Exercising My Soul as a Boston Marathon Guide for the Visually Impaired

By Dr. Vincent Hau, vitreoretinal physician and surgeon at the Kaiser Permanente Riverside Medical Center, California

Vincent Hau guiding Richard Hunter as they run the Boston Marathon

VIncent Hau guiding Richard Hunter at the Boston Marathon

Like most avid marathon runners, I’ve always dreamed of running the most prestigious marathon race in the world: the Boston Marathon. I first qualified when I was a medical student nearly 11 years ago, but was afraid of requesting time off from my third-year clinical rotations to run it. For the following 10 years I’ve always regretted never asking.

Since joining Kaiser Permanente, an institution that values an employee’s health and well-being via a strong work-life balance, I’ve been able to achieve qualifying for the Boston Marathon again. Ten years later, in 2014, I ran the post-bombing marathon in a personal record time and shared in showing the world how a terrorist act would never dissuade the spirit of our running community.

This year, after having to take nearly a half-year hiatus from training due to plantar fasciitis and Achilles tendonitis, I knew that in running Boston I would not get close to the time I achieved last year. In fact, I wasn’t even sure if I should be running at all, since I was still recovering and had run for only a couple of weekends prior. When I asked my orthopedic surgeon and physical therapist if I should run Boston, they answered with silence and that special smirk that implied they knew I would run it anyway if they said no. 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.

Focus on Function: The Low Vision Exam

Optometrist Jen Salvo offers insight into the low vision exam.

Optometrist Jen Salvo offers insight into the low vision exam.

This post was written by Dr. Jennifer Salvo, a low vision optometrist. She sees patients for MABVI in Holyoke and Springfield and also provides low vision care in Wellesley Wayland, and Hyannis through her private practice. For more information about Dr. Salvo and her low vision practice, visit www.metrolowvision.com  or call her at 508-740-0706 to schedule an appointment.

If you have impaired vision, and your eye doctor is unable to restore your vision with treatment or surgery, where do you go for help? When your doctor tells you, “There’s nothing more I can do” or “These are the strongest glasses I can give you”, what is your next step?

Many people give up at this point and become increasingly isolated and depressed due to their vision loss. However, there is help available, and your next step should be a low vision exam. A low vision exam is far different than the one you receive when you visit your retina doctor or glaucoma specialist. It is a functional assessment–meaning that the low vision doctor will assess your ability to perform daily tasks, hobbies and activities, and will also address safety concerns.

After performing various vision and reading tests, the low vision doctor will evaluate and prescribe appropriate devices and make recommendations for improving your functioning. The doctor may recommend LED magnifiers, high-powered reading glasses, telescopes, television glasses, or video magnifiers. He or she may also recommend in-home training with an occupational therapist who specializes in working with visually impaired individuals.

Although you may receive a new glasses prescription at the low vision exam, glasses will not restore vision that is lost due to retinal damage or eye disease. However, the low vision doctor can help you maximize the use of your remaining vision.  The low vision exam is the starting point for receiving the services and devices to help you regain independence  and maintain activities you enjoy.

Click here to hear Boston-area low vision optometrist Richard Jamara describe how he helps individuals living with vision loss.​

Exploring vision rehabilitation with Dr. Jamara

Dr. Jamara (left) receives an award for his dedication to patients with vision loss. Pictured with Dr. Jen Salvo and a MABVI low vision patient.

Dr. Jamara (left) receives an award for his dedication to patients with vision loss. Pictured with Dr. Jen Salvo and a MABVI low vision patient.

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. Continue reading