So you know that class in optometry school that you just never understood?
The one that, despite your best and most earnest of efforts, you dramatically bombed?
Well, mine was Vision Rehabilitation (the artist formerly known as Low Vision).
It’s not like I suck at optics, but for some reason, when VAs aren’t recorded in Snellen fractions my blood vessels seize up and I just pass out. For once I’m not exaggerating–I legitimately have an awkward fight or flight reaction that results in me on the floor. Let me summarize a few of the salient points I get confused about:
I don’t think I’ll ever know how small 0.4/2M is.
I will never understand what distance you move the hand-held magnifier away from your face to get a clear image.
And don’t even get me started on Feq and how to calculate it
(A vast majority of you are scoffing because those things are so extremely basic for you. I commend you for being too cool for school. To the select few that share my low vision terror: Rest assured, we stand united.)
Anyway, it’s no surprise I headed to my first shift at Chicago Lighthouse with extreme trepidation. The Lighthouse is an organization that serves blind or visually impaired patients, and it’s home to the oldest low vision clinic in the country.
All I could remember was how dismally I performed on that lab practical in third year. I was quite certain the patients would immediately uncover me as the scam artist that I was, and I would get kicked out the door before I could even attempt an Feq equation.
However to my immense relief, low vision exams are best performed when you tag-team. Perhaps it’s because I have the maturity and general world-savvy of a three-year-old (as in, none at all), but I always prefer to work with a buddy in this setting. Especially if they are much smarter than you and can patiently explain to you what 0.25/4M really means.
Exams for the partially sighted and those who suffer from vision loss vary significantly from those we perform in primary care. Firstly, expediency is of no matter. These exams are designed to be slow and careful rather than quick and dirty. (Not that you should ever be quick at the expense of cleanliness’) The patients are often accompanied by family members, companions, nurses, caregivers, or seeing eye dogs. Not always, but most of the time, they have endured vision loss in a way you or I cannot truly comprehend.
In third year, we all walked around ICO with our eyes taped shut and relied on a motility cane and a friend to navigate the corridor, but it’s one thing to experience the world as a partially sighted individual for a few minutes and quite another to live it. It’s hard to imagine a world where you can’t rely on your sight, and how things we hardly give a second thought to–like knowing what time is it–require some adaptive technology.
The technology is what really knocks my socks off. And in this sub-zero weather, taking off my socks is a pretty big deal.
The advent of things like the iPad, CCTV, ZoomText, TV glasses, telescopes and magnifiers have transformed the field.
I’ve been blown away more times than I can recount by patients barely reading the 10/200 line on the Bailey-Lovie Chart but happily telling me about how they like to read, watch TV, send emails, and go for walks outside. Rather than be deterred by their visual status, they are perhaps the ones that value it the most.
It’s not an easy field to specialize in, but it is undeniably rewarding.
As primary eye care providers, we may be the first ones to see a change in the retina or optic nerve. Alongside our cohorts in ophthalmology, we may be involved in their pre- and post-operative care (if the situation warrants). But there comes a time in the natural progression of several of these ocular diseases where there is no more medical management to be had.
There are no more surgeries.
There are no more injections.
There are no more lasers.
A careful trial frame refraction has allowed the patient to see something that the state has constituted as Legally Blind.
And then they come to the Lighthouse. With thoughtful questions and an intense case history that puts the other 20-second ones to shame, these doctors learn the visual needs of their patient, their goals, and their motivation. It is truly a joint effort between patient and doctor, where both parties are trying to find a device that addresses the patient’s desire.
In the end, it’s not a matter of math or optics or Sturm’s Conoid.
It’s sitting down with someone and taking the time to talk to them. It’s addressing their needs. It’s being patient. It’s reminding them that this is not the end of the road but rather the beginning of a new one.
It’s these sub-specialties of optometry that really make you realize how cool of a job we have. In what other profession can you prescribe a 3x Stand Magnifier and allow a woman with advanced retinitis pigmentosa to read her beloved fiction books again? When else can you give a man with a severely constricted visual field a reverse telescope and see his face light up because he can see the whole room? Where else can you prescribe Cocoons to a three-year-old who’s been diagnosed with Achromotopsia and is extremely photophobic and see his entire demeanor change?
And seriously: When else do you get to hold 16 trial lenses in each hand and become a human phoropter?
So I guess the bottom line is, don’t be scared of the math.
Be excited you are able to change someone’s life and that all it takes is a few trial lenses, some light, and some thoughtfulness.
Because at the end of the day, vision rehabilitation exams are a daily reminder that hope springs eternal.
