At the completion of this article, the reader should be able to improve their management of people with low vision, including:
- Understand the fundamental importance of empathy in the diagnosis of low vision
- Review the latest developments in magnification devices, screen readers and other tools
- Understand the value of early referral, and how it impacts the patient journey
- Review a list of National and state low-vision support services.
Nikita Thomas
BASc, MOrth
Clinical Trial Coordinator, Centre for Eye Research Australia & Royal Victorian Eye and Ear Hospital, Melbourne
Fleur O’Hare
MPhil (Med) B.Orth (Hons)
Unit Manager of the Retinal Gene Therapy Unit, Centre for Eye Research Australia & Royal Victorian Eye and Ear Hospital, Melbourne
Senior orthoptists from the Centre for Eye Research Australia NIKITA THOMAS and FLEUR O’HARE share their perspectives on holistic low vision care, and how timely referrals for support can have a positive impact on quality-of-life for affected patients.
In a world that often takes clear vision for granted, individuals with low vision face unique challenges. Navigating daily activities can be a complex task, but with the right support and timely referrals, the journey becomes more manageable. Eyecare and allied health practitioners are in an excellent position to provide services that can improve the quality-of-life for people with low vision.
According to Vision 2020 Australia, it is estimated that over 575,000 Australians are vision impaired or blind.1 The prevalence of low vision in our community is higher in older age adults, commensurate with higher rates of sight-threatening eye conditions such as glaucoma and age-related macular degeneration.
The term ‘low vision’ refers to permanent vision impairment that significantly interferes with visual function, and cannot be adequately corrected with spectacles, contact lenses, medication, or surgery.2 Vision impairment may be caused by various eye conditions, such as macular degeneration, diabetic retinopathy, glaucoma, and inherited retinal disease, as well as neurological or traumatic injuries.
Towards a person-centred approach
When considering referrals for low vision support and care, it’s essential to have a comprehensive understanding of the cause of the vision loss and its impact on the person’s daily function. It is also important to consider the individual’s personal and social circumstances when considering management options and to discuss this with them to encourage agency in managing their needs.
A truly person-centred and collaborative approach to low vision management is achievable. It is vital that optometrists, orthoptists, ophthalmologists and the individual patients work together to map out the low vision management options available and identify the best plan. This also promotes a holistic partnership to low vision care and allows for a more comprehensive evaluation of a person’s needs. A strong multidisciplinary collaboration allows the individual to feel cared for and supported.
In our experience, we often hear stories of how the diagnosis of eye disease, and the reality of expected progressive vision loss, was delivered in a non-empathetic way. Our experience corroborates with the experiences shared in the UK where patients can feel like the diagnosis was ‘like being hit with a brick’.3 The manner in which such news is delivered can have long lasting impact. Providing empathy, support and facilitating the provision of appropriate support services is key to alleviating some of this impact.
The importance of early detection and referral
Certainly, early detection and early referral also supports this journey as well. In fact, they are cornerstones of effective low vision management. Regular comprehensive assessments, that go beyond standard visual acuity tests, are vital. These should encompass visual field evaluations, reading ability and contrast sensitivity measurements, which all contribute to understanding how best to optimise residual vision.4
Implementing standardised assessment protocols enhances the accuracy of low vision diagnoses, facilitating appropriate referrals based on the individual’s unique visual function profile. A focus on what is achievable (‘abilities’) rather than what has been lost (‘disability’) is the ultimate goal.
Don’t wait until your patient’s vision has reduced to legal blindness, or near-complete blindness. There is a window of opportunity to allow training and education before vision is severely limited.
Encourage referrals to certified low vision rehabilitation specialists who can provide personalised training, adaptive technology recommendations and orientation and mobility instruction. These services, as listed in Figure 1, aim to enhance independence and quality-of-life for those with low vision. These services often also provide individuals with training, job placement assistance and community integration programs, giving a sense of independence within the community.
