WRITER Dee Makadia

In optometry, supporting vision means looking beyond the prescription. As our population ages and conditions such as age-related macular degeneration (AMD) become more prevalent, many patients are doing everything medically recommended, yet still drifting away from the activities that give their lives meaning.

The real challenge isn’t always clinical – it’s functional, emotional, and behavioural. Through conversations in residential care settings, a clear pattern is emerging: when optical support, compassionate coaching, and physical vitality are addressed together, patient outcomes shift. In this article Dee Makadia explores practical, clinic-ready ways to help patients with low vision maintain independence, confidence, and connection.

Recently I visited a local residential care home to talk about eye health – simple, practical ways to keep vision optimal and circulation moving. But before I started, I spent time simply listening.

Many of the residents were already seeing ophthalmologists and receiving injections for macular disease. In fact, an Australian study of residential aged care facility residents found “more than 70% to have some form of eye disease”.1

The residents I spoke to went on to explain they’d done everything right medically, yet most had quietly given up on the things that once brought them joy. Each resident had a magnifier, some old, or cheap, while others were more expensive. Unfortunately, only a handful admitted they could use them comfortably. “It’s just too hard now,” Margaret Peterson* said, switching off the dim light on her magnifier and setting it aside.

That moment hit me: when vision loss isn’t supported holistically, people lose more than clarity, they lose their identity and their connection to the outside world. Studies show that loss of mentally stimulating hobbies, like reading or puzzles, can increase the risk of cognitive decline and dementia.2 Supporting our patients isn’t only about enabling them to see better, it’s about offering a more holistic approach to improve the quality of their later years.

AN AGEING POPULATION

Eyes go through phases like the seasons. I call it the ‘eye cycle’. Spring is the time of ocular development, which we’ll class as 0 to 21 years old. Next is summer from roughly 22 to 42; a time where environmental and external stressors play a large role with eye health. Autumn follows from 43 to 65 years old. This is where presbyopia arrives and we notice a steady decline in our reading ability – but also systemic health issues, such as diabetic retinopathy, may start presenting in the eye. From 66 to 100 is winter. This is where conditions like dry eyes, cataracts, AMD, and glaucoma are highly prevalent.

It’s imperative to have early conversations with our patients about lifestyle and habits. For example, most of us older optometrists have seen a 65-year-old patient who has smoked cigarettes since they were 17 years old and now have some sort of eye or body ailment. What we do in the spring and summer of our eye cycle, affects the vitality of our eyes in autumn and winter.

Australia’s population is ageing,3 meaning older adults now represent a much larger share of the population than in the past, and this cohort of seniors hasn’t always had the opportunity to look after their overall health during their spring and summer.

More people are moving into independent and residential living each year,4 more are presenting with eye diseases and that brings new challenges for eye care. Not every facility is accessible. Not every resident can get to a clinic. And for many, even when they do, the follow-up support can fall short.

So, how do we adapt? I see three essential areas:

1. Optical and visual aids that genuinely work,

2. Compassionate coaching and communication, and

3. Understanding the physical connection between body health and eye health.

These three aren’t separate – they overlap. Each one supports the others, helping older adults maintain independence, confidence, and a sense of purpose.

VISUAL AIDS THAT TRULY EMPOWER

When I asked residents about their magnifiers, frustration was the common thread. Some had small, inexpensive lenses that distorted text. Others had high-end digital devices that were too complicated or too dim. The result was the same: disappointment.

Older lens designs, such as those introduced over 15 years ago, often rely on plastic lenses with high aberration and single LED lights. Many are too heavy or awkward for tremor-affected hands. And while digital magnifiers exist, the technology gap can be intimidating. One gentleman told me, “I just don’t understand it – there are too many buttons, and it’s not always got charge when I need it to work.”

