Low Vision Rehabilitation: How it Works

Low vision rehabilitation is an education and training process for people who have a low-vision condition that cannot be corrected by glasses, contact lenses or corrective surgery. Training programs are designed for practical, functional solutions to challenges that arise because of a person’s limited eyesight.

Intro

A program of low vision rehabilitation is one that helps people with the condition of low vision. This program trains people to use what is left of their vision to perform day-to-day tasks. The goal is to give them independence and improve their quality of life. 

The term low vision describes a condition of partial loss of sight that can’t improve even with prescription eyeglasses, surgery or other treatments. It varies in degrees, but it does not include complete blindness.

Even though ordinary glasses cannot correct vision to normal, 20/20 vision, visual aids can assist a person to see better. 

Find a LASIK Surgeon

Candidates for Low Vision Rehabilitation

According to the American Academy of Ophthalmology, anyone with visual acuity worse than 20/40 is a candidate for low vision rehabilitation. But the American Optometric Association considers low vision to be between visual acuities of 20/70 to 20/200. If one’s sight can’t get better than 20/200, the person is considered legally blind.

Visual acuity refers to the sharpness of vision. Visual acuity of 20/70 means that you must stand 20 feet to see an object that a person with ordinary sight can see from 70 feet. 

Causes of Low Vision

Older adults are most at risk for developing low vision because so many of the causes are related to aging and health conditions that emerge later in life.

Among the common causes are:

• Diabetes
• Glaucoma
• Macular degeneration
• Eye injuries and traumas

Types of Low Vision

There are several types of low vision. The most common are:

• Blurred vision
• Night blindness
• Peripheral vision loss
• Central vision loss
• Reduced contrast sensitivity
• Glare light sensitivity

Blurred Vision

For one of several reasons, blurred vision describes a state when you cannot focus enough to see things crisply, even with the use of glasses or contact lenses. Nothing focuses correctly.

Night Blindness

Night blindness, or nyctalopia, means you can’t see at night or in places with dim lights. You may not develop complete blindness, but you’ll have more challenges than others in places like movie theatres and restaurants. 

Loss of Peripheral Vision

Loss of peripheral vision, or side vision, is also called tunnel vision. It means you can’t see objects on your sides, directly above or below your eyes.

Your central vision is unaffected: you can see anything directly ahead of you. You can recognize faces and read, though slowly. But you’ll have challenges with mobility.

Loss of Central Vision

This is also called having a blind spot. It occurs when a blur appears at the center of your eye, but your side (peripheral) visions are still working.

This condition makes it difficult to read, see distant objects, and recognize faces. However, it may not affect your mobility.  

Reduced Contrast Sensitivity

This condition makes it difficult to distinguish between light and shades. Images appear cloudy, and you can’t separate them from their background.

This problem is more prominent in low light, bright light and fog settings. 

Glare Light Sensitivity

This occurs when you’re more sensitive to standard light levels. Your eyes are overwhelmed by lights and may feel pain or discomfort. Images appear washed-out.  

What Do Low Vision Rehabilitation Specialists Do?

Low vision rehabilitation aims to make the best use of your remaining vision to perform daily activities. A person with low vision has a higher risk of getting into accidents. That means one crucial role of a rehabilitation specialist is to train you to perform duties for yourself without causing accidents. 

Training centers on activities like:

• Grooming yourself 
• Cooking in the kitchen 
• Using magnifiers to read 
• Modifying your home for easy navigation and safety 
• Managing finances 
• Writing
• Improving lighting conditions  
• Labeling appliances, medications and clothing 

What Does Low Vision Rehabilitation Entail?

The purpose of low vision rehabilitation is to provide functional and realistic training to solve most of your day-to-day challenges that arise because of your poor sight. To achieve that goal, you first will have to go through an overall evaluation and assessment of your eyesight.

Next comes the detailed and practical training of how best to live with your vision limitations. After that, specialists will education about how to modify your lifestyle and living environment to best accommodate your condition.

Finally, you will get an introduction to medical devices that could help you.

Eyesight Evaluation

The beginning evaluation involves a face-to-face meeting with a therapist to determine your rehabilitation needs and the best program for you.

A specialist will ask you a few questions to understand your eye history and general health. For instance, how has your visual impairment affected your reading, computer use, driving, work, television viewing, traveling, and other activities? 

Visual Assessment

After evaluation, the specialist will examine each eye to measure the level of visual acuity. Usually, doctors use charts to test visual impairment.

