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Low Vision: Hope for the Visually Impaired

The Low Vision Enigma
In an extremely colorful and multi-faceted world such as the one we live in, it is an enigma that so many concepts are considered as plainly black and white. One such enigma is the concept that people are thought of as either sighted or blind – with no gray areas in between.

For all intents and purposes, the health delivery system in our country is geared towards treating the sighted or managing the blind. What happens to the significant population of individuals who have neither normal visual function nor are completely unsighted?

They are relegated to a seemingly hapless limbo of the “untreatable.” And given a choice, most health care providers would assign them to the realm of the blind; when in fact, they are partially sighted or visually impaired: what we in ophthalmology classify as Low Vision.

Low Vision is a condition wherein people find everyday visual tasks difficult to do in spite of the use of regular glasses or contact lenses, and maximum medical and/or surgical management for their eye problem. Reading newspapers, shopping, watching television or simply walking around and traveling independently become Herculean tasks.

The problems may involve central vision, thus resulting in difficulties of recognition of detail and color, but allowing ambulation and travel. Or they may involve peripheral or navigational vision preventing independent travel; but sparing the central vision such that the patient is capable of “seeing” but only through a tunnel of clear sight. Or they may be any combination of the above.

Causes of Low Vision
According to the latest National Survey on Blindness, more than a mil¬lion Filipinos suffer from Low Vision. The fact is that as high as 60 to 70 percent of persons classified as blind actually have some useful residual vision. So in actuality, the Low Vision statistic may even be an underestimation.

One of the leading causes of acquired blindness, both in the developed and the developing countries, is diabetes. The end-stage complications in the eye result in what is termed Diabetic Retinopathy – wherein the retina, or the “film” of the eye, is progressively made susceptible to bleeding and scarring brought about by the chronic insult of uncontrolled sugar levels. Unfortunately, a great majority of this advanced damage to the retina is not reversible and this results in partial or complete loss of vision.

Other common causes include age-related degeneration of the retina (macular degeneration), optic nerve damage from diseases such as glaucoma, untreated or neglected cataracts, corneal diseases, eye trauma and birth defects. Low Vision in children is a particularly important condition as the full potential of the child can be maximized with earlier intervention.

Detecting Low Vision
Although it may necessitate the services of an eye doctor (ophthalmologist) to accurately diagnose Low Vision, certain signs may lead one to suspect its presence. If one is wearing his regular glasses or contact lenses and still has difficulty:

  • recognizing faces of known friends and relatives
  • reading street/bus signs
  • walking independently in unfamiliar places
  • working because the lights appear much dimmer than they used to
  • matching colors
  • reading tag prices in supermarkets or stores
  • reading regular newspaper articles
  • performing activities of daily living, such as cooking, eating, sewing, locating hairbrushes or toothbrushes;

then, one may very well be displaying signs of possible low vision or visual impairment. Naturally, the earlier the condition is diagnosed, the better the chances of undergoing appropriate treatment.

What Can Be Done
The most common phrase that patients with Low Vision hear from their health care provider is that “nothing more can be done for your eye.” And although it may be true that not much else can be done for the eye, it is almost never true that “nothing more can be done for the patient.”

The worst fate a visually impaired individual may suffer is that he be treated as blind. They are taught Braille and advised not to “overuse” their eyes so that some vision will always remain. These fallacies of treatment must be abandoned. Instead, the visually impaired should be referred to a Low Vision service for further management. A Low Vision specialist is an ophthalmologist or optometrist who is qualified to train the visually impaired/ Low Vision patient to effectively utilize his remaining useful vision with special aids such as special glasses, magnifiers and miniature telescopes. Non-visual training for ambulation and activities of daily living may also be undertaken such that the patients can be reintroduced into the “mainstream” of society in general. The Low Vision team incorporates other health care professionals such a rehabilitation medicine specialists, psychologists/psychiatrists, occupational/physical therapists, and the like for a holistic team approach that addresses the patients’ particular needs.

This team approach is essential to the rehabilitative process and includes all available devices and technology to help the patient adapt to vision loss. Ultimately, the aim is to help the patient resume crucial activities he used to do — within reasonable limits relative to the actual visual problem.

What Should Be Done
In the end, the age-old adage “An ounce of prevention is worth a pound of cure,” stands the test of time. Regular eye check-ups help detect preventable and treatable eye diseases. The sooner the medical condition is recognized, the sooner the proper eye specialist sees the patient, then the earlier the condition can be diagnosed. Once diagnosed, the proper management can be undertaken.

Proper referral to a Low Vision service would then maximize the possibility of successful treatment and the maintenance of remaining vision. Truly, there is hope for the visually impaired.

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