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Background: With the estimated increase in the number of Americans with vision-related disabilities on the horizon, the need for optometrists with expertise in low vision rehabilitation services will increase. State optometric certification in low vision rehabilitation is currently only available in 3 states through affiliations between the state optometric associations and other organizations or government entities., Methods: A mail survey was conducted among Michigan Optometric Association member optometrists designed to address the current percentage of optometrists who practice low vision rehabilitation as well as the percentage who are low vision certified through the Michigan Optometric Association and to establish future need for additional low vision rehabilitation providers in the state., Results: Of the 188 participants, only 26.0% stated that they provide low vision rehabilitation services, the majority of whom provide only primary care low vision rehabilitation. Only 6.4% of respondents are certified low vision rehabilitation specialists through the Michigan Optometric Association., Conclusion: The low percentage of optometrists in the state of Michigan who practice low vision rehabilitation may lead to a shortage of providers for the aging and visually impaired Michigan population seeking low vision rehabilitation services. Even fewer are certified low vision providers through the voluntary Michigan Optometric Association certification process., (Copyright © 2011 American Optometric Association. Published by Elsevier Inc. All rights reserved.)

Background: Vision loss in retinitis pigmentosa (RP) is a slowly progressive and inexorable threat to patients' independence. It is not surprising that RP patients, many of whom are young when diagnosed, are at high risk for stress related to their vision loss. To address these issues, eye care providers need to be aware of what coping strategies RP patients use to successfully manage their vision loss., Methods: We held focus groups with 8 legally blind RP patients to help us better understand how they cope with the stress that is generated from their progressive vision loss and fluctuations in vision. Focus group sessions were audio-taped and resulting notes were coded using conventional qualitative analytic techniques., Results: Two themes were identified: (1) "kicking and screaming" captured the ways in which RP patients fight to maintain their independence in the face of worsening vision; and (2) "there are so many worse things" describes how RP patients keep their vision loss in perspective. These RP patients demonstrated high levels of resiliency. In particular, they often used humor as a coping mechanism., Conclusion: Understanding the ways in which RP patients manage their gradual, impending vision loss may lead to improved quality of care for this patient population., (Copyright 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: The goal of this survey study is to determine the low vision rehabilitation training practices of optometrists who prescribe near magnifying devices for low vision patients who have moderate visual impairment from age-related macular degeneration., Methods: A total of 2,028 surveys were sent electronically or by mail. A total of 136 optometrists reporting a special interest in low vision rehabilitation responded to an 18-item survey about practice mode, educational background, affiliations, and other demographic information. They were queried on methodology, frequency, and specific strategic content of rehabilitation training., Results: Sixty-eight percent of the 136 respondents were private practitioners. Fifty-four percent of all respondents agreed that they train patients for 1 hour or less. Nine percent provided 3 or more training visits and were more likely to utilize an occupational therapist. Forty-six percent of respondents reported using various other personnel to perform the training. The majority of respondents spend 25% of their time examining low vision patients. Eighteen percent of all respondents were low vision residency trained., Conclusions: Descriptions of current practice patterns are difficult to ascertain without consensus on terminology and management criteria among low vision practitioners. This survey and accompanying literature review support the need for clinical research and education that will establish an efficacious and cost-effective model for private outpatient low vision rehabilitation for individuals with various levels of vision impairment to determine the true availability of low vision rehabilitation care in the United States.

The scope of clinical low vision services and access to comprehensive eye care through U.S. schools for the blind and visually impaired is not well known. Advances in medicine and educational trends toward inclusion have resulted in higher numbers of visually impaired children with additional cognitive, motor, and developmental impairments enrolled in U.S. schools for the blind and visually impaired. The availability and frequency of eye care and vision education services for individuals with visual and multiple impairments at schools for the blind is explored in this report using data collected in a 24-item telephone survey from 35 of 42 identified U.S. schools for the blind. The results indicate that 54% of the contacted schools (19) offer clinical eye examinations. All of these schools provide eye care to the 6 to 21 age group, yet only 10 schools make this service available to children from birth to 3 years of age. In addition, two thirds of these schools discontinue eye care when the students graduate or transition to adult service agencies. The majority (94.7%) of eye care is provided by optometrists or a combination of optometry and ophthalmology, and 42.1% of these schools have an affiliation with an optometric institution. When there is a collaborative agreement, clinical services for students are available more frequently. The authors find that questions emerge regarding access to care, identification of appropriate models of care, and training of educational/medical/optometric personnel to meet the needs of a very complex patient population.

