Tools and Technologies for Patients With Low Vision

Ask any patient with low vision (vision that is uncorrectable with eyeglasses, contact lenses, medication, or surgery¹) and they will tell you the condition can make everyday tasks difficult to complete. Now consider the fact that one-third of patients with low vision don’t receive a referral once they are diagnosed.² However, not every patient with low vision requires a consultation with a low vision specialist.

A variety of low vision rehabilitation options are available to assist these individuals and help them live and work independently and safely. Although eye care practitioners routinely encounter patients with low vision, they aren’t all equipped or confident enough to manage these cases effectively. Thus, the decision to refer a patient to a low vision specialist should be guided by the patient’s best interests. This may involve continuing their care yourself while furthering your own education on low vision or referring them to another provider if you do not feel confident in managing their condition adequately.

In consideration of space, this article will forgo discussing the details of the low vision examination and focus solely on the latest tools and technologies available to enhance the lives of patients. However, it is acknowledged that each low vision case requires a different therapeutic approach. Editor’s note: Due to the extensive and increasing number of devices on the market, the tools and technologies discussed in this article are not an exhaustive list of those available; they merely provide a representation of what exists.

LOW VISION RESOURCE REVIEW

In addition to non-optical devices such as large print books, magazines, newspapers, audio books, talking watches, and a growing assortment of other resources, from basic to highly advanced, low vision devices also include optical magnifiers, telescopic devices, filters, and illumination devices. Although patients can purchase some low vision devices themselves online, Casey Krug, OD, FAAO, a low vision optometrist at the Low Vision Centers of North Carolina in Asheville, North Carolina, recommends they undergo a low vision evaluation, if possible. “This ensures they choose devices that are truly effective for their needs, rather than making uninformed purchases that may not benefit them,” she says. An evaluation also allows patients to demo and trial many devices before buying them.

Low Vision Aids

Special devices referred to as low vision aids can often allow individuals to regain some useful vision. Low vision aids can be divided into two categories: optical aids (eg, simple magnifiers) and advanced technology (eg, apps, closed-circuit television, handheld video magnifiers). Most of these devices enhance contrast, control glare, and magnify objects. Low vision aids can help patients maximize their remaining sight and maintain independence.

In addition to low vision devices and aids, Patrick D. Yoshinaga, OD, MPH, FAAO, chief of the Low Vision Rehabilitation Service at Marshall B. Ketchum University’s Southern California College of Optometry in Fullerton, California, shares that there are many other resources available to those with blindness or visual impairment. Referral for assistance with mobility, activities of daily living, safety, home assessments, device training, support groups, disability accommodations, driving rehabilitation when appropriate, and counseling are an important part of a comprehensive low vision evaluation. “Device and resource recommendations should be based on the individual patient’s needs as well as the patient’s specific eye deficits, including issues with acuity, contrast, illumination and glare, and scotomas and other visual field loss,” he advises.

Apps, Software, and More

“The biggest area of expansion is apps,” says Dr. Yoshinaga, “because many are free and most people are using devices such as smartphones and tablets, even older patients.”

Dr. Yoshinaga explains that apps fall into one of four main categories: identifying apps (like TapTapSee; Cloudsight); real-time assistant apps (Be My Eyes/Be My AI, which is a free mobile app that connects blind individuals and those with low vision with an AI assistant to make the world more accessible); apps with navigation that allow patients to walk independently, find a train station, get on a bus, etc; and multifunction apps, such as Seeing AI (Microsoft) and Envision AI (Envision Technologies), which are both free apps available for Android or iOS that use the device camera to identify things such as color, people, and currency, scan barcodes, etc.

There is also a wide variety of advanced technology available to assist individuals in maximizing their remaining sight and maintaining their independence. Bioptics are a type of vision-enhancing system that combines a telescopic device with conventional eyeglasses. The telescope allows the patient, with a slight tip of the head, to seamlessly transition between regular eyeglass vision and the telescope’s magnified view, offering enhanced vision without interruption. There’s also a wearable headset, OcuLenz (Ocutrx), that is not yet available but is designed to locate and map a patient’s central scotoma caused by macular disease, then move images and text away from the scotoma onto the surrounding healthy retina, allowing the patient to see better. The headset will also keep doctors up-to-date with disease progression through the company’s in-home patient monitoring.

Rehabilitation

An optometrist who provides low vision rehabilitation services can help patients with low vision regain their independence and improve their quality of life by teaching them techniques to help them perform daily activities with their remaining vision. Some government and private programs are available that offer different types of counseling, assistance, therapy, and more. With the advances and availability of smart phones and assistive apps, improved access to low vision care is possible. Also, according to Dr. Yoshinaga, telemedicine technology designed for low vision follow-up care (aka telerehabilitation) is being studied in hopes of offering improved outcomes for patients with low vision.

LOW VISION: NOT TO BE IGNORED

Low vision is considered a serious vision impairment, as it interferes with a person’s daily life in many ways. If left untreated, patients can become withdrawn, less active, and even depressed. Some may not seek treatment themselves, but if a patient lands in your chair and you identify them as having low vision, it’s important to get them assistance as soon as possible. In Dr. Krug’s experience, patients who start with basic low vision aids often require advanced solutions later on. Therefore, merely stocking basic aids may not sufficiently address their evolving needs. Something else to consider: “Integrating low vision services into a practice successfully often requires a dedicated approach,” says Dr. Krug. “Simply having a sporadic low vision patient may not be enough to make it a viable practice builder.” For those looking to make low vision a cornerstone of their practice, it may necessitate a full commitment, possibly dedicating entire days to this specialty to provide comprehensive care and to truly enhance practice growth. Without this level of commitment, the potential to build a practice around low vision services might not be fully realized. And again, if you’re not comfortable delivering this care, keep in mind there’s a great network of your colleagues who are (see When It’s Time to Phone a Friend).

Editor’s note: This article was reviewed by and written with valuable input from Drs. Krug and Yoshinaga. Sincere thanks to both for sharing their expertise, insights, and experience.