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Low vision programs
can help individuals adapt to their limited vision through
various strategies and devices, such as magnifiers,
telescopes, large-print publications and talking products.
About two years ago, Audrey Lee Smith*, then a limousine
driver, began to experience blurry vision. He went to
an optometrist, hoping that glasses would help. However,
after the optometrist examined Mr. Smith’s eyes,
the vision specialist told him, “I can’t
give you glasses today. There’s bleeding in your
eyes because of your diabetes.”
Mr. Smith had Type II
diabetes for many years, and although he took medicine
to help control his blood sugar levels, it wasn’t
enough. “I have a new 'religion' now—I eat
right, exercise, and take my medicine. For a time, though,
I’d have that piece of pie and put sugar in my
coffee,” he says. His poorly controlled diabetes
resulted in diabetic retinopathy, a condition that damages
tiny blood vessels in the eye’s retina.
Although well-established
treatments exist that can slow progression of diabetic
retinopathy, nearly 75,000 Americans continue to lose
vision due to this disease each year. Many diabetic
patients do not have a retinal examination until the
disease has progressed into its proliferative stage
with abnormal retinal blood vessel formation, when vision
loss can be irreversible.
Fortunately for Mr. Smith,
his condition was treatable. Dr.
Neelakshi Bhagat, assistant professor of ophthalmology
at New Jersey Medical School and chief of vitreoretinal
surgery at University Hospital, performed a painless,
outpatient procedure called laser photocoagulation to
seal the bleeding vessels and prevent the growth of
abnormal new vessels. Laser photocoagulation does not
improve vision, but it can stop a person’s vision
from getting worse.
Mr. Smith’s story
does not end there. Today, because of additional consequences
of his diabetes (retinal edema, which is abnormal retinal
swelling, and cataracts, a clouding of the eye’s
lens), the 60-year-old is one of 1.3 million Americans
who is legally blind. By definition, a legally blind
person, with the best correction possible (glasses,
contacts, or surgery) cannot see better than 20/200
and/or has a visual field of less than 20 degrees or
“tunnel vision.” There’s an even larger
number of Americans—an estimated 14 million, or
1 in every 20—who have low vision and cannot see
better than 20/70 with the best correction possible.
“Children with
conditions such as congenital glaucoma, albinism, or
retinopathy of prematurity can have low vision, but
many people who meet the definition are adults over
40,” says Dr. Khadija Shahid, a resident-trained
low vision optometrist at University Hospital. “The
conditions most commonly associated with low vision
are diabetic retinopathy; macular degeneration, which
causes a loss of central vision; glaucoma, a condition
that damages the optic nerve; cataracts; and diabetic
retinopathy.” Many times, a person might not know
he or she has one of these conditions, but senses that
something is wrong: it’s difficult to read, cook,
or sew; lights don’t seem as bright anymore; or
it’s hard to visually recognize the faces of relatives
or friends. Anyone experiencing these problems should
make an appointment with an eye specialist.
To serve the vast numbers
of people with low vision, the Institute of Ophthalmology
and Visual Science (IOVS) at the New Jersey Medical
School (NJMS) opened the Center for Low Vision Rehabilitation
and The Applied Vision Research Laboratory in April
2004. Low vision clinical services have been available
for several years at NJMS on a part-time basis, but
the Center is a full-time, comprehensive operation that
encompasses clinical care; community outreach; and research.
“The Center is important to the people of Newark
and surrounding communities. Minorities tend to have
a high prevalence and severity of diabetic retinopathy
and glaucoma, and there are many blacks and Hispanics
living in our area,” says Dr.
Marco Zarbin, chair of ophthalmology at NJMS. “It’s
also a very important resource for all New Jerseyans.
We don’t duplicate services offered by community
ophthalmologists, but rather, complement them. When
necessary, our affiliation with University Hospital
and the University of Medicine and Dentistry of New
Jersey enables us to work closely with specialists from
other disciplines, such as otolaryngology, pediatric
neurology, and physical medicine and rehabilitation.”
