Visual rehabilitation refers to a process by which persons with vision impairment learn to maximize the use of their remaining vision in order to lead as independent and safe a lifestyle as possible.  This remaining vision is often referred to as a person’s “residual vision”.  The ultimate goal of visual rehabilitation is to help persons with visual impairment lead more personally satisfying and productive lives.

“Low vision” is a term that is commonly used to describe impaired vision that cannot be corrected with glasses or contact lenses.  A person with low vision typically has a loss in visual acuity or peripheral vision (visual field) that interferes with the ability to carry out everyday visual activities, like reading, driving, getting around, working, finding objects, and so on.

In some cases persons with low vision are also “legally blind”.  In the United States, a person is considered to be “legally” blind under the following conditions:  having central visual acuity of 20/200 or worse in the better eye, or having a visual field that extends to less than 10 degrees from the fixation point, or its greatest diameter is less than 20 degrees, or both.

However, for some people, their vision impairment may not be severe enough to meet the legal definition of blindness, but they still are considered to have “low vision” because their visual impairment causes difficulty in everyday visual activities.

It is important to keep in mind that visual rehabilitation is not just for persons who are legally blind, but also for others with low vision having minor to moderate visual impairment.   For example, it is not unusual for persons with visual acuity in the 20/40 to 20/100 range to seek visual rehabilitation services because they need assistance compensating for their difficulties.

The most common group of clients seen in visual rehabilitation centers are persons with macular degeneration, especially older adults with AMD.  Since the major problem in AMD is impairment in central vision, rehabilitation strategies for persons with AMD center on educating and training clients about compensatory strategies to overcome loss of central vision.  These compensations do not restore vision to normal.  Rather, these compensations are strategies for working around the vision impairment or enhancing the residual vision so that the person can perform visual tasks that previously had been impossible or exceedingly difficult.

Who provides visual rehabilitation services?
These services are provided by a number of professionals, who often work together as a team.  These professionals include ophthalmologists, optometrists, occupational therapists, and rehabilitation educators, who have undergone specialized training in visual rehabilitation.  Psychologists and social workers often participate in providing visual rehabilitation services, especially assisting in issues having to do with adjustment, coping, and family issues.


What are visual rehabilitation services for persons with AMD?

Magnification
Magnifying lenses and other special devices make what you’re looking at bigger so it’s usually easier to see.  However, they do not make vision clearer for the person with AMD.  Popular magnifying devices are microscopes, hand held magnifiers, stand magnifiers, telescopes and closed circuit televisions.  A vast array of these devices are available, with a few examples pictured here.  These types of devices can be  helpful in reading.  They are prescribed after a thorough evaluation of the patient’s visual function to meet their particular visual needs.  Although most of these devices are available without a prescription, we recommend that persons with AMD consult with a doctor specializing in low vision, thus affording them the widest possible range of low vision devices to determine which devices will be most helpful before making purchases.  Proper training in the use of these devices is also a key part of effectively using them.

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Eccentric Viewing Training
Because persons with AMD have decreased central vision, they may benefit from training to enhance the use of their side (peripheral) vision.  This is called eccentric viewing training.  Eye “exercises” are prescribed to teach clients to use the best location in their peripheral vision to achieve maximal visual acuity or contrast sensitivity.

Environmental Adaptations
There are a variety of environmental adaptations and non-optical devices that the doctor or rehabilitation specialist will suggest after discussing the persons’s living or working environment.  These adaptations range from lighting improvements, visual design enhancements such as adjusting color, contrast, and texture, and convenient devices that help with carrying out specific visual tasks, such as check-writing, using the telephone, shopping, self-care activities, and driving.  Suggestions will also be provided on ways to make the home safe given the visibility problems the person may be facing.

Orientation and Mobility
Orientation refers to awareness of one’s position in the environment, and mobility refers to the ability to travel efficiently and safely from one location to another.  These skills are taught by specially trained visual rehabilitation professionals.  Persons most likely to benefit from this training include those with new onset blindness or severe visual impairment, including some patients with AMD.  This training can include the use of a long white cane.  The long cane is swept in front of the user in a systematic back and forth manner to detect obstacles and changes in the surface that they are traveling on (curbs or steps for example).  It also serves to identify the user as a person with vision impairment, which is useful information for other pedestrians or drivers moving in the same area.  Using a cane for mobility purposes is a sophisticated skill that requires a training program.

Another less sophisticated mobility enhancement technique is called sighted guide.  Many patients with AMD can benefit from this technique.  The person with vision impairment grasps a guide’s arm just above the elbow and walks just slightly behind and to the side of the guide whose arm rests naturally at their side.  The follower can then sense the movements of the guide to enhance their mobility through the environment.  The guide can also give verbal clues such as “we are approaching a curb.” This is most useful in unfamiliar environments and can be taught easily by most members of the rehabilitation team.  This technique does not require formal orientation and mobility instruction.

Guide dogs are rarely useful for AMD patients.  Both the guide dog and its user must receive rigorous training for the partnership to be effective.  Dogs are taught basic travel skills such as obstacle avoidance and safe crossing of streets, but they cannot independently guide their user through the environment.  They follow the verbal instructions of the user.  To receive a guide dog, the potential user must be legally blind and able to maintain the dog with proper exercise, feeding, grooming and veterinary care.  Since AMD spares the peripheral vision, most patients do not require the use of a guide dog to move safely about their environment.

Psychological and Social Services
Loss of vision can have varied effects on a person’s daily life, and as such, individuals with vision impairment may need guidance or assistance in adjusting to the loss of vision, People with functional vision loss from AMD may become angry, depressed, frustrated or simply deny the changes they are going through.  Patients experiencing these feelings should be evaluated by and if indicated, treated by a psychologist.  Local support groups for persons with AMD or vision impairment can also be very helpful.  Patients with AMD may also benefit from the services of social workers who can facilitate issues related to family relationships and community involvement like transportation.