Current Options in Low Vision Rehabilitation

Samuel N. Markowitz, MD, FRCS(C)

Disclosures

Geriatrics and Aging. 2009;12(4):208-211. 

In This Article

Abstract and Introduction

Abstract

Low vision can result from loss of macular function, with loss of peripheral vision or from loss of hemi-fields of vision such as in cases with stroke. Low vision rehabilitation (LVR) is the continuation of care after all other means for restoration of vision were used and failed. Modern LVR is a multidisciplinary endeavour responsible for providing assessment, prescribing devices, and conducting training sessions for individuals with low vision. Ontario recognizes the diverse needs of individuals requiring LVR interventions, covers LVR assessments and LVR training sessions, and provides financial subsidies for the purchase of low vision devices.

Introduction

Vision loss is one of the most common conditions affecting older adults. It not only reduces their ability to cope with daily living activities, but also it affects the safety and quality of life of the individuals. In many cases, vision disability is overlooked by older adults and their caregivers in favour of urgently needed care for chronic pain or cardiovascular and musculoskeletal disorders. Low vision is vision not acceptable to the patient or to the significant other. It can result from loss of macular function such as in age-related macular degeneration, or because of loss of peripheral vision as in retinitis pigmentosa or endstage glaucoma, or from loss of hemi-fields of vision, such as in cases with stroke.

Compounding the issue is a lack of awareness among the public as well as among caregivers and health care practitioners of available therapies and resources to promote low vision rehabilitation (LVR) -- despite the fact that Ontario has one of the most advanced and comprehensive LVR programs in the world. The Ontario Health Insurance Plan recognizes the diverse needs of individuals requiring LVR interventions and covers LVR assessment and training sessions. Together with the Assistive Device Program (ADP) of the Ontario Ministry of Health and Long-Term Care, which provides financial subsidies for the purchase of low vision devices, it puts Ontario in the enviable position of being the only province in Canada and the only jurisdiction in North America to have comprehensive publicly funded LVR services for its residents.[1]

Modern LVR offers real, significant, proven, and much appreciated help for all persons with vision impairment. It is a multidisciplinary endeavour of professionals with a specialty in LVR who are responsible for providing assessment, prescribing devices, and conducting training and therapy sessions for individuals with low vision.[2] Within the framework of this model, ophthalmologists and optometrists serve as the low vision specialists, performing the initial low vision assessment (LVA) and many other LVR services. Opticians and others serve as providers and dispensers of low vision devices prescribed by the ophthalmologist and the optometrist. Occupational therapists and a variety of low vision trainers, teachers, and educators provide one-on-one training for rehabilitation of visual functions and functional vision. A primary care practitioner should suspect low vision when witnessing loss of visual acuity, loss of central or peripheral fields of vision or oculomotor dysfunction.

It is estimated that there are about 10 ophthalmologists, 60 optometrists, and 2,000 other vision rehabilitation trainers and teachers across Canada providing LVR services. Ophthalmologists and optometrists mostly provide LVR services from their offices or from university-based clinics. Most major universities in Canada have established LVR clinics within their Department of Ophthalmology or Optometry. The Canadian National Institute for the Blind (CNIB) along with other nonprofit institutions across Canada, such as Institut Nazareth et Louis-Braille, the Montreal Association for the Blind, the Retinitis Pigmentosa Foundation, and AMD Alliance, provide a variety of services and support to patients with low vision. Such services include counselling and referral, orientation and mobility training, rehabilitation teaching, sight enhancement services, technical aids programs, library services, and career development and employment services. These groups also serve as a first station where referrals for formal LVAs are made to ophthalmologists and optometrists specializing in low vision.

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