Tell us about yourself. What is your background, education, and training?

I have an undergraduate degree in biology from the State University of New York (SUNY) at Stony Brook, and a Doctorate in Optometry from the SUNY College of Optometry in Manhattan. I am currently a faculty member there and conduct the College’s Homebound Eye Care Program in Manhattan.

The Homebound Eye Care Program was started by the SUNY College of Optometry about 20 years ago and sends optometrists into local neighborhoods in Manhattan and Queens to provide high-quality eye care for people who are confined to their homes. Our homebound patients include older adults, people with multiple disabilities, and people with other health conditions, such as stroke, cancer, obesity, paralysis, and dementia. Some of our patients are also without family or other homecare services. These conditions can make it challenging, if not impossible, to access health and eye care services that are available in the community.      

Can you tell us more about the Homebound Eye Care Program? It sounds like an interesting and much-needed service.  

We bring portable eye examination equipment to the patient’s home, determine his or her eyeglass prescription, and perform basic tests for eye disease. We also provide eyeglasses to our patients when needed, for both distance and reading. I am a certified low vision specialist in New York State and spend much of my time evaluating individuals who have low vision and/or visual impairments.

If a person in the Homebound Program is visually impaired, I can perform a basic low vision evaluation and bring simple low vision optical devices to the patient’s home, such as different types of magnifiers and magnifying reading glasses, to see if he or she can use them to read more easily.

We have been particularly fortunate this year and last, because we received a generous grant from the Reader’s Digest Partners for Sight Foundation. The grant pays for simple reading lamps for our homebound individuals who have inadequate reading light. The floor and table lamps that we dispense are enormously helpful for a good number of people who live in dark apartments and have no way of obtaining proper lighting. It’s been a life-changer for many people – they really appreciate it.

How does an individual qualify for services from the Homebound Eye Care Program?

The only qualification for our Homebound Program is that the individual has difficulty getting out of his or her home. For example, if a person lives in a fourth-floor apartment in a building without an elevator and can’t get up and down the stairs, we will come to them. If someone is in hospice care or is paralyzed, we will certainly make a home visit. A good percentage of our homebound patients are poor, on limited incomes, and often live in public housing projects.

There is a great need for visiting doctors of all types in New York because of the high proportion of older adults who are homebound and whose everyday living needs are often unmet. I get to meet people who have had very interesting lives and I’m able to see them in their home environments – and also at the end of their lives. Some people become very lonely and enjoy my visit for the personal contact I provide – it can really brighten up his or her day.

One of my patients is Sally L., a 70-year-old woman with post-polio syndrome, who is paralyzed and bed-bound. Sally had a professional career as a speech pathologist when she was more mobile. She also spent two years in an iron lung in the 1950s when she was a teenager. I convinced her to learn to use a laptop computer and the Internet, which has completely changed her life. Sally is featured in “Homebound,” a documentary film I created about my patients. She is a very interesting and spiritual person and is now an old friend.

You sound like a very busy person. Do you provide low vision services in any other settings?

I’m also the Director of Low Vision Services at the New York Eye and Ear Infirmary in Manhattan. I have always worked exclusively in the field of low vision rehabilitation and I find it very satisfying to help people with low vision learn to use their remaining functional vision more effectively to perform important everyday tasks, such as reading newspapers, writing, telling time, reading medication labels, and seeing the computer screen.

A comprehensive low vision examination involves a thorough assessment to determine whether special low vision optical devices, better lighting, or other types of training can help the person with low vision to use his or her functional vision more effectively.

Please note: You can read more information about the specifics of a low vision examination and vision rehabilitation services at the conclusion of Dr. Freed’s interview.

After the low vision examination is completed, I then help each patient to determine his or her individualized visual goals. For example, does the patient need to read mail, medication labels, newspapers, or books; thread a needle; or see a computer screen?

When the patient has determined his or her visual goals, we can then decide on the type of low vision optical device, such as a hand-held magnifier or magnifying reading glasses, or low vision non-optical device, such as better lighting or special light-filtering sunlenses, that might help with a given task.

In addition to low vision optical or non-optical devices, the low vision specialist can recommend a referral to vision rehabilitation services for specialized training from a Certified Vision Rehabilitation Therapist (CVRT), a Certified Orientation and Mobility Specialist (COMS), or other vision rehabilitation professionals.

Do you work in any other locations?

I work in several hospital-based ophthalmology training programs in and around New York City, in which I help train medical doctors who are specializing in eye surgery. I teach contact lens fitting, low vision, and optics. Optics is a science that deals with the properties of light, including the way light changes direction when it passes through a lens, which is part of refractive error testing, or determining the best-corrected regular eyeglass prescription.

These clinics include The Long Island Jewish-North Shore University Hospital, St. Luke’s Roosevelt Hospital, Bronx-Lebanon Hospital, Queens Hospital, and New York Eye and Ear Infirmary. As you can imagine, my schedule is very hectic, but I love to teach these subjects. I try to get the resident doctors to think about how their patients will function visually after they leave the eye clinic environment. The doctors in training are really smart and I enjoy helping to train them. 