Background: Many individuals with vision impairment experience significant loss of the ability to perform daily living activities, which often results in a further decline and loss of quality of life. Appropriate rehabilitation of the population with vision impairment has the potential to both improve individual abilities for health and personal management as well as maximize utilization of available health care resources., Methods: The case for an evidence-based model for the vision rehabilitation health care team as a medical rehabilitation program is presented. The recommended strategy has 3 main components: development of a consensus team clinical practice guideline leading to a future evidence-based team guideline for vision rehabilitation; evaluation and measurement of the knowledge, attitudes, and practices of the involved vision rehabilitation professionals before and after implementation of the new paradigm; and measurement of outcomes that estimate the effects of the proposed paradigm on patient care by measuring both the improvement in visual ability of the patient and the economic impact of the model on optometric practice., Conclusions: Development of a state-of-the-art evidence-based transdisciplinary team model guideline will facilitate improvement in the quality of life of individuals with diseases that result in chronic vision impairment.

Background: Persons with vision loss may have limited ability to experience visual arts and difficulty navigating unfamiliar environments. The Center for Advanced Visual Studies at Massachusetts Institute of Technology developed a Retinal Imaging Machine Vision System (RIMVS) "seeing machine" to project "word-images" onto the retina and permit navigation through virtual architectural environments., Methods: Ten subjects with visual acuity < or = 20/70 in the better-seeing eye were recruited. Subjects viewed word-images that were projected on the retina of the better-seeing eye and asked to interpret the images. Subsequently, they were asked to recall as many images as possible. Participants also practiced navigation through a computer-modeled building that was projected onto the retina. A survey elicited subject response to the RIMVS., Results: Six subjects correctly interpreted all 10 word-images; no subject interpreted fewer than 8 correctly. Seven subjects felt that the word images afforded easy recall, and 7 subjects responded that the technology might assist subsequent navigation in unfamiliar environments., Conclusions: Responses reflect a general interest and potential with the RIMVS. Further studies are warranted to explore the value of the RIMVS as a tool to enable visually compromised persons to experience and appreciate visual arts and as a navigation aid.

Background: A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers., Methods: The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed., Results: Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services., Conclusions: Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

Background: There are few descriptive studies of children and adolescents with low vision in the United States. Our study describes a pediatric/adolescent population at the Illinois School for the Visually Impaired (ISVI), detailing the etiologies of low vision and the devices prescribed., Methods: A retrospective record review was conducted of 260 consecutive students who had been examined at the twice-yearly Lions of Illinois Low Vision Clinic at ISVI between the years 1991 and 1999. Data collected included age, race, sex, best-corrected visual acuity, ocular diagnoses, the etiology of low vision (if known), and low-vision devices prescribed., Results: The population was 60% male. Ages ranged from less than 1 year to 20 years of age. The mean best-corrected distance visual acuity was approximately 20/200. Optic atrophy, cataracts, and retinopathy of prematurity were significant etiologies of low vision; however, the largest group of patients had a diagnosis classified as "other." Hand-held telescopes, bifocals/high adds, and tinted lenses were the major low-vision devices prescribed., Conclusions: While optic atrophy, cataracts, and retinopathy of prematurity were common causes of vision impairment among students at ISVI, the largest group of students had an etiology from a wide range of disorders. Information on the causes of low vision can help with decisions on the allocation of research funds and resources for low-vision devices.

Background: Clinicians frequently prescribe reading devices for low vision patients having a central field loss. This study seeks to provide comparative information the clinician can use to assist patients in selecting the most cost-effective device(s) for reading., Method: In this study we compared optical devices with two types of closed-circuit televisions (CCTVs) that differed in two important characteristics: price, and whether the camera was stand-mounted with an X-Y table or whether the camera was handheld. A "within-subjects" design was used with 22 subjects. The primary comparisons between devices were subject reading speed, duration, and preference., Results: Subject reading speed and duration were significantly greater with the CCTV systems than with optical devices; however, no significant performance differences were found between the two types of CCTVs. Patients did express a clear preference for one versus the other type of CCTV, with an overall preference for the stand-mounted system. When asked to consider the price differential between types of CCTVs, patient preferences were about equally divided., Conclusions: Clinicians can expect significantly better initial reading performance for patients with central visual-field losses when reading with CCTVs versus optical devices. Handheld CCTVs, when compared with stand-mounted systems, are less expensive, provide equal performance, and have slightly lower subject preference ratings. The current study provides clinicians with objective performance data and subjective preference data that can be used to help patients with central visual-field losses select the most cost-effective reading device.

