Low vision optometrists examine patients with severe vision loss, vision that cannot be corrected by traditional clinical means. Low vision optometry is a process of examination, determination of functional vision, and coordination between the optometrist and other low vision professionals including low vision therapists, orientation and mobility specialists, occupational therapists and teachers of the visually impaired.
The American Optometric Association outlines the goals of low vision optometric care as the following:
- To evaluate the functional status of the eyes and the visual system
- To assess ocular health and related systemic health conditions and the impact of disease or abnormal conditions on visual functioning
- To provide appropriate optometric rehabilitation intervention to improve the patient’s visual functioning, taking into account the patient’s special vision demands, needs and adjustment to vision loss
- To counsel and educate patients regarding their visual impairment and ocular and related systemic health status, including recommendations for treatment, management and future care
- To provide appropriate referral for services that are outside the expertise of the optometric low vision clinician
A key development in the field of low vision rehabilitation has been the American Academy of Ophthalmology’s (AAO) SmartSight initiative. The goal of SmartSight treatment guidelines is to provide physicians with the tools necessary to help their patients make the most of vision less than 20/40, and recommend referrals for low vision rehabilitation for patients whose vision loss can’t be corrected surgically or otherwise.
According to the Centers for Disease Control (CDC), nearly 1 in 1000 children in the United States has some degree of low vision. The American Academy of Pediatrics states that 75 percent of learning during the early years is processed through vision. Because vision is a learning sense, children with visual impairments may not learn to perform some tasks as quickly as those with normal vision. Children with subnormal vision often look and act like any other child in the classroom and on the playground, making it difficult to distinguish them from normally sighted children.
Low vision pediatric rehabilitation services should involve a multidisciplinary team including an ophthalmologist, optometrist and low vision specialist, plus educational and rehabilitation services. Each child’s evaluation needs to be individualized. No two children with low vision experience low vision the same. The visual assessment, history and examination are age and ability dependent. The goal of low vision rehabilitation is to help each child achieve his or her maximum potential. Visual impairment or blindness does not mean the child cannot learn, just that he or she must learn differently. This is our challenge as providers. Visual impairment in the first years of life demands urgent attention, just as any other developmental delay. Visual acuity is not the only factor determining which child needs low vision services. Functional vision is the most important issue. How does functional vision affect development and quality of life?
Visual Function:
Visual function does not necessarily correlate with visual acuity. The visual system is immature at birth with visual acuity of 20/400. Children with the same acuity level will function differently dependent on neurological and cognitive factors, as well as their own experience.
Refractive Error and Low Vision:
Visual acuity of all children entering elementary school should be evaluated and appropriate optical correction given. Follow-up is dependent on initial findings as well as family history and other risk factors for visual impairment.
All children with disabilities should have an examination by an ophthalmologist or optometrist (because of the high incidence of ocular pathology) and a referral to a low vision rehabilitation specialist.
Contact Lenses:
Contact lenses are often ignored as a component of providing low vision rehabilitation for the visually impaired. Contact lenses can be the first choice for best corrected visual acuity with high refractive error and/or nystagmus, aniridia, albinism, cone dystrophies and ocular trauma. Age should not be a factor in inclusion or exclusion for fitting a pediatric patient.
Glasses may benefit children with other developmental delays prescribed at lower hyperopic powers than the developmentally normal child. You must ensure that glasses are worn.
Low Vision Optical Aids:
Children should be encouraged to use residual vision with the use of optical and non-optical aids. Adequate spectacle correction needs to be employed if indicated. Abilities (motor and cognitive), maturity and responsibility also determine which low vision devices should be prescribed.
Low Vision Non-Optical Aids:
Learning environments should be adapted to the diagnosis and functional abilities of the child.
Orientation and Mobility Training:
Orientation and mobility training (O&M) is administered by certified O&M specialists. This important training helps individuals who are visually impaired to regain confidence in daily travels by becoming aware of their surroundings and setting out plans to avoid obstacles. This includes training on how to use a white cane.
For more information visit www.cybersight.org.
♦ Case Report: A timely referral in maintaining quality of life
♦ The Challenges of Multiple Sclerosis and Visual Impairment
♦ ROP with Significant Systemic Implications
♦ Contact Lenses for Infants with High Refractive Error: Evidence of the Sooner the Better!
The purpose of Low Vision Grand Rounds is to emphasize and explain the multidisciplinary process of low vision rehabilitation, from physician referral to low vision examination to low vision rehabilitation and support resources. Held on a quarterly basis, Low Vision Grand Rounds examines patient case studies, including implications for management of co-morbidities and low vision rehabilitation interventions, in the spirit of collaboration. Low Vision Grand Rounds is beneficial to all professionals involved in the low vision patient’s continuum of care.
Low Vision Grand Rounds Calendar
♦ October 14, 2010 – The Global, Interdisciplinary Team Approach for the Diabetic Patient
♦ January 13, 2011 – Driving and the Low Vision Patient
♦ April 14, 2011 – Vision Rehabilitation for Neurological Vision Loss
♦ July 14, 2011 – Early Intervention and Pediatric Vision Rehabilitation
6:30 pm-8:00 pm | Hors d’oeuvres & cocktails will be served
Envision Vision Rehabilitation Center
INTRUST Bank Community Services Hall, Lower Level
610 N. Main, Wichita, KS
For more information and to RSVP, contact Dr. Park’s office at (316) 440-1690.
Dr. Park sees patients who have been referred by their optometrist, ophthalmologist or family physician. Once a consult is set-up, low vision assessments and treatment plans can be established. Please print off and fill out this consult request form if you have a patient you would like to be seen by Dr. Park.