Low Vision, High Reward

I was the first in my family to go into optometry, and my path toward low vision was not a traditional one. While finishing my bachelor’s degree, I worked for an optometrist who had a strong interest in low vision, and that exposure sparked my interest in this area of care.

While my exposure to low vision in practice was inspiring, my experience in the classroom was more humbling. I wasn’t an A student in my first low vision course, and, at one point, a professor even suggested low vision might not be the right fit for me. What that experience ultimately reinforced, however, was how different low vision looks in real-world practice compared with the academic setting.

That realization motivated me to pursue hands-on training. So, I completed low vision externships at a US Department of Veterans Affairs and later at a private practice, followed by a residency in private practice that had a strong low vision emphasis. Those experiences solidified my belief that low vision care thrives when it is patient-centered, practical, and intentionally integrated into the clinical workflow.

After residency, I returned home to Asheville, North Carolina, where I created a low vision clinic from the ground up. While I am not an owner, I was given full autonomy to develop and run the clinic based on the clinical and operational framework I learned during residency, with the support and mentorship of my residency director. I function as the sole low vision practitioner and oversee clinical care, workflow, referrals, and program development, with support from a remote office manager who manages scheduling and phone communication.

Today, I practice low vision 2 days per week and manage dry eye disease at a separate private practice on 2 additional days. The Low Vision Centers of North Carolina has since expanded, with offices in Wilmington, Charlotte, and Durham, with the goal of maintaining accessible locations within a few hours of major hubs across the state.

When I first began, my low vision schedule was far from full. Now, I am consistently booked 2 to 3 weeks out, and as demand continues to grow, I anticipate adding another dedicated low vision day in the near future.

The following are the core elements that made this growth possible:

MARKETING

Building a successful low vision practice starts with helping both patients and potential referring providers understand what low vision care is and where its value lies. We use brochures to do this and also include them in follow-up packets sent back to referring providers, reinforcing education and maintaining visibility.

In addition, we maintain a paid advertisement in our state magazine, which has helped expand awareness beyond traditional referral channels and reach patients who may not yet be connected to specialty eye care.

PATIENT EDUCATION

Compliance with low vision devices can be challenging without proper education. Therefore, in-office education is a critical component of each visit, ensuring patients understand how to use a device and why it benefits them. For patients who require additional support, we collaborate with an occupational therapist who can provide in-home visits, among other specialized training.

SCHEDULING

During my residency, low vision examinations were prioritized using a block scheduling system, with all other appointments built around them. I adopted the same model in practice. Initial low vision evaluations are scheduled for 90 minutes, while follow-up visits typically require half that time.

Pro tip: Successful integration depends on intentionally building low vision into your schedule rather than trying to fit it in between routine visits. Some practices may benefit from dedicating specific days exclusively to low vision care.

Regardless of practice setting, the demand is there; approximately 90% of my patients travel an hour or more to receive care.

EQUIPMENT

Startup costs can be kept manageable with equipment. A basic setup can include an examination chair, a slit lamp, and a focused selection of low vision devices, such as a closed-circuit television, prismatic microscopes, and telescopes. We reduced overhead by purchasing a used examination lane. Excluding rent, a realistic minimum startup investment is about $10,000.

FOLLOW-UP

Strong professional relationships are essential in low vision care. Early on, I relied on existing connections while also making cold calls to establish new referral pathways. Today, the majority of my referrals come directly from other doctors, and those comanaging relationships have been central to the clinic’s growth.

FACILITATING FINANCING

There are currently no insurance plans that cover low vision devices. However, many patients can access alternative funding options if they are willing to pursue them. I assist patients by completing necessary documentation and helping them navigate available resources whenever possible.

THE REWARDS

Respectfully, my hope is that I do not need to see my patients again because that means their device is working effectively and they are functioning independently. When patients do end up returning, visits are typically focused on straightforward troubleshooting, such as fit adjustments, retraining, or additional education. 

Low vision patients present with diverse needs, and the solutions often extend beyond what most expect is possible. From adaptive devices to individualized strategies, low vision care allows patients to return to work, maintain independence, and reengage with daily life. These outcomes reinforce why every OD should understand the value and the professional fulfillment of low vision care.