Eye Discoveries: Neuro-Ophthalmology and Visual Rehabilitation

In the past, ophthalmologists focused very much on the disease — particularly, to its diagnosis, treatment and risk reduction.

Insufficient emphasis was given to the patient’s quality of life, and how they would continue to function in society after visual loss had occurred. To many patients, loss of sight may seem like the end of the road. Many descend into frustration and depression.

NHG Eye Institute Direct Access Hotline

NHG Eye Institute is able to accommodate same-day/next day appointments. Depending on the level of care needed and the requested timing, most patients can be seen by an Eye specialist on the same day especially for requests received in the morning. For appointments, GPs should call 6359 6500.

Traditional and Electronic magnifiers
 

In recent years, greater understanding of the psychosocial impact of visual loss has led to greater efforts in visual rehabilitation. Studies have shown that early institution of rehabilitation is helpful in getting patients back on their feet. In stroke patients presenting with hemiparesis along with hemianopias, this is even more crucial as early visual rehabilitation also aids in expediting physical neurorehabilitation.

Visual rehabilitation or low vision rehabilitation aims to help patients develop compensatory strategies to fully utilise their existing vision or visual field. Compensatory strategies can include saccadic training, visual aid prescription and training, orientation and mobility, home occupational therapy visits and in select cases, prisms for hemianopia field expansion. The aim is not to reverse the underlying organic disease, but to help patients use their residual visual capacity more effectively. Visual rehabilitation is useful for conditions beyond neuroophthalmology, as patients with other causes of visual loss such as age-related macular degeneration and glaucoma also benefit from visual rehabilitation.

It has been a model in various countries, and in NHG Eye Institute, to adopt an integrated low vision rehabilitation programme, with clinicians (ophthalmologist), low vision optometrists and low vision occupational therapists each playing integral roles. At the NHG Eye Institute at TTSH, we have a twice-weekly combined clinic where patients first visit the low vision optometrist for refraction and visual aid prescription (if necessary), and subsequently the low vision occupational therapist. Despite the bad news frequently delivered in my clinic, we are now able to offer our patients some hope and motivation. It is extremely heartening to see patients return for their review after undergoing visual rehabilitation — happy, independent, and announcing their return to work, and their lives.

By Dr Chin Chee Fang, Head of Neuro-Ophthalmology Service & Consultant, National Healthcare Group Eye Institute, Tan Tock Seng Hospital