Chapter 4 - Vision Improvement Options
Vision Improvement Options
Help Is Available For Low Vision! The central vision loss caused by macular degeneration reduces or, at times, completely inhibits your ability to perform the everyday tasks you need to do. Fortunately, there are low vision doctors with extensive experience in prescribing low vision glasses and devices to help you function better.
What Is Low Vision?
Some professionals define low vision as “best-corrected vision (with conventional glasses or contact lenses), which is insufficient to do what you want to do, or enjoy the visual world around us”. More simply, low vision is a loss of eyesight that makes everyday tasks difficult or impossible.
Low Vision Care
Low Vision Care consists of a low vision evaluation and the prescribing of low vision glasses and devices to help you with your tasks, or the enjoyment of the visual world.
Low vision care is about doing. It’s about giving you the ability to do the things you are having difficulty with or just cannot see well enough to do. Many patients want help to continue with tasks like driving, reading, recognizing faces, watching television, writing checks, and enjoying recreational activities. Some want to return to their former occupation while others need help with the skills of daily living. Low vision care is about finding the right low vision glasses and devices to allow you to function and enjoy the visual world.
Low Vision Evaluation
The low vision evaluation isn't like any other eye examination you have ever had. It takes about one hour and is a vision exam, not a medical eye exam. Most low vision doctors conduct a low vision exam in four parts:
Conversation About Your Goals For The Eye Exam
Part one is a conversation about your goals for the exam. Unfortunately, as much as everyone wishes your vision could be completely restored, it is not possible at this time. Therefore, you and your low vision doctor must create a realistic “wish list” for the evaluation. You will benefit by being as specific as you can. For example, although many patients say they want to read the newspaper, most really want to read their mail, restaurant menus, and medicine bottles. All of those reading materials have different visual requirements, so having a goal of reading newsprint may not really be accurate.
Precision Vision Testing With Special Techniques
The second part is precision vision testing with special charts and special techniques to find what low vision doctors call your best retinal locus. That’s an area of undamaged retinal tissue that still has a usable vision. Then careful refraction is performed to determine if changing your regular eyeglass prescription will help.
Demonstrating Actual Low Vision Glasses And Devices
In part three, the doctor demonstrates actual low vision glasses and devices. You and the low vision doctor will determine the best form and level of help needed so you can perform the desired tasks. The telescope, microscope, prismatic and filter glasses with varying levels of magnification should be demonstrated so you can see the difference. Hand, stand and electronic magnifiers, as well as various levels of illumination and other forms of non-optical low vision devices, may also be demonstrated.
Eye Doctor's Recommendations For You
The last part will be the doctors’ recommendations on the best low vision glasses/devices for you. If you are satisfied with the recommendations, the doctor will order those aids and a dispensing appointment will be set up.
The Concept Of Task Specific
When determining recommendations, the low vision doctor must take into account your level of vision and the requirements of the task. For example, does the task require two hands? Increased illumination? A specific working distance? A specific amount of peripheral vision? Be as specific as possible when communicating your needs.
Types Of Low Vision Glasses And Devices
Low vision glasses and devices can be optical, electronic or non-optical and are described below.
Optical Low Vision Glasses & Devices
Low vision optical devices have one or more lenses that magnify the image making it easier to see. They can be over-the-counter or prescription based.
Magnifiers can be handheld, hanging or on a stand. They may have built-in lighting (illuminate magnifier). Hand and stand magnifiers are very useful for spot reading of prices, labels, thermostats, phone number, etc. They are not useful for continuous reading.
It is difficult to purchase a hand magnifier without knowing the level of magnification needed for your vision and task. The power markings on hand magnifiers are totally unreliable. Purchase your magnifiers from your low vision doctor after the evaluation.
Magnification combined with your eyeglass prescription in a pair of spectacles allow for hands-free continuous reading. They are quite useful for reading papers, books, magazines and the like.
Telescopes and Telescopic Glasses
Binoculars or monoculars can be handheld or spectacle mounted. Handheld monocular or binoculars are useful for short-term spotting of distant objects and can be used with very high power. They are not very useful when in motion, like riding in a car.
Spectacle-mounted telescopes (binoculars) can be prescribed for near, intermediate or distance tasks. They can be over-the-counter, or have your eyeglass prescription built into the system. “Full Diameter” systems take up most of the frame. “Bioptic” systems have the telescope at the top, with the rest of the prescription lens (the carrier) below. (see images).
Full diameter telescope systems are excellent for television, reading and recognizing faces. They are very adaptable for tasks requiring hands-free magnification at a specific distance. An example would be seeing music to play a piano.
Bioptic systems are excellent when it is necessary to have both a magnified image and a normal image available. They are the only low vision glasses that can help a driver see street signs, road signs and traffic signals. Most states allow bioptic driving. They are also excellent for theatergoers and spectator sporting events.
The Implantable Miniature Telescope is a tiny telescope surgically implanted in one eye. There are very specific patient requirements that must be met before this procedure can be undertaken. Talk to your low vision doctor about this possibility.
E-Scoop, Glare Control and Other Low Vision Glasses
E-Scoop glasses, invented in Holland in 2011, have 5 elements that result in improved central vision and contrast. Available in two proprietary tints, yellow and orange, these tints serve to increase contrast and reduce glare under varying conditions. You must observe the environment both indoors and outdoors and under varying levels of illumination to determine if they are right for you.
In addition, there are other tinted lenses that may help if E-Scoop is not for you. Your low vision doctor will help you determine the best tint for you.
