reflections THE HUMAN SIDE OF OPTOMETRY

Low Vision: The First Time

My most rewarding patient experience taught me two valuable lessons

STEVE STANEK, O.D., F.A.A.O.
SAN ANTONIO, TEXAS

In 1985, I had been practicing optometry less than a year when I.M., a nice lady in her early 40s, came to see me for an eye exam. I.M. had longstanding bilateral macular toxoplasmosis scarring resulting in 20/200 vision in each eye. She had just watched a TV program on low vision aids and she wanted to get fitted with an aid. Her goal was to go back to school to learn computers. At the time, I had a “chip on my shoulder” about low vision as I had been unable to do the optional low vision rotation in optometry school. Now faced with I.M.'s needs, the low vision process seemed daunting.

My Low Vision “Training”

Due to scheduling during the on-campus quarter of my fourth year, I ended up entering a “primary care” rotation. It was valuable training, but I had hoped to do low vision. However, my best friend, Jim, did get into the low vision rotation. So when I had free time, I would observe Jim in the LV clinic to learn what I could.

With my “limited” resources, I developed a plan for I.M.: I knew two optometrists in Denver, just one hour away, who had experience in low vision care. Each had a large wall locker full of low vision aids in their clinic. I had only an attaché size case with a few aids. I suggested to I.M. that I could do the health assessment and we would have her come back to try my aids. If these helped, I would refer her to my colleagues who would get her properly fitted.

The “Exam”

I.M. returned and I placed each of the low vision aids in the trial frame in front of her “better” eye. I explained and demonstrated to her that increasing the magnification would give better acuity but with a decreased field of view. It would also make it more challenging to “pick up” a particular object at distance. Overall, she was impressed. Fortunately, she had already learned to eccentrically view — to place the image on undamaged retina to improve her acuity. I knew she would need both far and near in a classroom situation. Some of the aids had a reading cap that could be focused for computer screen and reading distance. She was very enthusiastic. I referred her to my friends and I knew they would take good care of her.

Surprise

About a week, later I.M. called and referring to the low vision aid, she said, “Yours was better.” I almost fell out of the chair. It turns out that my little kit had a 6X telescope which the other O.D.s did not have. She came back and we were both excited when she read some of the letters on the 20/25 line. I ordered my first low vision aid. When it arrived I had the optician help me adjust the frame for her and we did some training. She took to it like the proverbial “duck to water.”

I.M. went on to take computer classes and told me that once before a test, her teacher quipped that she had an unfair advantage since she could “zoom in” on her classmate's paper's.

The Lessons

I.M. taught me two things: 1) When faced with a challenging situation, you probably know a lot more than you think, and 2) You never know what you can do until you try. To date this has been my most rewarding patient experience. OM