Managing Expectations of the Low Vision Patient and Their Family

By Lynne P. Noon, OD, FAAO, with Richard J. Shuldiner, OD, FAAO

For most people, there is nothing more devastating and frightening than vision loss. Patients fear a loss of independence and diminished self-worth. Patients often come to us with limited knowledge regarding their eye condition and prognosis. When referred to low vision services, many still hope that, finally, someone will be able to give them back their vision and make them whole again. It is our job to manage false expectations while never taking away hope. As low vision rehabilitation providers, there is nothing more important to the success of your visually impaired patient than education regarding their eye condition and the realistic solutions toward their independence. The following are some of the topics that we think are important to have the patient understand:

• The low vision examination is a functional evaluation that will allow the patient to perform daily activities despite their vision loss. They must understand that we can make them functional but must be flexible. They have a different vision and, therefore, cannot expect to perform their tasks similarly.
• We discuss the need for more than one pair of glasses, magnifying device, or other solution. I use the analogy of a carpenter needing more than one tool to build a house.
• We initially discuss all the tasks they struggle with, but we work on one task at a time when reviewing solutions. For most patients, reading is the first task they want to work on. Once the needed power is determined, present all options in that power, including reading glasses, reading telescopes, hand and stand magnifiers, and portable and desktop video magnification. Discuss the advantages and disadvantages of all solutions and have the patient work with all to decide on the best solution for their needs.
• If a second visit is needed, we review the patient’s progress and again review realistic expectations and solutions. Often, the patient needs to hear this several times before they fully understand. If they are doing well, we move on to other tasks.

Patients need help understanding optics or technical explanations, so we discuss things in a language that the patient can understand. We have visual or verbal ways of explaining how scotomas limit function, why moving reading material closer to the eye gives magnification, why the field is lost with increasing magnification, why they get a more extensive field of view by bringing an optical magnifier closer to their eye, why stronger magnifiers have smaller lenses and why “regular” glasses cannot magnify at a distance, etc. I have made many visual ways of explaining these concepts. If the patient cannot see the material, I enlarge it with a video magnifier.

Proper education of your patient and their family usually leads to acceptance of vision loss and low vision solutions. When patients truly understand their options, they will not continue looking for that “miracle cure or miracle glasses”.

Magnification minimizes distortion and scotoma.

Ring Scotoma simulation limiting function, despite magnification.