What is low vision?
Low vision describes any situation when a person's vision falls below the normal standard and is not amenable to any medical treatment or be fully corrected with spectacles or contact lenses.
This becomes significant when the vision is affected to the degree that it affects everyday life, for example the ability to drive, the ability to read or the ability to navigate around successfully.
This can have obvious practical implications on everyday life, but can also have implications for overall wellbeing – perhaps increased risk of injury, or on their social outlook and mental health.
There are a lot of organisations in the UK which aim to support those with low vision. The Royal National Institute for the Blind (RNIB) is the highest profile of these organisations and provides a wealth of information, visual aids and support to individuals with low vision.
Most hospital eye departments will have a low visual aid clinic that can provide optical visual aids to help with reading and writing.
Some regions will have visual impairment societies that can visit people and assess their home environment to see if any modifications can make everyday living more manageable.
The majority of people with low vision are elderly and often live alone, so a lot of these organisations hold lunches and other social events which are really invaluable in preventing these people becoming socially isolated.
There's a wide range of different eye conditions that can lead to a permanent loss of vision. More information can be found on these on the RNIB website.
However, in the UK the major cause of registered vision loss is macular degeneration.
Macular degeneration causes a loss of central vision, which can lead to problems when reading, recognising faces and other tasks requiring clear central vision. Often people need additional help from magnifiers or other devices to help them read.
In general, the types of tasks visually impaired people find difficult will depend on the underlying eye condition.
It is therefore important to understand what eye problem is causing the poor vision, whether any treatment is available and how this condition is likely to progress.
Having this discussion with the patient can help them to adjust to their sight loss and think of ways to help them cope in the future.
Counselling services can be accessed through your GP, or the RNIB offer a confidential emotional support service telephone helpline 0303 123 9999.
Registration or certification of low vision
In the UK, people with significantly reduced vision can be formally registered as 'blind' or 'partially sighted', the difference being dependent on the degree of visual loss.
Being registered makes it easier to access practical support from social services and can lead to concessions and benefits.
Registration is voluntary and confidential. The register is held by the social services or local council department and has two categories.
- Partially sighted (sight impaired).
- Blind (severely sight impaired).
Registration is completed by the patient's ophthalmologist who will examine them, discuss the benefits of being registered and with the patient's permission fill out the appropriate form to facilitate this.
They will make the decision based on your distance vision and field of vision measurements.
The rules about the level of sight loss needed to be registered are outlined on the RNIB website.
Assessment of visual needs by the local social services department can also be requested without formal registration.
Strategies for making the most of your vision
Many of the difficulties associated with loss of vision are due to reduced reading ability, and most people with low vision find magnifiers helpful for short daily tasks – such as reading mail or expiry dates on food. A wide range of magnifiers are available, and they differ in strength and how they are used. Some magnify close work tasks and others are used for objects further away.
Types of magnifiers for close-work.
- Hand-held: cheap and widely available in a good range of magnifying powers X1.5 to X15. They can be held in one hand, and they are often available with a light in them. It can however be difficult in some cases to use these if manual dexterity is affected by arthritis, stroke or tremor.
- Stand: slightly more bulky than a hand held magnifier, but they are fitted with a stand that rests against the page, making it easier to keep the object in focus. Stand magnifiers can be available in powers of 2x to 20x magnification and are often fitted with a light.
- Spectacle mounted: the magnifier lens is fitted into a spectacle frame. This is not the same as ordinary spectacles. It does allow both hands free but requires the book to be held very close to the spectacles. The stronger the magnifier, the bigger it makes the object appear. Unfortunately, the stronger magnifiers become the smaller the amount of print they can view. It is not possible for a really strong magnifier to cover the whole page of a book. Learning to use a magnifier can be a slow process and it is vital that appropriate instruction on how to use it properly is provided. The best way of finding the correct magnifier is by having a low vision assessment. Most NHS eye departments will provide a low vision service that loans out a range of magnifiers, free of charge. This is a good option because most people's sight loss will change over time, and therefore their magnifiers may need to be altered.
- Electronic magnifiers: spectacle mounted, hand held and stand magnifiers are limited to about 20x magnification, whereas some electronic aids can achieve 70x. Most electronic aids use a camera to create an enlarged image on a viewing screen. Other features can be incorporated, such as improved contrast and a zoom function. Electronic magnifiers tend to have to be bought privately but can often be trialled first.
- Computers and tablets: modern tablets can be very useful as the material on them such as books and newspapers can be enlarged very easily. Also on conventional computers email font can be enlarged, which offers a good alternate means of communication.
People with low vision in education and employment will often receive adapted IT equipment and electronic aids, if they are necessary for the individual's work or learning needs.
There are different distance magnifiers.
- Telescopes: telescopic systems can achieve a magnified image, but it's difficult to use due to the small field of vision. Training is often needed before a person can use the telescope well.
- Binoculars: you can use both eyes to view far off objects. This can useful if you have nystagmus (shaky eyes).
2) Adaptions and daily living aids
There's a large range of strategies and techniques that can help around the home, such as the following.
- Improved lighting: for some people, better lighting will improve contrast for reading and other tasks.
- Enhancing contrast: putting white stripes onto the edge of each step on a staircase will make them easier to detect, or marking switches and dials with bright coloured stickers will help show which setting is in use.
- Substituting other senses: talking books and newspapers are available or Braille lessons.
- Training in special reading techniques: this includes eccentric viewing, for people with poor central vision, is available in some areas.
The local social services or blind society are the best placed to give individual advice on what adaptations to the home environment may be made.
3) Rehabilitation services
Rehabilitation workers are provided by social services to assess and work with people in their home or other desired environment.
They provide practical solutions to daily living tasks that are made difficult by low vision.
An assessment is done to establish what will help someone overcome their difficulties. This is used to formulate a care plan. The care plan will list required changes and adaptations to person's home and their training needs, such as the following.
- Adaptations to the home: improved lighting and contrast, modifications to aid safe mobility and use of household items which have been modified for people with visual impairment.
- Training in daily living skills: enhancing kitchen or personal-care skills. Orientation and mobility: providing the training required to help people get about safely inside and out. This may involve training with a guide dog or white cane.
- Other services: include referral to occupational therapy or counselling.
This is a brief overview of the support available for people with visual impairment, however more information could be obtained on the RNIB website or by contacting your local low vision clinic.
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