“Visual rehabilitation is vital for visual aids to adapt well”
The Institut de la Màcula optometrist and collaborator, Carol Camino, specialises in low vision. Her area of work is the use and recovery of the rest of the visual field: visual rehabilitation is key for visual aids to adapt to patients, once their specific needs have been identified
When patients are diagnosed with an eye disease that prevents them from carrying out daily tasks and conventional optical solutions, such as glasses or contacts lenses, fail to improve the situation, they are usually referred to visual rehabilitation and a low-vision specialist.
"Patients with low vision are those whose vision or visual acuity is reduced or those with a diminished visual field," explains Ms Carol Camino, the optometrist and low-vision specialist at the Institut de la Màcula. "They may also experience a lot of glare outdoors and/or indoors, or low tolerance to changes in lighting".
The programme’s aim is to provide strategies that make it easier to carry out daily activities in the work, educational, cultural and leisure environments, thus facilitating social integration and personal autonomy. As Ms Camino explains, the purpose is to “attempt to use or recover the rest of the visual field. Helping the patient to adapt to the optical and electronic aids they need".
The symptoms of low vision
The latest advances in ophthalmology and the frequency of eye examinations mean that a large number of eye pathologies do not result in total vision loss. However, diseases such as age-related macular degeneration (AMD), retinitis pigmentosa, cataract, diabetic retinopathy (DR) and glaucoma can cause low vision.
The most frequent symptoms are loss of central vision or visual field - lateral, superior, inferior or as tunnel vision-, glare, image distortion and/or blurred vision.
On the first visit to the specialist, “a study will be conducted to assess the patient's vision. This determines their needs, the strength they need and what they require,” Ms Camino says.
The visual rehabilitation programme
"We begin to teach the patient how to use visual aids and also to train the visual skills that have been lost," the Institut de la Màcula specialist explains, "such as moving eyes properly through saccadic movements, scanning movements, eye motricity, tracking or training eccentric fixation”. Ms Camino says that “without visual rehabilitation, visual aids are of no use. We need to know how to use them and to train with them in order to take advantage of the strengthening of the rest of the visual field”.
The visual rehabilitation programme is prepared according to each patient’s pathology, needs and objectives, this being an individualised programme. “From glasses with light, manual telescopes or selective filters for glare to electronic aids in glasses and tablets,” Ms Camino says, detailing some of the visual aids that currently exist. However, she points out that "there are increasingly more new technologies from which to benefit." With this in mind, a path that is being worked on is bionic vision, with “the aim of obtaining artificial functional vision in the form of light as visual perception, partially replacing the natural vision that has been lost”.
Bionic vision “consists of glasses with a camera and infrared technology, attached to a processor. The goggle’s mini-camera generates a video of the environment that the patient captures and sends the data via cable to the processor. Through a series of algorithms, a transmission to the glasses is generated and infrared rays are sent. These travel to the retinal implant or microchip, generating an electrical stimulation that activates the brain through the optic nerve and recomposes the image,” Ms Camino explains.
In this field, the Institut de la Màcula collaborator sees a pathway that enables “blindness to become severe low vision” in the near future, after the implanting of a microchip in blind people has been achieved. However, she says that throughout this process visual rehabilitation will be “what is most necessary”. “We will need to teach a person who does not see to see differently. It will be essential to train the brain to see in this way and to identify objects with this type of vision,” she adds.