Article Date: 10/1/2004

High on Low Vision
Do you see potential in individuals with vision loss when many others do not? You may have the right stuff to become a low vision specialist. Here's some insight from a veteran.
By R. Tracy Williams, O.D., Wheaton, Ill., Illinois College of Optometry '79

You've been hearing about them all your lives. They've had a dramatic influence on everything from the economy and politics to fashion and entertainment. And now, they're likely to influence your career, as well.

They're the baby boomers. And they're marching at an unrelenting pace into their senior years. Right now, you're probably educating these patients about presbyopia. It won't be long before many of them will need other eyecare services, including low vision rehabilitation. Will you be ready?

Just like ocular pharmaceuticals and surgical procedures, low vision rehabilitation is a treatment modality -- and one worth investigating as you consider your choices in optometry. In this article, I'll discuss what it takes to be a low vision specialist and the rewards you can expect.

The Rewards of Low Vision Care

Although Medicare doesn't reimburse for low vision spectacles or devices, remuneration is available for clinical low vision care. Be sure you and your staff learn how to code properly for low vision care. A good place to start is with the American Optometric Association Low Vision Rehabilitation Section.

The best rewards of focusing on low vision rehabilitation, however, are gained in the professional satisfaction you receive from doing this mission-like work. It's gratifying to be the eye doctor who prescribed:

  • A 6X monocular telescope to a third-grade girl that enabled her to see her blackboard, a clock on the wall and her mother's face
  • Adaptive software and technology to a college student so he could be competitive in the classroom and confident in his career pursuits
  • Telescopic spectacles and referral to a rehabilitation driving program to enable a single parent to drive in the daytime
  • A CCTV system to an elderly man that helped him conduct his personal business affairs and see pictures of his grandchildren.

The fulfillment and joy that come from these experiences never end. It's truly a good feeling to be a low vision rehabilitation doctor.


Today, age-related macular degeneration is the leading cause of severe vision loss and legal blindness in older Americans. And diabetic retinopathy is a growing problem with devastating vision loss potential. Even now, a significant number of Americans are visually impaired. Estimates run from 3 million to 14 million, a number that's projected to double by 2020 as baby boomers age and enjoy longer life expectancy. In fact, by 2050, the U.S. population could comprise mostly elderly people. And not all of them will be in optimal health.

As these statistics reveal, there's a growing need for skilled low vision practitioners. And there's definitely room for growth. Of the 57,000 or so U.S. eye doctors (both O.D.s and M.D.s), fewer than 1,000 belong to the American Optometric Association's Low Vision Rehabilitation Section or the Vision Rehabilitation Committee of the American Academy of Ophthalmology.


What does it take to be a low vision specialist? The best low vision practitioners work with a patient's head and heart, as well as his eyes. They can see potential in individuals with vision loss when others do not.

A skilled practitioner understands the interplay of visual acuity, visual fields and contrast sensitivity, and is creative with optics. He's a good listener, communicator, educator and motivator. Using these skills, he can help visually impaired patients "re-invent" themselves and direct their energy toward fruitful pursuits rather than frustration, anger and depression.

The skilled low vision practitioner combines all these components -- listening, educating, motivating, clinical testing, prescribing, communicating action and supervision -- into a low vision rehabilitation plan.



A good low vision rehabilitation plan provides the appropriate tools, training and direction to maximize a patient's remaining vision, other senses and abilities to regain independence.

The Center for Medicaid/Medicare Services (CMS) has identified physicians, optometrists and ophthalmologists as the gatekeepers for low vision rehabilitation. As gatekeepers, we must understand the team concept of comprehensive low vision rehabilitation. Our team may include rehabilitation teachers and counselors, occupational therapists, social workers, orientation and mobility specialists, adaptive technology specialists and others. See "Team Building" for more on these specialists.

Low vision practitioners also must keep up with current ocular treatments, research, prevention, access to support groups and programs directed toward people with vision loss.

We also must be skilled clinicians to keep a close watch on any disease progression so we can make timely referrals to appropriate specialists when necessary. The low vision practitioner comanages patients in two directions: Specialty ocular health needs and additional rehabilitation interventions. This is an important and critical role that only the low vision rehabilitation specialist is trained to provide.

