Book review
Low Vision – The Essential
Guide for Ophthalmologists
Dr Keziah Latham feels that a book aimed at ophthalmologists will
be of great benefit to all eye care practitioners
T
his book has been published
to support the new curricu-
lum for specialist training
in ophthalmology, which
recognises that there has
been a lack of awareness of low vision
issues by ophthalmologists. As such, it
is aimed at ophthalmologists, but it also
contains lots of information relevant to
the practising optometrist or dispensing
optician in a very readable and cost-
effective format.
The book is laid out in the following
chapters:
● Epidemiology. Around two million
people are estimated to have difficulty
seeing in the UK at present. With 80
per cent of visually impaired people
being over 65 years old, and with
the number of people aged over 60
projected to increase by 57 per cent
over the next 30 years, it is not difficult
to see that visual impairment will
become an increasing issue in eye
care. Causes of visual impairment are
discussed, and the important point
is made that the need for services is
determined by a patient’s needs and
difficulties, not by their VA or registra-
tion status.
● Low vision in daily ophthalmological
practice. This chapter includes helpful
nuggets on ways to interact with
visually impaired patients in terms of
greeting, history taking and breaking
bad news. The overview of assessment
of visual function is necessarily brief,
but covers important areas like the use
of logMAR charts and contrast sensitiv-
ity assessment.
● Certification and registration. In the
UK only half of those who could be
registered as visually impaired are
actually registered, perhaps partly due
to a lack of awareness by ophthalmolo-
gists. Registration is an important issue,
as funding of services is based on the
epidemiological data gathered from
registration. The process is covered in
some detail, such that optical practition-
ers can use the information to identify
patients who could be registered (or
their category changed), and to inform
them of what will happen as a result of
the referral. A useful table of current
benefits available to those who are
opticianonline.net
registered is also provided.
● Multidisciplinary working. This
chapter outlines the professionals to
whom an ophthalmologist (or optom-
etrist or dispensing optician) might
refer a patient for different services,
including low vision services, social
services, employment services and
voluntary organisations. It can act as a
helpful checklist to a practitioner that
they are aware of the specific services
offered in their area.
● Magnification and magnifiers. The
optics of magnifiers are not covered in
this book – there are plenty of other
excellent books that cover this subject.
The purpose of the chapter is to outline
the range of devices available so as to
recognise which patients might most
benefit from low vision assessment for
magnifying aids.
● Adaptations to daily life. Non-optical
aids that may help visually impaired
people are outlined in this chapter.
Many would be obtained from
resource centres (again, a good prompt
to the practitioner to check that they
are aware of their nearest one). Optical
practitioners themselves are ideally
placed to discuss other adaptations in
primary care – the use of tints, lighting
or contrast for example.
● Low vision in children. Although
vision loss in children is less common
than in the older population, those with
poor vision from childhood will experi-
ence many more ‘visually impaired
years’. Many also have additional
disabilities. Information specific to
children is provided in this chapter,
and covers breaking news, registration,
education services, assessment and
visual aids.
● Assisting patients with low vision is a
multi-disciplinary area. Whatever we
do as practitioners in terms of advising
optical aids such as high adds, magni-
fiers, or lighting advice, our patients
also need other services to provide
practical and emotional support and
allow them to adapt to life with a
visual impairment. Recent research1,2
suggests that one of the main barriers
to patients accessing low vision services
is not being aware of the services that
are available, and specifically not being
informed of other services by their
medical professionals, or not being told
that services are relevant to them.
As primary care practitioners, both
optometrists and dispensing opticians
are ideally placed to advise our patients
about the services in our areas – but only
if we know about them ourselves. By
having an overview of what services
can help a person with low vision, we
are much more likely to be able to guide
our patients to the services that they
most need. This book does not provide
information on services available in any
given area, but does act as a ‘checklist’
that practitioners can use to identify the
services and professionals relevant to
them and their patients.
Hopefully this book marks the begin-
ning of the end for patients being told
‘there’s nothing more we can do for
you’, when what is meant is that there
is no appropriate medical treatment
available. This book is a great overview
of just what can be done. I would
highly recommend it for any practising
optical professional, and shall be adding
it to the reading lists for my optometry
and dispensing optics students. ●
References
1 Overbury O, Wittich W and Ferraresi P.
Barriers to visual rehabilitation – a new
starting point. In Gresset, J. & Overbury,
O. (Eds.) Research and Rehabilitation
Partnerships – Proceedings of the 9th
International Conference on Low Vision.
Vision 2008, Montreal, Canada.
2 Pollard TL, Simpson JA, Lamoureux EL and
Keeffe JE. Barriers to accessing low vision
services. Ophthal Physiol Opt, 2003; 23,
321-327.
● Low Vision – the Essential Guide for
Ophthalmologists by Anne Sinclair and
Barbara Ryan is published by Guide Dogs
for the Blind, and is available from amazon.
co.uk, price £5.
● Dr Keziah Latham is senior lecturer at
Anglia Ruskin University
08.08.08 | Optician | 23