Frequently Asked Questions
What is Low Vision
Low Vision can be defined as best corrected vision (with conventional glasses, contact lenses, LASIK, or cataract surgery), which is reduced to the point of interfering with the tasks you want to do.
There are two variables in the definition: level of vision and tasks you want to do.
Vision may be reduced from medical, congenital, or traumatic causes. Tasks may include regular everyday activities like reading, writing, driving, or watching television. Tasks may also include specialized activities relating to occupation or recreation.
The goal of low vision care is to find ways for you to do the task with the level of vision you now have.
What Causes Low Vision?
Medical conditions, birth defects and trauma are the major causes of low vision.
The leading cause of vision loss in our senior population is Macular Degeneration, both wet and dry types. In the dry form, the cells in and around the macular portion of the retina break down and cease function. There is no cure and no way to replace those damaged cells. The wet form is caused by fragile blood vessels that leak fluid between the retinal layers at the macula. The goal of treatment is to stop the leakage and prevent further leakage. Avastin, Leucentis and Eylea are the medicines injected into the eye for this purpose.
Cataracts are part of the natural aging process of the eye in which the clear lens becomes cloudy. Surgery to remove and replace the lens is a common treatment and highly successful. In some cases when surgery is too risky, low vision devices can be useful.
Diabetic Retinopathy is a major cause of vision loss directly related to blood sugar. Blood vessels in the retina leak, causing cell damage and vision loss. Regulating blood sugar is critical. Laser photocoagulation has been used to limit damage and, recently, injections of Avastin, Leucentis and Eylea have been successful as well.
Glaucoma is the second leading cause of blindness. Glaucoma is characterized by an increase in the pressure inside the eye. In the more rare acute form, severe pain is present causing the person to seek medical care. In the chronic form, often called “the sneak thief of sight,” there are no symptoms until significant peripheral vision loss occurs. For this reason, regularly scheduled eye examinations are essential.
Retinitis Pigmentosa is a group of inherited conditions causing night blindness and peripheral vision loss. Low vision devices are helpful in some cases.
Albinism is a congenital disorder characterized by the complete or partial absence of pigment in the skin, hair and eyes. Albinism is associated with a number of vision defects, such as photophobia, nystagmus and astigmatism. Lack of skin pigmentation makes for more susceptibility to sunburn and skin cancers
Stargardt’s disease is an inherited form of juvenile macular degeneration that causes progressive vision loss usually to the point of legal blindness. The progression usually starts between the ages of six and twelve years old and plateaus shortly after rapid reduction in visual acuity. Symptoms typically develop by twenty years of age, and include wavy vision, blind spots, blurriness, impaired color vision, and difficulty adapting to dim lighting.
Retinopathy of prematurity (ROP) is a disease of the eye affecting prematurely-born babies generally having received intensive neonatal care. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. All preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.
Low vision devices have been extremely beneficial in improving performance in those with Albinism, Stargardt’s disease and ROP.
Strokes and traumatic brain injury are the most common traumatic causes of vision loss.
How is a Low Vision Exam Different?
A low vision examination is quite different from a regular eye examination usually lasting one hour or more. It is a “vision and function” examination; therefore medical tests such as dilation are usually omitted.
The first part of the low vision examination is speaking with the patient to find out how reduced vision is affecting their life. A “wish list” is created so the doctor understands what the patient’s goals are.
The second part is extensive vision testing. The doctor uses low vision eye charts rather than the regular Snellen “E” chart to measure level of vision. Careful refraction is performed to find out if a new “regular” eyeglass prescription will help.
Part three works with magnification, illumination and other optical and non-optical low vision devices. The doctor must determine the best form and level of magnification needed for the person to perform the desired tasks. Telescope glasses, microscope glasses, prismatic glasses and the new, E-Scoop lenses, of varying levels of magnification and strength are presented to the patient. Illumination levels must be determined as lighting plays a major role in vision.
Part four is another conversation with the patient to determine the best form and level of magnification for that particular person’s task requirements. The doctor’s recommendations for low vision glasses, nutritional supplements and illumination or other services are presented.
How Much Will This Cost?
Each member of The International Academy of Low Vision Specialists is an independent doctor of optometry. Each office sets their own fees and are happy to discuss them with you. Most insurance plans do not cover low vision making this an out of pocket expense. Most offices accept credit cards and offer financing. Do not hesitate to discuss fees before your appointment.
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. In addition, a hand magnifier and reading lamp may be recommended as well. 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. 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.
Where Do I Find a Low Vision Doctor?
Go to our “FIND A DOCTOR” locator. All members of The International Academy of Low Vision Specialists are independent doctors of optometry who have extensive experience in caring for low vision patients. All have completed The Low Vision Intensive Training Course in California offered by Dr. Richard Shuldiner. Dr.Shuldiner is a Low Vision Diplomate in the American Academy of Optometry and has trained hundreds of optometrists in providing low vision care as Clinical Director at The New York Lighthouse and Clinical Director of Low Vision Optometry of Southern California.
What is the Free Telephone Interview?
The free telephone interview was developed by Dr. Richard Shuldiner as a way of limiting the time, expense and disappointment of people who probably cannot be helped by low vision care. Dr. Shuldiner determined that asking the right questions on the phone could determine if a patient was qualified for low vision services. “If not, why put the patient through the time and expense only to be extremely disappointed?” says Dr. Shuldiner. Members of the IALVS use the free telephone interview and speak to every patient personally. They 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 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.
What If My Vision Changes After I Get The Glasses?
Almost always, prescriptions and magnification levels can be changed without the need for a whole new pair of glasses. Most doctors offer from six to twelve months of changes at nominal or even no charge to the patient. It is interesting that changes are actually rarely needed.
How Do I Pay For Them?
Since most insurance, including Medicare and supplemental, do not cover the expense of low vision care, the patient must bear the expense. Credit cards are accepted at almost every office. Usually financing is available, sometimes with no interest. Discuss this during the free telephone interview. Use our doctor directory to find a low vision optometrist near you and to discuss how low vision care may improve the quality of your life.
Can a Low Vision Doctor Help Me?
Our Low Vision doctors fit their patients with custom vision aids and devices, allowing them to maximize the use of their remaining vision.