In multiple studies, vision loss has been ranked as one of the most feared health concerns — and conditions that impact sight are on the rise. With a growing aging population, eye conditions such as age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy continue to increase in prevalence.
When a person loses their eyesight, it not only signifies a physical change; there are psychological and emotional implications as well. Research published in 2020 found that vision loss is associated with mental health challenges, and data suggests that rates of depression and anxiety are higher among people with visual impairments. The researchers concluded that it is essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health issues among patients with visual impairments.
At the University of Colorado Anschutz, optometrists in the Low Vision Rehabilitation Service at the Sue Anschutz-Rodgers Eye Center provide comprehensive, integrated care and collaborate with clinicians across campus to help patients cope with the impacts of vision loss.
“It can be a grieving process for some patients. For them to be truly successful in terms of adapting to vision loss, they need to have the right tools that allow them to adapt on a physical and psychosocial standpoint,” says David Simpson, OD, assistant professor of ophthalmology and Low Vision Rehabilitation Service optometrist.
To help bridge care for patients, Simpson develops partnerships with clinicians like Emily Haller, LCSW, MBA, an instructor in the Division of Geriatric Medicine at the CU Anschutz Department of Medicine and a licensed clinical social worker who cares for older adults through the integrated behavioral health program at the UCHealth Seniors Clinics at CU Anschutz and in Lone Tree. Although their clinical expertise differs, both Simpson and Haller share the common mission of improving their patients’ quality of life as they face complex issues.
“Patients don’t exist as just their AMD, depression, or diabetes diagnoses. They exist as a whole person whose different conditions can interplay and interact, and those interactions are unique and deserve to be treated as such,” Haller says. “Interdisciplinary care is a best practice for any type of health care. Having everyone at the table, so to speak — perhaps most importantly, the patient themself — helps ensure patients get the care they need and deserve.”
Simpson was intrigued by optometry from a young age, having received his first pair of glasses at age 3. Now, as an optometrist who specializes in low vision rehabilitation, he helps patients — primarily older adults — who are unable to fully correct their visual impairments with interventions like glasses, surgery, or medical treatments.
“We meet people where they’re at in terms of their needs. We want to work with patients on specific goals they have and develop ways to help them achieve that,” Simpson says.
These interventions may include learning how to use accessibility features on smartphones, optical devices such as telescopic glasses or magnification tools, or non-optical tools such as cutting boards or measuring cups designed specifically for people with low vision.
In addition to optometrists, the Low Vision Rehabilitation Service also offers occupational therapy to patients, so they can learn how to use these tools effectively.
“The types of tools that people with vision loss need may not be intuitive to use, so having occupational therapists available to help us implement our recommendations for patients is key to overall success,” Simpson says.
Most often, patients are referred to Simpson by other ophthalmologists and optometrists. The common reasons for visual impairment include glaucoma (a condition that damages the eye’s optic nerve, which connects the brain and eyes), diabetic retinopathy (a leading cause of vision loss for people with diabetes), and AMD (a disease of the eye’s retina that damages central vision).
As part of his exam with patients, Simpson collects an extensive history from patients to get a sense of their condition, goals, and day-to-day lives. During these conversations, it’s not uncommon for patients to become emotional and shed tears as they reflect on a loss of independence due to their declining vision.
“I tell patients they are not alone in the experience they’re having, so they don’t feel isolated,” Simpson says. “That’s why it’s valuable to talk about how they are feeling and provide resources, such as referrals to psychiatrists, community-based providers or organizations, support groups, or other clinicians.”
“The nature of the patients we see is that, unfortunately, their vision is unlikely to improve significantly — so success isn’t necessarily bringing vision back. It’s helping people get to where they want in life despite their vision loss,” he adds.
As an integrated behavioral health provider, Haller prioritizes whole-person care by considering the multitude of factors that can affect patients, from their health conditions to the “environmental and systemic factors that may impact their ability to live and thrive,” she says.
Her patients are older adults who have been referred by a primary care physician because they may need help with changing certain health behaviors so they can achieve a health goal, such as improving their medication adherence or coping with a new medical diagnosis.
“There is something so special to me about supporting folks in challenging moments to find opportunities for hope by making small or big changes in their lives,” Haller says.
Haller has witnessed firsthand how the low vision team can change patient lives for the better. About a year ago, an older adult patient at the UCHealth Seniors Clinic was referred to Haller. The patient was experiencing vision loss due to AMD, which research shows can degrade the quality of people’s lives and is a risk factor for depression.
The patient, who was accustomed to being an independent caretaker in their family, could no longer perform everyday tasks like reading the mail and writing checks. This really impacted the way the patient viewed themselves and had a big impact on their mood. However, the low vision team provided the patient with a low-vision device that they trained the patient on how to use, enabling them to regain those abilities.
“For this patient, it was such a boost of self-confidence. When I first met the patient, they were really down and feeling sad. By the time the patient came back to the clinic after learning how to use the new device, it was as though I was seeing a different person. A light had been turned on,” Haller says. “I think for this patient, it was so empowering to be given this technology and taught how to use it. And it was powerful to see that change as the patient got back a sense of their identity.”
Historically, eye care, mental health, and behavioral health have been treated as separate silos of the health care industry, Haller explains. However, clinicians at CU Anschutz work to make care more integrated. This includes discussing how to best care for patients who seek care from both services.
These collaborations are also extending beyond patients — they are helping train the next generation of ophthalmologists to provide personalized, holistic care. This year, the CU Anschutz Department of Ophthalmology invited Haller to participate in an educational training day for ophthalmology residents. Throughout the day, residents learned how community providers of different specialties care for patients of all ages.
Haller says the educational day was a great opportunity to talk about behavioral health services across the lifespan and specifically as it pertains to older adults, as well as the mental health impact of conditions that are treated by the low vision team.
“It's important to discuss ways we can help patients process a new diagnosis or a change in their functional status, as well as how to connect folks with additional support if needed,” Haller says. “I think it's also really important for all health care providers to know that you don't have to be a therapist to be therapeutic. You can be supportive, compassionate, and help destigmatize conversations about mental health as just another aspect of a person's overall health and well-being."
“It was a powerful day, because these residents will likely practice across the country, so it’s important to equip them with the resources and skills they’ll need in their field,” she adds. “I believe we need to continue partnering for this in the future.”
For Haller and Simpson alike, they want other clinicians to know that vision and mental health are key aspects of a patient’s whole well-being. Not all patients will be interested in discussing or accepting help with their mental health, but Simpson emphasizes that it is still important to bring up the conversation.
“If someone is experiencing vision loss, it can be overwhelming. Don't be afraid to bring up mental health concerns because we want patients to feel that they can be open about their experience,” he says. “Addressing the overlap of vision and mental health, however, is not something that eye care providers can do on our own. That is where having these resources and connections to other clinicians is critical, so we can collectively help patients achieve their own definition of success.”