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Low Vision Assessment and Rehabilitation

Outcomes

Diabetic Control

His diabetes is now under excellent control with a mean hemoglobin A1c of 6%. This is the result of instituting twice-daily insulin therapy, and because of better understanding of diabetic nutritional therapy. Through extensive education Dr. Cole increased his motivation to maintain these improved blood glucose values over an extended time, thereby decreasing the possibility of further loss of vision or impairments in renal function. Mrs. Cole played an important role in this improvement.

Diabetic Eye Disease

The diabetic retinopathy at presentation had a very poor prognosis in the absence of treatment. The proliferative diabetic retinopathy with its propensity to develop intraocular scar tissue was controlled by heavy peripheral panretinal laser treatments. There are modest neovascular truncal vessels persisting on both optic nerve heads but there is no active neovascular proliferation and they continue to be stable on long-term observation.

Both maculas had been diffusely edematous from severe macular ischemia when Dr. Cole first presented. Extensive and repeated grid laser treatments finally dried up both maculas. The visual acuity in the right eye gradually recovered to a nominal 20/40 visual acuity over many months, after the completion of the macular grid treatments. This marked improvement in visual acuity took 8 or 9 months to establish, but aided considerably in Dr. Cole's ultimate visual functioning. Although nominally 20/40 in his better right eye, he functions at a somewhat lesser level, due to patchy, focal losses of sensitivity within the macular area. The visual acuity improved little in the left eye. His eyes continue to be reexamined at three-month intervals. The appearances of both retinas are shown below.

Right eye	Left eye
Color and fluorescein angiogram views of both maculas after 18 months following treatment. The diabetic retinopathy is now essentially inactive. The white areas and the mottled pigmentation represent areas of laser treatment. There is no residual macular edema.

Use of Low Vision Aids

Since his initial low vision assessment in October, 1998, he has substantially improved his skills for independent functioning. While the CCTV's and computer are his primary tools for reading at work, he now uses a 5X illuminated stand magnifier at home for brief reading tasks. For reviewing x-rays he uses the lightbox under the CCTV.

Dr. Cole's computer literacy is an ongoing process. He can now do basic forms and financial operations if necessary, but often defers to Mrs. Cole as it takes him much longer. He is currently using 72 to 84 pt font instructions to learn newer applications. Monitor contrast of white print on a blue or black background is preferred for maximum contrast with minimal glare.

Mobility Issues

Markedly constricted fields secondary to his extensive laser treatments and patchy central visual loss necessitate cane use for ambulation. With his 54" folding cane he travels independently in routine environments. He does not usually travel solo in unfamiliar urban areas. He reports no falls or incidents with cane travel. Dark gray full coverage fit-over sunglasses are used for photosensitivity on bright sunny days with dark amber used in more cloudy or overcast conditions.

Social

The financial effects of his vision loss have been noticeable. Dr. Cole states his patient load has decreased somewhat due to a combination of occasional patient diffidence and economic downturn in the area.

At a recent professional meeting, Dr. Cole enjoyed the presentation of the speaker but could not visualize the slides. He will be scheduled for a follow-up assessment in low vision soon for another evaluation of possible telescope use at meetings and spectacle binoculars to enhance TV viewing.