Focus on Fundamentals

With a goal to refresh our knowledge and learn more, let’s take a tour through the basics of low vision—the condition, its key causes, and what treatment can look like.

➤ The Definition: Low vision is defined as vision loss that cannot be corrected with glasses, contacts, or surgery. The American Optometric Association (AOA) uses two different categories to characterize low vision: partially sighted and legally blind. This doesn’t include complete blindness, as patients with low vision can still detect light, and visual aids can still provide some level of improvement.

➤ The Causes: According to the AOA, the most common types of low vision are loss of central vision, loss of peripheral vision, blurred vision, reduced contrast sensitivity, glare light sensitivity, and night blindness.

Low vision can affect many people for a wide range of reasons. “Sometimes vision loss is inevitable,” says Richard Shuldiner, O.D. “With some of these things, no matter what you do, you’re going to lose vision. And that’s what low vision doctors treat.”

Medically, there are many eye diseases that can cause low vision. Some common causes are amblyopia, cataracts, glaucoma, and macular degeneration. Unrelated to conditions of the eye, low vision can even occur as a result of head injury, brain damage, stroke, and as a symptom of diabetes, called diabetic retinopathy.

“People who have medical conditions that cause vision loss really need two eye doctors,” says Dr. Shuldiner. “The primary care is going to take care of the medical—the retina doctor, the cataract surgeon, the glaucoma specialist. But they also need a vision doctor.”

➤ The Treatments: When it comes to treating patients, as a low vision doctor, “It’s more about doing than seeing—how to keep the patient functioning and doing the things that they want to do,” shares Dr. Shuldiner.

A low vision doctor will choose a device—whether it’s a telescope, microscope, prism, or filter—depending on how much vision a patient has left and the tasks they need help with.

➤ Key Insights: As the founder of the International Academy of Low Vision Specialists, Dr. Shuldiner has been at the forefront of pushing the understanding that vision treatment is completely different from medical treatment. “One of the big issues in the eyecare field is the lack of referrals of patients with vision loss to low vision optometrists,” says Dr. Shuldiner. “I’ve been trying to alter the culture from, ‘There’s nothing more that can be done,’ to, ‘There’s nothing more that can be done medically, but visually, there are low vision doctors that can help you.’”

According to Dr. Shuldiner, the last five years of electronic developments in optical devices have pointed to the future of treating low vision. Currently, much of the technology comes in the form of large virtual reality sets that, for some patients, make mobility difficult.

In the upcoming five years, Dr. Shuldiner expects these devices will be small enough to insert into glasses, likely with auditory operational abilities, to help people identify and move within the world around them, comfortably and confidently.