Electronic Low Vision Devices
These devices, utilizing video cameras and video screens can be handheld, desktop or head borne. Some can incorporate your eyeglass prescription. They are useful when optical magnification is inadequate or inappropriate for the desired task.
Advantages of Electronic Magnification
Increased and variable magnification Increased contrast
Disadvantages of Electronic Magnification
Cost Requires battery or access to power Weight and cosmetics Mobility In general, use electronic magnification when the task requires high magnification and or high contrast. Use optical magnification for all other tasks.
Electronic Aids to Vision
As of this writing, there are a limited number of devices on the market for those with severe visual limitations that are utilizing auditory assistance fabricated within eyeglasses. OrCamis such a device. OrCam uses a video camera in an eyeglass frame to “see” and then “speak” the information to the wearer.
There are numerous “apps” for smartphones that offer magnification and reading ability for the visually impaired. An example is Seeing Ai, which can read product labels, read documents, and identify persons and currency.
Software Low Vision Devices
Several companies produce software for a computer for the visually impaired. Screen magnification, contrast enhancement and text to speech are some of the advantages.
Non-Optical Low Vision Devices
Devices that promote freedom and independence by altering the environment are called non-optical low vision devices. They include supplemental lighting, items in large print such as books, calculators and telephones, talking watches, needle threaders, felt tip pens, raised line paper, super jumbo playing cards, and bump dots on appliances.
Other Low Vision Professionals
Some O/T’s are trained in working with low vision patients. They may use therapy exercises to enhance the use of peripheral vision. They may also demonstrate, recommend and sell over-the-counter optical and non-optical devices. Your O/T will work with you to find your strongest point of vision (best retinal locus) and focusing on using that point to perform whatever tasks you desire.
They may also help alter your environment for safety, teach you to handle the skills of daily living, and offer other help like marking your oven with bump-dots at various temperature settings.
Orientation Mobility Specialist
O/M specialists teach visually impaired, totally blind or mobility impaired people how to move around in the environment. The OM specialist may recommend and teach the use of aids like white canes and guide dogs. The goal of working with an OM specialist is to increase independence and safety.
First, understand that every state in the United States has different visual requirements for obtaining a drivers license. The fact is there is no scientific study that demonstrates a specific amount of central and peripheral vision necessary for safe driving. There are simply too many factors at play, so the truth is, all DMV vision requirements are arbitrary.
Your low vision doctor should know your states vision requirements thoroughly. Some of the rules are difficult to find and may be confusing to the layperson. If you are motivated to continue or return to driving, and you believe you can be a safe driver, talk to your low vision doctor.
Handicapped driving instructors teach people with all sorts of handicaps to drive safely. They can adapt the vehicle with specific aids to allow a safer driving experience. In the case of low vision, the instructor will work with the patient on using peripheral vision, bioptic telescope glasses and careful techniques to adjust to the vision loss.
Vision Rehabilitation Specialist
Vision rehabilitation specialists (VRTs) help people who are blind or who have other vision impairments in living independently. This can include instructing clients in the use of optical and non-optical aids, such as text-to-speech readers and computer magnifiers, as well as teaching ways to maintain their hygiene, prepare meals, complete home repairs, and manage their finances.
Agencies For The Blind And Visually Impaired
Your State Department Of Rehabilitation
The DOR offers services that aid low vision or legally blind people adjust to everyday living. Through the DOR, special career training may be available. They may recommend businesses that offer employment opportunities to the legally blind. The DOR website features links to assistive technology, social security incentives, discrimination laws, healthcare information and many other resources.
Office Of The Aging
The State Office of the Aging is an agency that specializes in assisting seniors with low vision and gathers funds federally and through private donations. The agency connects patients with valuable resources ranging from health insurance counseling to information on elder abuse. The Office of the Aging is committed to serving the public.
American Foundation For The Blind
The AFB is a national non-profit started in 1921. Helen Keller, the famed deaf and blind political activist and author, partnered with the foundation for over 40 years. Keller strived to improve the lives of those struggling to adjust to blindness. The foundation holds the same values and seeks to provide equal opportunities to the blind.
The Braille Institute
The Institute is a private, non-profit organization that offers classes in the skills of daily living. They have technicians that demonstrate hand and stand magnifiers and electronic devices but do not have a low vision doctor to determine the exact magnification needs of the patient. They also offer services according to age including child, young adult, adult and senior services. The institute offers a library of free books in audio, large print and Braille.
Low Vision Ancillary Services
Many eye doctors advertise low vision services. However, caring for a patient with low vision takes extensive training. Low vision doctors must have the knowledge, understanding, compassion and experience to deal with:
- Vision loss psychology
- Low vision optical and non-optical devices
- Advanced high powered optics
- Telescopic optics
- Advantages and disadvantages of each low vision device
- The ability to analyze tasks by level of vision, illumination, contrast and more
- The relationship of magnification to mobility
- The relationship of magnification to the field of view
- The relationship of magnification to the depth of focus
- Ancillary professional services for the visually impaired
- Agencies that serve the visually impaired
The doctor’s services should also include the demonstration of various low vision devices so you can determine the benefits before they are ordered.
To find a low vision doctor that best suits your needs, these resources can be of help:
- The International Academy of Low Vision Specialists (www.IALVS.org).
- The American Academy of Optometry, Low Vision Section (www.AAOPT.org).
- Or, simply Google: Low Vision and ask the doctor lots of questions.
A final word of caution: There is no state board or state certifying agency for low vision doctors. Do your homework! Research the experience of the doctor in helping low vision patients function better.
“There is nothing better than helping someone to read again with low vision glasses”
Dr. John Jacobi, Low Vision Optometrist