I Won’t Know Unless I Try

Post by Brian Klotz

Ellie Leach at MABVI's Senior Connection 2014

Ellie Leach at MABVI’s Senior Connection 2014

Ellie Leach had never used a computer. No email, no games, no web browsing – as she puts it, “I had never even used a typewriter!” Over twenty years ago Ellie, now 78, was diagnosed with macular degeneration, a medical condition that causes vision loss, putting yet another obstacle between herself and tech-savviness.

Today, however, Ellie is the proud owner of an iPad, which she uses to email friends and family, play games, and listen to her favorite music.

“It’s like I’m alive again,” she says. “I feel like I’m a part of everything again.” Continue reading

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An Inaugural Low Vision Doctor Collaboration

Post by Jen Salvo, OD

I have been working for almost a year now as Medical Director for the Massachusetts Association for the Blind & Visually Impaired. And I have to say, besides the opportunity to hang out with the cool kids on Team with a Vision, the highlight of my year took place last week at the inaugural MABVI Affiliated Low Vision Providers meeting.

What happens when you get a group of low vision doctors together? Crazy good times! Okay, maybe not crazy, but definitely good times and a feel good vibe of camaraderie and collaboration.

A photo of the low vision doctors who attended the MABVI Affiliated Low Vision Providers meeting

A photo of five low vision doctors who attended the MABVI Affiliated Low Vision Providers meeting last week.

In attendance (from left to right) were Dr. Lyuda Sutherland, who sees visually impaired patients at Eye Center of the North Shore in Salem; Dr. Richard Jamara, low vision professor at New England College of Optometry and low vision provider for New England Eye; Dr. Jane Orenstein, who sees visually impaired patients at her practice in Whitinsville; Dr. Jennifer Salvo (yours truly), who provides low vision exams for MABVI in Holyoke and Springfield and at Metro West Low Vision in Wellesley and Hyannis; and Dr. Caroline Toomey, who performs low vision exams at MABVI’s Worcester location. Missing from the photograph is Rev. Arthur T. MacKay, OD, who serves visually impaired patients in Wellesley, Newton, and Natick.

Our newly formed band of low vision docs eagerly shared information and concerns about the dreaded topics of Meaningful Use and Electronic Medical Records and their impact on our practices. Dr. Jamara discussed his work with the Massachusetts Commission for the Blind (MCB) and how MCB is working to facilitate the registration of legally blind patients with the Commission.

We talked about bioptic telescopes, which are mounted in eyeglasses. Bioptics can be used for viewing street signs or in school settings to view the board at the front of the room. The focusable ones can also be used for near tasks and detail work. With the aid of a bioptic telescope, a small number of patients, whose vision falls within a certain limited range, are able to drive again with a restricted license.

A photo Dr.Salvo's father in law using a bioptic telescope

A photo of Dr.Salvo’s father in law using a bioptic telescope

Here is my father-in-law modeling a bioptic telescope (he is a good sport). As you can see, the telescope sits above the eye so it doesn’t block vision through the glasses. This particular model cannot be used by drivers in Massachusetts because it is focusable. Imagine the havoc wreaked by a driver trying to focus his telescope as he drives down the highway!

For those individuals who are candidates to use a bioptic for driving, the challenge is to make sure they are able to drive safely while wearing and using the telescope . At our meeting we shared information about local adaptive driving training programs that can provide these patients with training and assessment.

We also discussed the difficult aspects of a low vision doctor’s work—telling patients that they should no longer be driving or that they are legally blind. We recognize that for many people the hardest part of vision loss is the loss of independence and the feeling of isolation that can result from losing one’s driver’s license. When counseling these patients, I encourage them to attend a local low vision peer support group. A person struggling with the challenges of vision loss can greatly benefit from the support of peers who are also visually impaired and dealing with some of the same issues.

Another issue of importance to low vision providers is how to help our patients maximize the effectiveness of the devices we prescribe for them. Without proper training, lighting or ergonomics, low vision devices often wind up unused and in a drawer. Dr. Toomey and I shared how invaluable it is to work with MABVI’s occupational therapists (OTs) who provide patients with in-home vision rehabilitation. The OTs not only train patients to use prescribed devices for performing tasks and activities, they also provide home lighting and safety assessments and strategies, help patients to maintain compliance with medications, connect them to other agencies and services, and help improve patient satisfaction and outcomes. Here is one of our OTs, working with a happy patient!

