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Statement on the Role of Optometry in Low Vision

DOCTORS OF OPTOMETRY ARE INDEPENDENT PRIMARY HEALTH CARE PROVIDERS WHO EXAMINE, DIAGNOSE, TREAT AND MANAGE DISEASES AND DISORDERS OF THE VISUAL SYSTEM, THE EYE AND ASSOCIATED STRUCTURES, AS WELL AS DIAGNOSE RELATED SYSTEMIC CONDITIONS.

The American Optometric Association supports the interdisciplinary approach to rehabilitation of patients with low vision (legally blind and/or visually impaired). As part of the blind rehabilitation network, the optometrist plays an integral role through diagnosis and management of the low vision patient and prescription of optical, non-optical and electronic devices to provide this population with optimal use of remaining vision. Optometrists who provide comprehensive low vision care establish clinical treatment plans including, but not limited to, prescription, training, education and interdisciplinary consultation.

American Optometric Association

There are, conservatively, 4 million Americans with significant vision impairment, with some estimates that the number may be as high as 10 million. The National Center for Health Statistics estimates that the number will double within the next decade.

This population of pediatric, career/vocational, elderly and multi-handicapped individuals seeks goal-directed activities of daily living and maximum levels of independence.

Reliable estimates indicate that less than 25 percent of the visually impaired have received comprehensive low vision rehabilitation.

The AOA is committed to working with associated professional and comsumer organizations to improve access to high caliber, comprehensive low vision services and blind rehabilitation programs by increasing public awareness and by contributing to the development of progressive public policies through advocacy.

Optometry participates as an integral part of the blind rehabilitation network through the provision of comprehensive clinical evaluation and management of the low vision patient.

This includes prescription of optical, nonoptical and electronic devices that help these individuals maximize the use of residual vision, and administration of associated training techniques and strategies.

Optometrists interact with colleagues in medicine, blind rehabilitation, social work, psychology, education and physical/occupational therapy to coordinate treatment plans to meet the immediate needs of low vision patients and their changing needs over time.

The AOA encourages and supports development of technology related to adaptive diagnostic procedures, evaluation equipment and design of state-of-the-art low vision devices.

The AOA Low Vision Section provides a forum through which members and interdisciplinary colleagues who serve the visually-impaired may expand knowledge and exchange ideas.

What is Legal Blindness?

Legally blind people have a visual impairment of a certain magnitude based on their acuity (sharpness of vision) and/or their visual fields (a measurement of their side or peripheral vision). The definition states that in order to be legally blind, the person must have acuity equal to or worse that 20/200 in the better eye with their best conventional optical correction (i.e., eyeglasses or contact lenses) in place, and/or the person has a visual field of 20 degrees or smaller without the use of any special field increasing devices.

What is a Low Vision Examination?

I feel that it is important for you to understand what a low vision examination is and how it differs from the more usual eye examinations you may be familiar with.

A low vision examination is a special type of vision examination. Uniquely designed charts and particular diagnostic techniques are used during the evaluation in order to determine what type of device may enhance your vision. Specialized optical systems such as stronger than usual spectacles or contact lenses, hand and stand magnifiers, and various types of telescopic corrections are utilized to assess your maximum visual abilities. Recommendations for appropriate non-optical devices may also be made. These optical and non-optical corrections are tailored to your specific eye problem, current usable vision and your particular needs. The goal of the evaluation is not only to find the most appropriate devices to help improve your ability to function visually but to make certain you are comfortable using the prescribed devices.

A low vision evaluation will not restore any vision that you have lost up to this point, nor will it prevent any further deterioration. The low vision evaluation will help you function better by enhancing your remaining vision.

A low vision examination may include corrections for distance and near vision, contrast enhancement, glare reduction and recommendations for non-optical devices. These corrections and recommendations may help you with your vocational, avocational (i.e., hobbies) and daily living skill needs.

Fully-sighted people can use their vision to see objects at many different distances. They can also see objects of varying sizes. They are either able to do this with their own eyes or with the assistance of conventional glasses or contact lenses.

Low vision patients require the assistance of specialized low vision devices to maximize their vision. Often, visually impaired patients must use different powers and types of devices for specific tasks.

It is not uncommon for low vision people to require multiple devices for different tasks and needs under various conditions of use. Distinct devices may be needed for such optical tasks such as reading, writing, sewing, and watching television.

I would be more than happy to answer any specific questions you may have about the potential benefits of a low vision evaluation.

General Follow-up Eye Appointments

Low vision devices help you function with your current vision. These devices do not restore lost vision or prevent further possible deterioration.

In order to maintain the health of your eyes, you must be sure to keep all of your recommended eye care appointments. Under no circumstances should you discontinue the use of any of your medications unless you are specifically instructed to do so by your medical doctor.

What Is Magnification and How Does It Work?

Simple magnification enables the retina or back of the eye to see objects that are either too small or too far away. In the case of low vision patients, enlarging an object may make it easier for the person to read or see the details he or she must be able to see. Magnification is most useful when the macula (area of the retina giving us the ability to see details) is not functioning well. Magnification can also be helpful when other portions of the eye are affected.

