Eyeworld

32 | EYEWORLD | WINTER 2025 ATARACT C OPENING DOORS by Liz Hillman Editorial Co-Director About the physicians Rosa Braga-Mele, MD Professor of Ophthalmology University of Toronto Toronto, Canada Danielle Ledoux, MD Specialized Pediatric Eye Care Beverly, Massachusetts Susannah Rowe, MD, MPH Assistant Professor of Ophthalmology & Vision Sciences Boston University Chobanian & Avedisian School of Medicine Beverly, Massachusetts Madhura Shah, MD PGY-2 Weill Cornell Medicine New York, New York thing to say, because we're taught 'First, do no harm,' is 'Let's just not do this.' But that doesn't serve the person who can't see," Dr. Rowe said. Instead, Dr. Rowe advocates for a broader, more inclusive understanding of quality of life. "Do they like to go for a drive with their sister? Do they enjoy a TV show? Did they stop walk- ing, potentially because they can't see anymore? These are the markers we need to consider. It's arguably even more important for someone who can't tell you that directly." In many cases, input from family members and caregivers becomes essential. Their obser- vations—changes in routine, loss of interest in activities, increased anxiety—can reveal the silent toll of cataract-related vision loss. Madhura Shah, MD, a second-year resident, said there isn't training in medical school for how to assess patients' vision-related quality of life when they can't communicate in the typical way. "We have a pretty rigid checklist in medi- cal school for a primary care visit … but in this setting, I was seeing that you have to take a step back and try to understand why the patient is there and what needs to be done to improve their care," Dr. Shah said. The benefit of restoring vision for these patients can go beyond expectations. One of Dr. Rowe's patients—a man with Down syndrome in his 50s—had been diagnosed with dementia prior to surgery, she recalled. Meeting patients with disabilities where they're at P atients with disabilities can experience unique challenges when in need of cataract surgery, but some ophthalmol- ogists who find themselves being re- ferred these patients say the challenge for the patient often begins before they ever sit in an exam chair. This vulnerable patient pop- ulation can face distinct ethical, logistical, and systemic barriers to care. Danielle Ledoux, MD, said patients with disabilities, especially cognitive and mental ones, are "no different than any other patient population, but the means by which you gather information is a little different," causing some physicians to think they don't have the capabili- ty or capacity to treat these patients. "So, I think there's a care gap," Dr. Ledoux said. Rosa Braga-Mele, MD, said it's easy to look at a person with a disability and think about how they're going to need more of your time and/or be more challenging. "But what I think about is everyone deserves the same level of care. It may take me a little extra time, and it may be more of a challenge or require more planning and logistics, but there is no greater satisfaction than giving someone who could po- tentially not advocate for themselves the ability to receive the same healthcare as everyone else and give them their sight back. You can change their world completely." Barrier 1: understanding vision-specific quality of life The first and perhaps most overlooked barrier to care for patients with disabilities, especially those who are neurodiverse or have cognitive disabilities, is the assessment. How do you determine visual disability in a patient who is non-speaking or has difficulty communicating? "We don't train people in how to under- stand vision-specific quality of life for someone who's non-speaking," said Susannah Rowe, MD, MPH. "We need to understand what people do with their eyesight when they don't do paid work, they don't read, and they don't go to school." Without clear metrics for benefit—and with the potential for increased risk—the ethical path forward could be non-intervention. "The safest More education Dr. Ledoux and Dr. Rowe recommended an online training module created by the Massachusetts Department of Public Health and the Massachusetts Department of Development Services. "Ensuring Equitable Access to Vision Health Care for Individuals with Intellec- tual and Developmental Disabilities" is a free, on-demand resource. View the sessions by scanning this QR code.

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