An OT helping a low vision patient

An OT helping a low vision patient

All in all, it was a productive first meeting, and a great opportunity to relax and chat and network with peers. Truth be told, we low vision doctors are considered a bit odd by our fellow optometrists, since we work with patients with serious eye conditions, but we don’t treat the disease—we treat the person, focusing on helping them to function in their daily lives. With the history-taking, identification of goals, and the low vision assessment, our exams can last an hour and a half! (Many a patient has told me, patting me on the arm on their way out of the exam room, “You must have the patience of Job.”) We are anomalies in the increasingly fast-paced medical world. So the opportunity to gather with my fellow low vision doctors means a lot to me. Our “low vision doctor support group” as they are calling it at MABVI, is a wonderful way for us to share ideas and concerns and to learn from each other. Our collaboration will benefit not only our professional growth, but our patients, as we share ideas on how to better help them achieve their goals and improve their quality of life.

If you are interested in becoming a MABVI Affiliated Provider, please contact Jennifer Salvo, OD at jsalvo@mabcommunity.org or email Shaun Kinsella, MABVI’s statewide director, at skinsella@mabcommunity.org.

What low vision specialists can do for diabetes patients

Whether you have cataracts or glaucoma, vision loss doesn’t mean saying goodbye to your daily routine. With help from a low vision specialist, people with diabetes and vision loss can manage their health and continue to live fulfilling lives.

Diabetes can cause vascular changes in the retina, which can cause blood vessels to leak blood products, and if they leak into the center of the retina (known as the macula) it can cause blurry, distorted vision. Diabetes can also increase the risk for developing other conditions such as glaucoma and cataracts.

That’s where the low vision specialist comes in. While optometrists perform exams and check-ups, low vision specialists are key for patients who want to monitor their vision loss and find new ways to continue their daily routines.

“The comprehensive eye examination has been done by others. We’re focusing on visual function and trying to help our patients do what they need to do on a daily basis,” says Dr. Philip Silver, the low vision specialist at the Joslin Diabetes Center.

Dr. Silver, who has worked at Joslin for more than 20 years, helps people with diabetes maintain their current level of vision and adapt to whatever vision loss they experience.
“Just improving patients’ quality of life by maximizing their vision keeps me going every day,” he says.

Low vision specialists help determine if factors aside from a patient’s diagnosis could be contributing to vision loss. Some patients may be diagnosed with diabetic retinopathy or degeneration, but not discover until later that they also have cataracts and glaucoma. Cataracts can make the lens cloudy, and glaucoma can damage the optic nerve, both causing more vision loss if left untreated. Detecting other conditions early on could make the difference between a patient having 2200 vision (legal blindness) and going completely blind, Dr. Silver says.

“It’s not just focusing on one disease that a person was diagnosed with,” he adds. “There are other things that have to be ruled out too.”

Technological advancements have made controlling diabetes, and thus one’s vision levels, easier for patients. Today patients can use insulin pumps and glucose monitors to maintain normal glycemic levels and blood sugar levels.

However, low vision specialists do not only monitor the effects of diabetes on vision. They also must assess patients’ current vision levels and their goals. By learning those details, low vision specialists can direct them to the right devices and therapy options to adapt to their vision loss.

Among the most common tools are magnification glasses or handheld magnifiers. One of Dr. Silver’s patients who loves to travel has a telescope mounted in her glasses to read gate signs. She also uses bifocals so that she can read. Other patients may use large print labels on their medications or household items, as well as smartphone applications that help with reading or labeling.

Low vision specialists may also send patients to occupational therapists who may help make their houses more adaptable or help them use certain devices at home.

“We’re not going to restore your vision, unfortunately, but we are going to try to maximize the vision that you have left,” he says. “There’s so much that can be done for a patient who is either losing vision or has lost vision that they owe it to themselves to get a low vision exam.”

WATCH: An Introduction to low vision optometry