Low Vision Optometry: A Student’s Perspective
Low Vision Optometry: A Student’s Perspective
by Hannah Yoon (New England College of Optometry, Class of 2020)
Of the various specialties of optometry, low vision was the one that I was least familiar with when I started my optometry journey. It wasn’t until my third-year of optometry school that I took a course on Low Vision Rehabilitation, and had the great fortune of working with Dr. Nicole Ross (member Waltham Lions, LOVRNET provider) as one of her student interns at the NECO Center for Eye Care’s Low Vision Clinic. The course and my clinical experience with Dr. Ross opened my eyes to a specialty of optometry whose services are in high demand, yet many optometrists shy away from. In Massachusetts, the incidence of low vision patients is nearly 10,000 and according to the Massachusetts Society of Optometrists (MSO), only 96 Massachusetts- based optometrists indicated that they practice low vision.
As a fourth-year optometry student, I am constantly reflecting on what I want my post-graduate career in optometry to look like. What are my strengths as a clinician? What services can I provide the community? What patient needs are unmet? My experience working with Dr. Ross’s patients in clinic made me realize that low vision lies at the perfect intersection between my genuine desire to connect with patients and the growing demand for optometrists to integrate low vision services into clinical practice. Considering that 21% of people over 65 experience some type of vision impairment and that the 65-84 year old population is expected to increase 1.5x’s by 2030, the importance of low vision services is clear, now more than ever.
My very first patient at NECO’s Low Vision Clinic had macular degeneration and dystonia. She couldn’t speak, but could understand speech and communicated with two gestures: thumbs up or thumbs down. We were able to tailor her exam without forfeiting the quality of the measurements we were taking by making slight modifications, like swapping out the ETDRS visual acuity chart for the HOTV chart, and using LEA symbol playing cards to measure near acuity. “Can you point to the letters you see over there on this card?” “Is this better or worse?”
Photo Courtesy of Good-Lite (www.good-lite.com)
We continued to probe and trial various devices until we were able to recommend MaxTV glasses, which would allow her to start watching her favorite daytime game shows again. Despite the fact that she was nonverbal, she left the appointment as any other “normal- sighted” patient would: with a solid recommendation from the optometrist that would help her achieve her visual goals.
Photo courtesy of Eschenbach (www.eschenbach.com)
At the Carroll Center for the Blind (a MA-LOVRNET partner), I met a patient with retinitis pigmentosa who had felt neglected by his previous eye care provider and came to the Center in hopes of receiving more comprehensive care. After completing his eye exam, we brought him to the device training station to show him the wide variety of contrast-enhancing technologies that are currently available, including the Ruby (a portable CCTV) and Iris Vision (a head-mounted display), and reverse telescopes for spotting. At the end of his appointment, he expressed a sincere happiness about feeling more optimistic about his performance at work and knowing that he had finally found a provider who would thoroughly address his concerns.
My experiences in low vision clinic have really challenged me to think outside the box of the “traditional” eye exam, and have encouraged me to shift away from my typical focus on achieving a certain level of acuity. The low vision exam has taught me to appreciate and value the subjective responses of the patient, and to focus on the patient’s functional vision through measurements of contrast sensitivity and MNREAD. I also love that the low vision exam revolves around the patient’s visual goals and aims to maximize the patient’s current vision, instead of fixating on the loss of vision.
Through my brief, yet meaningful introduction to low vision thus far, I have learned that low vision optometry is a challenging specialty, but not for the reasons I used to think. I now understand that the real challenge of low vision is being able to adapt the “typical” eye exam to each patient’s unique set of concerns and disease manifestations, in order to recommend optical devices and technological resources that will best improve the patient’s quality of life. Luckily, as members of the low vision care team, which includes ophthalmologists, occupational therapists, O&M specialists, and others, low vision optometrists are not alone in their mission to provide the comprehensive care that low vision patients deserve. Low vision services require a team- based approach.
The patients I have worked with in low vision clinic have taught me the importance of approaching any optometry exam with the same attitude: an honest willingness to take care of the patient to the fullest extent. I am grateful for the new challenges that low vision clinic introduced me to because the problem-solving skills I developed from these challenges will carry over to help me untangle my most difficult patient cases in other specialties of optometry.
As much as low vision care strives to serve the patients, it has also served me as a learning clinician by teaching me to trust more in my current skill set and to be a better listener for my patients. I am truly excited to continue learning more about low vision, which will ultimately prepare me for not only my 4th year rotation at VA Long Beach’s Blind Rehabilitation Center, but also for residency and beyond!
Hannah Yoon is an OD/MS dual degree program student at the New England College of Optometry (NECO) in Boston, Massachusetts. She is from Rochester, NY and graduated with her Bachelor of Science degree from Boston College in 2012. As a fourth-year optometry student, she is going to be rotating through clinic sites, such as VA Long Beach, IHS Bethel, and VA Hudson Valley. She plans to pursue a residency in ocular disease/low vision after graduation.