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Research Highlights
Study backs expansion of low-vision program
September 2, 2008
At 79, retired construction supervisor Melvin Green of
Troutman, N.C., still likes to do repairs around the house,
such as replacing electrical switches or even restoring a deck.
His activity level is noteworthy for anyone his age, but it’s even
more so because Green has macular degeneration—an eye
disorder that blurs sight in the center of the visual field. His
condition worsened a few years ago when blood vessels burst in
both his eyes. "It cut out my forward vision," says Green.
The Navy veteran has learned to partially compensate for his
sight impairment, however, through low-vision therapy at the
nearby Salisbury VA Medical Center. The program doesn’t
improve eyesight per se, but it does teach patients to use various
adaptive devices—such as closed circuit TVs or handheld
magnifiers—so they can keep on doing daily tasks.
Green received his therapy as a participant in the two-year VA
Low Vision Intervention Trial (LOVIT). The study, which
involved 126 legally blind veterans in Salisbury and Hines, Ill.,
tested the effectiveness of providing lowvision
therapy on an outpatient basis. Until
recently, veterans with low vision were
treated mainly at regional centers that were
usually far from their homes—and that often
had waiting lists. In Jan. 2007, however, VA
announced a major three-year expansion of
outpatient vision services. The move came
before the findings from LOVIT were
released—they were published in the
Archives of Ophthalmology this past May—but the study offers a resounding
confirmation of the benefits of outpatient
low-vision therapy.
"Patients who were unable to
independently read their mail, their
newspaper or their VA appointment letters
were able to do so after receiving low-vision
therapy and obtaining low-vision magnifying
devices to enhance their remaining vision,"
says lead investigator Joan Stelmack, OD, an
optometrist in the Blind Rehabilitation
Center at the Hines VA.
'Huge expansion of services'
Veterans who need the most intensive
therapy—generally, those with total vision
loss—can still receive comprehensive
training at one of VA's 10 blind
rehabilitation centers. But now, every VA
eye clinic nationwide will offer at least
basic low-vision services, and access to
more advanced therapy is being expanded
within every VA region. "This is a huge
expansion of services, and we’re thrilled,"
says Ricki Mancil, MA, COMS, CLVT, a
low-vision therapist at Salisbury. Stelmack
in Hines calls it "a significant milestone."
VA estimates there are more than a
million visually impaired veterans over the
age of 45, about 90 percent of whom have
some remaining vision. About 80 percent of
all visually impaired veterans have a
progressive disability caused by age-related
macular degeneration, glaucoma, or diabetic
retinopathy. Among the newest generation
of war veterans, many of those who have
suffered blast injuries experience vision
problems. Some of these issues may be
treatable through low-vision therapy, while
others require different approaches.
VA provides adaptive devices
for home use
For veterans like Melvin Green, expanded
access to low-vision therapy is likely to mean
huge gains in quality of life. Green learned
strategies from Mancil such as shifting his
eye slightly to the side when focusing on an
object, to take advantage of his peripheral
vision. He also uses a closed-circuit TV for
paying bills and handheld magnifiers for
reading food labels or other small print.
VA also made Green a special pair of
glasses for working at the computer and
provided him with a device called an
Acrobat—a video magnifier with a 19-inch
monitor and a removable camera that rotates
340 degrees. When changing a wall switch,
for example, Green might first hold the
camera up to the electrical box and view the
wiring on the monitor. "I get a picture in my
mind of what's in there, and then I can do it."
More than just therapy, Green says he
also received plenty of encouragement from
Mancil. "She told me there’s nothing you
cannot do, within reason. She worked with
me and showed me that I could do a lot
more than I thought. I think she created a
'monster'—now that I found out I can
work, I work."
This article originally appeared in the September 2008 issue of VA Research Currents.
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