What’s clear is that modern magnifiers should focus on simplicity, brightness, and contrast. Devices with higher-lumen LEDs and easily adjustable colour temperature, can dramatically improve comfort and clarity. It’s also worth noting that blue light emitted from LEDs, while useful in moderation, has been linked to increased oxidative stress in retinal tissues, which may contribute to the progression of macular degeneration4 – this is being researched further. In addition, close proximity and long-term exposure to harsh LED lighting have been associated with ocular surface issues like pterygium, as highlighted by an ophthalmologist in a phone-repairer case study in Australia.5

Providing residents with the best suited magnifier is often the turning point. When vision aids become supportive rather than challenging, independence increases – but how else might we empower patients? Is a visual aid enough?

COMPASSIONATE COACHING: SEEING THROUGH THEIR LENS

In optometry, compassion isn’t an optional skill – it’s one of the most valuable lessons I learned from my mentors.

So, what’s the difference between empathy and compassion? Empathy allows us to understand a patient’s fear of losing independence. Compassion, however, goes one step further – it’s the commitment to never saying ‘nothing can be done’, and instead proactively guiding the patient toward a meaningful outcome.

Many of the residents I spoke with were initially focused on finding new products. But as the conversations continued, it became

clear there were also opportunities to support their lifestyle habits and daily routines.

How did I discover this? I simply asked. Compassionate coaching starts with curiosity:

• What daily tasks feel most challenging? (Start broad to build rapport, then refine your questions.)

• What’s stopped you from using your magnifier or continuing your hobbies?

• What brings you joy?

• What does your current diet and exercise routine look like?

By framing questions this way, you open the door to genuine emotional connection – and that changes everything. In one clinic I worked with, we introduced a simple ‘three discovery question’ rule. Team members asked open questions, so patients felt truly listened to, but the real impact came from the quality of the listening and the response. Each team member would acknowledge what the patient shared and then follow up with a thoughtful question that gently elevated the conversation. This approach led to higher patient satisfaction scores and overall team culture improved. Patients felt heard, and team members felt more supported and confident in their interactions.

Compassion also extends to a patients’ support network. Encouraging caregivers, offering them reassurance, giving guidance, and inspiring confidence to not give up, plays a vital role in how successfully the patient progresses.

When families are invited to share observations, celebrate small wins, and understand how lighting, movement, and daily routines influence visual outcomes, it helps maintain meaningful consistency between home and clinic.

THE PHYSICAL SIDE OF VISION: MOVEMENT, METABOLISM, AND THE EYES

During a recent discussion with an ophthalmologist, we found ourselves circling back to one major theme: longevity begins with physiology. Blood pressure, glucose levels, and thyroid function all influence ocular health – and they’re all affected by movement, something that’s often overlooked in daily conversation.

As the body slows down, circulation to the retina decreases,6 meaning less oxygen and fewer nutrients reach the retina. In macular disease, this matters. Encouraging gentle movement isn’t just good for general wellbeing; it supports eye health too.

Even small, achievable exercises make a difference, such as:

• Foot pumps while seated to support calf circulation,

• Gentle ankle rotations and light axillary massage to assist lymphatic movement, and

• Deep diaphragmatic breathing between TV segments to support oxygen exchange and circulation.

I often demonstrate these in workshops – and the surprised response is always the same: “You mean something this simple can help my eyes?” The answer is yes.

CONNECTING SIGHT, MIND, AND BODY IN INDEPENDENT LIVING

Good long-term vision relies on three pillars: aids, mental support, and physical vitality. Ignore one, and the outcome changes.

If you ever went to a residential care home 30 years ago, most residents would watch TV all day, sitting in the same chair. Research has since shown that television viewing time was associated with increased risk of cardiovascular mortality.7 Fortunately now, programs with varying levels of activity have been included in care facilities to encourage movement and interaction, protecting both mental and ocular health.

As clinicians, we can’t change every variable, but we can start the conversation. A few encouraging words, offering magnifier solutions with improved lighting, and discussions around the benefits of gentle activity can re-ignite hope. When patients feel empowered to act, they do.

*Patient names changed for anonymity.

Dee Makadia is an optometrist and founder of Eyehouse.com.au and the SeeBigger magnifier range. With two decades of clinical experience and extensive work with senior adults, he regularly delivers education sessions within residential care settings across Australia. He has a particular interest in practical low vision solutions that support independence and quality of life.

References available at mivision.com.au.