Visually Impaired Persons: Assess and Assist

Visually Impaired Persons: What must be Understood to Assess and Assist. Until approximately 10 years ago abnormalities of focus were the primary cause of vision loss and the focus of ophthalmic and optometric clinicians worldwide. However with the improvement in the methods to measure and repair the ocular optics (spectacles, contact lenses, corneal and cataract surgery), the major cause of mild, moderate, and severe vision loss throughout the world has now become macular disease caused by the severe rapid expansion of diabetes as well as the aging population, The difficulties in managing retinal disease are caused by three significant problems: 1)The failure of patients to seek attention of an ophthalmic provider until vision abnormalities interfere sufficiently with daily visual function, most often defined by when the second eye becomes involved because the brain in daily function merges the images of the two eyes to one composite with varying dominance. 2) The physician fails to understand the vision deficit because of the reliance on chart acuity, which fails to measure functional vision. 3)The physician relies upon retinal examination to define the onset of disease. Although current laser coherence tomography imaging can define the structural abnormalities with considerable improvement, the images are typically interpreted with failure to attach digital quantification of the abnormalities, or currently with the use of engineering-derived digital measurements that are poorly associated with defining the function of the retina under conditions of varying luminance and color-contrasts. This discussion will present a vision of what must be done in order to detect, understand, and predict the course of macular disease in the individual patient so that treatment can be instigated sufficiently early to prevent functional loss. First the diabetic at first diagnosis and those persons genetically at risk of developing macular degeneration must undergo multi-wavelength, coherence, tomography imaging at regular intervals with the images registered and presented in overlay so that dynamic changes over time can be understood and quantitated. Second, the monocular and binocular vision of an individual…