The Coil LED Illuminated Pocket Magnifier from Hilco is easy to use and portable.

Serving an aging population with compromised vision is easier than you think. Here’s how to integrate it into your practice.

Low vision rehabilitation is simply an extension of the care we already provide””assessing eye health, monitoring changes, refracting for maximum visual acuity and, where appropriate, referring for treatment or co-management.

If the refraction does not improve the visual acuity to the level required for the desired activity (typically reading), a first approach might be to provide additional lighting to increase the contrast of the material. If that is not adequate, magnification becomes the next option: bringing objects closer (relative distance magnification), making objects bigger (relative size magnification) or a combination of the two. This can be done using a trial frame and trial lenses, giving both you and the patient a realistic appreciation of the improvement, the working distance required and the lighting necessary to maximize success. If prescribing a near lens stronger than a “conventional” add power demonstrates that the patient can be helped but is outside of your comfort zone, both you and the patient will have the confidence to proceed with a more in-depth assessment by a provider who is more experienced with providing low vision care. Meanwhile, there are some basic treatment options you can share with your patients.

The easiest devices to demonstrate increased magnification are illuminated handheld magnifiers, such as the Coil LED Illuminated Pocket Magnifier from Hilco or the Optolec PowerSlider Handheld Magnifer.  Here”™s one tip: maximum magnification is achieved when the patient views through their distance correction and when the material is held at the focal length of the magnifier.

Large print materials can be recommended for easier reading.  Another option are new e-readers with the ability to enlarge and increase contrast when using an LCD screen to view content.  Even when using a larger font, the appropriate near lens must always be considered to compensate for the closer working distance.  Here”™s another tip: although magnification is the underlying method for helping these patients, results may be modified by contrast sensitivity, distortion, multiple scotomas, visual field restrictions and the difficulty of finding the appropriate eccentric viewing posture.

There are challenges with this patient population beginning with the amount of evaluation and rehabilitation time necessary to achieve success. This intervention will vary based on the psychological stage of acceptance the patient might have with the loss of vision, similar to Kübler Ross”™s model of grief based on emotions around dying: denial, anger, bargaining, depression and acceptance.

Also, the initial visit might take longer than usual and will depend on the patient”™s visual ability and the complexity of goals and device or devices recommended. Additional office time for rehabilitation training might also have to be factored in, just as assessing and fitting some types of contact lenses requires additional time and patience before reaching the final prescription. In the end, as with other aspects of eyecare, the ultimate success will be based on the patient”™s appreciation of the usefulness of the prescribed treatment options. OO

Paul B. Freeman, OD, FAAO, Diplomate Low Vision is in private practice in Pittsburgh, Hermitage and Beaver Falls, PA.


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