Not
Just “Getting Older”
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Janet
Rowley, CLVT (seated) and Khadija Shahid, OD operate
a closed circuit TV (CCTV). These are useful to
persons with low vision for reading, looking at
photos or any small object (such as label on prescription
bottle.) |
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Many people consider
vision loss to be part of the aging process and adjust
their lives accordingly. They stop reading the newspaper
because it’s hard to see the print; activities
once enjoyed are cast aside, because the frustration
of dropping knitting stitches or losing card games is
too much; and convenience meals replace home-cooked
ones. The Low Vision Center’s core mission is,
through low vision rehabilitation, to educate people
with low vision about the many things they can do with
the appropriate strategies and low-vision devices.
“Most people don’t
know what low vision therapy is,” says Dr. Zarbin.
“Low vision therapy has a rehabilitative role
for people with visual limitations similar to what physical
therapy offers people following orthopaedic or neurological
surgery.”
Low vision services begin
with an in-depth questionnaire and an examination, both
markedly different than the “usual” visit
to a vision specialist. The questions cover medical
history, but also seek information about a patient’s
daily living activities. The answers enable the optometrist
to develop an individualized plan for low vision therapy.
“The questionnaire asks, ‘What’s important
to you?’ People with low vision don’t all
have the same lifestyle, and that’s why a low
vision rehabilitation plan is tailored to the individual,”
says Dr. Shahid, who, along with Janis
White, OD, PhD, is a co-director of the Center for
Low Vision Rehabilitation.
After the questionnaire
is completed, the patient is examined by the low vision-trained
ophthalmologist or optometrist, as is the case at the
Center for Low Vision Rehabilitation. During a regular
exam with standard eye charts, the room is darkened
to assess how little a patient can see. For a low vision
exam, the room lights are on and a special chart is
illuminated. “We want to measure a person’s
maximum functional vision under the best conditions
possible,” says Dr. Shahid. In addition to distance
vision, the patient’s color vision, contrast sensitivity,
glare sensitivity, and visual field (both central and
peripheral) are assessed.
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Jumbo
sized playing cards, like the ones pictured above,
are designed for people who enjoy playing cards
but have impaired vision. |
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Once the questionnaire
and the physical exam are completed, Dr. Shahid determines
what low vision devices to prescribe and develops a
low vision rehabilitation plan for the patient, who
then meets with Janet Rowley, a certified low vision
rehabilitation therapist. Over several one-hour therapy
sessions, Ms. Rowley explains what lifestyle adjustments
and low vision devices are available for the patient
and, in a practical, hands-on way, how to use them.
The daily living accommodations
include such things as purchasing large print checks,
using a tactile mark to set the oven dial, or arranging
spices in alphabetical order. There are “talking”
blood glucose monitors and cups that emit a warning
beep to prevent an overflow. Specially designed wallets
have compartments for different currencies, and there
are familiar board games created for people with low
vision.
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Computer
software like ZoomText™ makes computers accessible
and friendly to low-vision users. |
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On the high-tech end,
there are special access technology software programs
such as ZoomText™ and Open Access™, which
through magnification and speech synthesizers give people
with low vision full access to the World Wide Web, e-mail,
and any personal computer-generated text. Telescopes
and magnifying devices run the gamut from simple to
sophisticated.
Ms. Rowley, the low vision
therapist, is familiar with low vision devices and lifestyle
applications not only from her education, but because
she herself is legally blind. She has albinism, a genetic
condition that produces a range of visual problems including
poor visual acuity, light and glare sensitivity, and
nystagmus. “I haven’t experienced some of
the losses that people with low vision do, such as not
being able to drive, because I have never driven,”
says Ms. Rowley. “Yet, I think low vision patients
identify with me, because they see me holding reading
materials close to my face or using a hand-held telescope.
