High on Low Vision
Do you see potential in individuals with vision loss when many others do not? You may have the right stuff to become a low vision specialist. Here's some insight from a veteran.
By R. Tracy Williams, O.D., Wheaton, Ill., Illinois College of Optometry '79

You've been hearing about them all your lives. They've had a dramatic influence on everything from the economy and politics to fashion and entertainment. And now, they're likely to influence your career, as well.

They're the baby boomers. And they're marching at an unrelenting pace into their senior years. Right now, you're probably educating these patients about presbyopia. It won't be long before many of them will need other eyecare services, including low vision rehabilitation. Will you be ready?

Just like ocular pharmaceuticals and surgical procedures, low vision rehabilitation is a treatment modality -- and one worth investigating as you consider your choices in optometry. In this article, I'll discuss what it takes to be a low vision specialist and the rewards you can expect.

GROWING NEED

Today, age-related macular degeneration is the leading cause of severe vision loss and legal blindness in older Americans. And diabetic retinopathy is a growing problem with devastating vision loss potential. Even now, a significant number of Americans are visually impaired. Estimates run from 3 million to 14 million, a number that's projected to double by 2020 as baby boomers age and enjoy longer life expectancy. In fact, by 2050, the U.S. population could comprise mostly elderly people. And not all of them will be in optimal health.

As these statistics reveal, there's a growing need for skilled low vision practitioners. And there's definitely room for growth. Of the 57,000 or so U.S. eye doctors (both O.D.s and M.D.s), fewer than 1,000 belong to the American Optometric Association's Low Vision Rehabilitation Section or the Vision Rehabilitation Committee of the American Academy of Ophthalmology.

ESSENTIAL SKILLS

What does it take to be a low vision specialist? The best low vision practitioners work with a patient's head and heart, as well as his eyes. They can see potential in individuals with vision loss when others do not.

A skilled practitioner understands the interplay of visual acuity, visual fields and contrast sensitivity, and is creative with optics. He's a good listener, communicator, educator and motivator. Using these skills, he can help visually impaired patients "re-invent" themselves and direct their energy toward fruitful pursuits rather than frustration, anger and depression.

The skilled low vision practitioner combines all these components -- listening, educating, motivating, clinical testing, prescribing, communicating action and supervision -- into a low vision rehabilitation plan.

	LOW VISION SPECIALISTS WILL BE ON THE FRONT LINES AS ELDERLY PATIENTS FIGHT TO MAINTAIN THEIR QUALITY OF LIFE.

DEFINING A GOOD PLAN

A good low vision rehabilitation plan provides the appropriate tools, training and direction to maximize a patient's remaining vision, other senses and abilities to regain independence.

The Center for Medicaid/Medicare Services (CMS) has identified physicians, optometrists and ophthalmologists as the gatekeepers for low vision rehabilitation. As gatekeepers, we must understand the team concept of comprehensive low vision rehabilitation. Our team may include rehabilitation teachers and counselors, occupational therapists, social workers, orientation and mobility specialists, adaptive technology specialists and others. See "Team Building" for more on these specialists.

Low vision practitioners also must keep up with current ocular treatments, research, prevention, access to support groups and programs directed toward people with vision loss.

We also must be skilled clinicians to keep a close watch on any disease progression so we can make timely referrals to appropriate specialists when necessary. The low vision practitioner comanages patients in two directions: Specialty ocular health needs and additional rehabilitation interventions. This is an important and critical role that only the low vision rehabilitation specialist is trained to provide.

A successful rehabilitation plan addresses far more than vision. An effective plan may help a visually impaired student gain an education and career. It may help a patient become more employable, or help a working individual with a recent vision loss stay employed. A good plan can make the difference between patients remaining in their own homes or having to move to an assisted living facility. It also can provide mobility options to ensure safe travel. Good plans can tickle the human spirit and "lift" the person with vision loss.

SECRETS TO SUCCESS

The most successful low vision rehabilitation outcomes begin with an eye doctor who catches the "fever" to work with visually impaired people. Once you've acquired the basic clinical skills, you'll progress into the "art" of this specialty practice, having the satisfaction and fun of seeing patients accomplish the sort of daily living activities most people wouldn't believe possible. You'll begin to realize that the next best thing to a cure is improvement, which can lead to happiness and peace of mind.

There are learning curves to developing low vision rehabilitation skills and using prescribed tools properly. You'll also realize that the energy, enthusiasm and encouragement in your voice can help your patient's progress, as well as ward off depression. You can help people change, cope and most importantly, continue to live life. There also are many opportunities to be creative, designing glasses with telescopes, microscopes, special prisms, filters and other tools.

And if you're lucky enough to work with other rehabilitation professionals, you're often personally lifted by their contribution and unending compassion -- a wonderful experience that, sadly, so many eye doctors never see.

GETTING STARTED

Your approach can begin with the very basics. Do what you can at your office and make a connection with a comprehensive low vision service or practice. Once you've seen the difference you can make in patients' lives, I'm confident you'll make vision rehabilitation an integral part of your practice.

Dr. Williams is executive director of the Deicke Center for Visual Rehabilitation in Wheaton, Ill., which provides low vision rehabilitation annually to more than 1,300 patients.