Welcome to question of the day #335

Welcome to question of the day #335

I have recently seen several patients with reduced vision due to cataracts and/or age-related macular degeneration and I couldn’t help them see better with a new spectacle prescription. I always find it difficult to explain that new glasses won’t help with vision. Do you have any suggestions?

I have come across this recently as well. I was working with a 95-year woman who had had a stroke and was paralysed on her left side. She’s been told at a previous eye examination that she had cataracts. Her glasses were in good condition but slipped down her nose. She complained that her vision was misty for TV viewing and she couldn’t see small print. She had a hyperopic prescription and a +3.00DS add in her current bifocals.

She had 6/12 in each eye and N10 in her right eye and N8 in her left eye with moderate cataracts in the eye and dry age-related macular degeneration in her right eye. There was no significant change in her prescription.

I advised her that the cataracts were causing her distance and near vision to be misty and that she had dry age-related macular degeneration which was causing her to struggle with small print. I also advised her that making her glasses stronger would not help her see any better. She knew that her general health was too poor to undergo cataract removal and accepted this. I told her that as her glasses were in good condition she should continue with these. I adjusted the frame to make it sit better on her face which she was grateful for.

I informed her that she had the dry version of age-related macular degeneration in a mild form and gave her an Amsler grid with instructions for home testing and advise her to call me if any of the grid lines became distorted. I also advised her to purchase a reading lamp and gave advice as to how to position it for optimum illumination of her reading material.

She was grateful for my honesty about new glasses not helping, for the information about cataracts and age-related macular degeneration, and for the Amsler home testing. Even though I couldn’t help her see better she was happy because my information helped her understand what was going on with her eyes. I will review her in 12 months.

Sometimes even when new glasses will not help we can still help our patients by listening and providing clear information.

Our work is more than recommending new glasses.