Guest blogger Bryan Gerritsen is a certified low vision therapist (CLVT) and owner of Low Vision Rehabilitation Services, providing low vision services throughout Utah. He is also the author of An Overview of Low Vision Devices, What are Low Vision Optical Devices?, Helpful Non-Optical Devices for Low Vision, Electronic Magnifiers and Magnifying Systems, and the Video Series: Better Lighting for Better Sight on the VisionAware website.
In the first installment of his series on low vision and vision rehabilitation services, Bryan discusses the fundamentals of vision loss and the many helpful options for low vision rehabilitation. As Bryan says, “Like success following a hip replacement, or in learning to play the piano, it takes practice, it takes persistence, and it takes patience. It takes hard work. But there is help. There is hope.”
There is Hope, There is Help; However …
You may be frustrated and feel like there is almost no hope, because you have an extremely serious vision loss. On the other hand, you may have fairly good visual acuity, but may also be discouraged because of frustrating vision challenges due to a visual field loss, a stroke, or an eye disease. Regardless of the cause of your vision loss, the type of loss, or the extent of your loss, you may wonder if there really is help, and may start to question if there is hope.
Be assured that indeed there is help, and there is hope. There are people who really do care. There are service providers who really can help. And there is reason to hope that you or the one you care about can continue to function, to a large degree. Most likely, no doctor, no surgery, and no pair of glasses can make your vision perfect again. But there are services, there are people, and there are devices that can help.
How Do You Begin?
Perhaps the starting point is the desire to want to make things better. The key is to be motivated to want help. One ophthalmologist I work with told me about 12 years ago that he finds that the patients who do best in low vision care are those who are motivated to want help. That was a “no brainer” remark, but it is completely true. If you don’t want help, or you don’t want to improve, the chances for making improvement are much more diminished. So the first “however,” which accompanies the fact that indeed there is help, is this: “However, you need to want help, and to accept help, before there can be hope.”
Serious Vision Loss: It’s More than Decreased Visual Acuity
Decreased visual acuity is not the only reason a person may have a serious vision loss. Donald Fletcher, M.D., a noted ophthalmologist and retinal specialist, makes a classic point: “Vision is more than acuity.” And conversely, vision loss is more than the loss of visual acuity.
Interestingly, a person may have pretty good visual acuity (20/40, for example), yet have a nasty visual field loss from a central scotoma (or blind “spot”), or greatly diminished contrast sensitivity function.
Decreased Visual Fields
Vision problems can be due to decreased visual fields, whether it is a peripheral (side) visual field loss, a central visual field loss, or the loss of half (or other variants) of the visual field. Peripheral field loss may be from glaucoma or retinitis pigmentosa. A central field loss may be due to macular degeneration, Stargardt disease, or a number of other eye conditions. A loss of half of the visual field may be due to a stroke, head trauma, or a glioma (brain tumor).
It may even involve a bothersome “ring” scotoma: instead of a total area of central visual field loss, there is an “island of geographic sparing” near the center (a donut-shaped scotoma area that surrounds the clearer central vision), which is the area of the visual field the person often tries to use to see faces or text. It can become very frustrating, despite the fact that their visual acuity may be relatively good.
Diminished Contrast Sensitivity
Vision problems may also result from diminished contrast sensitivity function, which is perhaps the least discussed – yet one of the most significant – causes of difficulty. Contrast sensitivity refers to the ability to detect differences between light and dark areas. Contrast sensitivity generally is present in macular degeneration, diabetic retinopathy, cataract, and a host of other eye diseases.
It’s a “Hidden” Visual Disability
As you can see, reduced visual acuity may be the least of the of the person’s problems. Yet if they tell the doctor or the technician (or their spouse or children) that they have trouble reading, the technician (or children) probably think, “You shouldn’t be having that much trouble reading, since you have 20/40 (or 20/60) visual acuity.” Therefore, the technician or doctor probably doesn’t refer the person for low vision care. And the spouse or children may not encourage the person to get help yet. But they are indeed having real problems.
