What happens to someone who wakes up one morning and can no longer see? It could happen to any of us at any time – clinician or client. Stoic wisdom might suggest that one prepares for loss by imagining it has already happened and resolving to accept the change, to embrace life fully, whatever happens. How do we prepare?
Vision changes are an expected part of aging. The need for reading glasses may be the initial sign of losing elasticity in the eyes when changing focus near or far, adjusting between light and dark, outdoors and indoors, or day and night. With the expanding aging population, many wonder whether their vision changes are within the range of normal eye aging or a serious eye condition that may significantly worsen vision, possibly requiring medical treatment. Only an eye doctor can determine the difference; early detection and treatment may help maintain vision.
Vision loss often triggers or worsens depression and anxiety, and depression and anxiety may worsen vision. This bi-directionality of physical and mental illness suggests that the approach to wellness and recovery benefits from addressing vision function and emotional function concurrently, when possible.
What Else Do You Need to Know about Vision Loss?
Regular comprehensive eye exams are crucial for the early detection of eye disease. During Covid, non-urgent doctor visits were paused. If you or your clients haven’t recently had an annual eye exam, now is a good time to set one up. Healthy eating and exercise habits support eye health, too. When regular glasses, contact lenses, medication, or surgery can no longer correct vision problems, a referral is made to a low-vision optometrist, who prescribes specialized glasses or a magnifier and recommends tools and exercises to help people read, work, socialize, and enjoy other activities. Even those who are totally blind may benefit from a low vision exam and may be prescribed protective sunglasses.
Eye drops or injections may prevent or reduce the progression of vision loss from some common eye conditions, such as glaucoma and macular degeneration. In February 2023, the first FDA-approved drug treatment for dry macular degeneration was announced and other treatments are in the pipeline, awaiting approval. Clinical trials provide access to participation in promising new research and can be located online at the National Eye Institute and clinicaltrials.gov. Only an eye doctor can prescribe treatment.
Medical conditions affecting vision include stroke, traumatic brain injury, cataracts, diabetic retinopathy, detached retina, Retinitis Pigmentosa, Usher Syndrome, optic nerve atrophy, albinism, Stargardt Disease, and Charles Bonnet Syndrome. Magnifiers and task lighting are low-tech tools for increasing functional vision. Adding lamps that are easy to turn on and changing to LED bulbs may help. Clearing any clutter and cords on the floor at home reduces fall risks. High-tech devices include electronic readers, CCTVs, and handheld readers, which enlarge text. Some devices audibly narrate text and describe individuals in the room. Many free phone apps magnify text and read aloud. Computerized sight canes aid with navigation.
Who Helps?
For direction and guidance, social workers can help sort through negative emotional reactions to the loss of vision and learn about the resources available. As knowledgeable, supportive listeners and thought partners, social workers can plant seeds for adjustment – de-escalating despair and depression, evaluating overall needs and strengths, and connecting people to the path of learning.
Optimally, an individual’s needs, goals, and priorities are considered, which helps cultivate emotional access to specific, timely support services and inspires hope for improved quality of life. Those struggling with multiple crises benefit from both information and compassion to help re-direct their focus from loss to learning.
Since Covid, health insurance coverage has expanded to video calls and phone sessions, increasing access to individual psychotherapy, especially benefiting those with visual impairment. Outreach presentations about programs, services, and resources shifted from in-person to virtual, spreading a wide online information-sharing network to providers at medical centers and to community liaisons at senior centers, community boards, religious centers, and social service organizations.
Free, internationally available virtual support groups for coping with vision loss are available by phone or Zoom. In-person and virtual trainings provide demonstrations of accessibility features on phones and computers, phone apps, and high-tech vision aids. Additional support and enrichment opportunities include free case management services (NY Connects: 800-342-9871), free audiobook access (Andrew Heiskell Braille and Talking Book Library), escorted running (Achilles Club), InTandem Cycling, Blind Baseball, low-cost refurbished computers (Computers for the Blind), educational videos (YouTube), research participation and clinical trials (NEI and clinicaltrials.gov).
Vision rehabilitation specialists enable individuals with vision loss to attain their goals, training them in skills for navigating their home and community, shopping, going to school, and returning to work. They help people with low vision learn how to best use assistive technology and other tools that help them maintain their independence.
For those deemed “legally blind” by an eye doctor, the New York State Commission for the Blind provides, for eligible participants, access to independent living skills training – training in performing household tasks, orientation, and mobility skills, and a low vision examination. Also, vocational rehabilitation is provided for those interested in work, school, or career skills training. In New York City, three vision agencies provide Commission services – Helen Keller Services for the Blind, Visions, and Lighthouse Guild. Every state has its own commission for the blind.
Where to Start?
If you or someone you know has a concern or question about vision changes, now is the time to learn more. Asking for help opens the door to learning. With the help of social workers, people coping with vision loss can learn to take steps towards new ways of functioning, connecting to programs, resources, and individuals that help them emotionally adjust and functionally adapt.
This article has been reprinted with permission from New York State Society for Clinical Social Work, The Clinician, Vol. 54 No. 2.
Lisa Beth Miller, LCSW-R, BCD, is Outreach and Referral Coordinator at Lighthouse Guild and has a private practice. Lisa’s previous positions include Social Work Manager for Lighthouse Guild’s Continuing Day Treatment Program; Board Member of the NY State Society for Clinical Social Work Met Chapter; founder of the Society’s online Listserv; inpatient psychiatric unit social worker; outpatient behavioral health clinician in clinic and schools.
References
Ophthalmology Times: https://www.ophthalmologytimes.com/view/pegcetacoplan-approved-by-fda-for-geographic-atrophy-secondary-to-amd