These charts have a wide range of letters of different sizes that help measure your visual acuity and the type of visual impairment. Also, the doctor may check for depression since it’s a common problem for people with low vision. 

Rehabilitation Training

Once the assessment is over, the specialist will create a rehabilitation plan based on your goals. You’ll attend about two sessions a week, lasting 1 to 2 hours. Training will focus on:

• Daily activities. This training helps you gain independence by showing you how to perform daily activities by yourself. 
• Vocational rehabilitation. This training may be necessary if you want to stay employed. It includes mobility training, especially in public. For instance, crossing streets, climbing stairs, public transport, and using guide dogs. 
• Personal adjustment counseling. This counseling focuses on helping you and your family cope with visual impairment. It may also include marital counseling. 

Environment Modification

It involves making changes to your home to make it friendly to you. Simple modifications may work if you have a mild vision loss. But if you have severe low vision, you’ll need additional devices. 

Low Vision Devices

Your therapist will introduce vision improvement devices to you. These devices help to magnify distant images. They include handheld magnifiers, single-vision spectacle magnifiers, dome magnifiers, and a monocular telescope.

Your therapist will select an appropriate device for you based on what you want to do and your ability to operate it. 

What to Look for in Low Vision Rehabilitation Services

Both government and private rehabilitation facilities exist. When choosing a low vision rehabilitation center, whether government or private, consider the following: 

• Whether services are free. If not free, how much they charge and whether you can use Medicare or insurance. 
• Ask if the services include home assessment, prescription for devices, and mobility services. 
• Check for availability of resources and support groups.
• Ask whether you can get visual aids on loan and if they’re returnable. 
• Check the kind of training they provide and if it matches your needs.
• Ask if services include an evaluation by an optometrist or ophthalmologist. 

Costs & Paying for Low Vision Rehabilitation

The cost of low vision therapy differs depending on where you live and who provides the service. These costs include initial consultation ranging from $100 to $700 and weekly appointments from $75 to $165 per week. 

States may assist low vision people who meet a certain level of visual acuity. Here, your doctor has to refer you to a state-sponsored program. Plus, you’ll need to provide the doctor’s report of the best-corrected visual acuity.

Medicare

If you are 65 or older, you are likely to qualify for Medicare. But if you are younger than 65, you can only qualify for Medicare assistance if it is determined that you have a confirmed disability. That declaration is a process in itself.

Low vision is a disability if it prevents you from working. Unfortunately, Medicare can’t cover low vision devices. Generally, it doesn’t cover eyeglasses and lenses.

Insurance

Most insurance companies do not cover low vision because therapy can be time-consuming. However, it is possible to find a few private insurance companies that cover it. Be sure to check with your insurance company whether they have low vision coverage.  

How to Find a Low Vision Rehabilitation Specialist

Low vision rehabilitation centers are available in all states. You can start your search by asking your eye doctor.

You are likely to find low vision rehabilitation specialists in large hospitals, some universities, charitable organizations, and state governments. Organizations that serve the blind are also likely to have these specialists.   

FAQs

Can low vision be restored? 

Low vision can’t be restored by surgery, prescription, or glasses. However, visual aids such as magnifying glasses can help improve a person’s sight. 

What does a vision rehabilitation therapist do? 

A low vision rehabilitation therapist trains people with vision impairments to perform daily tasks for themselves. The aim is to help them be independent and reduce the chances of accidents.  

Who needs visual rehabilitation?

A person with a visual acuity of 20/70 to 20/200 needs visual rehabilitation. That means you must stand at least 20 feet to see an object that a person with normal eyes can see standing 70 to 200 feet away.

References

1.  

   Low Vision and Vision Rehabilitation. America Optometric Association.

2. Low Vision Services: A Practical Guide for the Clinician. (December 2018). Therapeutic Advances in Ophthalmology.  

3. Low Vision. (October 2020). Cleveland Clinic.  

4. What is Low Vision Rehabilitation. (September 2013). Prevent Blindness.

5. Low Vision Devices for Children. (June 2007). Community Eye Health Journal.  

6. Low Vision Rehabilitation Teams and Services. (September 2021). American Academy of Ophthalmology. 

7. Cost of Vision Therapy: Examples from All 50 States. Strabismus Solutions.  

8. Medicare for People with Low Vision. (October 2018). The Blind Guide.