Vision and Independence

Vision and Independence

What's the relation?

Every single person who was born with functional eye sight has built their daily patterns around what that particular sense affords them. Without being too verbose, we can clearly acknowledge all the ways that vision helps us on a day to day basis. From driving to video chatting with our far away friends or family, our eyes play an integral part in how we enjoy our time on earth. 

Medicine is advancing and the life expectancy of the average American is rising year by year. People have more access to healthcare and cutting edge treatments than ever before. Unfortunately, some areas of medicine are lagging behind. Not due to lack of effort, but more from the complexity of the task involved in treating a particular condition. Macular degeneration is one of those areas.

What is the scenario?

Macular degeneration comes in two forms: wet and dry. We will be talking about the dry form in this article. Dry AMD (age-related macular degeneration) is usually a slow progressing disease. It's characterized by progressive symptoms of blur, darkening of central vision, and distortion of images or straight lines. Because the disease is so slow to progress, many people find minimal issues with continually adapting their lifestyle to the new challenges presented by the slow progression. Most patients just buy a stronger magnifying glass or make other accommodations once or twice a year depending on severity of the change. The problem comes when those small accommodations add up without being realized.

The part of vision affected by AMD is the central vision. Naturally, this is also the portion that we rely on for driving. This single thing is the hardest portion of aging that many people have to come to terms with. In the last 50-60 years, American independence has reached an all time high. More families are able to afford a vehicle for every person in the household instead of just a single family vehicle. This allows for men and women to truly be in control of every facet of their lives. Going shop when and where you want, not relying on rides for transportation or the limited availability of public transportation, all these allow people to be independent in the highest regard. When aging changes set in, that freedom becomes threatened, and that's a very hard pill to swallow. 

As a patient...

If you have been given a diagnosis of AMD, don't start to panic and think that you're going blind in 3 months. You likely still have many years left of functional vision. The only warning to consider is that on the road, it's not just you, and a single visual error can change peoples entire destiny. A patient at our clinic lost his mom and his dad in the same car crash due to an impaired driver. All 3 are patients here so it hit our staff and doctors pretty close to home. With impaired central vision, depth perception is also affected. So there is increased chances that you'll misjudge your proximity to another item and bump it or miss a turn and let your car drift into another lane or off the road. 

This article is not intended to fear monger, but rather give a patient a rooted understanding that there are some changes to expect with this disease, and to make sure that you prepare yourself mentally for the time that may come when you need to lay the keys down. It's an incredible challenge to give up 70-80 years of independence when the rest of your mind and body is so well preserved and your vision deteriorates to a crippling status. It's an emotional challenge we face in our clinic every day to deliver the news that a patient has reached a point of vision loss that would classify them as a danger on the road way. 

As a family...

It's important to understand that the patient is going through some major changes in this time. Giving up independence affects more than just daily activities. It's also a sign of mortality and many people have a hard time coming to grips with the status in life they're entering, the senior years. A positive community response surrounding the patient is very important in making this transition bearable. Patients who have surrounded themselves with willing children, grandchildren, siblings, etc...are able to cope with this change much better than "loners" who have no one to depend on but themselves. Obviously we can recognize that the people with no safety net will choose dangerous actions that suit their needs as opposed to becoming a burden to non-intimate familial relations. This is the challenge. 

Generally speaking, an eye doctor will not "take" a license away from someone. Sure, we can make recommendations, but usually the decision to give up the keys must come from either the family or patient themselves. As a rule of thumb, the only time an eye doctor will affect the driving or independence of a patient is when the DMV contacts the eye doctor for a professional opinion on the patient's ability to safely pilot a vehicle. All we do at that moment is provide visual acuity results from the most recent exam. If the acuities fall within legal range for the state of residence, then there's no issue renewing the license. However, if the acuities fall outside of the legal range, then the DMV will block license renewal and the patient will then be forced to make other accommodations. In some cases, the DMV will impose unique restrictions on licenses such as only driving during day light hours, only driving within a certain distance from home, or maybe even a maximum of a certain speed. 

I say all that to say this: if you're worried that your loved one is making a bad choice by continuing to drive after the eye exams reveal they should not be, a good conversation is the best route to take. As with anything, a posture of understanding and support will go a long way. Let them know that you are on their side and that you'll do whatever you can to make them feel non-burdensome during this transition. After a few months, things will smooth over. And now, more than ever, the introduction of services like Uber and Lyft make it much easier to get around. Giving a loved one a phone with an Uber account will help them see that they still have independence and don't have to trouble a family member when they can just call a cab. Of course, not every patient will respond well to this, especially if their vision has already failed to the point where they can't use a phone or see the screen anymore. But if that's the case, the question of driving should not even exist. 

Every now and then, a family will have to make a power play and literally take the keys from someone. This is few and far between in our experience. Generally, a person will response, albeit reluctantly, to the genuine concerns expressed by close family. 


Our independence is deeply integrated into our being. When every other part of us is saying we're still able to be on our own, but our vision is saying otherwise, it's a major change to come to grips with. But it's not impossible to make safe decisions as well as maintain an active lifestyle as a result of AMD. Using the tools and resources available to 21st century citizens, a person can get around and enjoy daily living without compromising much of their freedoms they've come to appreciate throughout life.

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