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  • YO Need to Know: Referring Patients for Vision Rehabilitation Services


    As a young comprehensive ophthalmologist three years out of residency training, I developed chronic back and knee pain that did not respond to conservative treatment measures.

    This made it challenging to participate in normal home and work activities. Consultations with numerous physicians over several years resulted in two surgeries, many months of physical therapy, and numerous trials with anti-inflammatory and analgesic medications but to little avail. I was still unable to comfortably carry out routine activities. 

    The day came when I had to stop doing surgery. I never returned to the operating room. An identity crisis ensued. Focusing on finding a cure, my doctors never referred me to pain management clinics or to professionals who could help me to develop skills to live successfully with chronic pain physically and emotionally. Believing there was nothing more that could be done, the impact of chronic pain on my life slowly but predictably took a toll, and I ultimately found myself an inpatient being treated for major depression. 

    Having experienced this crisis, I began thinking about the many patients I saw with irreversible vision loss from chronic eye disease. Were they, like me, struggling with daily activities? Were they depressed because they believed nothing more could be done? I really didn’t know; I had never asked. When I did, I found that many of them were suffering and struggling, often for a year or more. But no one was providing the hope or help of a referral for vision rehabilitation services to help them live successfully with their vision loss.   

    As a full-time vision rehabilitation specialist at an academic medical center, I now see that this oversight is alarmingly pervasive in ophthalmology. Having evaluated over 7,500 patients, I find that many are not referred to me by their ophthalmologist. Many have been struggling with activities of daily living for over a year. And even though vision rehabilitation can provide optical devices, skills training, environment adaptations, and counseling, it is rarely suggested at all. A specialty focused on finding a cure is neglecting the options that can help patients live successfully with their vision loss. This falls far short of providing truly comprehensive eye care. 

    What YOs Can Do

    But there is something that young ophthalmologists can do to aid their patients. Here is what you need to know:

    While examining the eyes, never forget that behind the eyes is a person. 

    This person has abilities, skills, and talents they want to enjoy, but are hindered by irreversible vision loss. 

    When considering visual acuity, never forget that your patient cares less about the numbers than what reduced vision affects. Ask them about their impairments, and refer them for help. 

    Many ophthalmologists will wait for a certain level of reduced visual acuity before they mention low-vision rehabilitation. Yet someone with age-related macular degeneration (AMD) may have 20/30 vision but cannot read or drive.

    Ask patients with chronic eye disease and irreversible vision loss, “Does your vision loss make it difficult for you to participate in your daily activities?” If the patient answers “Yes,” refer them to someone who can manage the impairment while you continue to manage the disease. 

    Vision rehabilitation is not simply about magnifiers. 

    Truly comprehensive low-vision care seeks to minimize impairment in every aspect of daily living. Nonoptical tools such as adjusting lighting, enhancing contrast, developing visual skills to navigate around scotomas, and utilizing hearing and touch are among many available options beyond a simple magnifier. 

    Impairment management requires different skills from disease management.

    You don’t need to personally provide low vision services. There are individuals in your community specially trained and available to assist your patients to live as independently, safely, and enjoyably as possible. These may include ophthalmologists, optometrists, occupational therapists, orientation and mobility specialists, low vision therapists, and vision rehabilitation therapists. 

    Find out about the vision rehabilitation services in your community.

    When your patient needs help managing their impairment, you will be equipped with information and brochures.

    If you need assistance finding services, the Academy can help. Go to our low-vision resources page and click on the link to locate the low vision rehabilitation services near you.

    Not every eye disease has a medical or surgical treatment or a cure. But there are many resources available to help patients live successfully with vision loss if we would only ask important questions and make low vision referrals. 

    As ophthalmologists, our role includes protecting sight through disease management and surgery. But even when we cannot cure the disease, we can still empower patients’ lives. Their diagnosis doesn’t need to be their destiny.

    Headshot of John D. Shepherd, MD About the author: John D. Shepherd, MD, is a low vision specialist and ophthalmologist. He is also an assistant professor in the Department of Ophthalmology and Visual Sciences at University of Nebraska Medical Center.