Orthoptists can play a key role in supporting individuals with complex vision needs, but they also need the support of an NDIS that does a better job of assisting people with disabilities to live ordinary lives, writes Ms Jemila Kanu.
As Australia’s world-leading National Disability Insurance Scheme (NDIS) continues to evolve, there are opportunities to enhance support for individuals with low vision and neurological vision impairments, particularly through improved recognition of the functional impacts of vision loss and the critical services that enable full participation in daily life.
A significant gap lies in the awareness and integration of vision-related supports, particularly for children with conditions such as cerebral visual impairment (CVI), retinopathy of prematurity, optic atrophy, or visual field loss.
These complex conditions do not always present as a traditional “eye problem” but can have a profound impact on how someone interprets the world, navigates space, and engages with others. When misunderstood or misclassified as purely medical, essential vision supports may be inadvertently excluded from NDIS plans.
This issue becomes especially apparent when families seek vision services such as orthoptic low vision assessments, vision therapy, assistive technology, orientation and mobility (O&M) training, or environmental adaptations, only to find that they fall outside the scope of current support pathways.
Yet, for people living with neurological vision impairment, these services are vital to building independence and safety.
Seven-year-old Maya is one such example.
Born extremely prematurely at just 23 weeks, Maya lives with cerebral palsy, epilepsy, and multiple forms of vision impairment, including bilateral optic atrophy, CVI, and severe visual field loss. A recent assessment of her functional vision showed a visual acuity of 6/24 with both eyes open and a visual efficiency of just 15%, factoring in visual field loss, contrast sensitivity, and visual processing difficulties.
For Maya, recognising faces, interpreting cluttered environments, and sustaining visual attention can be daily challenges. Her vision can appear to “switch off” when she’s overwhelmed or fatigued, affecting everything from learning in the classroom to safely navigating new spaces.
Without appropriate functional vision supports, children like Maya miss out on the chance to develop crucial life skills. These are the supports that can help them interpret visual cues, move through their environments safely, and participate in learning and play at a higher capacity.
Orthoptists are uniquely qualified to assess and support individuals with complex vision needs, particularly where neurological vision impairment is involved.
However, recent changes to NDIS legislation have made it increasingly difficult for participants to access orthoptic care, as these services are sometimes excluded or not clearly recognised within funding categories.
As a result, families are left navigating fragmented systems, often without access to the most appropriate vision professionals.
Despite Maya’s well-documented challenges, her requests for vision-related supports were not approved in her NDIS plan. The decision cited that her needs were already met through ophthalmology follow-up – a valuable medical service but one that does not provide the day-to-day functional support required to use vision effectively.
Similarly, it was suggested that an occupational therapist could provide orientation and mobility training, although such services require specific expertise and qualifications offered by Orientation and Mobility Specialists.
Maya’s case is not unique. Many families across Australia report similar experiences, particularly when the vision impairment stems from neurological causes. The need for better recognition of functional vision loss and specialist services within the NDIS is clear.
Fortunately, this represents a significant opportunity for positive change. Enhancing planner awareness, refining assessment processes, and ensuring access to qualified orthoptists and O&M specialists could make a meaningful difference for Australians living with low vision.
Recognising vision supports as functional, not just medical, would bring the NDIS into closer alignment with its core goal: to support people with disabilities to live ordinary lives.
With greater understanding and integration of vision services, children like Maya can receive the support they require to thrive, not just medically, but functionally, socially, and developmentally.
It is a small shift that could bring a lasting impact.
About the Author: Jemila Kanu is the founder of In-Sight Vision Therapy in Perth. An orthoptist with more than 13 years of on-field experience, she is dedicated to supporting individuals living with visual impairments and neurological conditions.
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