Because this is a hidden disability, and their visual acuity is still quite good, the person may begin to feel that no one understands. They may begin to believe that there is no help, and no hope. This hopelessness may be hard to comprehend if all that we consider is the person’s fairly good visual acuity. But if family members, technicians, or others were to see slides or results of the person’s visual field loss or their contrast sensitivity function, they would quickly realize why the person is indeed having trouble reading and doing certain tasks, despite their comparatively good visual acuity.
What Help is Available?
Help may come in many forms:
- It may come in the form of improved illumination for all tasks, as well as enhanced contrast.
- It may come through “eccentric viewing” training, by learning to look off to the side, around their central scotoma or “spot.”
- It may come from the combination of a helpful magnifier or digital device and good illumination.
- For a person who has had a stroke and a resultant hemianopia (loss of half of the visual field, usually present in both eyes, called “homonymous”), the best help may come from training in eccentric viewing, tracking, and scanning, paired with tools like an inexpensive typoscope to help keep your place on the reading line.
But the message is that – regardless of the type of loss or extent of the loss – there is help, there is hope!
Help for More Serious Visual Losses
For a person with a very serious visual acuity loss, and perhaps also a serious loss in visual field and/or contrast sensitivity function, there is still help and hope and helpful training:
- There are incredibly strong low vision optical devices, including illuminated magnifiers, microscopic spectacles, loupes, telescopic monoculars, and glasses.
- There are some marvelous portable digital and electronic magnifiers that can be used anywhere to read almost any text, even with extremely poor vision.
- There are desktop electronic video magnifiers and closed circuit television systems (CCTVs) that have wonderful 24-inch high-definition monitors.
Most people assume that the main function of an electronic video magnifier, CCTV, or digital magnifier is to magnify print, which of course they do very well. But perhaps one of the most important benefits and advantages is that they enhance the contrast of anything being viewed. Thus, a person with pretty good visual acuity (for example, 20/60 or 20/80) may not need a lot of magnification; however, because their contrast sensitivity function is very poor, a CCTV or a portable digital magnifier is a godsend for them, because it makes things brighter and enhances the contrast.
For people with almost no vision, there are a cadre of options with speech output devices. Some CCTVs also come with optical character recognition (OCR) and speech output. This can be of great benefit to a person with a serious vision loss, to enable them to hear the text read out loud as it is shown on the screen. Other devices are stand-alone units with OCR and speech output. There are also audio players and talking books and specialty reading products and services. Almost every month, new options and devices are introduced, and it is always exciting to follow the latest new devices.
But Returning to My Cautionary “However …”
Sometimes a person with a vision loss wants help so desperately that they are willing to pay almost anything for a solution. They are almost looking for a miracle. News programs on television or magazine articles often feature the latest head-mounted cameras for the visually impaired, or other things like implants, almost making them sound like a miracle solution for a person with low vision.
It does not have to be expensive. The lead ophthalmologist at one of the eye centers where I work got very concerned that some of her 80 to 100-year-old patients with low vision felt they got scammed by a person selling very expensive telescopic glasses, claiming that they would help them to read again. This ophthalmologist had me write an article for the local paper on “What is low vision rehabilitation?” In it, I made the statement that help for low vision does not need to be expensive.
Don’t look for a miracle solution. Your eye doctor and service providers can’t make things perfect for you, nor can they bring your vision back to what it was at age 20. But they can help make things better. While there is help and there is hope, it does not necessarily need to be expensive. And it will probably not produce a miracle solution.
Like success following a hip replacement, or in learning to play the piano, it takes practice, it takes persistence, and it takes patience. It takes hard work. But there is help. There is hope.
Part 2 of the Series
In Part 2, Bryan explains what you can expect from your low vision exam and your low vision devices. Readers in Utah and neighboring states can call Bryan at 801-547-5903. They can also email Bryan at firstname.lastname@example.org or visit his website at www.lowvisionrehabservices.com. Finally, you can ask your own eye care specialist for more information about low vision services and low vision practitioners, or use the AFB Directory of Services to locate service providers in your area.