Understanding Low Vision Care and Low Vision Devices: Part 2 in a Series on Low Vision and Low Vision Services by Bryan Gerritsen, CLVT

Bryan Gerritsen head shot

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 Part 1 of his series about low vision and vision rehabilitation services, Bryan discussed the fundamentals of vision loss and the many helpful options for low vision rehabilitation.

In this week’s concluding Part 2, Bryan explains what you can expect from your low vision examination and the low vision devices that have been prescribed for you. 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.”

Regular Eyeglasses and Vision Correction

When you were age 20 or 40 or 60, what did you do if your vision changed? You went and got new glasses, which probably solved most of your vision problems: seeing things more clearly that were far away, at an intermediate (arm’s length) distance, and up close. In this case, your new glasses worked well because they corrected vision problems related to the front parts of your eye, including the cornea, iris, and lens, and/or the front-to-back length of your eyeball.

But when you are older, and if you have macular degeneration, diabetic retinopathy, or any other eye disease, your vision problems are most likely caused by changes related to the back parts of your eye, including the retina and optic nerve. In this case, changing your glasses by ½ or ¾ of a diopter (which is how we measure the strength, or power, of glasses and lenses, and is typical of an average change in a new prescription), probably won’t make much of a difference in how you see. What you do need now is a much stronger eyeglass correction – along with improved illumination and enhanced contrast.

But most importantly, what you also need is training—perhaps to view things slightly off to one side, rather than straight ahead, due to the presence of distortion, blurriness, or a blind or blank “spot” (scotoma) near the center of your vision.

An Initial Low Vision Training Session: the Basics

Near the beginning of a visit with a patient and their family, I often tell them that they were probably expecting to get a magnifier or new glasses to help them. I explain that we will get to that, but tell them that there are things that are perhaps even more important than a magnifier or devices – or at least as important.

Finding the Blurry “Spot” and Learning to See around It

NEI image of how someone with macular degeneration sees: overall blurriness with a blind spot in the center
What a person with macular
degeneration may see

If the person has distortion, blurriness, or a central scotoma (spot), I explain that the first order of business is to help locate where the scotoma is most problematic and, conversely, where they can see best. (In the field of low vision, we call it the preferred retinal locus or PRL). I then provide training for the first 25-30 minutes to help the person learn to look around that blurriness or spot, even though many people don’t even realize they have a spot.

I explain to the person and their family that no matter how good a magnifier, strong reading glasses, or an electronic video magnifier might be, that spot will always be in the way if they look straight ahead.

I show the spouse or children “simulator goggles” to illustrate how the spot may appear to the person. I tell them about a patient who said that if they don’t want to see people’s faces in church, they just look straight ahead. Good low vision care includes training—to help a person use their remaining vision to the utmost. It may include training to help them look slightly off to one side, around their blurriness or that spot.

Low Vision Training is More than Just a Magnifier

About 26 years ago, I interviewed to be the low vision specialist at a center for the blind. They asked me what I would change about their services if I was hired. I stated that I would change their name, which at the time was “Low Vision Lens Service.”

They asked me why I would change the name. I said it implied that they were just giving out lenses, such as magnifiers.

They asked me, “What is wrong with that?” I said this implies that all they are doing is handing out magnifiers to their patients.

They asked me, “What is wrong with giving a magnifier to a patient?” I responded, “Low vision is much more than a magnifier.”

They asked me, “What is low vision, then?”

“Low vision is more than a magnifier,” I answered. “It includes training, such as ‘eccentric viewing’ training to learn to see around a person’s blurriness or scotoma/spot. It includes helping the person to improve their illumination. It includes helping the person to enhance contrast. It includes helping the person to reduce glare, along with many other services.”

Incredibly, they still hired me, and we changed their name to “Low Vision Services.”

Good Low Vision Services Include Training

Good low vision care should provide training, and not just with magnifiers and other types of low vision devices. Good low vision care will tutor persons with low vision and their families about the need for improved illumination and options for various lighting choices. It assists persons to learn ways to enhance contrast in every room and part of their home, school, or workplace. It teaches ways to reduce glare, as well as to improve organization and reduce clutter.

Good Low Vision Services Encourage Early and Prompt Referrals

Good low vision rehabilitation services help people to get help early in the process of their vision loss. It encourages doctors, staff, and others in the community to refer patients early. Doctors often ask, “At what point should I refer my patients to you?” I’m sure they are looking for a specific visual acuity that the person should be at before they refer them, such as 20/100, 20/200, or even 20/400.

The answer has nothing to do with visual acuity. People should be referred to low vision services when they have trouble doing everyday tasks, such reading, preparing meals, seeing faces, or driving. And the person themselves, their spouse, or their children should also seek help early on, whenever they feel they are having difficulty with these tasks.

Explaining Low Vision Devices

To help better understand low vision devices, I like to compare them to the tools used to build a house. A hammer helps with some tasks, a screwdriver with other tasks, and a wrench, plane, or a saw help with still others. As helpful as a hammer is, it won’t help you build the whole house. And a single pair of glasses probably won’t help you do everything any more. You need different tools for different tasks.

Similarly, low vision devices are used for different tasks, and do different things:

Therefore, most persons with low vision may have 4-5 devices (tools) to do different tasks:

  • a strong magnifier or device for reading at home, and a portable device for reading at a restaurant, store, or church
  • telescopic glasses to see the television, and perhaps a telescopic monocular to read signs, menu boards, and the aisle numbers in a grocery store
  • a device for seeing the computer screen or sheet music better
  • sunglasses to help reduce glare, and perhaps even two pairs: amber/orange for bright sunny days, and yellow for cloudy days, early mornings, or indoors.

It’s not that a low vision clinic is trying to sell you many different devices; instead, it’s because different devices do different things at different distances, and are used for different tasks.

Just Changing Your Prescription Glasses Is not the Answer

Many persons with a vision loss expect that changing their prescription glasses, like they have done all their lives, will solve all their problems. In the past, when a person’s vision changed, they just got new glasses to see more clearly. And that is what they expect to happen now. However, with a serious vision loss, just making their prescription glasses a little stronger by ½ or ¾ of a diopter will probably not solve the problem any longer.

The person with a vision loss may need +8 diopters, +12 diopters, +20 diopters, or even +40 diopters. And just as important, they probably need improved illumination. One pair of glasses or one tool may not solve all of their problems or help with all tasks, just like a hammer won’t help build the whole house. Different tasks require different tools.

No Tool is a Miracle Tool

Finally, no tool is truly a miracle tool. No magnifier, no strong reading glasses, telescopic devices, or even electronic or digital device will make things perfect. It will require a willingness to do things in a new way, the patience to try and persist, and the will to work to make it happen. It takes desire, it takes the support and help of those around you, and it takes going back to the low vision rehabilitation service for further training and for revision of the devices you are using, if your vision changes or your needs change.

Low vision care is not a “one and done” visit. I was strongly influenced by Dr. Randall Jose, who brought his optometry residents to the center in Atlanta, Georgia, where I worked in my first job. His belief for good low vision care was that it should be a three-visit minimum. I also believe this helps to ensure good training and proper follow-up.

Persistence Is Key!

I love to use the following quote from Ralph Waldo Emerson: “That which we persist in doing becomes easier to do, not that the nature of the thing has changed but that our power to do has increased.” I wrote a song to that verse and added these words at the ending: “Persist, keep trying.”

For More Information

Readers in Utah and neighboring states can call Bryan at 801-547-5903. They can also email Bryan at info@lowvisionrehabservices.com or visit his website at www.lowvisionrehabservices.com.

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.