Eyeworld

98 | EYEWORLD | APRIL 2023 G UCOMA by Liz Hillman Editorial Co-Director rehabilitation specialists will first evaluate to see if glasses maybe help improve vision before visual aids are introduced." Traditional aids Mr. Mohiuddin said that while most people im- mediately think of magnifiers as visual aids, the first thing he recommends is proper lighting and glare control measures. "Simple sunglasses or blue light-blocking filters may help reduce glare, and certain color temperature lighting positioned in the right place may help illuminate a task or environ- ment that may allow a person to see their best," he said. "Common complaints we hear from pa- tients with glaucoma when they notice changes in their vision include increased sensitivity to glare, everything appearing dimmer, or trouble seeing in low light conditions. Later in their vision loss, complaints may include total loss of vision or loss of peripheral vision creating chal- lenges walking around and navigating environ- ments safely." Mr. Mohiuddin said he regularly demon- strates conventional and electronic magnifiers, handheld options, and glasses-mounted tele- scopic devices, as well as specialty filters for glare control and photosensitivity. He said there are a number of non-optical modifications as well, such as using contrasting tape to mark the edges of stairs and no-cut gloves or chopping aids, as a couple of examples. Overview of visual aids: new technology and dependable tools T here is a significant focus on stopping progression of optic nerve damage and subsequent vision loss in glauco- ma, but what about patients who have already reached a point of vision loss? What modern visual rehabilitation technologies and services are available to them? According to a review article published in the journal Eye in 2022, "relatively little effort has been focused on the practical question of how to maximize visual ability (perform every day, visually-mediated tasks) and minimize the effects of impairment in persons with glauco- ma, particularly those with advanced disease." 1 Compared to other medical specialties, the au- thors of this paper wrote that in ophthalmology, "significant barriers exist in the integration of rehabilitation into glaucoma care," including vi- sual changes being gradual and fluctuating, the need for multiple conversations with patients, limited time for the primary glaucoma specialist to guide patients in visual rehabilitation and/or limited visual rehabilitation specialists in their area, and difficulty getting patient commitment and/or trust in the visual rehabilitation process. Mona Kaleem, MD, said that even if patients experience problems with their vision, some don't bring it up with their care providers. She also said that the physician, in general, doesn't spend a lot of time talking to patients about their functional deficits, focusing more on IOP, testing, and visual acuity. She said that asking three questions could help ophthalmologists determine if a patient would benefit from a vision rehab consult: 1) Do you have problems reading? 2) Do you have difficulty walking? 3) Have you fallen in the past 6 months? If they answer yes to any of these, a referral is recommended. "If there is VA of 20/50 or worse, any contrast sensitivity loss, any field loss or scotoma, you should start having conversations with your patients about vision rehab," Dr. Kaleem said. "Vision loss is both a spectrum and a jour- ney, with some people experiencing improve- ments and declines in their vision over time," said Omar Mohiuddin, OTR/L, CLVT. "When vision loss first begins to impact a person's ability to do functional tasks a referral to vision rehabilitation services is recommended. Vision About the sources Mona Kaleem, MD Associate Professor of Ophthalmology Wilmer Eye Institute Johns Hopkins University Baltimore, Maryland Omar Mohiuddin, OTR/L, CLVT Occupational Therapist Duke Eye Center Duke University Durham, North Carolina Jullia Rosdahl, MD, PhD Associate Professor of Ophthalmology Duke Eye Center Duke University Durham, North Carolina This shows different low vision aids and techniques. Source: Omar Mohiuddin, OTR/L, CLVT

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