One can magnify materials using various optical devices such as: spectacles, hand or stand magnifiers, telescopes or even closed circuit television sets. Not all devices are useful or appropriate for everyone. A low vision evaluation will determine the most appropriate power and type of device required to maximize visual function.

Glare Complaints

A common difficulty many people with low vision experience is an increased sensitivity to both indoor and outdoor glare. Simply defined, glare is useless stray bright light. Glare can make some people feel uncomfortable, for others, glare can impair or reduce their vision. If you are having a problem with glare, please return for a glare evaluation to determine which tint, absorptive lens, or non-optical accessory may reduce your symptoms.

Near Spectacles or Microscopes

The prescription of low vision devices is very task specific. Low vision near spectacles or microscopes enhance your ability to see near tasks by magnifying the material for you. They have the advantage of leaving your hands free, enabling you to work with or hold the object you wish to see rather than requiring you to hold a stand or hand magnifier in your hand. You will find that because these lenses are stronger than most conventional lenses, you will have to hold the materials you wish to see closer than you would with ordinary glasses.

Your new near spectacles or microscopes were prescribed in order to help you read and enjoy close-range hobbies.

It is not uncommon for you to find that your vision may not be adequate if you use this prescribed device for any task other than the task it was prescribed for. If your vision is not adequate for other tasks, please contact me. You may need additional devices to successfully accomplish your other desired tasks.

The Importance of Anti-Glare Coatings

Glare or stray light can make one feel uncomfortable or can, in some cases, interfere with vision. A special anti-glare coating can reduce the amount of stray light entering the eye, yet increase the amount of more useful light. This coating can provide more comfort and in some cases, better visual function. It may even be appropriate to combine an anti-glare coating as well as a tint. It is for these reasons, I have prescribed an anti-glare coating for you.

Special lens care is required to clean your anti-glare coating. To obtain optimum lens performance, please use cleaning solutions specifically approved for your lenses.

Telescopes

A telescope is a device that can be used to enlarge objects at a distance. There are many types of telescopes. There are hand held telescopes that vary in size. Some are even small enough to be worn as rings. Other telescopes are worn suspended around the neck for easier accessibility. Telescopes can be clipped on over your glasses or permanently attached to your glasses.

The selection of the proper telescope for you depends on the vision you currently have, the condition of your eyes and the task you will be using your telescope for.

Closed Circuit Television

Basically, there are two components of closed circuit television. Materials you wish to view are projected onto a television screen by the use of a specially designed camera.

A closed circuit television has many advantages. It allows materials to be magnified very easily and in some instances, the magnification is greater than the magnification possible by optical devices alone. A closed circuit television can also improve the contrast of materials you desire to work with. There are many other abilities that a closed circuit television may have, depending on the particular features of the set.

Should you wish additional information, I would be more than happy to answer any questions.

Large Print Materials

As part of your low vision evaluation, it was determined that you are able to read large print materials with your optical correction.

Many publishers are printing books and magazines in large print format. This material can be obtained by joining certain book clubs or by purchasing subscriptions for large print.

Printing types and styles vary from company to company. If you have not already seen a particular company's large print books, I strongly suggest that you either request a sample edition or sample page before you purchase from a particular company.

Medications

If you are having difficulty seeing the names of your medications or the instructions of their use on the medication label, for your safety and health, ask your pharmacist to either capitalize your instructions and use the darkest ink available or to write your instructions in large print for you on the label. Be sure to use the optimum low vision device as well.

If you pharmacist has any questions about this request, please have him/her call me personally.

Nutrition

There are many theories concerning the role of nutrition in vision. We feel that a nutritious, well-balanced diet is a good place to start. If you wish to take vitamins, we often recommend a general multi-vitamin mineral supplement in a food form.

I would be more than happy to discuss this with you in more depth.

Disease Progression

Many of our low vision patients are afraid to ask whether the disease process they have will cause total blindness. In your particular case, we expect that your vision will stabilize at some point. While your vision will fluctuate, sometimes for the better and sometimes for the worse, if there are no other disease processes or trauma to your eyes, we do not expect that you will go totally blind.

It is important that you follow all of the instructions given to you regarding your eye care. At the first sign that you feel your vision is changing, please call for an immediate priority appointment. Make sure the receptionist is informed about the fact that you feel your vision is deteriorating. While there may not be any treatment to prevent further deterioration, sometimes there are treatments available to prevent further loss. Never make this decision on you own.

You and your eye care professional are partners in your eye care!

Enlarged Phone Dial

As part of your low vision evaluation, it was determined that you could benefit from an enlarged rotary or push button dial for your telephone(s).

These are free of charge or available at low cost if you contact your local customer service representative or the national special needs center of the telephone company.

Many phone companies also produce enlarged number phones in designer colors and styles. You may wish to contact your local phone representative for details or visit the phone appliance area in many electronic or department stores.

Helpful Links

• www.eschenbach.com
• www.lighthouse.org