Improving Your Low Vision Communications Skills

Thomas I. Porter, OD, FAAO

Many years ago it was written that eye care is a blend of both art and science.  I’m certain the author must have been thinking of low vision care when he penned that phrase.  Providing low vision care can be broken down into three basic components; enhancing contrast, magnifying images, and teaching the patient to more effectively use their remaining vision.  The last area, the teaching and patient education, is where art far exceeds science and unfortunately it is the one area most of us are not taught in school.

Effective counseling and education is based upon good communications. Fortunately for most of us, this is a skill that can certainly be learned and improved with practice.  Most patients will come to you with lots of questions but unfortunately many have never been adequately addressed.  To be effective in your role as the low vision expert you must be able to answer specific questions as well as help patients understand some very complicated concepts.

Communications experts often recommend that a message be structured so that the average 12 year old could understand it.  Remember that it is always easier to expand upon a simple idea but much more difficult to go back and try to restate something that the patient didn’t initially understand. Most of us have had the experience of presenting a technically correct idea and later realize that the patient totally missed our point.  You can minimize this by occasionally asking the patient to paraphrase what you just said or by asking simple, leading questions.  Also look for non-verbal cues such as nodding the head or dipping the eyebrows that may give you an indication of the depth of understanding.

A particularly effective communications technique that works quite well in low vision is to use simple analogies.  By comparing complicated concepts with the more familiar most people can grasp a better understanding of our point.  An example would be,  “the eye is like a camera, if the roll of film goes bad inside the camera then a stronger lens won’t improve the picture.  Therefore with macular degeneration simply changing your basic prescription glasses won’t significantly improve your vision.”
One of my mentors addressed a patient’s questions about the need for multiple low vision aids by comparing magnifiers to the tools of a carpenter.  “For a carpenter to build a house he needs a toolbox full of tools.  Each tool does a specific job very well but there is no one tool that can do everything.”  I have taken this general idea and incorporated it into my discussion about how “learning to use vision” is often as important as the low vision aid.  I say, “With the proper pots and pans a gourmet chef can make a wonderful meal but in my hands those same pots and pans would produce a mess.”  “The difference isn’t in the utensils but rather the skill of the person using them.” 

Over the years I have observed dozens of very accomplished low vision practitioners and no two communicate with their patients in quite the same way.  However, all shared several common communications traits.  They all speak rather slowly.  Most use short sentences and generally communicate just one idea at a time.  In each case they begin counseling and educating the patient from the minute they greet the patient and continue counseling and educating throughout the exam.  There is no obvious division between the examination part of the visit and the summary and treatment plan. Questions are answered with very simple, non-technical information.  And by using this continuous counseling and education techniques the low vision professional begins forming the treatment plan early in the office visit.

Most new low vision practitioners spend lots time reading about low vision exam techniques as well as the hundreds of specialty low vision aids but completely overlook fine-tuning their communications skill.  Develop your own style of communicating low vision information to your patients.  Don’t hesitate to “practice your lines” until you have a natural, effective and comfortable message that you can incorporate in your examination protocol.  I found spending a little extra time working on better communications skills paid off in streamlined patient encounters, increased clinical success and added overall enjoyment of low vision care.