Occupational therapist Terri Fletcher shows Ida Wheeler how to make the most of her remaining vision.
If life is a journey, then 103-year-old Ida Wheeler is its road warrior. As a young woman with Jewish heritage, she escaped Nazi Germany and fled to the Philippines. Instead of finding freedom on the islands, she was interned for the duration of World War II. Eventually, she found her way to Northern California, where she taught foreign languages in Oakland public schools, but she still managed to travel the world. Over the years, she would visit 105 countries.
As life started slowing down, it took another unexpected turn when she began to lose her vision to age-related macular degeneration. Still, she kept driving until age 99. But as her vision continued to narrow, so did her life. A year ago, she moved into an assisted living center, where she spends her time alone in her room, waiting for meal times. Reading, her connection to the world she once traveled, was no longer possible.
Ida's friends knew she needed to find a new way to connect to the world, so they made an appointment with ophthalmologist Donald C. Fletcher, MD, who specializes in low-vision rehabilitation. Ida was doubtful he could help her, but she was up for the short trip to the Pacific Vision Eye Institute in San Francisco. She did not expect that a one-hour appointment with Dr. Fletcher could help her chart a new course.
After Part of Your World Disappears, What’s Next?
"The biggest tragedy isn't that people have lost vision, it's that they don't know what to do about it. If you can empower people so they know what to do about it, they can decide for themselves what's next." – Donald Fletcher, MD
The terms low vision and visual impairment are used interchangeably and cover a wide range of vision loss. It describes poor vision that can't be fixed or improved with glasses, contacts or surgery. It doesn't mean the person is completely blind. Instead, blind spots disrupt their field of vision, making part of their world disappear. Vision rehabilitation helps them make the most of the vision they have left so they can live independently.
Dr. Fletcher is a leading authority on low vision rehabilitation. He started his career as an ophthalmic surgeon specializing in retinal diseases; devastating conditions that can't always be cured by surgery and medication. He found himself repeating a sentence that bothered him: "I’m sorry, this is all we can do for you."
Is that true?, he asked himself. Is there really nothing more to be done? So, he went back to school to learn about vision rehabilitation. He discovered simple tools and techniques that have the power to change a patient's outlook on life. That was 35 years ago.
The field has advanced significantly over the years, offering more effective technologies and strategies. Today, he can offer solutions that range from a simple, portable video magnifier that can enlarge text and objects to high-tech glasses with cameras that allow people to read text and see faces.
"The biggest tragedy isn't that people have lost vision, it's that they don't know what to do about it," Dr. Fletcher said. "If you can empower people so they know what to do about it, they can decide for themselves what's next."
There is Something More
Dr. Fletcher met Ida's skepticism with his sunny optimism, as he put her through a battery of tests to determine the extent of her vision loss. He then brought in an occupational therapist, his wife Terri Fletcher, to help determine the best techniques and devices that could help Ida get around the problems presented by her low vision.
It's a powerful combination of creative problem solving and motivational coaching, dedicated to improving the patient's quality of life.
"I enjoy dealing with people, not just the eyeball," Dr. Fletcher said. "Surgery is fun. But I love taking someone who is in a bad mood about their vision loss and trying to turn them around; get them to see some joy in life. It's a fun challenge. I never get tired of it."
Dr. Fletcher has improved the lives of both young and old patients, but he enjoys working with centenarians the most. "There is no substitute for 100 years of living on the planet to get a handle on what's important and what is not," Dr. Fletcher said.
Ida was no different. But she would also prove to be one of his more challenging patients. She had a small island of vision remaining, surrounded by an ocean of darkness. It was unlikely Ida would get back to reading her beloved New York Times with a simple magnifying device. Her best options would be vision substitution devices, such as books on tape and personal voice-activated assistants, like Google Home or Amazon's Alexa.
One of Terri Fletcher's best suggestions to help Ida at mealtime was ridiculously simple: A black placemat and a portable LED light. Eating had become a struggle because she couldn't see her food clearly. It was humiliating to bring what she thought was a fork full of food to her mouth, only to find it was empty. Simply putting a black placemat under the white dinner plate and placing a portable light over the place setting provided enough contrast and illumination to make a difference for Ida.
"I really didn’t think he could do anything for me," Ida said. "I'm glad I came here today."
Ophthalmology + Low Vision Rehabilitation = New Life
About 3.5 percent of people over age 65 in the United States are candidates for vision rehabilitation, a percentage that's expected to grow as this age group reaches 84 million by 2050. Age-related macular degeneration, Ida's condition, is one of the leading causes of visual impairment. Other common contributors include diabetic eye disease, glaucoma and inherited retinal diseases.
Unfortunately, many patients are referred for vision rehabilitation as a last resort, once their disease has advanced to a late stage. But it's most effective when introduced early in a patient's visual loss, so they can involve themselves in the process as they learn how to move around in their new world.
"The goal of low vision rehabilitation is to keep people living," Dr. Fletcher explained. "I've seen wonderful successes. But I have to be honest, we don't bat a thousand. Not everyone exposed to the techniques and devices are going to take advantage of them. But for those who do, it makes all the difference."