Hope in sight

SINGAPORE — A sudden severe viral eye infection last year left Mr Nasiruddin bin Pengut, 32, completely blind in the left eye. He also lost most of his right eye’s visual field — the total area that can be seen when the eye is focused on one point.

Yet, Mr Nasiruddin is now able to read, as well as use the computer and touch-screen devices after undergoing a low-vision rehabilitation programme at National University Hospital (NUH), which sees 80 to 100 new patients with low vision each year.

He also has no problems retrieving his mail and taking walks around the neighbourhood on his own.

Low vision refers to visual impairment that interferes with daily activities, but cannot be corrected by medical or surgical interventions, said Ms Eileen Lim, an occupational therapist at Tan Tock Seng Hospital (TTSH).

Said Mr Danial Bohan, senior optometrist at NUH’s Eye Surgery Centre, low vision affects mainly the elderly, as the number of potentially blinding eye conditions, such as glaucoma and age-related macular degeneration, increases with age.

FROM DESPAIR TO ADAPTING TO LOW VISION

People with low vision still have some usable residual vision, said Ms Lim.

Added Ms Chen Xuanyu, a low vision-trained senior occupational therapist from NUH Rehabilitation Centre: “With the use of various low-vision aids and strategies, they are still able to do what they want to do and lead a fulfilling life.”

Mr Nasiruddin’s independence after his vision loss did not come easily. The former architect had to rely on his mother to help him with everyday tasks such as identifying food on his plate.

Mr Nasiruddin learnt to adapt after Ms Chen taught him to identify the area of best vision for a visually-impaired person. Using this, he was able to maximise the use of his remaining vision for daily activities.

Ms Chen also visited him at home to explore how his family could make the space more low-vision-friendly. For instance, items at home were rearranged, brighter lighting was added to his desk area, while coloured tapes were used to enhance contrast in the environment. Rubber bands were tied to essential items such as toothbrushes to help him identify them.

However, stigma and lack of awareness about low-vision rehabilitation have prevented some patients from seeking help early.

Said Ms Chen: “It is important to note that low-vision patients who make early adjustments and adaptation often do better. Simple tools like the magnifier can make a huge difference to their lifestyle needs”.

OCCUPATIONAL THERAPY FOR LOW-VISION SUFFERERS

Dr Dawn Lim, associate consultant at NUH Eye Surgery Centre, said demand for low-vision services has increased in recent years.

More institutions now offer occupational therapy services together with their existing low-vision rehabilitation programmes. Typically, the patient is first assessed by a low-vision optometrist, who prescribes suitable optical devices, such as magnifiers and telescopes for specific visual tasks, said Ms Chen.

A low-vision-trained occupational therapist then works with the optometrist to teach patients how to use the prescribed tools, she said.

TTSH launched a low-vision occupational therapy programme in 2013, after noting an increase in patients with visual impairments who were referred to occupational therapists following events such as falls, said Ms Lim.

TTSH’s programme has seen a steady growth from about 40 patients at its launch in 2013 to about 100 patients last year. The number is expected to increase, given Singapore’s ageing population, said Ms Lim.

Since last year, Singapore National Eye Centre’s (SNEC) low-vision clinic has been working with occupational therapists from Singapore General Hospital to cater to patients who have problems with activities such as reading, or who need help modifying their homes or workplaces, said Dr Yvonne Ling, senior consultant in charge of Low Vision Service at SNEC.

The Singapore Association of the Visually Handicapped (SAVH) also provides occupational therapy to visually-impaired clients to help them re-orientate and rehabilitate with the use of a white cane. It sees about 30 to 40 cases each month.

Meanwhile, NUH Eye Surgery Centre has plans to expand its low-vision programme, so that patients — especially the elderly with little or no social support — do not fall through the cracks, said Dr Lim. For instance, the team is looking at ways to equip community-based occupational therapists with the necessary skills to manage low-vision patients.

As part of a new pilot initiative, the NUH team will also work with nursing homes and eldercare centres to integrate basic vision screening into their existing work processes.

“This is to ensure that people with low vision can be identified early and receive the necessary treatment or care,” said Dr Lim.