About the Author:
Dr Deepa Kerketta Khurana is the Hon. Secretary of the IAPC.
She is also an Associate Professor at the Department of Anaesthesia and Intensive Care at the VMMC and Safdarjung Hospital, New Delhi.
World Sight Day is an International Day of Awareness, held annually on the second Thursday of October. This year’s theme is ‘Love your eyes’. In light of this, I would like to highlight the role and intersection of palliative care and blindness and vision impairment.
Visual impairment is a condition when a person has sight loss that cannot be fully corrected using glasses or contact lenses. Certain life-limiting or chronic conditions can lead to blindness or vision impairment. The reasons for blindness can be traumatic injuries, infections of the cornea or retina, uncorrected refractory errors, retinal detachment, age-related macular degeneration, cataract, glaucoma or diabetic retinopathy.
Malignancies like Breast, lung, colorectal, prostate, uterus, cervix, skin, thyroid, kidney, leukaemia, multiple myeloma, and sarcoma were associated with ocular metastasis 1-2. Visual disturbances in advanced cancer patients are very rarely, evaluated, or for that matter even adequately treated.
Tips to prevent vision loss:3
- A comprehensive dilated eye examination
- Well-controlled sugar levels
- Maintain blood Pressure
- Maintain cholesterol levels
- Eat healthily
- Maintain weight
- Wear protective eyewear when doing risky jobs
- Quit smoking
- Take proper precautions when wearing contact lenses
- Early warning signs are to be seen in cancer patients by an ophthalmologist
Vision impairment is associated with reduced Quality of Life (QoL), mental and health issues, and difficulty in coping with the new circumstances for the patient. In those patients who have completely lost vision, the physicians should start thinking about palliative care.
Palliative care has a role from the time of diagnosis of blindness or vision impairment all the way until probably helping such individual’s and their families, cope with the situation.
Physicians have a role, for example, in patients with glaucoma. The physician in this scenario, should think about keeping intraocular pressures low and managing pain. This can be managed by the application of topical atropine, NSAIDS, and steroids to consider enucleation if acceptable to the patient. All these options can be presented to the patient and their families. In those situations where there is a complete loss of vision, removing the diseased eye can drastically reduce pain and improve the patient’s quality of life.
Patients need to be counselled and supported to believe that life does not end with this situation and that, it’s just a different phase in their lives. They can also be offered psychotherapy and vocational training.
These patients’ can also be engaged in hobbies that do not require vision, like music therapy.
It might be difficult to learn Braille for those patients nearing the golden years of their lives. For such patients, other methods like recorded audiobooks can help those patients who enjoy reading. Advanced techniques like textured organisational tools and adaptive equipment can be also designed for patients with vision loss.
The authors from a systematic study, highlighted the lack of data on the effectiveness of rehabilitation in low-middle income countries, which is a grave concern, as visual rehabilitation services are scarce and that the concerned population suffers from a severe lack of skilled workers and funding4. They further suggested that the service providers for people who are visually impaired should be trained in recognising depression and anxiety, and have access to pathways for referral to mental health services, as appropriate.
There is a further dearth of studies comparing the role of palliative care in blindness or diminished vision patients. We urge institutes to include patients with blindness and vision loss in their institutional palliative care programmes, while designing and implementing the same.
- Mewis L, Young SE. Breast carcinoma metastatic to the choroid: analysis of G7 patients. Ophthalmology. 1982 Feb 1;89(2):147-51.
- Eliassi-Rad B, Albert DM, Green WR. Frequency of ocular metastases in patients dying of cancer in eye bank populations. British Journal of Ophthalmology. 1996 Feb 1;80(2):125-8.
- Wallace S, Alao R, Kuper H, Jackson ML. Multidisciplinary visual rehabilitation in low-and middle-income countries: a systematic review. Disability and rehabilitation. 2022 Apr 10;44(8):1164-75.