Donald C. Fletcher, M.D., is one of the world’s leading authorities on low vision rehabilitation.
Dr. Fletcher is a clinician and researcher in the field of retinal diseases and low vision rehabilitation. He is a medical doctor and an ophthalmologist who has completed fellowship training in both retinal diseases and low vision rehabilitation. After completing surgical training, he gave up surgery to devote his practice to patients who could not have their vision restored by any medical means.
He is affiliated with, and routinely sees patients at, California Pacific Medical Center, Department of Ophthalmology in San Francisco; Envision in Wichita, Kansas, where he is Medical Director; the University of Kansas Medical Center, Department of Ophthalmology in Kansas City; and Retina Consultants of Southwest Florida in Fort Myers, where he is Director of the Low Vision Rehabilitation Center.
Dr. Fletcher is also affiliated with the Smith-Kettlewell Eye Research Institute in San Francisco, where his research interests include macular function in low vision patients; outcomes of occupational therapy training of low vision patients; and psychology in low vision rehabilitation.
He has provided low vision rehabilitation care for over 25,000 patients in the last 28 years. He also is actively involved in research and education in low vision rehabilitation. He has extensive publications in the field and has brought several low vision products to the market.
Dr. Fletcher earned his M.D. degree in 1982 from the University of Alberta, Canada, and completed Fellowship training at Presbyterian Medical Center in Denver, Colorado and Pacific Medical Center in San Francisco, California.
He is the Past Chairman of the American Academy of Ophthalmology Low Vision Committee. He is the recipient of its 2013 Secretariat Award for volunteer service in helping others learn techniques to live with low vision and has also received its Honor and Senior Achievement Awards for outstanding contributions to ophthalmology. He is the recipient of the Meritorious Achievement Award from the Association for Education and Rehabilitation of the Blind and Visually Impaired for Outstanding Lifetime Contributions to Low Vision.
Dr. Fletcher has a special interest in the provision of low vision care in underserved areas and has helped establish low vision clinics in various US locations, Canada, China, the Philippines, Chile, Brazil, and Zimbabwe.
Maureen Duffy: Hello Dr. Fletcher. It’s an honor to speak with you about your life and work in low vision rehabilitation. To begin, can you tell us what first drew you to the field of ophthalmology? And when did you become interested in the study and practice of low vision?
Dr. Donald Fletcher: While training in management of retinal diseases, I became frustrated by how many patients I could not help. I got tired of hearing myself say, “I’m sorry that is all we can do for you.” So out of that frustration, I signed up for another fellowship in low vision rehabilitation. I fell in love with the discipline of low vision rehabilitation; that was in 1986 and I have done it full time since then. I am still having a lot of fun – I look forward to every day’s work.
MD: Many of our readers tell us they had never heard of low vision rehabilitation services before visiting our website – and in fact, a student research group from the New England College of Optometry just completed a study in which they identified a number of barriers to low vision treatment. Can you explain to our readers what low vision rehabilitation services are (or should be) and what they can expect during an initial appointment with a low vision practitioner?
DF: It really is no different from other forms of medical rehabilitation. When a patient is left with some type of impairment, it interferes with life’s activities, decreases safety, and lowers the quality of life. Whether you have a broken back or low vision, rehabilitation aims to find ways to enhance residual capacity, make adaptations, and keep us doing the things we want to.
The specifics of low vision rehabilitation include an initial evaluation by an eye doctor where the type of impairment and rehabilitation potential are assessed. The doctor’s assessment is followed by a period of training by rehabilitation professionals who teach the patient how to use remaining vision and utilize vision enhancement equipment such as magnifiers.
It is not a simple process and when comprehensive rehabilitation is undertaken it is infinitely more effective than ordering a magnifier from a catalogue. To undertake low vision rehabilitation on one’s own is as silly as an amputee ordering an artificial limb from Amazon.com and strapping it on themselves!
For those with moderate or severe low vision, it usually requires several hours of training and weeks of practice to master adaptive skills. As well, vision can change and it is often necessary to revisit the process and repeat again. I recommend a yearly follow-up with your low vision doctor to ensure that optimal equipment and performance is being accomplished.
MD: Another important – but frequently overlooked – component of low vision rehabilitation services is emotional support for the person with low vision and his or her family members. Recent research by Dr. Barry Rovner and colleagues supports the concept that integrated low vision and mental health treatment – bridging ophthalmology, optometry, psychiatry, psychology, and rehabilitation – can reduce or prevent depression. I am aware you also believe that “the emotional status of the low vision patient is the major factor affecting rehabilitation outcomes.” Can you tell us more about ways we can better combine emotional support and low vision rehabilitation?
DF: It is widely appreciated that vision loss leaves us human beings discouraged and often in a very profound way. Dr. Barry Rovner in Philadelphia has recently reported some fascinating research in addressing this problem. His research has shown that low vision patients experience less depression when they are involved in a structured program of behavioral activation therapy. The more active and involved the patient is, the less likely they are to become depressed. It makes a lot of sense to me and this is the whole point behind low vision rehabilitation. We want to keep people participating in life – as George Burns said approaching 100, “As long as you are alive, you might as well keep living.”
MD: You are also one of the original founders of the Low Vision Rehabilitation Study Group, which meets annually in San Francisco. Can you tell us more about it? What topics will you be discussing this year?
DF: This is simply a gathering of us low vision rehabilitation professionals who get together to discuss tough problem cases and share any new ideas that we have come up with in the last year. Every year we meet the beginning of February in California to escape winter in other locations. There is no registration fee and I have yet to have any participants tell me that they did not get their money’s worth!
MD: Can you tell us about your current research interests?
DF: Some of my current interests include how to train patients to make compensatory eye movements to overcome central visual field defects. We are looking at how macular degeneration can make hand/eye coordination difficult. We are also looking at new inexpensive reading charts that help to quickly isolate central visual field defects on reading performance. We are always interested in how the latest off-the-shelf technologies can be applied to low vision patients, too.
MD: What do you regard as the next great frontier in low vision rehabilitation practice?
DF: Looking into my crystal ball here … it is a little foggy … but I think when we start to implant stem cells into the retina it is going to be quite a rehabilitation challenge to teach patients how to use these newly connected cells. Vision is so much more than eyeballs – teaching the brain how to interpret these visual precepts should be no easy task. Personally, I don’t see any of us in this field going out of business soon!
We thank Dr. Donald Fletcher for his support of VisionAware and for his longstanding research and practice on behalf of blind and visually persons worldwide. It has been a privilege to speak with you.