March 3, 2022 – When Alabama-based cardiologist Joseph Fontenot, MD, was 50, he noticed that the picture on the movie theater screen didn’t look sharp. “I guess they don’t make films as well as they used to,” he thought.
He developed other visual problems, so he consulted ophthalmologists. He was diagnosed with angioid streaks of the retina, a condition similar to macular degeneration, for which there was no treatment at the time.
“I was told my vision was likely to get worse, which it did, and relatively quickly,” Fontenot says. After a few months, he could no longer drive or read anything but large print.
He heard about vision rehabilitation services from another patient with his condition whom one of his doctors put him in touch with.
Thanks to the skills acquired through vision rehabilitation, Fontenot was able to continue practicing as a cardiologist, using an electronic magnifying glass that helped him read test results and patient charts. His vision continued to deteriorate, but he learned new ways to compensate.
Soon, other doctors in Fontenot’s group practice began referring their visually impaired patients to him for help and information. “I started to realize that the majority of people with this problem have no idea what’s available or what to do,” he says. He decided to get certified as a vision rehabilitation therapist and open a practice. Today, Fontenot is chairman of the Vision Rehabilitation Committee of the American Academy of Ophthalmology.
What is low vision?
Doctors call vision impairment that is chronic and cannot be corrected by medication, surgery, or the prescription of different eyeglasses “low vision,” says John D. Shepherd, MD, clinical spokesperson for the American Academy of Ophthalmology and assistant professor at the university. University of Nebraska. The most common causes of low vision in the United States are glaucoma, macular degeneration, and diabetic retinopathy. Treatments can stop further vision loss, but will not restore vision that people have already lost.
Most ophthalmologists focus on providing treatments or medications for the disease, Shepherd says. Low vision specialists treat visual impairments caused by the disease. “It’s a whole different paradigm and a whole different way of approaching the situation.”
Visual impairments can be quite varied, says Shepherd. “A person may have difficulty reading, writing a letter, working on devices such as the computer or smartphone, paying bills, functioning independently in the kitchen, or going about their hobbies. -favorite times or other activities that require our eyes.”
He advises patients to ask their eye doctor if their condition is treatable and if their vision can be repaired. “If not, you’ll need help coping with the impairment, and that’s where low vision specialists and vision rehabilitation come in.”
What does visual rehabilitation offer?
Low vision specialists can address three main areas, says Shepherd.
One is vocational training for vision. A person with macular degeneration, for example, cannot see the details of what is in front of them, but they still have vision. “Professional training can help these people understand how to stop relying on the ‘bad’ areas of the eye and bring the best areas to what they want to see,” he says.
Vision specialists also offer advice on modifying your environment, such as taking advantage of lighting and contrast to make it easier to complete tasks. Low vision specialists can also recommend a wide range of devices that can improve a person’s vision and enable them to perform a given activity better.
Low vision rehabilitation begins with an assessment of the person’s specific needs: What is the area of the person’s impairment? What is the person having trouble doing? Based on the assessment, the therapist will know what to recommend and how to work with the patient. In fact, says Shepherd, “I can’t think of an activity in which there are no ways to help people. [with low vision] participate. »
‘Best Kept Secret’
Steven Kelley, a Vermont-based vision rehabilitation therapist, says he considers vision rehabilitation “the best-kept secret,” not just among patients, but even among medical professionals.
One reason: “They don’t know this type of service exists,” he says. Additionally, vision rehabilitation therapists are often viewed as providing social rather than medical services, and vision rehabilitation is not covered by most insurance.
But the lack of insurance coverage does not mean vision rehabilitation is expensive or has to be paid out of pocket. Usually the cost is covered by state agencies, Kelley says, at little cost to the patient.
Vision rehabilitation therapists often work in agencies that provide services to people who are blind, which can be “intimidating” for people because “many seniors don’t consider themselves ‘blind’ if they have recently lost their sight. says Kelley. But that’s based on a misunderstanding, he says, since vision rehabilitation therapists provide services to people at any point on the low vision spectrum, not just those close to blindness.
Getting services as soon as possible is important, says Kelley, who has low vision himself. He started struggling with his vision 20 years ago when he was working in web design. He was diagnosed with myopic degeneration and ended up losing his job before he could “figure out what was going on and what to do about it.”
He eventually discovered the field of vision rehabilitation therapy. He became more involved and received training and certification so he could help others. Today, he has his own vision rehabilitation practice.
Another reason to seek vision rehabilitation as soon as possible is that some research suggests that people with new vision loss who do not receive services within the first 3 months may become depressed because their vital functions, such as reading and driving are reduced. “Then you have clinical depression on top of vision loss, which makes vision rehabilitation more difficult,” says Kelley.
Where to get help
Fortunately, “there is a lot of help available – you just need to learn where to look for the resources that are out there,” Fontenot says.
National Library Service (NLS)
NLS is a free service for people with low vision, blindness or other types of reading disabilities. NLS distributes books and magazines (in Braille or audio format) that are instantly downloadable to personal devices (such as smartphones or computers). For those who don’t use these technologies, Kelley says, an easy-to-use “talking book reader” is sent free of charge. Books are shipped on cartridges to be inserted into the machine, and the cartridges are returned to the NLS in specially provided return envelopes.
Hadley is a program that provides hands-on help, learning opportunities, free connection and support to anyone with a visual impairment, as well as their families and healthcare professionals. Kelley, who also works at Hadley, says she offers free workshops online and over the phone.
VisionAware is a free service for visually impaired adults, their families and healthcare professionals. It offers practical advice, resources and information on eye diseases and disorders, ways to connect, blogs from peer counselors and a searchable directory of services, including vision rehabilitation providers.
US Department of Veterans Affairs (VA)
Veterans or active duty military who are blind or partially sighted can get advanced vision care and rehabilitation through VA, including devices and technology (with training on how to use them) ), visual skills training to help them with everyday tasks, sensory training, mobility and orientation training, counseling and group therapy to help people cope with their vision loss, as well as many other services.
Kelley says each state has services for the visually impaired, available for free or on a sliding scale basis. These can be found at: https://www.enhancedvision.com/low-vision-resources.html
Additional resources include:
The Lighthouse Guild
800-284-4422 (TTY 711)
national eye institute