Focus on vision for all rehab patients

Don’t assume patients have good vision

Providing low vision rehab services can greatly enhance patients’ daily lives, from helping them find what they need at the grocery store to seeing pictures of grandchildren. But attention to vision can also lead to better outcomes in the rest of your rehab program.

"There are a lot of people who have macular degeneration — the leading cause of adult vision loss — who come to a rehab department with a broken hip or other problem," says Lylas Mogk, OD, chairwoman of the San Francisco-based American Academy of Ophthalmology’s Vision Rehabilitation Committee and director of the Visual Rehabilitation and Research Center at the Henry Ford Health System in Detroit. "If the therapist says, you do it this way, put your hand right here,’ and the person can’t see what they’re demonstrating, then they’ve got a problem. People in this generation with macular degeneration do not walk in saying, I can’t see what you’re doing.’"

Mogk’s own father, who is now 96 and has been diagnosed with macular degeneration, found himself in such a situation about four years ago. He was unable to walk after a hospital stay, and a therapist came to his house to help. "When I got home, he said to me, I got all this information about how to walk, but my real problem is I can’t see,’" Mogk says. "The instructions were carbon copy handwriting on pink paper, and he couldn’t read them at all. She probably spent an hour with him, and she never knew he couldn’t recognize her face or see what she was writing."

Even if your facility does not have a specific vision program, pay attention to visual problems throughout the course of your regular rehab activities, Mogk says. No matter what problem you’re addressing in rehab, if your patient can’t see your demonstrations or read your instructions, you won’t get far. And don’t make the mistake of thinking this is not a problem your program faces: Statistics show that 17% of people have macular degeneration by age 65, and 30% have it by age 75. Those numbers don’t count the other causes of low vision, such as glaucoma and diabetic retinopathy.

Here are some effective ways to help visually impaired patients, according to Mogk:

  • Enhance visual contrast. Even in very early stages of macular degeneration, patients lose contrast sensitivity. Make all handouts high-contrast, with big, black letters on white paper. Take care with activities as well — don’t have patients try to pour black coffee into a black cup.
  • Control lighting and glare. People with macular degeneration are especially sensitive to fluorescent lights.
  • Reduce patterns. If you put a bunch of pills out on a flowered tablecloth for a patient to count, those pills will seem to disappear.
Need More Information?
  • Lylas Mogk, OD, Director, Visual Rehabilitation and Research Center, 15401 E. Jefferson Ave., Grosse Pointe Park, MI 48230. Telephone: (313) 824-2401. E-mail:
Need More Information?
  • Don Fletcher, OD, Director, University of Alabama at Birmingham, Center for Low Vision Rehabilitation, 1720 University Blvd., Suite 380, Birmingham, AL 35233. Telephone: (205) 488-0736.
  • Sameena Malhan, MD, Medical Director, SSM Rehab, DePaul Health Center, 12303 DePaul Drive, Bridgeton, MO 63044. Telephone: (314) 344-6691.
  • Pam Roberts, Manager-Quality, Education, and Research, Department of Rehabilitation and Post Acute Care, Cedars-Sinai Medical Center, Los Angeles. Telephone: (310) 423-6660.