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Hope and Help for Older Adults with Low Vision

Older adults with partial loss of vision — whether due to illness or injury — face many challenges in everyday life that most of us can only imagine. And for most people, the limitations of partial vision loss can also exact a heavy emotional toll — increasing the risk of depression, anxiety, and social problems.

“People who have partial vision loss — also called low vision — have lost a degree of independence as a result of their condition,” explains Laura Dreer, PhD, a clinical psychologist who provides evidence-based counseling and mental health services to low vision patients and their families in the UAB Department of Ophthalmology. “These feelings of loss can lower self-esteem and lead to depression and anxiety for some. We help patients and their families adjust to their new reality by teaching them specific strategies to compensate for their vision loss and to cope more effectively with their challenges. We want patients to feel empowered by what they can do – instead of focusing on their limitations.”

What is Low Vision?

The term “low vision” refers to people who have experienced partial loss of vision and have at least some residual vision remaining. Vision is usually 20/40 or worse in the better eye. “For some people with low vision, acuity may be fine, but peripheral vision may be impaired,” says Dr. Dreer.

Low vision may result from a number of conditions and diseases, including: glaucoma, retinitis pigmentosa, diabetic retinopathy, macular degeneration, stroke, and eye injury.

Common Challenges of Low Vision

“Low vision can greatly impact everyday activities and quality of life for older adults,” explains Dr. Dreer. “Low vision is considered a chronic health condition, and a significant number of older adults and their families may experience difficulty adjusting. However, it’s also important to recognize that there are individual determinants to adjustment and that many of these patients are resilient.”

Older adults with low vision experience a range of challenges, including:

  • Driving — A number of individuals with low vision are unable to drive, which represents a loss of independence.
  • Medications — “Being able to read and take medications correctly and safely can be a problem for older adults with low vision,” observes Dr. Dreer.
  • Functionality of daily living, such as reading and paying bills, self-care — Routine, everyday tasks can also be difficult for people with low vision.
  • Social Problems — Many people with low vision may develop feelings of isolation and loneliness as a result of their condition. This can increase the risk of depression and anxiety.

Low vision can also be difficult for families as they learn to adapt to their loved one’s condition and sometimes assume new roles. This may be an even greater issue for families when their loved one has other chronic health problems also requiring assistance (for example, Alzheimer’s disease, and stroke). “Because most low vision patients look fine — especially if they walk without a cane — families can sometimes forget about the difficulties their loved one is experiencing. This can also make it difficult for them to empathize with their loved one and understand the many challenges he or she faces on a daily basis,” Dr. Dreer explains.

How Rehabilitation and Mental Health Services Can Help

The UAB Department of Ophthalmology is dedicated to helping low vision patients learn how to make the most of their remaining vision and providing support, evidence-based counseling and education to patients and their families. “Referrals can come from a variety of healthcare professionals (such as optometrists, ophthalmologists, primary care physicians) or self-referrals,” says Dr. Dreer. “Patients are traditionally referred when it is determined that nothing more can be done either medically or surgically to improve the patient’s eye disease.”

Dr. Dreer explains that a more proactive approach might include early detection of people who may be at risk for problems with adjustment shortly following their diagnosis. “Referrals for mental health services at that time may help motivate patients for long-term care, teach them coping strategies, educate them regarding their eye disease, help them identify community resources, and prepare them for future challenges related to their particular eye disease,” she says. “Thus, this type of strategy may help to minimize or prevent long-term problems with coping and enhance adjustment.”

The Department features a multidisciplinary rehabilitation team comprised of:

  • Medical Services
  • Occupational Therapy
  • Mental Health Services

“Occupational therapists help patients learn to compensate for their vision impairment by teaching new ways of doing everyday tasks,” explains Dr. Dreer. “The goal is to help patients make the most of their remaining vision.”

A unique feature of the Department of Ophthalmology is its emphasis on the emotional and psychological factors involved in low vision. “Traditionally, Departments of Ophthalmology haven’t addressed this important aspect as part of comprehensive eye care,” explains Dr. Dreer. “But increasingly, eye care providers are recognizing the value of mental health services as an integral part of vision services.”

Family members are encouraged to participate in every patient’s initial evaluation and to remain involved as much as possible during the course of treatment. “We provide ongoing education about changes related to vision loss as well as the patient’s specific disease or condition. Also, we provide evidence-based counseling for patients and their families either individually or jointly depending on the presenting issues,” Dr. Dreer says. “Family members often have concerns about how to deal with their loved one’s depression as well as how to manage family life and work while helping their loved one. We can address all of these issues and concerns during treatment.”

Dr. Dreer stresses that if possible, it’s important that patients are screened for problems with adjustment shortly after their diagnosis of a chronic eye condition — to intervene before depression and frustration have set in. “We’re currently developing support groups — one for patients and one for families,” explains Dr. Dreer. “These groups will provide low vision patients valuable opportunities for peer networking, learning coping skills, and discovering positive ways to adjust to their new situation.”

For more information about the UAB Department of Ophthalmology Mental Health Services Clinic for individuals and families living with vision impairments, please contact Dr. Laura Dreer at (205) 325-8681 or by .

Article last updated: April 16, 2009 4:45 PM