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by Dr. Ahmed Abdullah, Centre for Sight

When someone says, "I can see" or "I cannot see" it does not need further elaboration. But when someone says "I cannot see well" or "I can see but not well enough", these statements need some further clarification to understand what they really mean. It takes us into the grey zone of Low Vision where things measured and decisions taken vary according to the individual concerned, his symptoms, his expectations and his limitations.

According to WHO more than 35 million people worldwide are in need of Low Vision Care. Most of them are in developing countries.

Having Low Vision is the third most commonly occurring physical impairment in those over the age of 65, exceeded only by heart disease and arthritis. Many who are visually impaired have found help with their vision problem through Low Vision Care.

Vision is a complex sense, encompassing the ability to perceive detail (acuity), colour and contrast, and to distinguish objects. These capacities can diminish naturally with age. While most visual changes can be corrected by glasses, medicine or surgery, visual changes caused by eye disease, poor health or injury can cause permanent vision loss. If the loss is total, the result is blindness. If it is partial, the result is a vision impairment known as "low vision." A person with low vision has severely reduced visual acuity or a significantly obstructed or diminished field of vision.

Signs of Low Vision

* Difficulty in recognizing a familiar face

* Difficulty in reading - print appears broken or distorted

* Difficulty in seeing objects and potential obstacles such as steps, curbs, walls and furniture

Low Vision is a condition that cannot be corrected by conventional eye-glasses / contact lenses, medicine, or surgery and is usually the result of injury, poor health or a variety of disorders that affect the eye (many age related), including: Macula Degeneration, Diabetic Retinopathy, Glaucoma, and Retinitis Pigmentosa etc.. This decrease in vision may be permanent or sometimes reversible.

Under these Low Vision circumstances, regular eyeglasses held at normal distances may no longer be sufficient to allow someone to drive or even to read big-print materials, but there are numerous other approaches which may be beneficial to these individuals. The concept of Low Vision is based on the fact that these people with partial vision still retain some usable vision. With proper orientation, help and encouragement, by using proper devices they are able to see better, and utilize that vision in a useful way.

Generally speaking, a person who has nearly lost his vision is preoccupied with his lost vision. The Low Vision expert will skilfully direct him away from that depression and make him understand still how much he could achieve with the remaining vision. This Low-Vision philosophy aims at making persons aware of their remaining vision, so that they do not just focus on their loss or their impairment. Low-Vision training is the most essential part of Low-Vision services.

In developed countries Low Vision Care is an integral part of the general eye care facilities available to the public. Even the private ophthalmology practices include a special section where individuals with partial sight are taken care of. These units are manned by specially trained professionals called Low Vision therapists. Thousands of people are examined in these centres daily where Low Vision Care services are provided.

But unfortunately in our country as there was no such facility, all these years, patients with Low Vision have often been turned away with statements such as, "Nothing more can be done," putting the blame of defective vision on old age.

The door to rehabilitation is thus effectively closed, and the patient is left to adjust in a haphazard fashion, often becoming a burden on relatives and on society, finding Low Vision Care by chance if at all.

It is with great pleasure that we note that the first Low Vision Centre in Sri Lanka was opened recently at the General Hospital Kandy under the auspices of leading ophthalmologists Dr. Saman Senanayake and Dr. Tissa Senarathne. It has been a long felt need among the eye patients in Sri Lanka to have such a centre as a stepping stone for vision rehabilitation.

At this centre a trained Low Vision practitioner will first accurately assess the patient's level of usable vision. 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, clock 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.

Patients will also be asked specific questions about his 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 grey shirt 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? Etc.

According to the findings of this examination the ophthalmologist may prescribe low vision devices that can maximize the use of remaining vision.

With the help of these devices the quality of the image can usually be improved. Low Vision devices are special lens systems designed to magnify or illuminate images to improve visual functioning.

These may take the form of optical products such as stand mounted or hand magnifiers, telescopes, high-powered spectacles, absorptive filters or electronic devices. In addition, there are many helpful non-optical devices, such as large print newspapers, magazines and books, magnifying make-up mirrors, writing and signature guides, and computer screen enlargement programs etc.

Typically, Low Vision Care is an ongoing service in which eye care and rehabilitation professionals work with the visually impaired persons over time to meet their visual goals. An initial Low Vision evaluation will take approximately one hour, but additional follow-up visits of 15-30 minutes may be needed until all of the visual goals have been satisfied.

One thing that should be kept in mind is that Low Vision Care will not restore lost sight. The focus of the Low Vision therapy is not curing the vision impairment; instead, it is rehabilitation - finding new ways for the patient to continue to function and enjoy what's important to him or her, to assist the visually impaired in maximizing their remaining functional vision.

In addition to learning how to use optical devices, people with Low Vision can acquire new strategies for accomplishing everyday tasks, working productively, coping with vision loss and getting around safely.

The adaptive process, in coordination with low vision services, is known as vision rehabilitation; its goal is to equip people who are visually impaired with the skills and confidence needed to function as independently as possible.

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