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Glaucoma Editorial How We Can Improve the Lives of Our Patients Who Have Already Lost Vision or Will Lose Vision in the Future George L Spaeth, MD Louis J Esposito Research Professor, Wills Eye Hospital, Philadelphia, US Abstract An overview of “How We Can Improve the Lives of Our Patients Who Have Already Lost Vision or Will Lose Vision in the Future,” presented at the American Glaucoma Society Meeting, 2015. Keywords Vision loss, quality of life, glaucoma Disclosure: George L Spaeth, MD, has no conflicts of interest to declare. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: March 31, 2015 Published Online: October 16, 2015 Citation: US Ophthalmic Review, 2015;8(2):96–8 Correspondence: George L Spaeth, MD, Wills Eye Hospital, 840 Walnut Street, Philadelphia PA 19107, US. Email: gspaeth@willseye.org Thirty-nine million people in 2012 could not see the external world at all. Two hundred and forty-six million people saw the world poorly. Many of these people lose the ability to function and consequently have a decreased quality of life. Much of that decreased ability to function, along with the attendant worsening of quality of life, is unnecessary. It is truly tragic that many patients and many physicians do not know what can be done to help the lives of those who have already lost vision or who will lose vision in the future. Among my patients, for example, only 12 % know how to use a computer to magnify, and only 4 % are aware of how to use a computer to turn print into voice, or vice versa. Many agencies, such as Associated Services for the Blind and Visually Impaired (ASB) in Philadelphia, and many support groups exist to help those who have reduced vision, but a large number of patients are unaware of these agencies, and physicians are slow to refer to them. Ophthalmologists, of course, have a primary responsibility to preserve vision, but they can do much more than that. While their first task is to be knowledgeable, skilled, and appropriate, they need to remember that to enhance the ability to function, they need to care for their patients with that goal in mind. Different aspects of vision have different effects on a person’s ability to function. For most acts, for example, VA is more important than visual field. Figure 1 illustrates the relationship between VA and the ability to perform nine different activities of daily living (finding boxes in a store, reading signs from a distance, and recognizing faces). On the vertical axis is the score of the test known as the Assessment of Disability Related to Vision (ADREV). The higher the score, the better the function. The closeness of the relationship between acuity and the ability to perform the activities of daily living is clear. By contrast, in Figure 2, using the same test and comparing to the score for field, the scatter is obviously much greater. 96 The results are important for those taking care of patients who have glaucoma, but there are many other causes of visual loss. A common one is ocular surface disease resulting from various conditions, including medications used to treat the glaucoma itself. Making sure that excessive medications are not used is an important step in keeping people maximally functional. The goal is not regulation of intraocular pressure, or even preservation of visual field, but rather preservation of function and feeling. Physicians should know about how patients can be helped, including through use of optical magnifiers, both those that are self-illuminated and electronic devices, including computers. Much adaptive hardware and software can now assist character recognition, voice recognition, and voice reading. Many agencies, such as ASB, are expert in helping people remain mobile and independent and functioning well. Those dealing with people who lose vision need also to be aware of experimental devices, such as OrCam, a device attached to eye glasses that can recognize objects and “speak” the identity to the wearer. Perhaps the most important way ophthalmologists and other physicians can help preserve quality of life is simply to be aware of the problems associated with visual loss and to listen to their patients empathetically and knowledgeably. Ophthalmologists should want to know, should ask about, and should learn about their patients’ reactions to loss of vision that has already taken place, as well as fear that vision may be lost in the future, not to mention certainty of future visual loss. Several years ago I interviewed a large number of patients who had significant visual loss, not just from cataract, but from other causes as well. There were three commonalities: (1) they feared becoming Touch ME d ica l ME d ia