Low Vision Therapy

Low vision means vision that is less than normal and regular glasses, contact lenses, medicine or surgery will not improve. Daily activities like driving, reading mail or prescription bottles, preparing meals, seeing TV and recognizing faces may be difficult or impossible without special magnifiers or vision enhancement equipment.

Vision Assessment

You would initially have an OT evaluation to assess how you are currently using your vision and the difficulties you are having at home when you are attempting to read, write or perform activities of daily living. A low vision assessment will evaluate the remaining vision through a series of tests which may include a central field test that helps to identify where your missing vision or blind spots are. Other tests may include contrast sensitivity which helps the therapist understand how to provide adaptations that will increase contrast in your home and a reading test to identify where you make errors, how fast you are able to read and the size of print that you can read easily.

Visual Skills Training

Many patients with macular degeneration or central field defects have a blurred or blank spot in the center area of vision, which causes part of a word to be missing. Learning a new eye position can reduce this problem. Our occupational therapist teaches this technique and with practice, a dramatic difference can be made in performance of many daily activities. We hope to help you use your remaining vision more effectively. To best accomplish this objective, you should think about what visual task’s are a priority.

Low Vision Adaptations

Environmental adaptations may be recommended, which can include ways to change contrast or enhance it, lighting recommendations for home, glare evaluation for indoors and outdoors as the reduction of glare may allow you to see with improved ability. Organization techniques will be taught, which will allow you to locate frequently used items. Writing guides or writing adaptations will be demonstrated and practiced with, to allow you to be independent with writing tasks such as writing checks, writing your signature or making lists.

Devices

Following the completion of working on improving your visual skills, evaluation for low vision aids to allow you independence with your tasks. The therapist will work with you on each task that is difficult and provide adaptations or suggestions on how to be successful with the task and this may include the use of hand held magnifier, stand magnifiers, video magnifiers or reading spectacles.

Frequently Asked Questions

1. What is low vision?

2. Why don't stronger glasses make my vision better? I see a lot of people with thick glasses and they seem to see o.k..

Glasses are only able to focus the picture for your eye. If the retina is damaged from macular degeneration or other diseases it is like having bad film in the camera and changing glasses won’t make objects clearer. Glasses are like shoes- there is only one size shoe that fits you and there is only one power of glasses that fits your eye, so just as bigger shoes don’t allow you to walk better, stronger glasses don’t allow you to see better in the distance. However, very strong reading glasses may allow you to see small print that is held very close to your eyes.

3. Can I get glasses to help me see better when I drive or help me get my drivers license?

Glasses can improve the vision of people whose only vision problem is that they are nearsighted or farsighted or have astigmatism. Even the best glasses cannot overcome vision problems caused by eye diseases like macular degeneration, and therefore better glasses don’t allow you to see down the road better. Some states allow people to drive wearing specially made telescopes called bioptics that are mounted on glasses but are only used momentarily for spotting distance detail.

4. What is legally blind? Can I still read if I'm legally blind?

Legal blindness means vision in your best eye, with your best glasses, 20/200 or a severe visual field loss. It is not a measure of how much you can do or of how active you can be. With special devices and training, many people who are legally blind can read and write.

5. Does it hurt my eyes to sit close to the TV?

No. Physical harm cannot be done to the eyes by sitting close to a television set. Even sitting at 1-3 feet is o.k.. Radiation or other damage does not occur and more detail can often be seen because as you sit closer the picture is bigger.

6. Can I damage my eyes by using them a lot or if I'm straining to see? They often feel uncomfortable when I work so hard to see things.

You cannot overuse your eyes. They may feel uncomfortable or strained but this is from fatigue and your eyes will not be damaged. You may not be able to use them for as long a duration as you once did, but no harm will be experienced from use. Resting and sometimes using lubricant eye drops, as often as you feel the need, will allow you to resume visual activities and your eyes will feel better. Generally endurance improves with persistent practice.

7. Do I still need to see my other eye doctor (s)?

Even if you were referred to a vision rehabilitation specialist, you still need to see your regular eye doctors who are providing general care or treating specific medical/surgical eye problems. The rehabilitation specialist helps you do the most with the vision you have, with adaptive techniques, devices and training. Your eye doctor (s) tries to help maintain the vision you have with medical treatment or surgery. Both types of care may be going on at the same time

8. Does my insurance/Medicare cover any part of low vision rehabilitation?

Many insurances, including Medicare, cover a comprehensive evaluation and training in adaptive techniques by recognized low vision rehabilitation professionals. Medicare HMO’s in those states should also cover low vision rehabilitation. Insurances generally do not pay for optical assistive devices, however.

9. Why does it take time to find a way to help me see better? I want it fixed right now.

Seeing is complicated. It includes recognizing detail, distinguishing objects from their background (contrast sensitivity), having a full field of view, managing glare, and processing the visual message. Eye diseases may affect each of these differently for different people. To maximize your vision, each problem needs to be addressed for each task you want to do, and this takes time, training, and practice.

10. I sometimes have a sensation of seeing things that aren't there. Is that a dangerous sign about my eyes or is there something wrong with me mentally?

This is very common occurrence in people who have lost some vision. You may see colorful geometric patterns, people, animals or elaborate scenes anywhere you look and although they look real, you know they are not. This experience is often called phantom vision and the medical term is Charles Bonnet Syndrome . It is believed to be similar to phantom sensations that some people experience after limb loss. Charles Bonnet Syndrome is not an indication of worsening eye disease or of mental illness. It tends to become less frequent over time and rarely requires any treatment.

11. Why are parts of words missing and some small objects hard to find when I put them down? Sometimes I can see very small things, which puzzles me and other people.

