AOA 2023: Collaborative care in vision rehab

Carl Garbus, OD, FAAO, caught up with Optometry Times to tell us all about his presentation titled, "Vision Rehabilitation requires working with an interdisciplinary team for best practices," which he presented with Janis Winters, OD, FAAO; Harvey Richman, OD, FAAO, FCOVD; and Maria Richman, OD, FAAO, at the 2023 AOA Optometry's Meeting in Washington, DC.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Carl Garbus, OD, FAAO:
I'm Dr. Carl Garbus. I practice in Santa Clarita, California. I'm in private practice, and I have the opportunity to work at 2 rehabilitation hospitals as well as in my private practice.

I presented a case, a patient who had a cerebral visual impairment from a heart problem where she had an anoxic brain injury, which caused her to lose basically all of her functional vision. When I met her in the hospital for an evaluation, she was unable to perceive any detailed vision; the only thing she could see was a light off to the left side of the room.

She stayed approximately a month at the rehabilitation hospital, and during that time, she regained some color vision, just some rudimentary color vision, but no detailed vision. Then, when she was discharged, I had the opportunity to evaluate her at my private practice, and I do a neuro-optometric evaluation, and I learned that her visual fields were greatly impaired, and she only had some small amounts of vision in her upper field that we were able to ascertain through a visual field called a campimiter test.

So we introduced some types of therapy to improve her ability to move her eyes. We did ocular motor training, and coordinate with occupational therapy at one of the rehab hospitals close by where she can get some more training.

However, her form vision still was very limited. She could identify some objects, but they were—they had to be isolated objects. If they were close together, she was having difficulty determining what those objects were.

I also coordinated with the Braille Institute for O& M [orientation and mobility] training, and with the Department of Rehabilitation. My patient was her her current occupation was writer for television. And she wanted to get back into that role again. In order to do that, she had to learn how to use assistive technology, and we were able to get her involved with the Department of Rehab. They provide her with a free computer and an iPad and trained her on voiceover software. In this area, she could now communicate and start her writing, and start to learn how to process through the software program. And she became very adept at that. She could do emails as well. So I was able to communicate with her via email very easily.

So all in all, when it all was said and done, she's still learning how to use some of these new technologies but doing quite well and she's ready to get back into her work. In a different way, she's able to handle that. And I felt like we accomplished a lot with this patient.

One of the major things is that optometry plays a role of looking at the big picture, and seeing, "Where can we help the patient?" And we don't have all the tools. We have a lot of them, but we also have to coordinate with other professionals and other services. And that included, in this case, occupational therapy, it included the Department of Rehab and Braille Institute, and all the players coming together have a very important role in terms of helping the patient get to their best level of abilities to do everyday living skills. And so that's very important to consider when we're dealing with patients who have complex pathologies and histories.