"They told me nothing could be done, but then I had vision rehabilitation. What a difference!!"

Comments like this one are common when older adults experience vision rehabilitation. In the United States, visual impairment in older adults is generally the result of eye diseases that is due to the aging process. This is in contrast to normal vision changes related with aging and in younger individuals, which can be corrected with glasses and/or contact lenses. Standard glasses and contact lenses cannot correct the visual impairment that results from ocular diseases such as macular degeneration and glaucoma. I am asked daily if I can provide glasses to my patients with these diseases to "let me see the way I used to." Vision is the primary sensory modality of human beings. The neurological pathways for vision occupy a much greater portion of the human brain that do any of the other 4 senses.1 Visual impairment affects the ability to perform activities of daily living, orientation and mobility, and psychological well-being.2-4

In 2002, Massof reported that approximately 3% of Caucasians 65 and older and 5% of African American 65 and older were visually impaired.5 The Society for the Prevention of Blindness has determined that less than 10% of these people are totally blind and 80% of them have usable vision that could potentially benefit from vision rehabilitation.6 The portion of America's Population that is older than 85 is the most rapidly increasing segment. It is estimated that by 2040, 12 million people in the United States will be older than 85.7 There is going to be an increasing need for vision rehabilitation over the next few decades!! Furthermore, the United States needs to develop a system by which this form of rehabilitation can be provided to older adults.

Over the last few years, significant changes have occurred in Medicare funding for vision rehabilitation services. On January 1, 2000, Medicare policy took effect that provided for occupational and physical therapists to provide vision rehabilitation services such as training with optical devices to improve vision, training for driver rehabilitation when possible, and training for balance and independent mobility.8 However, gaps remain in Medicare's funding of vision rehabilitation services for older adults. Medicare does not provide funding for optical devices to help older adults maximize remaining vision. Professionals trained specifically to work with patients with visual impairment do not receive Medicare reimbursement for their services (low vision therapists blind, rehabilitation teachers, orientation and mobility specialists). Congressional legislation passed in December 2003 mandates a report from CMS in January 2005 that develops a nationwide reimbursement policy for vision rehabilitation, including the services provided by these professionals. However, vision rehabilitation has yet to become a part of the medical rehabilitation model in the United States. Pleas to change this policy have been made for more than 2 decades!!

This issue of Topics in Geriatric Rehabilitation is devoted to vision rehabilitation. With the aging of America and older adults being the predominant population in the United States being affected by vision loss, it is imperative that rehabilitation professionals know about the services that can be provided to help people with diminished vision. Vision rehabilitation is a custom-made process. Each person who comes to vision rehabilitation has different objectives and goals, just like rehabilitation medicine. The multidisciplinary team of professionals that works with an older adult with visual impairement provides a holistic approach to helping that person meet his or her goals or modify them to enable attainment of function.

The authors of the articles in this issue represent a broad spectrum of the different areas of vision rehabilitation. The history and evolution of vision rehabilitation is presented followed by articles on occupational therapy services, neuropsychology services, driver rehabilitation services, prevalence of visual impairment in the US older adult population and effect of vision loss on mental health, psychiatric services, optical services, and a controlled outcome evaluation of vision rehabilitation in a geriatric facility for independent living training following visual impairment.

My goal as the issue editor is to provide rehabilitation professionals and consumers with a knowledge base from which to draw when older adults with visual impairment meet the challenge of adapting to the change that vision loss imbues. "They said that nothing could be done," but as this issue reports, it can!!

As the issue editor, I express my appreciation for the life of Chuck Henderson, late husband of Susan Henderson, for his help in providing the photographs in her article. They will stand as a memorial to him!!

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