Low vision and rehabilitation for older people: integrating services into the health care system

Low vision and rehabilitat io integrating services into t Unfortunately, in many parts of the world, the above scenario is all too common in eye clinics. Faced with patients like Mary, eye care practitioners often feel uncomfortable and do not know what to say. Too often, therefore, these patients are turned away when in fact much can be done to help them. Patients like Mary, who are not completely blind, but whose sight cannot be improved either by treatment (such as cataract surgery) or by the provision of ordinary near or distance spectacles, are said to have 'low vision'. Low vision refers to a permanent loss of vision which makes it difficult for a person to perform many daily activities. A person with low vision presents all three of the following characteristics: impairment of visual functioning even • after treatment and/or standard refractive correction visual acuity ranging from light perception • to <6/18 (0.3 logMAR), or a visual field smaller than ten degrees from the point of fixation the person uses, or is potentially able to • use, vision for the planning and/or execution of a task. 1 People with low vision are, in principle, capable of using their vision and wish to do so. If given the appropriate low vision devices and training, they do not typically need to use white canes or to learn Braille (although these may benefit some persons with low vision as an additional or complementary support). Many of these patients are not technically considered blind, although they might be classified as such in their country. For patients with low vision, there is still hope for a better life. This is possible through the use of low vision devices and rehabilitation. Low vision devices (such as magnifiers) help patients make the best use of whatever vision is available to them. rehabilitation teaches patients how to adapt their environment appropriately in order to make the best use of their existing vision. Patients who are prescribed low vision devices are also taught how to use these devices in their daily life. The causes of low vision in older people vary according to region. In general, low vision can be due to glaucoma, diabetes, macular degeneration (which is not present in some parts of Africa), hypertensive retin-opathy, or retinal detachment. Cataract cannot be considered a cause of low vision, unless there is a good reason not to perform …