by Cydney Strand, RN

low vision exam

"It's not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change." - Charles Darwin

"But I thought you were going to help me," implored Mrs. Kern, as I began showing her how to use her new spectacles. The examination part of her low vision visit had concluded, and Mrs. Kern had felt optimistic. Unlike her last eye exam, at which she could barely see the large "E" at the top of the eye chart, she had just read three full lines of the low vision eye chart. Maybe things were improving, she thought.

Now in the instruction room of the low vision clinic, we were following the doctor's recommendation and working with a pair of spectacles that gave Mrs. Kern the ability to read the newspaper - but it meant having to hold the paper six inches from her face. And when she looked up at me, everything was out of focus again. Why did these glasses only work up close? Again, she protested: "I thought you were going to help me!"

The misunderstanding of what low vision care is - and is not - often causes confusion and frustration. Low vision care is about rehabilitation, not cure. It's about finding new ways to accomplish the tasks of daily life - whether it's writing a grocery list, watching a grandchild play soccer or reading a menu in a restaurant.

Examinations Tailored to Help You

A low vision examination, often the first step in vision rehabilitation, is designed to accurately measure how one's vision works in the real world - how it functions in day-to-day living. It's not only about how well you can see an eye chart, but also how well you can see faces, street signs, newspaper print, stove dials and all the other visual clues that guide you through the day. The low vision clinician uses special charts to measure how well you see both at a distance and up close. Additional vision tests measure contrast sensitivity and locate blurry or distorted areas in the visual field.

You will also be asked specific questions about your vision. Are you affected by glare - outdoors, indoors or both? Do you have difficulty seeing under different lighting conditions? Do you see better on sunny days or cloudy days? How do you describe your ability to see contrast, such as a light gray sweater lying on a white bedspread? Are there any blurred or distorted areas in your vision? Where are they? Do you see better when you look slightly away from the object?

Additional questions address your ability to manage activities and tasks of daily living. Expect to discuss with the low vision specialist how your vision impairment impacts your life. Do you travel independently? Can you safely prepare your own meals? What about grocery shopping, making phone calls or taking medications? Can you write checks and manage other financial tasks? How does your vision loss affect your participation in leisure pursuits or in employment-related activities? Do you have any special or unusual hobbies that will need some creative solutions?

Getting Equipped for Independence

The information gathered during a low vision examination enables the doctor to prescribe the device(s) that will best meet your individual needs. Device selection is based on several considerations:

  • How strong of a lens do you actually need? Can you use a weaker lens for some tasks? A strong magnifier can be difficult to use. It must be held very close to the object it's magnifying, and even the slightest motion can cause it to lose focus. The size of the area that can be viewed is also reduced as the magnifier gets stronger. In fact, the "best" magnifier is usually the weakest one that still allows you to accomplish a specific task. Sometimes it's even necessary to practice with a weaker magnifier in order to develop the skill to use a stronger one.
  • How and where will you use the device? Do you plan to carry it with you, or will it sit on your desk?
  • With what kind of activity will the device assist, and how close can you get to the task at hand? Very close (reading a newspaper), not too close (cooking an omelet) or not close at all (watching a theater performance)?
  • Do you need your hands to be free while doing the task, or can you hold a magnifier? Are safety issues involved?
  • How big are the items you wish to see? Can the activity be made easier with better use of lighting, controlling glare or increasing contrast?

While your doctor may suggest many options for devices, the final choice is yours. You'll also receive instruction in how to use them and time for practice. Getting accustomed to using most devices often requires additional practice at home.

Continuing the Rehabilitation Process

A low vision specialist will prescribe devices to maximize your existing vision, but there's more that can be done. Other vision rehabilitation professionals can offer guidance with activities that you may no longer be able to do visually. Alternative, non-visual solutions may need to be learned, while other tasks can, in fact, continue to be done visually with practice and patience. Success with one task can ultimately lead to additional accomplishments, and these positive outcomes may inspire you to achieve even more with your remaining vision.

Accepting change is part of the vision rehabilitation process. Often the hardest challenge is adapting to life with impaired vision. The motivation for change increases, however, if making it provides a personally meaningful reward - getting something you really want. This is why it's so important that the low vision examination address the specific needs of each individual. The doctor may guide you to the tools, but you make the tools work.

Few people can truly be prepared for their first low vision visit. The emotional stakes are high, and it's hard to know if your expectations are realistic. As I listened to Mrs. Kern, I understood that she had expected to be able to read as she had always read. And she expected to get one pair of glasses that would allow her to "do everything." To Mrs. Kern, "help" meant having her vision back the way it was. She needed time to adjust to a new definition of "help" - one that included her as a major participant.

The low vision exam marks the beginning of a challenging journey. With the proper tools and guidance, plus your own resourcefulness and determination, you can experience successes you didn't think possible.

Cydney Strand, RN, is a Clinical Educator.



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