5.4 Achieving Fluent Reading — Attempt #2


Let’s try again. We want to help a patient return to immersive, pleasurable reading, which means we need to get them reading at a fast-fluent reading speed.

Previously, I asked ‘could it be as simple as giving them a stronger magnifier?’ — meaning a magnifier strong enough to shift the print from its origin not just into the Visual Volume, but further, all the way into the patient’s Optimal Visual Volume.

The answer isn’t no. But it’s not yes either — it’s maybe. It also depends on whether the magnifier they use has a speed limit that allows fast-fluent reading. And as we saw, the stronger the magnification, the fewer high-speed options we have.

One of the biggest changes in low vision practice over the last decade or so has been the vastly increased range of really great CCTVs — desktop, portable, now even head-mounted.

The revolution under way at present is the increasing prevalence of smartphones and tablets, which patients often have and are familiar with using before they even develop vision impairment. That skill can then be utilised to turn those devices into quite low vision aids. Added to that is the demographic shift towards a new generation of vision-impaired patients who are less intimidated by technology than the generation who came before them.

Other Factors Limit LVA Suitability

So, is that it? Choose a stronger magnifier, but make sure it’s a fast one?

Not quite. We also need to consider the rest of the patient:

  • What if the patient has only one hand/arm? Suddenly there are a whole bunch of LVAs which would be fine in theory, but in practice they’re useless. Could you make them work with a special stand? Or would it be better to use a completely different magnifier?
  • What if the patient needs an electronic magnifier, but they can’t afford one? Or they are intimidated by anything high-tech?
  • What if they read fine with a low-magnification illuminated stand lamp, but their hand has too much arthritis to hold it? Or a magnifier lamp works well, but their arms don’t have enough strength or range-of-movement to position it properly? Or if their fingers aren’t strong enough to work the switch?
  • What if the patient really could read really well with a small portable CCTV, but they have short-term memory loss and find it hard to pick up new skills?
  • What if the patient could do brilliantly with any of a variety of aids, but what they really want is for you to give them those fabled ‘stronger glasses’ that will restore their sight to them without all the compromises that magnifiers entail?
Someone once told me that optometry would be easy if it weren’t for the people attached to the eyes. It’s true — all aspects of optometry should involve holistic patient care, but I think it’s low vision optometry that demands the most whole-person approach.

That’s our final challenge — the patient, and their broader circumstances.

Finally, Success

But once you’re through that — all of that — and you’ve still got a match…

Oh yeah!

… well then, you’re a legend, and you’ve changed your patient’s world.

That patient who is looking for vision restoration is always a difficult one. When they’re looking for restoration, they’re not ready for rehabilitation. This is one of the reasons I’m really not in favour of talking up all the research going on which hopefully will result in a cure… one day. Doing so makes us feel less helpless, but keeping that flame of hope burning doesn’t benefit the patient. Let’s face it, those cures are unlikely to ever become an option for our patients, at least not our elderly ones. And even if they do, what are they going to do in the meantime?

I don’t give up on them though. I usually schedule them to come in for a review in a year. Quite often I find at that stage they have evolved psychologically, to the point where they are ready to accept help.

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