Low Vision Doesn’t Mean No Vision: How Low Vision Rehabilitation Helps

Losing vision can be frightening and frustrating, especially when glasses, contacts, or surgery can’t fully fix the problem. But low vision does not mean the end of reading, cooking, working, or enjoying the activities you love. Low vision rehabilitation focuses on helping people use the vision they still have more effectively through training, adaptive techniques, and specialized equipment. With the right support and strategies, many people with low vision can remain independent and continue doing the things that matter most to them. 

What is low vision?

Low vision is impaired vision that cannot be corrected with surgery, glasses, or medication.  The most common cause of low vision is macular degeneration. Other common causes include glaucoma, cataracts, hemianopsia, and diabetic retinopathy. However, many different conditions can lead to low vision. 

Age-Related Macular Degeneration

Age-Related Macular Degeneration is a chronic eye disorder that can result in severe loss of central vision, but people rarely go blind from it. Medical treatment includes injections for wet ARMD, lifestyle changes, medication, and possible surgery as determined by an ophthalmologist. 

Wet ARMD- A more severe type of ARMD in which abnormal blood vessels leak fluid or blood into the macula, which is a part of the retina responsible for central vision, and causes faster progression. Wet macular degeneration symptoms usually appear suddenly and worsen quickly. They may include:

• Visual distortions, such as straight lines that seem to be bent.
• Reduced central vision in one or both eyes.
• The need for brighter light when reading or doing close-up work.
• Difficulty adjusting to low light levels, such as when entering a dimly lit restaurant or theater.
• Increased blurriness of printed words.
• Difficulty recognizing faces.
• A well-defined blurry spot or blind spot in the field of vision.
• Macular degeneration doesn't affect side vision, so it doesn't cause total blindness.

Dry ARMD- More common but less severe type of ARMD that progresses slowly over time. The American Macular Degeneration Foundation reports approximately 85% to 90% of the cases of macular degeneration are the “dry”.  This occurs when the tissue in your macula thins and loses cells responsible for vision. Patients with this “dry” form may have good central vision (20/40 or better) but substantial functional limitations, including fluctuating vision, difficulty reading because of their limited area of central vision, limited vision at night or under conditions of reduced illumination.  Other symptoms include:

• blurred or fuzzy vision
• the illusion that straight lines, such as the edge of a door or sentences on a page, are wavy
• the illusion that some objects are smaller than they really are
• the appearance of a gray, dark or empty area in the center of the visual field
• sometimes color vision is noticeably paler than usual 

Fortunately, diet and lifestyle changes can help slow the onset or progression of age-related macular degeneration. Lutein, Zeaxanthin and AREDs are supplements that show evidence of improving eye health for people with macular degeneration. 

Glaucoma

Glaucoma is a chronic eye disorder that can result in significant loss of peripheral vision secondary to abnormally high eye pressure, which causes damage to the optic nerve. This disorder is often hereditary and is the leading cause of blindness in people over 60 years of age. There are usually no early warning symptoms of glaucoma. Over time, you may slowly lose vision, usually starting with your side (peripheral) vision. Because it happens slowly, you may not notice your vision is changing at first. But as glaucoma progresses, you may experience blurry vision or vision loss.  Medical treatment includes eye drops, medication, lifestyle changes, and possible surgery as determined by an ophthalmologist. 

Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes and is often a comorbid condition of diabetic retinopathy.  It is a condition that chronically affects the tissue at the back of the eye and causes damage to the blood vessels in the retina. This can cause total blindness. Some people have no symptoms in the early stages of diabetic retinopathy. As the condition gets worse, people may develop:

• Spots or dark strings floating in their sight, called floaters.
• Blurred vision
• Changes in vision
• Dark or empty areas in their vision
• Vision loss

Medical treatment includes lifestyle changes, medication, blood glucose management, and possibly surgery.  Poorly controlled blood sugar is the leading risk factor and it is important to learn strategies for safe blood glucose management. 

Cataracts

Cataracts are a clouding over the normally clear lens of the eye. Cataracts are very common and more than half of Americans have cataracts by the age of 80.  They typically develop slowly over the course of years. If left untreated, they become the leading cause of blindness in older adults in the United States.  Symptoms of cataracts include:

• Blurry or cloudy vision
• Problems seeing in low light
• Less vibrant colors
• Yellow-tinted vision
• Light sensitivity
• Glare
• Halos around lights
• Double vision

The most effective way to treat cataracts is to have them surgically removed as soon as possible when determined by an ophthalmologist. Delayed removal may cause permanent decreased vision. 

Heminaopsia

Homonymous hemianopia is vision loss in half of the visual field on the same side in both eyes. The damage that caused this problem is in the brain and not in the eyes and is usually the result of a stroke or a traumatic brain injury. Anywhere from a quarter to three-quarters of vision can be missing. Symptoms may include:

• Bumping into objects while walking, such as furniture, door frames and people
• Difficulty driving, especially when changing lanes or attempting to avoid objects on the side of the road
• Difficulty finding or reaching for objects on desks or countertops, or in closets and cabinets
• Frequently losing your place while reading or having trouble finding the start or end of a line of text
• Sensation that something is wrong with your vision

Missing vision can play a factor in inattention or neglect in stroke patients. If hemianopsia does not resolve, visual scanning training is often beneficial to compensate for missing vision. 

What is low vision rehabilitation and how does it help?

The purpose of low vision rehabilitation is to develop compensatory strategies to maximize independence or substitute for diminished sight to improve overall quality of life. It’s like physical therapy for vision loss! It includes education, training and identification of community resources such as support groups and lending libraries.  Studies have shown that people feel an increased sense of independence, comfort, and self-worth after participating in low vision rehabilitation. Each treatment is modified for each individual person’s needs.

What does the low vision rehabilitation program include?

Low vision rehabilitation includes a variety of techniques to improve reading, task performance, and mobility in order to enhance engagement in daily activities including:

• Magnification assessment
• Contrast training
• Use of lighting
• Filter lenses
• Functional mobility
• Visual scanning techniques
• Environmental modification
• Task modification
• Education in low vision resources
• Electronic modification
• Oculomotor and vestibular training

 What To Do Now?

Low vision rehabilitation is not about giving up on vision — it’s about learning new ways to use it. Through therapy, adaptive tools, environmental changes, and training, people with low vision can often improve safety, independence, and quality of life. At Therapy Achievements, our therapists have specialized training in low vision therapy and the technology that can help you navigate the challenges of living with low vision. Our therapists will not only help you learn everyday adaptive techniques and use low vision technology, but can also help determine if you are a candidate for bioptic driving and provide training if appropriate. Don’t wait — call for an appointment today and let our low vision rehabilitation therapists help you get on with the job of living.