It’s all extremely normal for me, and I try to
help low-vision patients see the glass half full. Yes,
they have lost vision that can never be restored, but,
with the right tools in place, they can live a very
full and independent life.”
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Devices
such as these prescription telescopes and magnifiers
are designed to help patients with low vision. |
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Dr. Shahid, Dr. White,
and Ms. Rowley agree that patient motivation has a major
impact on the success of low vision therapy. “We
don’t have a pair of magic glasses that can give
a person his or her sight back," says Dr. Shahid.
“The most successful patient is someone who accepts
their vision loss and is willing to make the changes
that need to be made.”
“Going blind is
one of many people’s greatest fears. It has consequences
for them and their families, and we provide the best
emotional support we can for our patients,” adds
Ms. Rowley. “But the fact is, if someone does
not want to be helped, they can’t be helped.”
Looking
into the Future
What
is known about low vision and the low vision devices
available today are the result of years of research.
The Center for Low Vision Rehabilitation’s research
component, the Applied Vision Research Laboratory, currently
is working on two projects designed to identify people
with sight-robbing conditions before visual loss occurs.
Bernard Szirth, PhD,
is a world-renowned expert on ophthalmic imaging and
director of teleophthalmology at New Jersey Medical
School’s IOVS. He uses laser imaging and other
sophisticated technology to obtain precise images of
the eye. His current project, a collaborative venture
with NJMS’s endocrinology department, will use
a special digital retinal camera to screen people who
haven’t received regular eye care. “The
screening takes just five minutes, and it is done without
any special dilation of the eye,” says Dr. Szirth.
“In that short amount of time, we can determine
the presence or absence of vision threatening disease.”
A second project involves
a little-understood eye disorder called nystagmus. Nystagmus,
which can occur during childhood or develop later in
life, causes uncontrolled, jerky movements of the eye.
As Dr. Szirth explains, “This is a condition where
the eyes travel at equal velocity from left to right
(pendular) and results in the inability to maintain
the eye in a given position long enough to allow the
brain to register an image with sufficient information.
This uncontrolled eye movement in turn is partially
responsible for a patient’s low vision.”
Dr. Shahid’s and Dr. Szirth’s project will
use sophisticated eye tracking technology to pinpoint
the patient’s best area of vision, with the potential
of improving the patient’s visual acuity and leading
to a better quality of life.
Hope
Is in Sight
Having
the optimal quality of life was what motivated Mr. Smith
to make an appointment at the Center for Low Vision
Rehabilitation in June 2004. He was examined by Dr.
Shahid and then met with Ms. Rowley for therapy. Mr.
Smith is enthusiastic about regaining his independence.
He is interested in a large, electric magnifying glass
(“It lays on the newspaper and enlarges the print.”)
and a hand-held telescope. “I can no longer drive,
so I rely on the bus for transportation,” he says.
“But sometimes I can’t see the route number
as the bus approaches until it’s too late, and
I miss the ride I need. Ms. Rowley took me to a bus
stop with the telescope, and I was able to clearly see
a couple of blocks up the street.”
In time, Mr. Smith hopes
to be taking the bus frequently. The Center for Low
Vision Rehabilitation is also a referral source for
patients who might qualify for benefits and services
provided by the New Jersey Commission for the Blind.
Once Mr. Smith’s eligibility for state services
is confirmed, he plans to enroll in a job training program.
“I never would have known about the devices or
job possibilities without Dr. Shahid and Ms. Rowley,”
he says. “I like to work, and most of all, I like
to be independent.”
* a pseudonym
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| "We're
not here to restore their vision, we here
to restore their function,", says Janet
Rowley, CLVT as she works with Diane Robinson
in is this WB11 WPIX-TV New York segment. |
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* Requires Windows
Media Player
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To make
an appointment with one of University Hospital's low
vision experts, call 973-972-2097.
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