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Low vision program renews hope for sight by Heather Woolwine Public Relations Many physicians will admit that one of the original attractions to health care profession was the idea of seeing a patient’s problem, fixing it, learning from it, then moving on.   Accompanying that keen interest in problem-solving is their desire to help people, and the ultimate drive to succeed in offering the best patient care possible. One of the hardest things a physician can say to a patient is, “I’m sorry, but there’s just nothing else we can do.”   Patients with sight problems, or low vision, too frequently hear that answer, according to Stephen Morse, O.D., Ph.D, MUSC Ophthalmology associate professor. As director of the MUSC Storm Eye Institute Feldberg Center for Vision Rehabilitation, Morse offers a last outpost for patients accustomed to disappointment when it comes to living with low vision.   “We see any patient, adult or child, with a vision problem that can’t be fixed through standard ways. Our model of vision rehabilitation is a new way of looking at treating vision problems that has only begun to gain momentum throughout the country,” Morse said. “We help these patients regain their independence by teaching them how to live, work, and play with low vision; how to get them doing the things that most people take for granted everyday like reading nutrition labels, moving around the house, or looking at pictures of grandchildren.”   Low vision is beyond the scope of standard methods such as glasses, contact lenses, medication, or surgery. It could be caused by eye disease like macular degeneration or glaucoma, or vision complications as a result of diabetes or stroke. Low vision manifests as blurry vision, blind spots, loss of peripheral vision, or various other impairments. Regardless of the cause, these patients encounter difficulty in getting around in their everyday lives and, thanks to generous support from the Feldberg family, now have a place to turn for vision rehabilitation. One part optometry, one part ophthalmology, and one part occupational therapy, the techniques developed at the Feldberg center align with the respected collaboration of social workers, orientation and mobility specialists, and vision rehabilitation teachers to offer a comprehensive range of low vision services.   “We talk to the patients and ask them what it is they want to be able to do,” Morse said. “Do they want to read the mail? See faces more clearly, participate in hobbies or physical activities? Dependant on their answer, we then tailor a rehabilitation program to meet those needs.”   First, patients undergo a detailed evaluation designed to test the patient’s eye strengths, weaknesses, and overall health. This exam determines what magnification devices work best for that particular patient. Magnification devices include everything from magnifiers and telescopes to computer systems. Specialists help patients select devices and teach them how to use them. These dedicated staff members work with each patient until he or she is comfortable using the device in a daily routine. Often times, these training sessions include visits to the home, grocery store, and office. In addition, the center is housed with the Association for the Blind, which contributes to patient care as an added resource for help with low vision.   “Vision rehabilitation is a different way to do things, and sometimes patients do become frustrated because it requires a certain level of commitment on their part to make it successful,” Morse said. “But we break the therapy down into manageable chunks that are easy to process and understand so that anyone can do this. We can help these patients who have been told that there’s nothing left to be done about their vision problems. We can do it, and we want them here.” Low vision rehabilitation—A legitimate treatment While low vision rehabilitation helps patients considered beyond the realm of traditional vision treatments, many physicians remain skeptical about its results. Morse understands their caution, but is quick to explain the reasons behind it. “Of course they don’t want to send their patients off to someone who claims to have a treatment and then doesn’t do a thing to help, but,” he said, “this is much different from that. Basically, most optometrists and ophthalmologists out there just don’t know the details of our model of vision rehabilitation and why it is so much more effective than the old-style low vision treatment of the past. They wonder about vision rehabilitation and, frankly, just don’t know what it is. Sometimes it can be hard to convince them that we are legitimate, but once they understand what we do, they are quick to realize that they owe this to their patients with impaired vision for whom standard methods are unable to help.” Morse added that because of large patient loads and busy work styles, vision rehabilitation sometimes doesn’t even come up as an option in a patient’s treatment plan. “It’s not intentionally being left out, but the end result is that it is, in fact, left out,” he said. Through education, the Feldberg center is working to eradicate this problem and get all patients who would benefit from vision rehabilitation into the program.     Morse was also impressed with the support given to the center from the Storm Eye Institute (SEI) and its director, M. Edward Wilson, M.D., Ophthalmology chairman. “Dr. Wilson has not wavered one iota in his support of the Feldberg center and his commitment to vision rehabilitation helps keep us going. He keeps emphasis on low vision issues through his national appointments with various ophthalmologic societies and that helps to show how important vision rehabilitation is.”     Morse was also pleasantly surprised by the unanimous support of SEI’s faculty when the center began eight years ago. Initially it was a risky venture. Centers such as the Feldberg Center that are so rooted in time-consuming patient care are at risk of never making a profit. Morse said his SEI faculty colleagues looked passed this concern and whole-heartedly threw their support behind the center. “It impressed me that the faculty knew that the center would have difficulty completely funding its endeavors, yet their willingness to get behind the center was unwavering,” he said.     In addition to the center’s low-vision rehabilitation therapy, the center also is offering a new, somewhat controversial treatment called Vision Restorative Therapy (VRT). A company called Nova Vision recently began implementing this therapy nationwide. VRT is a daily, at-home therapy performed on a medical device and claimed to have restored visual function for patients suffering vision loss as a result of stroke or brain injury. Morse and his colleagues are proceeding with their own studies of VRT with two patients from the center. The jury may still be out, but they remain optimistic in hopes that VRT will provide another rehabilitation therapy appropriate for those with low vision.   “The idea behind Nova Vision VRT is neuroplasticity. By remapping existing cortical neurons that were not damaged by whatever brain injury exists, VRT is supposed to train the undamaged parts of the brain to participate in vision and expand function. It is controversial, but it’s a testament to Storm Eye and MUSC that they will explore new therapies to determine their effectiveness,” Morse said.   VRT is noninvasive and FDA-cleared, so it poses no threat to patients who use it. Johns Hopkins medical center and other academic institutions in the Southeast have incorporated it with varying results. “It’s hard to verify the theoretical mechanisms behind some of the results that others have published but many places have found that it works. Despite this certain level of controversy about VRT therapy, and instead of withholding it from our patients who really have no other treatment available, we felt that we would at first be very selective about who we would offer it to so we would be sure it would really help. Early results show that it can restore up to five degrees of central vision, which if you ask a person who didn’t have those few degrees before, it really does make a huge difference in their quality of life,” Morse said.     For information about the center, call 792-8100.     Friday, April 21, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.