Assistive technology
Advancements in assistive technology allow for individuals to lead a more independent life. It Is crucial for optometrists and orthoptists to keep informed about the latest developments in magnification devices, screen readers and other tools. Knowledge in the area also allows for informed referrals to the correct specialists who can provide further expert guidance on how to incorporate the devices into daily living.
Functional aids and alterations in an individual’s home or work environment facilitates a sense of freedom. Tactile markings, voice-activated appliances, large print calendars, and better lighting make a huge difference in ability to complete day to day tasks independently and inclusively.
10 common tools for newly diagnosed low vision patients5
If your patient is new to vision loss, it’s important they are introduced to the equipment and assistive technologies that truly support their needs.
- Magnifiers, from basic hand-held glass magnifiers to electronic versions and iPhone apps
- Mobility canes
- Dots – basic stickers and tactile markers to help those with diminished vision use home appliances
- Large print phones/keyboard
- Electronic personal assistants, such as Google Home or Alexa
- Seeing A.I. – A free app that provides a talking camera specifically designed for users with low vision
- Liquid level indicator – small cup attachment that allows those with low vision to pour liquids without over filling their cup
- Screen readers – software that uses an automated voice to read out loud words from text and alt-text based files on a computer screen
- Plastic writing guides
- Vision Australia library – Australia’s largest audio library.
Quality-of-life
Beyond the clinical aspects, optometrists and orthoptists contribute significantly to enhancing the overall quality-of-life for individuals with low vision. As mentioned, we recognise that emotional and well-being support across the entirety of the sight loss pathway may be needed.
Referrals to appropriate mental health professionals who specialise in vision-related challenges can provide tailored support. These support people may be found through enquiry to organisations that support those living with low vision.
As eye healthcare professionals, we play a crucial role in educating individuals and their family members about low vision and the unique challenges associated with it.
Participating in community engagement events promotes health awareness and shared understanding. Community engagement is also useful in fostering social connection, where people can learn from each other. Actively learning from, and listening to, people with lived experience of low vision has helped us become better clinicians.
Education around low vision support to individuals and their families is an extremely important part of low vision care. Providing timely information on adaptive aids, assistive technologies, and community resources helps to strengthen agency and patient driven decision making. Together, we can enhance and optimise low vision care.
Note: Although this article does not provide a comprehensive list of the organisations that provide low vision care in Australia, it does provides a few points of reference to help find the right people to help support those with low vision.
More reading
How optometrists can manage the visual consequences of low vision
Blind and low vision sector support NDIS review recommendations
Understanding funding for low vision services
References
1. B. Ah Tong, G. Duff, G. Mullen and M. O’Neill, August 2015, A Snapshot of Blindness and Low Vision Services in Australia, Vision 2020 Australia, National Disability Services, Australian Blindness Forum, Sydney. URL: https://www.vision2020australia.org.au/resources/a-snapshot-of-blindness-and-low-vision-services-in-australia/
2. Australian Institute of Health and Welfare. A guide to eye health data. Vision problems in older Australians URL: https://www.aihw.gov.au/reports/eye-health/vision-problems-in-older-australians/summary
3. Ferrey A, Moore L, Jolly JK. ‘It was like being hit with a brick’: a qualitative study on the effect of clinicians’ delivery of a diagnosis of eye disease for patients in primary and secondary care. BMJ Open. 2022 Jul 21; 12 (7): e059970. doi: 10.1136/bmjopen-2021-059970. PMID: 35863827; PMCID: PMC9315907.
4. Vision Matters – Orthoptic Vision Services. 1 Whitehorse Road, Deepdene VIC 3103 Australia. URL – https://www.visionmatters.com.au/
5. Vision Australia. Top 10 pieces of assistive technology for newly diagnosed patients. URL – https://visionaustralia.org/news/top-10-assistive-tech-for-patients
6. Adult referral pathway for blindness and low vision services [Internet]. 2023 [cited 2024 Jan 15]. Available from: https://www.vision2020australia.org.au/resources/adult-referral-pathway/
