LET’S TALK

LOW VISION

Suleiman Alibhai, O.D.

Retina Group of Washington
Krista M. Davis, O.D., F.A.A.O.
Columbia Lighthouse for the Blind
Eye Anatomy
Definitions

Legal Blindness
– Best corrected distance visual acuity of 20/200 or
worse in better eye
– Horizontal visual field of 20 degrees or less at widest
point in the better eye
Low Vision
– Worse than 20/60 in the better eye
– Significant field loss
– Impaired function
Goals of Low Vision
Management

Increase functionality
– Make the most of the remaining
vision
Provide link to community
resources and support services
Education
Common Conditions

 Macular Degeneration  Albinism

 Glaucoma  Nystagmus
 Diabetic Retinopathy  Cortical Visual
 Stroke/ brain injury Impairment
 Retinitis pigmentosa
 Optic Nerve disease
Functional Effects of
Low Vision

Loss of central vision (visual

acuity)
Loss of peripheral vision
(visual field)
Glare and contrast
Issues Related to
Decreased Acuity

Difficulty reading
Problems writing/ completing
paperwork
Inability to recognize
distance objects and faces
Issues Related to
Visual Field Loss

Location of scotoma important!

Generalized loss of visual field
difficult to compensate for
Mobility and independent travel
Reading may require adaptations
Issues Related to Contrast

Need for additional lighting

Problems with glare
Increased adjustment to changes in
illumination
Visual discomfort and fatigue
Exam Sequence

 History/ intake
 Visual acuity
 Visual field testing
 Pupils
 Extraocular muscle testing
 Refraction
 Color vision and Contrast Testing
 Ocular Health
Types of Acuity Charts

Distance
– Snellen (projection)
– Feinbloom/ SOSH
– ETDRS
– Lea Symbols
Near
– Single letter
– Continuous text
Distance Charts
Near Charts
Interpreting Near Acuity

Threshold acuity
– Difference between single letter and continuous
text
1.0 M = 20/50 = 8-10 point font
– Need to look at working distance
– Jaeger charts nonstandard
Typical sizes
– Newspaper = 1.0M
– Children’s books = 1.2 – 1.6M
– Large print = 1.6 – 2.0M
– Newspaper headlines = 4.0 – 5.0 M
Visual Field Testing

Confrontation
Arc perimeter
Vision Disc
Automated perimetry
Goldmann perimetry
Color and Contrast Tests

Ishihara
Color Vision Testing Made Easy
D-15
Pelli-Robson
Vistech Contrast System
Mr. Happy
Hiding Heidi
Color Vision Tests
Contrast Tests
Magnification

Enlarges image on retina to stimulate more

retinal cells
Can be achieved in many ways
– Relative Distance
– Relative Size
– Optical / Angular
– Electronic
Low Vision Devices

Distance
Near
Field enhancement
Non-optical
Distance Devices

Hand held telescopes

Mounted telescopes
Electronic systems
Telescopes
Electronic Distance Systems
Near Devices

Spectacles
– Prismatic ½ eyes
– Full-field microscopes
Magnifiers
– Hand held vs. stand
– Illuminated vs. non-illuminated
Telemicroscopes
Electronic Devices
Spectacle Microscope
Near Loupe
Hand Held Magnifiers
Stand Magnifiers
Electronic Magnifiers
Non-optical Devices

Glare reduction devices

Contrast enhancement devices
Computer software
Accessory devices
– Talking watches, clocks, etc
– Writing guides
– Tactile markers
Glare and Contrast
Lighting
Other Non-optical Devices
Adaptive Computer
Equipment
Additional Services

Orientation and mobility training

Independent living skills training
Support groups
Braille instruction
Computer training
Genetic counseling
Community Resources

Support groups
Paratransit Services
Books on tape
Audio described performances
Tactile tours
Large print publications
Educational services
Communication Goals

 Educate patient on eye condition

 Help them to understand what options are
available and how to use/ care for tools
– Glasses
– Low vision devices
– Technology
– Community resources
 Educate parents and teachers/ professionals on
functional implications
Functional Implications

Print size
Visual efficiency and fatigue
Mobility issues
Positioning/ classroom placement
Lighting/ glare reduction needs