Your Role in Vision Rehabilitation
We must empower patients to make the most of their remaining vision and to live as independently as possible
John Liu, Irfan Nizarali Kherani, Mark Bona | | Opinion
Vision rehabilitation is a vital (but often underrecognized) service for those suffering visual impairment (1). As ophthalmologists, we often encounter patients who could benefit from earlier vision rehabilitation treatment without immediately realizing it ourselves. In addition to managing the medical and surgical needs of our patients, we must also prioritize vision rehabilitation and its role in empowering patients to make use of their remaining sight to function and live independently. Here, we present five key points to remember in visual impairment and vision rehabilitation:
i) Visual impairment is on the rise. The need for vision rehabilitation services is growing in response to age-related eye diseases (for example, age-related macular degeneration and glaucoma), which is coupled with the staggering growth of the world’s aging population. In 2017, the global population of those aged 60 and over was around 962 million; by 2050, the number is projected to reach nearly 2.1 billion (2). In the US, roughly 3.22 million people were visually impaired in 2015. By 2050, this number is projected to double to 6.95 million people (3).
ii) Visual impairment can result in a variety of negative health outcomes and significantly affects activities of daily living and exacerbates symptoms of depression and anxiety in older people (4). Studies have shown that decreased vision is also associated with an increased risk of falls, hindering safe and independent living, subsequently resulting in earlier than needed admission to long term care facilities (5). Furthermore, a study in Canada showed that individuals with lower income, diabetes, a history of smoking or memory problems are more likely to suffer visual impairment (6).
iii) Vision rehabilitation is a service offered to people with low vision to optimize functional ability and independence (7). As part of the service, a formal assessment by an eye care professional will help characterize residual vision, which then informs a patient-centered rehabilitation plan. Strategies often include lighting techniques, magnifying devices, and adapting the home environment to optimize safety and navigation. Recent advances in technology have increased the types of assistive devices available; vision rehabilitation services also employ electronic and digital aids and smart devices to support patient care. Evidence suggests that vision rehabilitation services have a positive impact on patients’ quality of life, independence, and emotional well-being (7).
iv) Vision rehabilitation is part of the healthcare continuum with various providers involved in the circle of care, including optometrists, ophthalmologists, occupational therapists, social workers, and other rehabilitation specialists. Available resources vary by country. In Canada, for instance, Vision Loss Rehabilitation Canada (VLRC) is the primary provider of vision rehabilitation services nationally, and can help connect primary care physicians and eye care practitioners with vision rehabilitation specialists in caring for their patients with low vision (8). In the US, roughly 60 percent of the service entities providing low-vision rehabilitation are private optometry or ophthalmology practices, with a smaller percentage offered through government (mostly state) agencies (9).
v) Conversations about vision rehabilitation should be encouraged when ophthalmologists feel it may be helpful. Whether due to a lack of awareness or a lack of accessibility, vision rehabilitation can sometimes be overlooked in the overall care of a patient’s visual health. As eye care professionals, it is our duty to ensure patients feel empowered to make use of their remaining vision and are referred appropriately to rehabilitation so that they may be able to live and function independently.
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- National Academies of Sciences, Engineering, and Medicine, “Making Eye Health a Population Health Imperative: Vision for Tomorrow” (2016). Available at: https://bit.ly/3aYRrQq.
- United Nations, Department of Economic and Social Affairs, Population Division. “World population ageing: 2017 highlights” (2017). Available at: https://bit.ly/3b0Pkfg.
- CDC, “The Burden of Vision Loss” (2020). Available at: https://bit.ly/2Z642vF.
- G Kempen et al., “The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services”, Qual Life Res, 21, 1405 (2012). PMID: 22090173.
- S Lord et al., “Vision and Falls in Older People: Risk Factors and Intervention Strategies”, Clin Geriatr Med, 26, 569 (2010). PMID: 20934611.
- R Aljied et al., “Prevalence and determinants of visual impairment in Canada: cross-sectional data from the Canadian Longitudinal Study on Aging”, Can J Ophthalmol, 53, 291 (2018). PMID: 29784168.
- P Rabiee et al., “Vision rehabilitation services: what is the evidence? Final report” (2015). Available at: https://bit.ly/3cYHANn.
- Vision loss Rehabilitation (2020). Available at: https://bit.ly/3aWTTHc.
- C Owsley, “Characteristics of Low-Vision Rehabilitation Services in the United States”, Arch Ophthalmol, 11, 127 (2009). PMID: 19433720.