**5. The second opinion**

coping and mobilization, and (7) self-acceptance and self-esteem [5]. The duration and outcome of the stages are unpredictable. The social and relational factors discussed in the previ-

Professionals must stress the positive in all situations, and outline to family members that all aspects of vision must be appreciated and respected. While 20/20 to 20/40 may be the gold standard to function vocationally in everyday life, many will come to appreciate the ability to distinguish light and dark, colors, large gratings and basic physical forms. Conducting acuity tests with the Berkley Rudimentary Vision Charts to establish and define Log Mar vision below the 20/400 line is a good start. At this point, patients with advanced glaucoma, diabetic retinopathy, age related macular degeneration, retinitis pigmentosa, and many others must realize the value of whatever residual vision they have. This will encourage compliance with

Patients deal with the sudden traumatic nature of the bad news with denial and disbelief. They view the abyss of isolation and torment socially [5]. Three factors that influence the severity and intensity of shock are: (1) the significance of the loss to the individual, (2) the suddenness or unexpectedness of the event, and (3) the degree of visual loss. Denial often lasts as long as the multiple opinions and therapies continue to change; when the eye care

Tedrick [4] reports that self-pity is the main characteristic in the mourning and withdrawal phase. In this phase, individuals refrain from activities that they once loved to partake in. Tuttle and Tuttle [5] outlined the "D's" of depression as despair, discouragement, disinterest, distress, despondency and dissentment. The next stage in the adjustment process is reassessment and reaffirmation. In this phase/stage the client self-examines their life and finds mean-

In the next stage (coping and mobilization), the patient will find information and resource that will support them in the change [4]. This phase has cultural overtones that determine how smoothly, and at what rate it progresses. In Jamaica, the go-to is the Society for the Blind and the philanthropic body that supports rehabilitation is the Lions Clubs spread across the island. As the patient crosses this phase into the final of self-acceptance, he/she gains selfconfidence, and is able to accept the prognosis and move on with life. This may take a long

In societies with strong theosophical backgrounds, the role of religious beliefs and claims to divine intervention are often brought to the fore. Patients facing imminent blindness look to prayer and divine healing in order to stay positive about their prognosis [6]. As a spiritual meditation, the activity has been shown to have physiologic benefits: clinically significant reduction in and ambulatory blood pressure, reduced heart rate, cardiorespiratory

ous section are among others that will influence the sequence.

88 Causes and Coping with Visual Impairment and Blindness

the control of ocular and systemic diseases leading to blindness.

professional admits "we have done all we can do."

ing (purpose for living).

time, and some may never get there.

**4. Faith: influence of beliefs**

Murphy [8] writes of her experience with a poor visual prognosis, where second opinion changed her life in a day, from despair to hope. An ophthalmologist diagnosed her sudden onset of loss of vision as macular hemorrhage of questionable etiology, giving a 2-week period before anticipated total vision loss. Her second opinion from a younger eye surgeon (and has a good prognosis), gave a diagnosis of Central Serous Maculopathy which is self-limiting. Patients are entitled to this review, and doctors should have no insecurities about this, as medical research is very dynamic.

Diagnosis of irreversible (legal) blindness should be made by medical or eye care professionals qualified to make such pronouncements, and the same should be validated by objective methodology as far as is possible. There are legal ramifications to unfavorable visual diagnoses with socio-economic, emotional, vocational, relational, and psychological consequences. Pronouncements should be made in the presence of a legal support system, as well as the full cadre of relevant eye care professionals.

strategic plan of the Ministry of Education in Kenya was a highlight of Kenya Government's commitment to improving the fate of the disabled. Legislations and Governmental policies need to stand behind the inclusion and empowerment of visual impaired in their societies, thus minimizing the sense of dislocation and hopelessness of those with visual, and other

Coping with Visual Impairment: Helping our Patients Face the Truth

http://dx.doi.org/10.5772/intechopen.78675

91

The ability of sports to unite communities, regions, and cultures has been demonstrated time and again, and is even more powerful when viewed from the standpoint of disabilities. There is an added measure of respect and dignity that transcends the winner's podium. Just participation in itself lends to self-confidence, respect from community, and aids the rehabilitative efforts of those caring for the visually impaired. Physical activity among the visually impaired enhances coordination as well as sharpens proprioceptive and other senses that are needed in daily life. There is a bonus in other areas of health that would be threatened by a sedentary lifestyle that can result from the loss of self-confidence and independence accompanying sig-

physical impairment.

nificant vision loss.

**Author details**

Maynard McIntosh

**References**

Address all correspondence to: ophthalmicsuites@gmail.com

blindness. [Accessed September 12, 2017]

older-pe.html [Accessed: October 13, 2017]

impairment-and-blindness [Accessed: October 13, 2017]

Ophthalmic Suites and Caribbean Lasik Vision Centre (CLVC), Kingston, Jamaica

[1] Mills S. Darkness, Visible: The History of Blindness. History Today. Published September 9, 2013. Available from: http://www.historytoday.com/selina-mills/darkness-visible-history-

[2] Nyman SR, Gosney MA, Victor CR. The psychosocial impact of vision loss on older people. British Society of Gerontology. Available from: https://www.britishgerontology. org/DB/gr-editions-2/generations-review/the-psychosocial-impact-of-vision-loss-on-

[3] Fazalbhoy R. The right attitude towards blind children. Indian Journal of Ophthalmology1959;**7**:76-78 . Available from: https://www2.edc.org/NCIP/LIBRARY/vi/Organ.htm

[4] Tedrick B. Adjustment, losses and positive attitude: Dealing with vision impairment and blindness. Alliance for Equality of Blind Canadians. Available from: http://wwwblindcanadians.ca/publications/cbm/25/adjustment-losses-and-positive-attitudedealing-vision-

[5] Tuttle DW, Tuttle NR. Self-Esteem and Adjusting with Blindness; The Process of Responding

to Life's Demands. 3rd ed. Springfield, IL: Charles Thomas Publishers; 2009

Case in point: Macular holes are common, and when greater than 600 microns, have a poorer prognosis for repair and vision rehabilitation. This, until recently with the advent of autologous blood as an adjunct to macular hole surgery. Research continues to change the prognoses for vision rehabilitation in many cases traditionally considered end-stage. Informed second opinion should be a part of due process in the management of patients with unfavorable visual prognoses that can negatively affect their quality of life [9, 10].

The prognosis of conditions like glaucoma, retinitis pigmentosa and macular degeneration, to name a few are largely subjective. Advice on prognosis and related patient counseling needs to be collaborative, involving psychologist, ophthalmologist, patient, care-givers, and key opinion leaders who can use latest investigative and therapeutic tools to alter the course of progression where possible. Acceptance of a diagnosis and prognosis had a large cultural and socio-economic component that differs significantly according to the cultural milieu [11]. Second opinion in many cases may involve the use of tele-medicine, research, and professional exchanges across borders.
