MABVI sat down with Richard Jamara, a doctor of optometry and professor at the New England College of Optometry. He is also the attending low vision specialist at the New England Eye in Boston. Here are some highlights of the interview. Read the full interview here.
DR. JAMARA: So many people say to me when they finally come to low vision services, “how come I didn’t know about you sooner?” What happened is that they had gone for their regular eye exams. In their conversations with their doctor, they were able to say, ‘I have this problem,’ they gave them some solutions, but it didn’t meet their needs. As a matter of fact, standard eye care couldn’t improve their vision. So they began this kind of search of doctor to doctor, but the fact that low vision rehabilitation wasn’t brought up as an alternative was a problem for them, so they had to seek additional care. One of the things I realized is that so many people are missing out on things like magnification, tints for glare, so we started this idea of getting the information out to the practitioners so they could refer to low vision and start that network. It’s interesting because it’s kind of unnatural for me since I’m the kind of old-style doctor who sits and talks with the patient a little bit. What happens is I find the patient tells you what’s wrong and they also tell you how you can help them. A lot of times that takes a special event, that takes a special visit. One of the things that we learned is that the patient has to come in prepared for the exam. They have to come with that knowledge that they’re going to be presenting their information to the doctor, who needs that thinking time to process it and to get to be able to get them in that direction. This is an element that’s missing in their care. I say this at the College of New England College of Optometry. We’re always asking the students to become very efficient in their exam. We give them an hour and a half, the next year an hour, and then 45 minutes and then finally they’re down to 25 minutes when they’re in practice. We’re constantly getting them to critically think faster in the examination, and I think that’s important to have the regular eye exam volume that’s expected of them. On the other hand, I think the pendulum has to swing back a little, to say “tell me about your vision. What is it that you’re missing doing?” And then being able to identify, maybe in the electronic health records, what is a piece that could come up, and pop up and slow the patient and the doctor to have to say let’s head in another direction like low vision rehabilitation.
MABVI: Now elaborate on what you’re able to do in a low vision exam that then comes up with some recommendations of things that could actually make a difference for the person who has an uncorrectable vision problem.
DR. JAMARA: That’s a great point because the very first thing that everyone has to decide or understand or know, both the doctor and the patient, is that this vision problem is not going to be corrected. There’s no eye glass, no contact lenses, no medication or surgery that’s going to give the patient their vision back. Once that is identified, then we will say “well what you’re going to need is something to take its place. We’re going to have some type of device or resource that’s going to take the place of the vision loss that you just experienced.” Then what we’ll go into is asking questions about their goals, “What is it that you miss the most?” Identifying that, say if it’s reading, and then finding out the size they can see, say 20/100, what is the size they want to see, which is 20/550, which is the size of regular print, and then you have to see and magnify whatever they’re looking at two or three or four times. Once you establish that, you find what’s their sensitivity to light, and then a big thing that’s hard to detect, it takes that little extra time, is do they have a blind spot right in the middle of where they’re looking? They’ll often say, I can see you, but I can’t see your eyes, I can’t see your nose. That blind spot has to be moved over so they can look around it. And this is something some people learn to do and some people have to learn how to do. So with those things identified—their magnification, their contrast sensitivity and their scotoma or blind spot—that leads us then to the prescription of the magnification or the lighting that’s required, and that’s not done in the regular eye exam. That’s something that either has to be the optometrist that we trained would have the patient back to do that or that patient could refer to low vision services.