by Chiara Daina
It is a service provided by the National Health Service aimed at people in precise conditions of low vision. The distribution of the supply is still uneven
When you have a visual impairment it is not true that there is nothing more you can do. Sight is not recovered but you can learn to make the best use of the remaining visual potential through a rehabilitation operation, to have the maximum possible autonomy explains Filippo Amore, director of the national center of services and research for the prevention of blindness and visual rehabilitation of the visually impaired, based at the Gemelli hospital in Rome and financed by the Ministry of Health. Often, however, underlines the expert, those who would be entitled to it arrive late at the specialized center, or do not access it at all, because there is little knowledge among ophthalmologists about the rehabilitation process and the benefits it provides.
The criteria for prescription
The rehabilitation process is normally prescribed for those who have residual vision not exceeding 3/10. In fact, you could go as low as about 5/10 to get more benefits, stresses Love. Low vision is defined as severe at 1/10, moderate at 2/10, and mild at 3/10.
The sooner we intervene, making the most of the remaining retinal function, the greater the results, specifies the ophthalmologist. In developmental age, low vision leads to a delay in psychomotor development and continuous learning problems. Love, while in adulthood, loss of autonomy, work and role in the family with consequent psychological repercussions. The risk of falls and injuries increases in the elderly. Istat estimates that Italians aged 15 and over with severe visual impairment are almost one million (of which over 70% are over 65), those with moderate visual impairment 8.6 million (of which 45% are over 65 ).
The centers
The Italian section of the International Agency for the Prevention of Blindness (Iapb Italia onlus), which founded the national pole at Gemelli, has surveyed about 90 rehabilitation centers in Italy. But, as was denounced by the Ministry of Health in the latest Report to Parliament on the state of implementation of policies on the prevention of blindness and vision rehabilitation (law 284/97), the distribution of the supply of these services is still uneven. The disparity of access is evident if Basilicata has no centre, Sardinia only one and Lombardy as many as 16.
The treatments
The team, made up of an ophthalmologist, an orthoptist and a psychologist, first takes care of understanding how the subject sees, that is, how he uses his residual vision. A test of sensitivity to contrast, of adaptation when the brightness changes, of fixation stability of objects, of chromatic sensitivity and of the retina, is used to identify the area that best responds to the light stimulus and rehabilitate it, explains Amore. Then he defines a personalized plan to best train his vision condition. In the simplest cases we intervene with an optical aid, such as magnifying or prismatic lenses, portable or table video magnifiers and assistive software to facilitate the use of the computer. To choose the most suitable aid you need 2-3 training sessions in the specialist’s clinic.
In the most compromised cases, in which it is required to enhance fixation, in which the sensitivity of the retina is particularly poor and the visual acuity, i.e. the ability to clearly define the image, is less than or equal to a tenth, photostimulation exercises are necessary , oculomotor coordination and fixation, with biweekly sessions for five weeks. The first check-up scheduled 3 months later, the second 6 months and then once a year. We propose a questionnaire on the perceived quality of life upon admission, after a year and after each improvement intervention: over 60% of patients report having improved their use of sight concludes the ophthalmologist.
The necessary requirements for adults and children
Vision rehabilitation is intended for the visually impaired of any age, regardless of the cause. They must have already received a diagnosis of eye disease and have carried out an ophthalmological examination for clinical verification in the previous six months – clarifies Filippo Amore -. Among the most frequent diseases that damage the visual capacity are senile maculopathy, diabetic retinopathy, glaucoma and genetic retinal diseases. Despite treatment, more than 50% of patients experience progressive loss of vision and need rehabilitation.
In children, the main causes of low vision are: Retinopathy in preterm infants, eye malformations, congenital glaucoma and congenital cataracts, says Amore. Most rehabilitation centers treat all sections of the population, others are dedicated only to adults and others to children.
Symptoms
What are the indicative symptoms of low vision that should not be underestimated? Difficulty reading and writing despite the correction of glasses with presbyopic lenses, difficulty moving from one environment to another with different brightness, reduced field of vision, so you tend to move your head to see the whole of what you want to see, disorientation , not noticing obstacles and steps, apparently inexplicable falls, discomfort in crossing the road and driving – replies Love -. There is also an incorrect perception of colors and contours, a difficulty in recognizing faces and in carrying out normal daily activities.
The Italian section of the International Agency for the Prevention of Blindness (Iapb Italia onlus) has activated the toll-free number 800068506 (from Monday to Friday, from 10 to 13) to receive a telephone eye consultation from a doctor, for information purposes only , which cannot in any way replace the traditional ophthalmological visit. It is possible to request information by writing to [email protected].
How do you log in
Vision rehabilitation was included in 2017 in the essential levels of assistance that the National Health Service must undertake to ensure, having recognized its effectiveness. To schedule the first public consultation at one of the centres, you need a prescription from a general practitioner or specialist. On the website polonazionaleipovisione.it the list of centers distinct by region is available. This centre, at the Gemelli Polyclinic in Rome, is the point of reference in Italy for research and experimentation with new rehabilitation models. Including tele-rehabilitation at home. We have created an exercise software of progressive difficulty to be performed at home in front of a monitor 5 days a week, from Monday to Friday, for a total of 30 sessions – explains the director Filippo Amore -. The execution of the exercise is monitored by an operator directly or deferred.
September 6, 2023 (change September 6, 2023 | 08:09)
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