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Low Vision Rehabilitation: Caring for the Whole Person

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    Low Vision Rehabilitation: Caring for the Whole Person. Ophthalmology Monograph 12. Ed by D C Fletcher. Pp 162. £75. San Francisco: American Academy of Ophthalmology, 1999. ISBN1-56055-170-4.

    This book is one component of theLifelong Education for the Ophthalmologist(LEO) framework, produced by the American Academy of Ophthalmology. Those not claiming credits can still benefit from the multiple choice questions (with answers and explanations).

    The preface sets out a comprehensive range of educational objectives which are largely met by the text, but one has the impression that its primary (and most challenging goal) is persuading ophthalmologists that something can be done for the low vision patient. Ophthalmologists, more than any other group, apparently see vision loss as the “arch enemy”, and usually encounter visually impaired patients in the upsetting early stages of the condition, rather than when they are coping successfully. This is not to suggest that vision loss does not have profound effects on all aspects of the patient’s life, because seeing to read at near, intermediate, and distance is fundamental to independent living. Rehabilitation is the key to coping, and the patient is the prime mover in this: one can give them a magnifier but they have to want to read again, and must practise new skills to achieve this aim. By contrast, in traditional medical treatment, the physician is the source of action, the patient being asked simply for compliance.

    Although the book emphasises this shift of philosophical perspective, it also gives much practical guidance on patient assessment (psychological state, visual performance, needs in activities of daily living) and “treatment” (choosing and dispensing optical aids, and teaching the patient to use these and other strategies to make the best use of residual vision). All these topics are dealt with succinctly and clearly, although the text does verge at times on the overly simplistic: to dismiss the optics of stand magnifiers by saying that they are “designed for use with a standard bifocal add or reading glasses” makes the purist cringe, but is a perfectly acceptable assumption in 90% of cases. The brevity has perhaps led to some surprising omissions: the logMAR notation, although the design of the charts is described; the possible lack of correspondence as distance and near VA are interconverted; the effect of eye to magnifier distance on field of view (although it is incorrectly stated that it alters the magnification); the beneficial quadrupling of illuminance as the light source moves to half the distance from the task; the conversion of dioptric power of a magnifier to magnification.

    The book is least useful where its US origin becomes obvious—for example, driving regulations, useful addresses, and the qualification and certification of orientation and mobility instructors. There are occasions in the book when something is referred to but is not explained until the following chapter—PRL and ETDRS charts are two examples. This is perhaps inevitable in a multiauthor book, although the editor was co-author on most chapters, and should have been able to resolve this. These are minor quibbles, however, in a beautifully produced, easy to read book, with many high quality colour photographs and colour highlighted tables. The take home message comes through loud and clear: “A positive attitude, more than any other factor, serves to minimize the handicap caused by visual impairment”. This book seeks to engender this attitude among professionals, knowing that only then can they transmit this to their patients. It should be essential reading for all those working in ophthalmology clinics.