There's more to healthy vision than 20/20 eyesight!

Low Vision

What is Low Vision?

When standard eye glasses, contact lenses, medicine or surgery cannot provide sharp sight and the impairment interferes with a person's ability to perform everyday activities, an individual is said to have low vision.

What is a Low Vision Specialist?

A low vision eye doctor understands high-powered optics and magnification plus has working knowledge of the multitude of special glasses, magnifiers, electronic and non-optical low vision devices that can help those with reduced vision. A low vision eye doctor understands how to work with patients and families who can be extremely upset, fearful, and even depressed. A low vision eye doctor has compassion and empathy for what the patient and family is going through as well as the knowledge, resources and experience to help them adjust to the difficult situation.

What causes Low Vision?

Over 1.6 million older Americans are affected with Macular Degeneration.

Eye diseases or conditions may be responsible for visual impairment. Some of the more common causes include:

  • Macular Degeneration - A disorder that affects the retina, the light sensitive lining at the back of the eye where images are focused. The macula—the area on the retina responsible for sharp central vision-deteriorates, causing blurred vision, which may cause problems such as difficulty reading, and for some, a blind spot in the central area of vision. The most common form of age-related macular degeneration is known as non-exudative, or "dry" form, which usually results in more slowly progressive vision loss. More rapid and severe vision loss comes from exudative, or the "wet" form, of macular degeneration, when abnormal blood vessels develop under the macula and leak fluid and blood. Both the exudative and the non-exudative forms of macular degeneration are age-related, and the leading cause of blindness in people over 50.  Recent studies estimate that over 1.6 million older Americans are affected. The exact cause is unknown. Although age is the primary contributing factor to the development of macular degeneration, cigarette smoking and nutrition can also play a role in the development of age-related macular degeneration.  There are also juvenile forms that are hereditary and also result in vision loss.
  • Diabetic Retinopathy - Vision and/or visual functioning can fluctuate from day to day as a result of diabetes.  Diabetes can cause blood vessels that nourish the retina to develop tiny, abnormal branches that leak. This can interfere with vision and, over time, may cause severe damage to the retina.  Laser procedures and surgical treatments are used to reduce its progression, but systemic control of diabetes is a reputed factor.
  • Retinitis Pigmentosa - Retinitis pigmentosa gradually destroys night vision, severely reduces side vision, and may result in total impairment. An inherited disease, it usually produces its first symptom—night blindness—in childhood or adolescence.
  • Retinopathy of Prematurity (ROP) - Previously known as retrolental fibroplasia, retinopathy of prematurity occurs in infants born prematurely and is caused by high oxygen levels in incubators during the critical neonatal period.
  • Retinal Detachment - Retinal detachment may result in total impairment in the detached area of the affected eye. It involves the retina separating from its underlying layer. Causes are holes in the retina, eye trauma, infection, blood vessel disturbance or a tumor. Through early diagnosis, most detached retinas can be surgically re-attached with partial to complete restoration of vision if surgery is performed in a timely fashion.
  • Cataracts - A cataract is a clouding of part or all of the lens inside the eye. This clouding interferes with light reaching the retina at the back of the eye, resulting in a generalized loss of vision. Causes are aging, long-term exposure to the sun's ultraviolet radiation, injury, disease and inherited disorders. If the eye is healthy, a cataract can be surgically removed and vision restored, usually with intraocular lens implants. Cataract surgery has a high success rate in otherwise healthy eyes. However, there are still individuals for whom cataract surgery is not possible as well as those with other ocular diseases(s) that may require low vision rehabilitation to maximize the remaining vision.
  • Glaucoma - Glaucoma is a form of damage to the optic nerve, which can result in vision impairment. The optic nerve damage in glaucoma can be due to the internal pressure in the eye building up because of problems with the flow or drainage of fluid within the eye, or can result without increased intraocular pressure (normal tension glaucoma) due to insufficient blood flow to the optic nerve. There are no early symptoms in the most common form, but the first signs of damage are side (peripheral) vision defects and difficulty with night vision. Early diagnosis and treatment with drugs or sometimes surgery can minimize vision loss.
  • Acquired (Traumatic) Brain Injury - Vision can also be lost or damaged as a result of head injuries, brain damage and stroke. Signs and symptoms can include reduced visual acuity, visual field, or contrast sensitivity, blurred vision, eye misalignment, poor judgment of depth, glare sensitivity, confusion when performing visual tasks, difficulty reading, double vision, headaches, dizziness, abnormal body posture, and balance problems.

If the reduced vision impairs the ability to do the tasks you want to do, then it is low vision.

How is a Low Vision exam different?

A low vision examination is quite different from a regular eye examination. It is a longer examination usually lasting one hour or more. It is a functional vision examination; therefore medical tests such as dilation are usually omitted. The first part of the low vision examination is conversing with the patient to find out how the reduced vision is affecting their life. The "wish list" is created so the doctor understands what the patient's specific goals are. The second part is extensive vision testing. Careful refraction is performed to find out if a new "regular" eyeglass prescription will help. The doctor must determine the best form and level of magnification needed for the person to perform the desired tasks. Treatment plans may include telescopes, microscopes, and prisms, with varying levels of magnification and strength, therapeutic filters, non-optical options, and/or video magnification. Illumination levels must be determined as lighting plays a major role in vision. The goal is to effectively maximize the useable vision for activities of daily living.

How much will this cost?

The low vision evaluation will be covered by Medicare and/or insurance. Telescopic spectacles range approximately between $1000 and $3000. Microscope and Prismatic glasses used for near tasks range approximately between $500 and $1200. It is important to understand that low vision devices are "task specific." They are designed for the task the person wants to do. Therefore it may, and usually does, take more than one pair of glasses or magnifiers to handle the various tasks the patient wants to do. It is not unusual for a patient to need bioptic telescope glasses for outdoor travel and/or driving, full diameter telescopic glasses for television and microscope or prismatic glasses for reading. What is ordered depends upon the patient's wish list, commitment and financial resources.

When do I get my glasses?

It usually takes two to four weeks for specialized glasses to be fabricated because these are custom made devices. Arrangements can be made to have them sooner in some circumstances. If a person has a special event happening and needs the glasses, the lab will usually cooperate.

Do vitamins help?

For certain conditions, vitamins may be the ONLY help. We will discuss vitamin therapy with you during your evaluation.

What is the free telephone interview?

The free telephone interview is a way of limiting the time, expense and disappointment of people who probably cannot be helped by low vision care. We have determined that asking the right questions on the phone could determine if a patient was qualified for low vision services. During the free telephone interview, we will ask questions regarding vision, functional abilities, goals, motivation, health, and mobility to determine if an appointment is in the best interests of the caller.

How do I know if the glasses will work after I get them?

During the evaluation, the patient will use actual low vision telescope, microscope and prismatic glasses on the tasks desired. The doctor and the patient will see that they work BEFORE they are ordered. This will be done again when the patient picks up the glasses. We never order glasses until the patient knows that they work.

Examples of Low Vision Eyeglasses:

ClearImage II

Bioptic Telescopes / Full Diameter Telescopes