Optometric treatment of people with poor vision has always been a professional challenge. In regular optometry, a good and experienced professional will have 100% success in a perfect solution in which the patient will see well and feel well. In the field of poor vision, the situation is not always the same. Most often, eye disease causes an irreversible condition and there will be no improvement in the condition of the eye and the condition of vision. Therefore, there is no expectation of a perfect solution, but an attempt to do everything possible to improve the quality of life with regard to vision with the help of various types of solutions. This requires a lot of experience, knowledge of all the options available in the world today, and a lot of imagination and creativity.
Often the role of the optometrist who deals with low vision is to be present in an ongoing process that makes his role one of "low vision rehabilitation."
In recent years, thanks to innovative medical treatments that stop vision deterioration in various retinal diseases (such as Avastin, Lucentis, and Illya injections in age-related macular degeneration).
There is an increase in the number of patients whose vision is relatively preserved and who do not go blind and who can be helped with various aids. On the other hand, this is a wide range of people who, in the first stage, deal with helplessness and difficulty.
Many of the patients are in a situation where their vision is not perfect or even very poor, but unlike previous years when there were few and less convenient means, today it is possible to help with innovative aids.
An optometrist examination for the visually impaired, in my opinion, has become in recent years an integral part of the complex of treatments and consultations that a visually impaired patient should undergo, based on the assumption that the patient should be offered the variety of options available to him to improve his quality of life.
Many daily activities today require sharp vision of details. Reading, writing, working at a computer, playing a musical instrument are activities that even mild vision impairment affects and sometimes a special solution is needed. In addition to the aids, an optometrist for low vision rehabilitation must present to the patient abilities that he did not always know existed, such as peripheral vision. And teach the patient to use this ability in order to improve his abilities. He must check with the patient in what lighting he sees well and in what position of the head he will achieve greater comfort in vision.
At what stage of the disease should special glasses be fitted?
Even during the course of medical treatment, when it involves ongoing treatment (which sometimes takes months and years), the ophthalmologist stabilizes the patient's condition and then it is possible to adjust special aids and glasses for vision that has been damaged due to the disease.
Sometimes, even though the disease is not yet stable and there are changes, the patient needs some solution, so the specialist optometrist must take into account the condition of the disease and adjust the best temporary device.
In recent years, there has been a revival in the field of assistive devices for low vision. Not just magnifying glasses and telescopic glasses (although sometimes they have no substitute), but glasses that operate on other mechanisms and not specifically on improving magnification, but rather provide a solution to the issue of light entering the eye while taking into account the great difficulty of decreased contrast, the problem of glare, seeing halos, and more.
An optometrist for low vision rehabilitation takes all of these factors into account, knowing that even a patient with vision that can be considered "good enough" such as 6/12 - 6/18 can suffer from difficulties and frustration when they feel they do not see well!!
The main population suffering from vision impairment is the elderly population aged 65 and over.
Studies have found that an elderly person who has vision loss experiences feelings similar to the loss of a loved one:
In the first stage, shock and denial
A stage in which the patient understands that he is dealing with a serious problem that affects his quality of life, but is often in denial and is unwilling to accept the fact that there is no complete cure for his disease and that the condition is irreversible. He travels between doctors, optometrists, and other professionals in search of a complete cure.
Stage two: adaptation
A stage accompanied by anger towards the treating parties (doctors, optometrist, family members, etc.)
Stage three depression
Derived from the understanding that the situation will not return to normal.
This understanding is accompanied by a sense of loss and the knowledge that a change in lifestyle is needed.
Completion stage
Recognition of the situation and a desire to move on and try to improve the quality of life. This is of course the best stage for adapting assistive devices for low vision.
A low vision rehabilitation optometrist must be familiar with this process and identify where the patient is within the process.
Provide an appropriate solution to the situation and sometimes even retreat and not provide a solution at all, knowing that the patient is in a mental stage that is not yet ready to accept a solution in the form of an unusual accessory.
The patient's mere knowledge that a solution exists is sufficient at this stage. Most often, the patient comes back at a time that is convenient for him, when he has come to terms with his condition.
In conclusion
The role of the optometrist specializing in low vision is a complex one that requires insight and understanding beyond regular optometry. It requires experience and also basic psychological understanding. It certainly differs from the role of a regular optometrist in that it often involves a difficult physical and psychological process that requires empathy.
Patience and inclusion.
