Eye of the Beholder
by Melissa J. SmithRosalio Perez knew he needed to stop driving when he was involved in several car accidents. But catching the bus wasn’t easy. He’d stand at the stop, but the buses would pass him by. It wasn’t that the bus drivers were ignoring him. Perez wasn’t signaling them to stop. Why? He couldn’t see the route name and number displayed on the bus to determine if it was the bus he wanted to take. Low vision also discouraged Perez from crossing streets and shopping at the grocery store. But with vision rehabilitation, he has regained his independence.
"People here at my retirement home don’t believe I have a vision problem because I get around so well now," he said.
Low vision is a severe chronic impairment that limits a person’s ability to complete everyday activities, such as shopping, cooking, reading and traveling. Even with glasses, contact lenses, medicine or surgery, vision cannot be improved for people who did not seek early treatment for macular degeneration, diabetic retinopathy and glaucoma.
The Lions Low Vision Center of Texas at the Health Science Center provides rehabilitation services to patients with low vision. The clinic does not restore lost vision, but instead teaches people to effectively use their remaining vision. The center, established in September 2003 with a $250,000 grant from multiple sources including Lions Clubs International, the Lions of Texas and the Lions Sight Research Foundation, a part of Lions District 2-A2, is the only place in San Antonio where ophthalmologists, optometrists and occupational therapists work together to provide comprehensive services to patients.
"If someone loses his or her vision, he or she needs rehabilitation just like someone who has lost a leg," said Sandra M. Fox, O.D., director of the center and assistant professor in the department of ophthalmology. "People with low vision should not consider themselves disabled," she said.
Dr. Fox provides a low vision evaluation to determine the level of functioning vision. She spends time talking to the patient about his or her goals. After her assessment, she provides a low vision device recommendation based on the person’s goals and daily activities.
Low vision devices, which can help patients with their daily activities, include varying-strength magnifiers, closed-circuit televisions that magnify print, large buttons on phones and weekly medicine sorters.
"Everyone wants to be able to drive again, but that isn’t always a reality," Dr. Fox said.
Following the eye exam, patients visit with Melva R. Pérez, O.T.R., M.B.A., occupational therapist and assistant professor in the department of occupational therapy, to discuss their options for therapy.
"Following the low vision device recommendations from Dr. Fox, I teach the patient to use the device in order to perform tasks as effectively and efficiently as possible," Pérez said.
But low vision devices are only one part of the treatment. Patients also participate in therapy that can include anything from reading exercises to working on a machine, like the Dynavision. The Dynavision teaches people who have visual field loss due to a stroke, brain injury or glaucoma to move their eyes efficiently so that they become more aware of their peripheral vision. Lights cover the large face of the machine and as each of the lights flash, the patient must look in the direction of the light and press the button. The Dynavision also helps improve eye-hand coordination and reaction time.
Toni Ovalle, a former patient of the center, learned to effectively use her peripheral vision and improve her reaction time. After completing therapy at the center and working on the Dynavision for three months, she was able to pass the Texas Department of Public Safety’s driving test and drive herself to work again.
"I can run my own errands and I don’t have to take the bus anymore,"
she said. "I got some independence back."
Dr. Fox and Pérez work tirelessly to get the information about the clinic to patients and medical personnel alike by traveling around San Antonio and the surrounding area, making presentations about the services the center offers. Many of the people who are in need of low vision assistance don’t know there are services available. Ophthalmologists are pleased to know they have a new resource to recommend to their low vision patients.
"We feel that a big part of what we do is to serve as educators for our patients, our students and the medical community," Pérez said. "We’re hoping that low vision rehabilitation will be as common as any of the other rehabilitation services available."
As for Rosalio Perez, whose low vision resulted from diabetic retinopathy, life has greatly improved since receiving therapy and equipment at the clinic. He now even helps his blind neighbor make his way around."Some of my friends tease me by saying that I’m the ‘blind leading the blind,’ but I don’t care. I can finally read the prices at the grocery store," he said with a smile.
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