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Int Ophthalmol Clin. 1999 Fall;39(4):143-62.

Vision rehabilitation for age-related macular degeneration.

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Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.


Though the numbers of patients with ARMD are high, associated referrals for vision rehabilitation are not. Practitioners need to refer patients with age-related maculopathy when medical and surgical treatment are no longer possible, and patients need to be educated to that fact. The impact of improving activities of daily living may be monumental and benefits society as a whole. People who are visually impaired are often ill-prepared to deal with the substantial adjustment involved, further stressing their entire support system. It may not be safe for visual and systemic reasons for older adults to cook, clean, and maintain their home. Poor vision contributes to the already increased risk of falls and subsequent fractures in these patients. Individuals who may have already been told they can no longer drive now face the possibility of being unable to live in their houses. Their independence may be threatened dramatically and abruptly. All these circumstances contribute to anxiety and depression. Patients with ARMD need to be educated about their disease process (teaching that can never be assumed to have been initiated). They need to be educated that they will not go completely blind and that, with assistance, they can accomplish a great deal. With today's technology, it is not difficult to help visually impaired individuals with ARMD, unless they are not referred or lack motivation. The primary complaint of an individual with ARMD is recognition of central detail. This affects all activities of daily living, and patient performance is subject to the duration and severity of the disease (including the size, density, and location of the central scotoma) and to their understanding of the disease. Rubin and coworkers, found that slow reading performance of patients with a dense central scotoma might reflect inherent limitations of peripheral retina for complex visual tasks. ARMD in most cases lends itself to magnification that enlarges the object beyond the blind spot for visual recognition. Visual devices for distance, intermediate, and near tasks are usually helpful after patient education regarding their predicament and education for adaptation. Eccentric fixation techniques should be one of the first exercises mastered prior to further visual rehabilitation. Activities of daily living should be addressed with every individual, and appropriate assessment of existing problems and modifications to those problems should be implemented. Orientation and mobility should be offered to any individual who is legally blind or has difficulty with safe travel. A great deal of empathy is required on the part of the vision rehabilitation team. However, when patients lack of motivation, feel despair, or exhibit psychosocial overtones of reliance on others, they needs to be confronted, and appropriate action must be taken. Social work consultation and access to a support group can go a long way in mental strengthening and socialization. The author conducted a support group that, over a 10-year period, had a negligible dropout rate owing to the positive socialization obtained from attending the meetings. Older adults who are still working should be referred to an agency for vocational and financial resources if so desired. There is the issue of driving. In the United States, maintaining a driver's license is an important part of the quality of life. Older adults are the most rapidly growing segment of the driving population in the United States. The percentage of drivers older than 65 is expected to increase 17% by the year 2020. The rate of traffic fatalities among older adults has increased substantially, although the overall rate of fatalities is declining. The elderly drive fewer miles but have the highest rate of crashes per miles driven. Many important issues regard the older adult driver. (ABSTRACT TRUNCATED).

[Indexed for MEDLINE]

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