In 2000, I traveled to Aravind Eye Hospital in Maduri, India. Cataracts are a leading cause of blindness in developing nations and this world-famous eye hospital provides care free of charge for people in need. Cataract surgery is done in assembly-line style and the division of labor makes the outcome very efficient. You can see my photos from this trip on my personal web site at http://banjoben.com/India.htm.

What made you interested in pursuing low vision as an optometric specialty?

My father was an optometrist and he instilled in me the importance of having compassion for people in need. He was a particularly influential person in my life. I gravitated to low vision because it is unique. I liked how the field of optometry combined the disciplines of optics, physics, anatomy, physiology, and psychology.

As I noted before, I enjoy figuring out each patient’s refractive error, which is the eyeglass prescription needed for the clearest possible vision. Because of its rigorous study of clinical refraction, the profession of optometry is well suited to the field of vision rehabilitation, in addition to other clinical areas, such as primary eye care and contact lens fitting.

We hear you’re quite an excellent musician, too. Can you tell us more about that?

Whoever told you that was right! I am a crackerjack bluegrass banjo player. You can go to my web site at www.banjoben.com for samples of my music. I perform with my band on weekends at parties and concerts, and sell CDs of my music online. I started playing the banjo at age 15 and never stopped. In March 2009, I was featured on the cover of the Banjo Newsletter:

I also give music lessons at my home studio. Making music is artistically creative in ways that my day job is not. Teaching optometry is fun, but performing live music with my friends is an exhilaration that is hard to describe.

My recording work includes film soundtracks (Raising Arizona); The Simpsons; television commercials; The Waverly Consort; PBS soundtracks; off-Broadway orchestral work; and independent self-released original recordings.

What do you like best about VisionAWARE? Do you have a favorite feature or section on the site?

I like your features about individuals who dedicate their professional lives to helping others. I also like that you provide information about low vision rehabilitation to people throughout the country who might not know about these services otherwise.

How can our readers contact you to learn more about your low vision services?

• At the SUNY College of Optometry Homebound Program: Call 212-938-4040 to speak to a secretary for a homebound appointment.
• At the New York Eye and Ear Infirmary (14th Street and Second Avenue in Manhattan): Call 800-222-9816 to schedule an appointment.
• At the Long Island Jewish-North Shore University Hospital in Great Neck, NY: Call 800-222-9816 to schedule an appointment.

Here are additional links and information from Dr. Freed and VisionAWARE about low vision examinations and low vision services:

A comprehensive low vision examination should include the following components:

A Low Vision History

• When your vision problems began
• Any prior vision rehabilitation services you’ve had
• Questions about activities that are becoming difficult for you, such as reading, meal preparation, and/or walking indoors and outdoors

Visual Acuity Testing

• Tests to determine the sharpness or clarity of both your near (reading) and distance vision
• Special low vision acuity test charts can include the Early Treatment Diabetic Retinopathy Study (EDTRS) Distance Acuity Chart or the Feinbloom Distance Low Vision Acuity Test:

EDTRS Distance Acuity Chart (L) and Feinbloom Distance Low Vision Acuity Test (R)

• Determining your best-corrected regular eyeglass prescription
• This is important, even if you have low vision.

Sensitivity to Contrast

• The ability to see faintly printed reading material or to detect differences between light and dark areas
• If you have low vision, increasing the contrast between an object and its background will generally make the object more visible.

An example of contrast sensitivity: A white wastebasket is more visible against a black background.

Visual Field Testing

• Determining how much side (or peripheral) vision you have and how much surrounding area you can see
• A low vision exam will include more precise visual field measurement, using a computerized visual field analyzer, such as the Humphrey field test or a non-computerized visual field test, such the Goldmann field exam.

Humphrey Field Test	Goldmann Field Exam

In addition to the low vision examination, your low vision specialist can recommend a referral to vision rehabilitation services for specialized training in the following areas from a Certified Vision Rehabilitation Therapist (CVRT), a Certified Orientation and Mobility Specialist (COMS), or other vision rehabilitation professionals:

• Communication skills: reading and writing, braille, and assistive computer technology
• Independent living and personal management skills: home management, home modifications, home mechanics and repair, personal self-care, financial management, leisure activities, and using the telephone
• Independent movement and travel skills: orienting yourself in indoor and outdoor environments, moving about safely indoors, using transportation, and traveling safely outdoors with a long white cane or other device
• Counseling to help the person, their spouse, family members, and friends adjust to their vision loss
• Support groups that provide an opportunity to meet other adults who are blind or have low vision.

Here are some additional links to help readers in other parts of the country locate vision rehabilitation services and instruction:

• Find state and local vision rehabilitation services
• Find products for independent living
• Vision Rehabilitation Professionals