Vision loss from diabetic eye disease is a well-known complication of diabetes and typically requires medical management by an eye doctor (an ophthalmologist or optometrist, depending on severity). Treatment goals are to limit disease progression and to restore as much sight as possible. Despite the best medical treatments available, the vision you are left with may still be insufficient to do the things you want to do – for example: driving a car, seeing a computer monitor, or reading from a book or cell phone. If this sounds like something you or a loved one are experiencing, you should make an appointment with a doctor who focuses on helping patients with these types of functional impairments – a low vision optometrist.
What Is Low Vision Optometry and How Is It Different from “Traditional” Optometry?
To illustrate the differences, let’s start with a few definitions. The term ‘low vision’ refers to vision loss that impairs your ability to do the things that are important or necessary for you despite wearing glasses or contact lenses. ‘Visual acuity’ is a measure of the sharpness of your central vision (e.g., 20/40). Visual acuity is not a measure of visual functioning, it only provides one (sometimes deceptive) piece of information. There are patients with very good visual acuity that cannot read a simple line of text, or who need to use a white cane to ambulate safely, while others with very poor visual acuity may be functionally less impaired.
Low vision optometrists look at more than acuity; they are trained to determine the extent of the functional vision loss, how it impacts a patient, and how to utilize a specialized set of tools to help people achieve their visual goals, maintain independence, and enjoy life by getting back to the things they love. For some patients, this means tasks like reading mail, reading prescription bottles, grocery shopping, driving, and watching television.
By contrast, “traditional” optometrists are the general practitioners for the eye. They perform routine examinations to ensure the continued health of the eye, manage specific eye conditions, and provide glasses or contact lenses to correct changes in refractive error.
When to See a Low Vision Optometrist
Throughout life, when one’s vision becomes fuzzy, they go to their general optometrist for an eye exam and a new eyeglass prescription. However, patients with low vision often find that those new glasses just aren’t helping like they used to, and they still struggle to see the things they want and need to see. This is the time to see a low vision optometrist.
What to Expect at Your First Visit
Low vision evaluations are goal directed, so I suggest you carefully consider your goals ahead of time, and write them in a list organized from greatest to least important. While offices typically have samples of different print sizes and different types of media (iPads, newspapers, etc.), you should bring your own goal-related materials whenever possible to ensure the best outcomes. Low vision evaluations are lengthy and may take 1-2 hours. I always recommend that people have a friend, family member, or caregiver accompany them and stay in the room during the evaluation – there is a lot you are going to want to remember. You will be exposed to many types of low vision aids, from traditional to unusual looking (but often very helpful) glasses, electronic devices, and handheld optics. Some types of aids may be available for you to take home that day or shortly thereafter, while advanced custom devices (e.g., telescopic glasses for driving) may take a month to fabricate. Remember, keep an open mind when it comes to the cosmetic appearance of devices – the doctor’s job is to help you to see better and function better, not to help you look better!
Common Goals & Results
Common goals that low vision doctors help people to achieve are: to better see street signs and traffic lights while driving, the faces of loved ones, their television and computer screens, books, newspapers, mail, and portable electronics (cell phones, tablets, etc.). Not every goal is achievable by everyone, but most diabetic patients can be helped to some degree, and for some people, results can be life-changing. Helping a person with diabetes to see better while driving, for example, can open the doors to holding down a job, grocery shopping, socializing with friends, etc., and lead to an increased sense of independence and purpose.
Low Vision Optometry & Insurance
While the best news for visually impaired patients is that ‘help is available’, the worst news may be that most insurance companies will not pick up the tab for low vision devices. Depending on your level of vision impairment and the particular aids with which you are most successful, the cost may range from a few hundred to a few thousand dollars. Fortunately, there’s no guesswork when it comes to low vision aids and, by the end of a low vision evaluation, you will have been exposed to different types of devices and tried them out firsthand. You will know how helpful each device is and will have all the information to make an informed decision.
How To Find a Low Vision Optometrist
Most people have never heard of low vision optometry, so it is not surprising that only a small percentage of people who would benefit from low vision care ever receive it. One of the best ways to find out what low vision services are available in your area is to Google the term “low vision” along with the name of your city or state.
It is important that the doctor you choose has experience with advanced custom low vision aids (glasses mounted with telescopes or telemicroscopes, for example), as this will give you access to many types of solutions that would not otherwise be available (such as glasses that aid in seeing street signs while driving). An excellent resource for locating a low vision optometrist with this type of experience is the International Academy of Low Vision Specialists (IALVS) website: www.IALVS.com. This is not an all-encompassing list of low vision doctors, and your Google results may turn up other good leads. Do your research!
The Importance of Low Vision Care
In the course of practicing general optometry for many years, I found myself face to face with low vision patients who were not receiving the help they deserved. Generally, these patients were doing their part – they were seen regularly by primary care doctors, ophthalmologists, optometrists, and some had even taken advantage of community support resources. But still they suffered from vision loss and the emotional effects of vision loss – isolation, dependence on friends and family, hopelessness, and depression – and they were being told that ‘nothing more could be done’. The truth is that quite often something can be done. Ultimately, I gave up my career in general optometry to assist people who struggle with vision loss, and to educate the community about the important role low vision care can play in the lives of visually-impaired patients.
Low vision evaluations are painless, and they are typically positive and uplifting experiences that explore customized vision enhancement options that most patients never knew were possible.
For more information, visit eyehelpsandiego.com.
Additional Resources:
A Dose of Dr. E: A Peek and a Poke Inside My Eye Appointment
Diabetes and Eye Health: How to Protect Your Peepers
Facebook Live: Diabetic Retinopathy, Macular Edema & Diabetes-Related Eye Care
You made a great point about how the doctor you select must have experience with cutting-edge custom low-vision aids (glasses mounted with telescopes or telemicroscopes, for example), as this will open up a world of options for you that would otherwise be inaccessible (like glasses that help with road signs while driving). I’m going to tell my sister about this because she’s been whining about headaches from her visual issues. She must decide whether or not she needs to think about using prescription glasses.