Whether we were born with a visual impairment or developed vision loss later in life, not seeing well in our very ‘visually oriented world’ can impact one’s life in many ways.
For seniors, who likely knew normal vision most of their lives, difficulty reading small print may be the first challenge they notice and they assume that stronger reading glasses will do the trick. Sometimes though, as a result of disorders such as macular degeneration, diabetes or glaucoma, the seeing issues become more complicated, and usually conventional eyeglasses, contact lenses, medication or surgery don’t offer effective solutions.
For children, who were born with a visual impairment from disorders such as Albinism, Nystagmus, Achromatopsia, or developmental issues, ‘seeing’ was never ‘normal’ to begin with. Young adults may have had normal vision in their early years and then may develop changes in their vision from Stargardt’s Disease (similar to macular degeneration but in younger individuals), Retinitis Pigmentosa and Choroideremia (both of which reduce night vision and create tunnel vision).
It is reasonable to assume that the major challenge that individuals with reduced vision may have relates to reading. Low vision aids including conventional optical magnifiers, special high-powered eyeglasses, and newer digital technologies there are many excellent ways to magnify print to make it easier to read. In addition, there are many ways to access text without reading it ourselves—there are books on tape, MP3 players, text to speech apps, listening to the radio and TV, not to mention others who can read to us.
However, not only do we use our vision to read and see things, our distance vision is an important social sense. We use it to make eye contact, read body language and feel connected to the world around us. There is a growing body of research1 that shows that loss of distance vision can create feelings of isolation and can lead to depression. Other studies2 show that a lack of visual engagement in social settings and in visually-guided activities can even contribute to cognitive decline.
When one can’t recognize faces, read signs, or feel secure in one’s environment, the general inclination is to not engage in such challenging activities and to avoid potentially uncomfortable situations. We won’t go to church because we can’t recognize people and don’t want to miscall their name, or worry that a friend may think we don’t like them anymore because we can’t see them to say hello. If we can’t read signs it’s easy to mistake the men’s room sign for the women’s. Or the frustration of being unable to read the menu on the wall at a fast food restaurant can make the visit stressful. Also, when we’re unable to stay connected in social settings, we can start to feel ignored.
Children learn much of their social behaviors by getting non-verbal feedback from their friends, family and classmates. If they do something silly, visually impaired kids won’t see their companions rolling their eyes, smirking, or making fun of them, and hence they won’t learn that their action wasn’t well received. Nor can they engage in the social activities that their friends enjoy such as watching TV, Sports, video games, movies, or even bowling or miniature golf.
Thankfully, modern technology, especially miniature optical telescopes mounted on eyeglasses, called bioptics, can help to alleviate many of the social and day-to-day seeing challenges that many individuals with reduced vision may face. Bioptic telescopes, work similar to binoculars. They enlarge the image making it easier for the user to see. If the individual can only recognize someone’s face no further than 4 feet away, a 4 power bioptic will let them see the face 16 feet away. In most states in the US individuals who were previously ineligible to drive due to their reduced vision may now be allowed to drive with a state-issued special bioptic telescope driver’s license.
Children with a visual impairment wearing a bioptic telescope will be able to see their teacher writing on the board, see sports scores on TV, the pins at the end of the bowling alley, not to mention seeing their classmate acting silly that everyone was laughing about, but that they previously couldn’t see or know about.
Not only can bioptics help one see better at distance, but most are focusable so they can be used to read computer screens, watch TV, read music on a stand, and engage in table top activities such as card playing , crafts and board games. Folks who have used binoculars know that when looking at different distances they need to change the binocular’s focus. This is also the case with bioptics, and the closer one looks the more focusing is required. Even a little head movement in or out can require that the focus be changed. That’s no longer the case with the innovative Ocutech Falcon Autofocus bioptic—the world’s only self-focusing bioptic telescope. It provides the most natural magnified image because wherever the user looks the image will be clear immediately. All that the user has to do is look, just like normal vision. Low vision experts know that the easier and more natural a device is to use, the more likely it will be found helpful and used by the individual.
One of the many convenient parts of wearing a bioptic is that it doesn’t interfere with walking and engaging in one’s normal day-to-day activities. The telescope is positioned at the top of the eyeglass frame, so that with just a simple downward head tilt the user can switch their sight from their regular eyeglass lens into the telescope eyepiece allowing them to see more clearly instantly—it works almost like upside down bifocals—in bifocals we look down to see better up close, and with a bioptic we look up to see better further away. Bioptics are lightweight and don’t obscure the user’s face, so not only can the wearer make eye contact with their companions, but their companions can make eye contact with them as well.
The American Academy of Ophthalmology, in their Preferred Practice Patterns3publication, states that referrals for low vision care should be recommended to all individuals with reduced vision. While legal blindness is defined as having one’s best vision with glasses or contact lenses (if helpful) of 20/200 or worse, or a visual field narrowing of 20 degrees diameter or less (about 2 hands width at arm’s length), many individuals with reduced vision are not legally blind but are said to have low vision. These individuals, whose best vision is 20/40 or less, may still be hampered by their reduced vision and can often benefit dramatically from low vision care.
The Vision Council’s Low Vision Division website4 states that all individuals with a permanent reduction in vision require two eye doctors—their medical eye doctor, usually an ophthalmologist, who will manage the visual disorder with medical or surgical treatments when indicated, and a low vision doctor, either an optometrist or an ophthalmologist, who will help to maximize the individual’s vision by prescribing low vision aids. The Vision Council’s Low Vision website also includes a Low Vision Prescriber Network listing where individuals can search for low vision specialists most convenient to them.
While the incidence of reduced vision is increasing, largely due to the increasing numbers of seniors5, the availability of low vision specialists is not expanding sufficiently enough to serve the need. Schools of optometry and residencies in low vision care are training more low vision specialists, however there remain many areas in the country where there are no convenient providers of these very valuable services. In addition the frequent lack of insurance coverage for low vision aids makes the costs of such equipment fall to the individual making them for many individuals unaffordable. However, low vision services and vision aids are available through the Veteran’s Administration, so veterans should request referrals from their VAMC eye care providers.
A coalition6 has formed by organizations and agencies that support the needs of the visually impaired to lobby Congress and Medicare for coverage of low vision aids. In the meantime, as those efforts continue, individuals who are visually impaired or parents of children who are visually impaired should consider the acquisition of low vision aids to be an investment to enhance one’s life-- not simply a cost. Low vision aids can dramatically impact an individual at all stages of their lives-- from schooling, to careers, to their social life and retirement years. A frequently heard refrain from individuals who have received low vision care and low vision aids is “They’ve changed my life!”
1. Effect of Depression on Vision Function in Age-Related Macular Degeneration Barry W. Rovner, MD; Robin J. Casten, PhD; William S. Tasman, MD Arch Ophthalmol. 2002;120(8):1041-1044. doi:10.1001/archopht.120.8.1041
2. Longitudinal Associations Between Visual Impairment and Cognitive Functioning: The Salisbury Eye Evaluation Study. JAMA Ophthalmol 2018 Sep 1;136(9):989-995. D Diane Zheng, Bonnielin K Swenor, Sharon L Christ, Sheila K West, Byron L Lam, David J Lee
5. Visual Impairment and Blindness in Adults in the United States: Demographic and Geographic Variations From 2015 to 2050. JAMA Ophthalmol. 2016;134(7):802-809