Issue link: https://viewer.e-digitaledition.com/i/89851
+++++++++++++++++++++++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++++++++++++++++++++++ CLINICAL SECTION: CARING FOR OLDER ADULTS +++ +++ Vision Rehabilitation for Adults: HELPING TO MAINTAIN INDEPENDENCE AND PRODUCTIVITY By Corrie Weitzel, OD, MS I MAGINE A WORLD that is forever fuzzy, cloudy or dark. For many individuals with some form of vision loss, this is a world that is all too familiar to them. More than 14 million people in the United States suffer from low vision that is not correctible with prescription eyeglasses, contact lenses or surgery. Most are over the age of 80. Leading causes of vision loss in older adults are cataracts, glaucoma, diabetic retinopathy and macular degeneration. Visual impairment can also be caused by stroke and traumatic brain injuries. While total blindness does not fall under the category of low vision, those who suffer from low vision are significantly impacted in their daily functioning. Vision impairment has a major impact on healthy aging and social interaction. Individuals with low vision have twice the risk of falling and four times or more increased risk of sustaining a hip fracture, are admitted to nursing homes up to three years earlier, make greater use of community services, have increased social isola- tion, have three times the prevalence of depression, are more likely to make medication errors, and have greater difficulty reading.1 Although vision can never be restored, there are ways to help individuals with low vision accomplish the tasks of daily living. Low vision rehabilitation programs can maximize the quality of life. Referrals often come from ophthalmologists and optometrists, as well as from geriatricians, primary care physicians, neurologists and orthopedic surgeons. Vision rehabilitation specialists discuss functional problems the patient is experiencing with their vision and test the patient's vision using specialized low vision charts at far and near distances. Other ocular function testing, such as contrast sensitivity and color vision testing, may also be performed. A therapist trained as an occupational therapist (OT) and a certified low vision therapist (CLVT) can assess the patient's functionality from a vision standpoint and evaluate how vision integrates with the person's overall function. For example, the therapist can assess how a patient with recent vision loss can function with co-morbidities such as Parkinson's, arthritis or other chronic diseases. Based on the individual's goals, a therapy plan is developed around five key components: + Lighting may include "daylight" light bulbs, focused lighting, appropriate lamps, ceiling or counter lighting, or use of special sunglasses to reduce brightness and glare. + Contrast utilized throughout the home can improve independence and safety. + Magnification devices, including over-the-counter glasses, pocket 32 | Cleveland/Akron/Canton MD NEWS s MDNEWS.COM s NOVEMBER-DECEMBER 2012 magnifiers and CCTV magnifiers, can help task performance. + Organization involves working with the patient and his or her family to develop an organization plan for each area of the home. + Counseling is extremely helpful for those who have a visually impaired relative or friend. Helping patients and family caregivers work through vision loss issues is important. In addition to optometrists and therapists, the low vision rehabilitation team may include social workers and psychiatrists to address the emotional and psychological adjustment to vision loss. Together, they can help individuals with low vision maintain their indepen- dence, encourage productive activity, and increase safety and life satisfaction. Dr. Corrie Weitzel, a vision reha- bilitation specialist in the Department of Ophthalmology at Cleveland Clinic, is based at Cleveland Clinic Senior Health and Wellness Center, 450 Avon Beldon Road, Avon Lake. On the east side of Cleveland, Low Vision Rehabilitation Services is offered at 10524 Euclid Avenue, Walker Building, 2nd floor, C-22, under the direction of Patrick Baker, MHS, OTR/L, CLVT, CDRS. s Reference 1. Car ter TL. Age-related vision changes: a primary care guide. Geriatrics. 1994;49(9):37–42,45.