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Magnification devices improve quality of life for patients, if properly selected
The demand for low-vision care will increase as the population of low-vision patients grows steadily.
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As the population of patients with age-related macular degeneration is expected to double within the next decade, low-vision care may become a useful addition to ophthalmic practices.
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“This is not a small concern. The prevalence of macular degeneration is likely to increase as the population ages,” said Mark Kirstein, OD.
Eli Peli, OD, said the population of low-vision patients is already large, and its expected growth should create a potential market for low-vision care products.
“Some products have improved in ways that may not look significant but are big improvements for patients. The LED illumination in the magnifiers gives a better light. Companies have learned to create products that spread the light evenly and uniformly on the reading material providing real help instead of creating glare, as some older models have,” Dr. Peli said. “The LED light sources last for many years so the patients don’t have to replace the bulbs. They also use less power, so the time between battery replacements is significantly longer, making them more cost-effective.”
“It’s typical with low vision to think of acuity, but the main thing is magnification, either optically or with a closed-circuit television, which now exists also in a handheld format,” Dr. Peli said. “These devices can be much more expensive, but they are excellent. Any patient who wants to read newspapers or books should get one if they can afford it.”
Some of the electronic devices can reverse text to white on a black background, which is preferred by some patients, especially those with cataracts, he explained.
Dr. Peli said he is working with a California company, DigiVision, to develop a device that is expected to provide an improved contrast enhancement for images on a television.
Getting started
William J. Broussard, MD, has tried incorporating low-vision care into his practice several times in the past. He found the most success with the service when the practice hired an optometrist who had a background in low-vision care.
“We tried on and off to have it available continuously without much success,” he said. “We would get someone trained, and they would leave. Finally, we got an optometrist on staff.”
Dr. Broussard encouraged fellow surgeons to hire staff that specializes in low vision, considering the expected increase of patients who will require low-vision care.
“This is a growing population, and unless we find some preventative treatment that is more effective that what we’re doing now, it will probably double within the next 10 years,” Dr. Broussard said.
Dr. Broussard said he turns to low-vision care for his patients when spectacles are no longer helping.
Tailor care to need
There is no individual device that works well for every patient, according to Dr. Broussard. This means that the low-vision specialist must take the time to match the patient’s need with the appropriate device.
“First, I question [the patient] extensively on how this bothers them and try to find out what this individual wants to do that is handicapped by their poor vision,” Dr. Broussard said. “Once I understand that, then I try to get them to understand that we can probably make it so they can do those things. But I do have to go through the process of trying to select which aid might be the best for them.”
Dr. Kirstein has a trial set of low-vision aids to suit the needs of many different patients, he said.
“Low-vision patients are typically patients who aren’t accomplishing with their vision what they’d like to do with standard eyeglasses,” Dr. Kirstein said. “These patients typically come in with some sort of eye disease. The most common is AMD, which is certainly the No. 1 reason why I see patients.”
Most of his low-vision patients are elderly people who want to regain the ability to read their own mail, enjoy a book or watch television, he said.
“Often, they don’t have goals related to driving because they usually don’t qualify to do that anyway, but they want to restore a lot of everyday goals, such as reading a syringe for diabetic patients,” he said. “I even had a woman who wanted to play cards again, so the important thing is to tailor it to what they want to do, not what I want to do for them.”
For computer-literate patients, there is also software designed specifically for low vision.
“I like to use some of the less expensive ones. They are easier for patients to use and don’t require batteries,” Dr. Kirstein said. “High-powered glasses can run as little as $80. More sophisticated aids can start at $1,000.”
Patients with late stage glaucoma are the most difficult to treat with low-vision care, Dr. Kirstein said.
“There are other aids for those patients, such as talking books that might be available through the government at no charge,” he said. “There are really a lot of resources out there that aren’t necessarily optical-related but can be very helpful.”
Compliance and feedback
“I find compliance is generally not good,” Dr. Broussard said. “Patients will make an appointment and not show up, or they don’t make the appointment at all. If I can get a patient who really understands what we’re talking about and wants it fixed, then the response is good.”
Patients are sometimes reluctant to use a device to assist their vision, and many are on fixed incomes and are afraid to spend money on magnification devices, Dr. Peli said.
“Cost is a factor,” Dr. Broussard said. “The better devices might cost $2,000 to $3,000.”
Medicare can be billed for the office visit, but it does not cover the cost of the devices for the patient, he said. Magnification devices can range in cost from $20 up to $5,000, but the affordable magnifiers are still effective, he said.
“If someone has 20/200 vision or better, I can usually make it so that patient can be able to read the newspaper,” Dr. Broussard said. “That’s is the gold standard for me. If I can get them to read the newspaper, then we’ve helped quite a bit.”
For Your Information:
- Mark Kirstein, OD, a diplomate in the low-vision section of the American Academy of Optometry, can be reached at 50 Staniford St., Suite 600, Boston, MA 02114; 617-742-6366; fax: 617-723-7028; Web site: www.eyeboston.com.
- William J. Broussard, MD, can be reached at 502 E. New Haven Ave., Melbourne, FL 32901; 321-727-2020; fax: 321-984-9547; e-mail: eyedoc1@metrolink.net.
- Eli Peli, OD, a professor at Harvard Medical School, can be reached at 20 Staniford St., Boston, MA 02114; 617-912-2597; fax: 617-912-0001; e-mail: eli@eri.harvard.edu; Web site: www.eri.harvard.edu/faculty/peli/index.html.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology.