Multidisciplinary Practice Committee.

Patients with low vision may not be able to do up-close work or qualify for driver's licenses without restrictions on the time of day they drive, Dr. Chu says. If they can't work, they may be hard-pressed to earn a living and support a family, he adds.

Dr. Chu also cites studies that indicate the learning of children with low vision in underserved communities—with uncorrected or under-corrected sight—is affected. When you affect learning, you affect children's potential and their futures, he says. He also notes higher comorbidities for older adults with some vision impairment.

"Vision is a long and continuing spectrum, and there's a certain point where people's vision hinders them from what they need to do," Dr. Chu says. "It affects their family and it affects them economically."

He adds, "The impact trickles down."

Study findings

An estimated 135 million people worldwide suffer from low vision, according to the National Eye Institute (NEI).

The NEI defines low vision as "a visual impairment, not correctable by standard glasses, contact lenses, medicine or surgery, which interferes with a person's ability to perform everyday activities." Among diseases linked with low vision are age-related macular degeneration, cataracts, glaucoma and diabetic retinopathy.

The recent study, "Visual Function, Social Position, And Health and Life Chances: The UK Biobank," was published online in July in JAMA Ophthalmology. UK Biobank describes itself as a national health resource and registered charity, with the goal of preventing, diagnosing and treating life-threatening illnesses, including eye disorders.

The objective of the study was to investigate the link between visual health and "the main factors that define an individual's life."

About 112,300 volunteers, ranging in age from 40 to 73 years, were evaluated on the basis of visual acuity and their social, economic, education and employment status. Researchers say participants in the most severe category—vision impairment, severe vision impairment, blindness—had three times the risk of being unable to work and twice the risk for being unemployed.

"Impaired vision in adults is common, and even near-normal vision, potentially unrecognized without assessment, has a tangible influence on quality of life," the authors concluded.

In addition to their findings, researchers urged changes in health policy.

"From a health policy perspective, our findings highlight the value of shifting thinking to overall population visual health and away from exclusive consideration of visual impairment," researchers say. "Our findings point to the antecedents of inequalities in visual health and highlight the potential for widening of gaps over time, particularly with managing population. We suggest that visual function needs to be embedded better in public health structures and processes as a key sensory health indicator that is routinely considered, both independently and as part of all-cause morbidity, as both a risk factor and health outcome measure."

Quality of life

It's worth noting that the study was conducted in the United Kingdom, where citizens have access to a national health service. Still, much can be learned from the study, Dr. Chu says. "We have poorer access in the U.S., so this study just accentuates the need here," says Dr. Chu, an advocate for community health centers in the U.S.

For Dr. Lowe, one of the revelations of the study is highlighting the role of doctors of optometry in diagnosing and treating patients with low vision. The technology is better so more patients can be helped, she says. Low vision care—including non-optical solutions, prescription glasses, optical devices and rehabilitation therapy—offer a better opportunity for doctors to help patients better manage their conditions.

"Technology has changed," Dr. Lowe says.

For patients with low vision, e-readers and tablets offer options for enlarging type on electronic devices. Separate, low vision devices—including magnifiers and spectacle-mounted telescopes—can range in price from $50 to $4,000.

The payoff for patients is independence and improved sight. Yet, for various reasons, patients don't always find their way to a doctor. Acceptance of their condition and cost are just a few reasons why. Medicare does not reimburse for low vision devices or the exam to determine the device.

"Only 9% of people who have been diagnosed with low vision get the help they need," Dr. Lowe says.

"There's such a huge opportunity in this field for optometrists," Dr. Lowe says, "especially for training people on their staffs to become certified."