Ophthalmologists can often treat anterior segment diseases and conditions, such as dry eye syndrome, cataracts, inflammatory conditions, infections, corneal ulcers, and more, but when there are constraints to that treatment or vision is temporarily compromised, patients can encounter challenges that make it difficult to see.
Kara Hanson, OD, associate professor of ophthalmology at the University of Colorado School of Medicine and director of the Low Vision Rehabilitation Service at the Sue Anschutz-Rodgers Eye Center, and her colleagues spend their days working with patients to overcome those difficulties.
“Symptoms can vary from person to person with anterior segment diseases, but we do see some commonalities,” Hanson says. “For example, lighting can make a big difference, so our job is to figure out ways to utilize light in the right way. We need light in order to see, but too much light can reduce visual function.”
Many patients also experience tear film issues in addition to the condition that brings them into the center.
Hanson recently shared tips that are commonly useful for patients with low vision at the CU Department of Ophthalmology’s 28th annual Ophthalmology Symposium.
“It’s our hope that these tips are useful for patients and for ophthalmologists who encounter questions about vision challenges,” Hanson says. “These strategies can be useful for patients who aren’t necessarily low vision but do experience symptoms that contribute to issues seeing.”
Using light to the patient’s advantage
Additional light can help, but, Hanson says, sometimes the eyes can be more sensitive because of their diagnosis or the treatment.
“If lighting is too bright, some people’s vision can ‘wash out’ or look faded,” she says. “But if there’s not enough light, it’s too dark and that doesn’t help either.”
The trick is to get the lighting just right and controlling what you can. This can be accomplished in several ways.
For those who need to reduce glare and function in bright environments, wearing a brimmed hat or visor may be enough. The brim blocks the direct light from getting to the eyes. Some people may benefit from wearing tinted lenses that block certain wavelengths of light, which may help to enhance contrast, depending on the color. Preferred tint color is very subjective. For example, many people say that a yellow tint works well indoors or on cloudy days, while others feel the yellow tint is “too bright,” Hanson says. Darker tints are often more helpful on sunny days. Wearing a brimmed hat and tinted lenses together can provide double coverage.
To reduce glare with screens, use a dark background, reduce brightness, or use the night settings that reduce blue light emission.
Conversely, other people need more light to see adequately. Hanson says adjustable task lighting can help patients direct the light exactly where they need it. The light should be positioned to the side or slightly behind the person and aimed at the task, away from the eyes. Flashlights and hands-free portable options that can be worn around the neck are good options to aid mobility and with everyday tasks, such as reading, seeing food on a plate, finding items in the pantry, and more.
“Getting the right combination of tools, like finding the right tinted lenses or changing screen settings, can take some trial and error,” Hanson says. “But it’s well worth trying different methods to see what works best with your vision. We can sometimes forget that a simple solution can make a big difference.”
Addressing dry eye for clearer vision
When patients in Hanson’s care complain about watery eyes or blurry vision, it’s often a sign that they are also encountering dry eye, which affects up to 50 million people across the country.
“Usually this is reflex tearing, but these tears are not the right consistency to keep eyes moist,” Hanson explains. “When I have a patient dealing with a primary reason for low vision and dry eye on top of that it can be worthwhile for them to see one of our dry eye specialists to address the specific cause of the dry eye problem.”
“We typically blink less when concentrating on a critical visual task, and when you don’t blink your tears evaporate,” she explains. “This creates a kind of hazy, foggy, cloudy vision and can make it even more difficult to see.”
In the low vision clinic, many patients find reading the visual acuity chart stressful, and they don’t blink. Hanson asks that patients experiencing intermittent blurry vision or tearing to take a break from the task. Closing the eyes for even a few seconds can help spread the tears across the cornea’s surface, thus improving vision again.
“A lot of the time when they’ve reset, taken a big breath, and relaxed their shoulders, they open their eyes and say, ‘oh now I can read that,’” she says. “In the long run this patient will benefit from getting treatment for the specific cause(s) of their dry eye symptoms.”