A successful rehabilitation plan addresses far more than vision. An effective plan may help a visually impaired student gain an education and career. It may help a patient become more employable, or help a working individual with a recent vision loss stay employed. A good plan can make the difference between patients remaining in their own homes or having to move to an assisted living facility. It also can provide mobility options to ensure safe travel. Good plans can tickle the human spirit and "lift" the person with vision loss.


The most successful low vision rehabilitation outcomes begin with an eye doctor who catches the "fever" to work with visually impaired people. Once you've acquired the basic clinical skills, you'll progress into the "art" of this specialty practice, having the satisfaction and fun of seeing patients accomplish the sort of daily living activities most people wouldn't believe possible. You'll begin to realize that the next best thing to a cure is improvement, which can lead to happiness and peace of mind.

There are learning curves to developing low vision rehabilitation skills and using prescribed tools properly. You'll also realize that the energy, enthusiasm and encouragement in your voice can help your patient's progress, as well as ward off depression. You can help people change, cope and most importantly, continue to live life. There also are many opportunities to be creative, designing glasses with telescopes, microscopes, special prisms, filters and other tools.

And if you're lucky enough to work with other rehabilitation professionals, you're often personally lifted by their contribution and unending compassion -- a wonderful experience that, sadly, so many eye doctors never see.


Your approach can begin with the very basics. Do what you can at your office and make a connection with a comprehensive low vision service or practice. Once you've seen the difference you can make in patients' lives, I'm confident you'll make vision rehabilitation an integral part of your practice.

Dr. Williams is executive director of the Deicke Center for Visual Rehabilitation in Wheaton, Ill., which provides low vision rehabilitation annually to more than 1,300 patients.





AMD Alliance International.

American Academy of Ophthalmology, Vision Rehabilitation Committee Preferred Practice Patterns.

American Academy of Optometry.

American Foundation for the Blind.

American Optometric Association, Low Vision Rehabilitation Section.

Deicke Center for Visual Rehabilitation.

Foundation Fighting Blindness.

Lighthouse International.

National Accreditation Council for Agencies Serving People with Blindness or Visual Impairment.

National Organization for Albinism and Hypopigmentation (NOAH).

Prevent Blindness America. 


Tools of the Trade

Many practitioners underestimate the tools and resources available to aid low vision patients. The fact is, we have many new tools to improve patients' vision and quality of life. Here's a look at a few of these new options:
  • High-power electronic magnifiers now come in all shapes and sizes. The portable, 10-ounce PocketViewer by Vision Works Inc., for example, uses a miniature video camera to transfer and enlarge text and images. Optelec offers portable electronic magnifiers and handheld optical magnifiers.
  • The Primer by Innoventions Inc. is a handheld electronic magnifier that connects to any television set. The Primer PC connects to any Windows-based computer. With these, patients can view enlarged documents on a TV or computer screen.
  • Insight Silver from Vision Technology offers a desktop CCTV, which includes 100,000-hour LED lighting and a magnification range from 4X to 85X with color, black-on-white and white-on-black viewing modes.
  • MAGic screen magnification software by Freedom Scientific offers a wide range of adjustments from 2X to 16X. This software is PC-compatible. Macintosh users can check out inLarge by Alva, which offers a similar magnification range.
  • Telescope and microscope spectacles, featuring lightweight metal frames, are available from Designs for Vision Inc.


Team Building

The best approach to low vision rehabilitation is a team-based strategy. Working with these specialists will help you provide improved quality of life for your patients:
Rehabilitation teachers and Occupational therapists Incorporate a doctor's prescribed low vision rehabilitation measures into adaptive training and instruction programs.
Rehabilitation counselors and Social workers Help patients develop adjustment and  coping strategies to meet the challenge of low vision. These professionals often are #009;networked with social services and involved with support groups.
Orientation & mobility specialists Evaluate and help low vision patients develop safe travel skills.
Adaptive technology specialists Work with technology, such as computer screen magnifiers, talking software, scanning software, Braille adaptations and other electronic #009;video innovations.]



Optometric Management, Issue: October 2004