For low vision specialists and those who consult them
Nice AMD treatment overview, but no mention of low vision…
March 17, 2010Posted by on
Last week’s edition of the British Medical Journal had a good review article on treatment of age-related macular disease. I’d recommend it as an overview to anyone who is interested in this topic, but there is a serious oversight (to my mind): there is no mention at all of the role of low vision services. This is particularly concerning as the journal’s primary audience is general practitioners (family doctors) who may well be consulted by patients for whom AMD treatment is not appropriate. The authors go so far as to mention that many people with AMD will not be able to perform visual tasks (after treatment) but make no further suggestion as to what should be done at that stage.
Together with some colleagues, I have written a letter to the journal to point out this oversight: it should be available on the BMJ website but to save you the effort of trying to find it I’ve duplicated our letter below.
We read with interest the excellent review paper by Chakravarthy which provided a clear overview of pharmacological treatment for age-related macular degeneration (1). However we were concerned that the role of low vision clinics was not mentioned in this article.
Intensive low vision services, which include the prescription of optimal spectacle correction, optical and electronic magnification, and advice on strategies to maximise residual vision, have been shown to improve visual ability in people with macular disease with an effect size equal to a visual acuity improvement of 8 lines of visual acuity (2). Even a single one-hour consultation in a hospital based low vision service improves quality of life by a similar amount to a treatment which restores 5 lines of visual acuity (3).
As Chakravarthy highlights, even after treatment which successfully restores retinal structure, many people still experience difficulty with critical visual tasks such as reading and face recognition. These are tasks with which low vision rehabilitation can assist (4) yet there is evidence that people who have received such treatment are less likely to be referred to low vision clinics (5).
We urge colleagues to ensure that referral to a low vision clinic is made for those people with macular disease where treatment is not indicated and for those where treatment does not restore the visual function to pre-disease levels.
Michael Crossland PhD MCOptom
Angela Rees MD MRCOphth
Gary Rubin PhD
Professor of Ophthalmology
1. Chakravarthy U, Evans J, Rosenfeld PJ. Age related macular degeneration. British Medical Journal 2010;340:526-30.
2. Stelmack JA, Moran D, Dean D, Massof RW. Short- and long-term effects of an intensive inpatient vision rehabilitation program. Arch Phys Med Rehabil 2007;88(6):691-5.
3. Pearce E, Crossland MD, Rubin GS. The efficacy of low vision device training in a hospital based low vision clinic. British Journal of Ophthalmology 2010;In Press.
4. Margrain TH. Minimising the impact of visual impairment. Low vision aids are a simple way of alleviating impairment. British Medical Journal 1999;318(7197):1504.
5. Sunness JS, Schartz RB, Thompson JT, Sjaarda RN, Elman MJ. Patterns of Referral of Retinal Patients for Low Vision Intervention in the Anti-Vegf Era. Retina-the Journal of Retinal and Vitreous Diseases 2009;29(7):1036-39.