Our central vision allows us to see what we look at directly and our peripheral vision allows us to see out of the corner of our eyes. Some eye conditions, including macular degeneration, cause blind spots or blurry areas in our central vision but leave peripheral vision intact. This means that out of the corner of your eye, your good peripheral vision may spot a small button on the floor, but the blurry area in your central vision, makes it disappear when you go to pick it up. If the blurry area or blind spot is small, you may see part of a word, or if you have several small blind spots words may pop in and out of your view.

12. Can I get a bigger strong magnifier so I can see more at one time? I can't see enough with this small lens.

In general the bigger the magnifier the weaker it is, and the smaller the magnifier the stronger it is. This is because strong magnifiers are very thick and cannot be made very large. Training and practice allows you to use magnifiers, even small ones, more effectively. Electronic magnifiers with screens offer strong magnification with a larger area of view.

13. Why can I read when I am here using your light but I can't with my light at home? I use a 200 watt bulb.

Higher watt bulbs alone do not necessarily make it easier to see print or perform other tasks. The type of bulb and direction of light is important. A low watt floodlight bulb in a gooseneck lamp, for example, is usually better than a high watt bulb in a shade lamp because the gooseneck lamp directs the light onto the print while the shade lamp beams its light in all directions. Different kinds of bulbs may provide optimal light, for example fluorescent, halogen or Chromolux. Low vision rehabilitation offices usually have optimal lighting, which you can also place in your home.

14. When can I get talking books?

The Idaho Commission for Libraries Talking book service is available free of charge to anyone who cannot read standard size print. The Talking Book tape player and cassettes of books and magazines are distributed through State libraries. Your eye care professional or agencies dealing with the visually impaired can provide you with an application and authorize use of the program.

15. Why can't I buy a magnifier at the store that will help me?

Most over the counter magnifiers are of low power and usually lower quality. They are not designed to be used by people with more advanced visual impairments. Patients with very early loss of vision may find help with this type of device. As the vision deficit becomes more severe the type and power of assistive device is better determined by an experienced low vision specialist who can match it to your vision level and needs.

16. Do I qualify for a benefit on my income taxes?

If you are “legally blind” (best vision of 20/200 or severe field loss, as determined by your eye doctor) you qualify for an additional deduction on your income tax. Some low vision rehabilitation programs emphasize visual skills and eccentric viewing training (use of undamaged parts of the retina that see a more complete and clearer picture).

Frequently Asked Questions about the Therapy

1. How will using an eccentric viewing position help me?

The normal visual system positions your eye so the image you are trying to see falls on the center of the macula. If that part of the retina is damaged you see a blur (inability to recognize faces) or an incomplete picture (miss parts of a word or letters within a word). This is very disruptive to reading and writing and other daily activities. By moving the eye to a different position when the center is damaged, you can receive a more complete and clearer picture of what you are trying to see. This will help you perform many of your activities more easily and increase your success with assistive devices.

2. Why does it require so much training time and how long will it take?

Re-educating the eye and brain to perform fine detailed activities with a new retinal location is a complex task. It is reprogramming your biologic computer. Activities you performed automatically now require a new system to complete. Once learned however it will speed up performance and activities will be accomplished with much less frustration. Patients frequently don’t achieve a breakthrough for 3 or 4 visits. The average number of visits to complete the program is six-eight.

3. Can't I do the training on my own at home? Aren't there instructions on how to do it?

Practice can be done at home and it does make a difference in progress and success. Because this is a complex process and everyone learns differently and has a different set of problems, the training has to be individualized. Observation of the patient, particularly eye position and eye movements, requires an experienced and skillful teacher to maximize results and continue progress. When patients are frustrated and struggling, changing techniques or exercises and encouragement by the therapist can make a big difference. Correcting mistakes early can save time and promote more rapid progress.

4. Is my vision going to get better with all these exercises and training?

You may feel that your vision has improved because of gaining better visual skills and use of an eccentric viewing position. Seeing a more complete and clearer picture is a big advantage over what you experience when looking at objects with the damaged part of your macula. The benefit is from maximizing the vision you have, not from treating your medical condition.

5. How does tracing help me see better and do my daily activities? It seems like kindergarten work. What about other exercises?

Tracing may seen very simplistic but you may have noted how difficult it is to perform accurately. This is a good measure of how well you can use your eccentric viewing position. The eye hand coordination and use of the new eye position will be a great advantage and benefit in performing many daily activities because of the clearer and more complete picture you will see. Repetitive exercises like tracing and identifying cards help to develop this ability. Exercises are designed to improve the visual skills needed to read, write and do many fine detailed tasks. It may also improve your handwriting legibility.

6. If I learn to use my eccentric viewing position, will it help me read?

Some people may be able to use an eccentric viewing position to read but it is very individually determined. The amount of vision loss and location of the blank spots (scotomas) in your vision affect the ability. Your knowledge of the location of the spots and visual skills learned in the training will definitely improve reading ability when coupled with appropriate assistive devices. Short reading tasks will be easier than stories or material with long sentences.

7. Won't it bother people when I look at them and I'm not looking straight ahead? Eye contact is important when conversing with people.

Sometimes the eccentric viewing position is not off center enough to be noticed. If it is more obvious, you may want to tell people that this is your way of looking at them and seeing their facial expressions more clearly.

8. Why doesn't the therapist give me a magnifier to use on the first visit?

When you lose vision from a central scotoma (hole in your vision) that interferes with fine detail tasks like reading, enlarging print may make it easier to see print but harder to put letters and words in sequence. Seeing only a word or two with a magnifier can slow reading to a point of poor comprehension and make the process very frustrating. Some basic visual skills gained under the guidance of a therapist before using devices can increase your success.

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