Low vision: tennis anyone?

The new NICE guideline emphasises that the majority of patients with symptomatic cataract will benefit from surgery, and importantly, delaying surgery until any chosen acuity threshold is reached is not cost effective. This applies to each eye considered for any individual patient. But what options are there when a patient is clear about wanting to delay surgery for the time being?

Case Study

Eighty-three-year-old AA had a very specific visual demand when I attended for a domiciliary eye test recently. She wanted two specific things; to be able to read the scores on her television during Wimbledon, and to have better glare protection than currently afforded by her photochromic varifocals.

The relevant clinical findings were as follows:
• Best corrected visual acuity; R 0.40, L 0.36 (binocular 0.36)
• External and anterior eye;
• Grade 1 blepharitis
• Poor tear quality and low volume
• All else within normal limits

Ocular health:
• Grade 2 mixed cataract right and left
• Early maculopathy with a few scattered discrete macular drusen and flecks of pigment
• All else within normal limits

She read comfortably with a +3.50DS addition and local task lighting. Her TV was three metres away, and offered a high definition image which she was happy with for all her viewing except when watching the tennis.

Importantly, AA was fully aware of her longstanding cataracts and, having been through several major operations on her knees and hip in recent years, was adamant that she wanted no further hospital treatment until absolutely necessary. So, was there any way of enhancing her distance acuity for a 3m screen while keeping her chair in her preferred position and without buying a larger TV set?

SightScope

Figure 1: The Sightscope Flip

The Sightscope Flip is a Galilean device, either binocular or monocular as required, that is easily fitted over existing spectacles and offers 1.7 or 2.2 times magnification (figure 1). When in the 2.2x setting the telescope was positioned over her spectacles and AA was able to achieve a binocular acuity of 0.04.

Figure 2: With 2,2x magnification AA achieved binocular acuity of 0.04

More importantly, she could manage text, subtitles and the all-important scores (figure 2). For the rest of her viewing, she was easily able to move the magnifier out of her sight line (figure 3). For outdoor glare and UV protection, I was able to supply a Cobalt glare shield for use over her specs (figure 4).

Figure 3: Out of her sightline

I will be reviewing her annually, with the proviso she gets in touch before then if there are any changes or has concerns, and will no doubt be discussing cataract referral with her at some stage in the future. But for now, 15-love!

Figure 4: Using the Cobalt glare shield over her spectacles