Vision rehabilitation services are crucial for improving the quality of life for patients with visual impairments. Madison Dunning, OD, of Duke Eye Center in Durham, North Carolina, has dedicated her career to providing specialized care to patients dealing with the challenges of vision loss. Her path to optometry and vision rehabilitation started early, shaped by personal experiences and professional training.
AN EARLY INTRODUCTION TO EYE CARE
Dr. Dunning’s understanding of eye care began at a young age. Growing up, her mother was a certified ophthalmic technician, so yearly dilated eye exams were a regular part of life. “I remember wondering what the doctor meant when he told my mom I had astigmatism when I was prescribed my first pair of glasses in middle school,” Dr. Dunning says.
Then, during an undergraduate course, Dr. Dunning noticed a peculiar instrument her mentor was using— a mounted spectacle telescope used to help her read and work on a computer. After some discussion, her mentor connected Dr. Dunning with her own optometrist, Tracey Glendenning, OD. Dr. Dunning spent some time training as an optometric technician at Dr. Glendenning’s office and decided to pursue a career in optometry.
RECOGNIZING THE NEED
Another pivotal moment for Dr. Dunning happened during optometry school. “During our low vision rehabilitation course, my professor, Erin Kenny, OD, presented a case of a patient with diabetic retinopathy and macular edema,” she says. “The patient had poor visual acuities and impaired contrast sensitivity. They were prescribed a stand magnifier to successfully see their glucometer and check their blood sugar. This case underscored for me how vision rehabilitation can be life changing. Without the stand magnifier, the patient’s ability to manage their diabetes was compromised, potentially leading to further vision loss that could have been prevented.”
Then she learned something that motivated her to get involved even more. According to the National Institutes of Health, the prevalence of visual impairment and age-related eye disease in the U.S. is expected to double by 2050. “Optometrists will naturally encounter more patients with vision impairment, and it’s important that all optometrists are able to provide a basic level of vision rehabilitation care,” Dr. Dunning says.
After graduating with honors from Salus University Pennsylvania College of Optometry in 2021, Dr. Dunning completed a residency in primary care with an emphasis on ocular disease, where she provided vision rehabilitation services to veterans once a week. Now at Duke Eye Center, she works in a state-of-the-art, multidisciplinary vision rehabilitation clinic that includes two optometrists, three occupational therapists and a licensed clinical social worker. This team-based approach allows for comprehensive patient care, ensuring that each individual’s needs are addressed.
ADDRESSING THE IMPACT
Visually impaired individuals may face numerous challenges including but not limited to photophobia, visual distortion, impaired contrast sensitivity, scotomas and visual field defects. These impairments can severely affect overall quality of life and independence. Vision rehabilitation is able to address difficulties with activities of daily living such as reading, writing, driving, cooking, mobility and more.
“Vision loss and blindness are a spectrum,” Dr. Dunning says. “Optometrists are well positioned and trained to understand how loss of visual function can impact our patients’ lives. Addressing these challenges requires a holistic approach, involving the right tools and a collaborative multidisciplinary effort.”
At Duke Eye Center’s vision rehabilitation clinic, Dr. Dunning says it’s not only a hub for patient care but also a critical training ground for future eye care providers and occupational therapists. In 2024, Duke graduated its first Doctor of Occupational Therapy (OTD) class. Occupational therapy students have the option to pursue a vision rehabilitation elective, which includes a 12-week internship in the clinic.
Medical students and ophthalmology trainees also rotate through the clinic, learning about the essential services provided to patients with visual impairment or blindness. Dr. Dunning regularly refers patients to a wide range of specialists, including occupational therapists, certified driving rehabilitation specialists, clinical social workers and orientation and mobility specialists.
EARLY REFERAL IS KEY
Dr. Dunning emphasizes the importance of early referrals to vision specialists. “Don’t wait until the patient has hand motion or light perception vision to refer to a vision rehabilitation provider,” she says. “Vision loss is a journey, and patients’ needs evolve over time. They may require multiple visits to a vision rehabilitation provider throughout their life.”
For optometrists looking to expand their low vision rehabilitation services, Dr. Dunning offers a few practical tips:
- Trial frame a higher add power at near. Demonstrate and discuss the closer working distance with your patient.
- Educate patients on assistive technology. All smartphones have accessibility options within the settings and a built-in magnifier. Provide a list of smartphone apps for visual impairment such as “Seeing AI” and “BeMyEyes,” and take advantage of assistive technology such as Siri or Alexa.
- Discuss direct task lighting. Recommend gooseneck desk or floor lamps. Many are available at local craft stores.
- Refer to a vision rehabilitation colleague. Utilize the The Vision Council Foundation’s Low Vision Prescriber Network to find a local vision rehabilitation optometrist in your area.
LOOKING AHEAD
As she continues her work at Duke Eye Center, Dr. Dunning remains committed to helping patients navigate the challenges of vision loss. She plans to take her next career step by sitting for the Fellow of the American Academy of Optometry (FAAO) oral exam in November 2024. Through her efforts, she hopes to empower patients to live fuller, more independent lives and spread awareness to other providers about the importance of these services.
