Chapter 89: Low Vision Rehabilitation

WHAT IS LOW VISION REHABILITATION?

LOW VISION REHABILITATION (LVR) IS A NEW subspecialty emerged from the traditional fields of ophthalmology, optometry, occupational therapy, and sociology, with an ever-increasing impact on our usual concepts of services for visually impaired patients, research, and education.¹

Ophthalmology medical and surgical treatments aim first and foremost to preserve and/or restore organ structures threatened or damaged by disease. The final goal of eye care, however, is to preserve and/or restore quality of life (QOL) and function previously enjoyed by the individual, preferably ad optimum.² Evidence-based data show that patients gain better visual functions such as visual acuity, fields of vision, contrast sensitivity, and oculomotor functions as a result of medical and surgical treatments, and better visual skills such as reading and mobility as a result of LVR training, together rendering better QOL.

LVR retraining is part of a multidisciplinary effort and essential for the optimal restoration of skills and QOL. It is generally agreed that LVR includes low vision assessments together with prescribing and provision of low vision devices as well as low vision rehabilitation therapy and training. It includes the treatment and education process that enables individuals who are blind or visually impaired to attain maximum function, a sense of well-being, a personally satisfying level of independence, and optimum QOL, which are critical to their safety and mobility. Function is maximized by evaluation, diagnosis, and treatment including, but not limited to, the prescription and dispensing of optical, non-optical, electronic, training, and environmental modifications and/or other treatments.

Permanent loss of vision is devastating and its impact on QOL and well-being of the individual is beyond levels of visual acuity measured in the office. Functional vision is the yardstick by which patients assess our interventions and not levels of visual acuity. Cataract surgery that restores vision to 20/200 may not be viewed as a success by the surgeon; however, it would be viewed as a 100% success by the patient who can again read newspaper print with visual aids.³

Background

Low vision (LV), blindness, and low vision rehabilitation (LVR) were recognized as health entities centuries ago. During his travels to China in the thirteenth century, Marco Polo discovered, quite surprisingly, that elderly people use magnifying glasses for reading, a practice that was swiftly adopted in Europe (Fig. 89–1). The advances in medical sciences witnessed during the eighteenth and nineteenth century brought new attention to eye diseases, blindness, and LVR. One could talk about LVR per se only starting with the beginning of the twentieth century. Roughly, we will talk about two historical periods before we detail the state of the art today.

Before World War II, from a demographic perspective, most of the visually ...