Background: Severe loss of vision can occur as a result of insults to the visual system. Depending on the level of insult, the patient can experience symptoms ranging from simple loss of visual acuity to more-complex visual motor and perceptual disorders, like visual-field loss and accompanying spatial disorientation, all of which can result in significant restrictions to the patient's mobility. This report describes the therapeutic use of ophthalmic prisms to treat patients with distinct visual impairments., Case Reports: The management of four patients, each with visual impairment of unrelated origins (age-related macular degeneration, brain injury, Friedreich's ataxia, stroke) are discussed, with special emphasis on the positive impact of prismatic prescriptions. With each case, we also discuss our reasoning for prescribing the particular prisms and their possible roles., Conclusions: Our clinical reports reinforce the notion that prisms can be effectively used in visual rehabilitation. The modulatory role of prisms is considered in terms of the neurology of the brain and its functions.

Purpose: The Department of Veterans Affairs LVES Study is a multicenter study to determine the effectiveness of the Low Vision Enhancement System (LVES) as a visual rehabilitation device. The purpose of this study was to explore the efficacy of the Beta 1 manual-focus LVES for improving visual acuity and contrast sensitivity., Methods: Patients whose visual acuity was 20/80 or worse in the better eye from any disease, who did not have significant visual field loss, who had previous low vision experience and were capable of working with the LVES were enrolled in a comprehensive prospective multicenter clinical evaluation. Initially, corrected spectacle visual acuities were measured using a standardized ETDRS chart. Contrast sensitivities were also measured with spectacle correction using a standardized Peli-Robson chart. These results were then compared to the acuities and contrast sensitivity obtained with the LVES at optimal magnification. Also, visual acuities were measured using an Eschenbach 3x spectacle-mounted binocular telescope, then compared to the acuities obtained using the LVES set at the lowest magnification (3x)., Results: All patients who completed the study demonstrated an improvement in visual acuity, with a median improvement of six lines of Snellen equivalent acuity using the LVES. Improvement in visual acuity was the same in both ARMD and non-ARMD causes of vision loss. Mean contrast sensitivity improved in 52 of 58 patients tested, with a mean improvement of 0.49 log units., Conclusion: The LVES significantly improves both visual acuity and contrast sensitivity in visually impaired patients who fall within the study criteria. Up to 10-fold improvement in visual acuity and up to 1.80 log units improvement in contrast sensitivity were noted in the study group when the LVES was used.

The new Millennium brings a new breed of low vision assistive technology--some of it straight out of science fiction--and a surge in patients who can benefit from it.

Background: Reports in the literature concerning best practice for the evaluation and management of children with visual impairments are limited, with a resulting lack of information concerning the potential for optimizing vision to enhance general development and assist with the educational needs of this population., Method: The development of a multidisciplinary approach to provide low-vision services for children with visual impairment has occurred over the past 18 years in Iowa. In that time, 1,348 children from around the state of Iowa have been evaluated through an itinerant low-vision service program, coordinated by the Iowa Braille School., Results: A low-vision clinic model--designed to provide services (primarily) for academic students--was not meeting the needs of the pediatric low-vision population in the state. After a statewide review of the program, changes were made that have resulted in low-vision services being provided to a greater and more diverse number of students. The roles of the various members of the multidisciplinary team will be reviewed. Changes in large-print orders and use by special education teachers in the state as a direct result of the low-vision services will also be discussed., Conclusion: Ongoing, comprehensive multidisciplinary low-vision services--including optometric low-vision care as a key component--are necessary to help children with visual impairments meet their educational, vocational, and avocational needs. With ongoing low-vision services, unnecessary costs such as those associated with large-print materials can be reduced, thereby creating significant savings to local, state, and federal special educational services.