If a person has one or more eye disorders such as glaucoma, cataract, macular degeneration, or diabetic retinopahty, it's important to have a low vision examination — performed by an ophthalmologist or optometrist who specializes in low vision — to determine whether special low vision devices, better lighting, or other types of training can help with utilizing functional vision more effectively.

The low vision specialist is trained to conduct a more functional eye examination that focuses directly on how a particular person's vision impairment affects day-to-day living. A low vision specialist can prescribe special optical devices, such as magnifiers, telescopes, or light-absorbing lenses, and recommend non-optical measures, such as improved lighting and adaptive equipment, large print reading materials and daily living equipment.

Questions to Ask during a Low-Vision Examination

During a low vision examination, it's helpful to ask the following questions:

• What is the cause of my vision loss?
• What is my visual acuity (central vision)?
• Do I have a peripheral (side) field loss?
• Is my condition stable, or can I lose more sight?
• How can I protect my remaining vision?
• Do I need any special medication?
• Do I qualify as "legally blind"? If so, what does "legally blind" actually mean?
• Am I entitled to any special services or benefits?
• What resources are available to help me?

Functional Vision

A low vision examination is based almost entirely on assessing your unique functional visual needs, capabilities and limitations and then prescribing possible 'solutions' that can include low vision optical or non-optical devices, recommended therapies, and resources that are helpful to your unique situation. The examination usually begins with you providing as much information as you can about your health, medical, and ocular history. You may be given tests that include measurement of your depth perception, color vision, contrast sensitivity, and curvature of the front of your eyes. You will have a visual acuity test with a wide range of low vision charts (that include different sized large letters and numbers) and a low vision refraction. Glaucoma tests may also be included, along with examinations of the external structures of your eyes, and a dilated internal examination.

A dilated eye (or fundus) examination includes the use of an ophthalmoscope. Only the pupil is dilated — not the entire eye. This allows the examiner to see through the pupil to the macula at the inside back wall of the eye.

The doctor and his staff may also introduce and measure your impact to different lighting conditions, and different colored filters. You may be tested with various telescopic systems, spectacle or handheld magnifiers, and different types of filters that can control glare.

As much of the examination will focus on what your functional needs are in your day-to-day living, you will be asked a wide range of easy-to-answer questions. Some of these questions will be about your habits or activities in reading and near vision activities, such as the following:

• What size print can you now read?
• Do you want to continue reading newspapers?
• Can you read your bills?
• Do you want to read the TV Guide?
• Do you "spot" read more than you read novels or other books
• Have you had low vision devices, such as magnifiers, in the past? If so, do you still use them? If not, why not?

In terms of everyday activities, questions may include:

• Can you see to use a checkbook?
• Can you read your watch?
• Can you do regular household tasks such as cleaning and laundry?
• Can you care for your personal grooming needs, such as shaving or applying makeup?
• Can you see to use the computer?
• Are you able to continue your hobbies?
• Can you see to view the television?
• Can you travel independently and safely?
• What difficulties might you be having when traveling in your community?
• Are you still driving? If so, do you still feel safe driving?
• Does bright sunlight bother you?
• Has your vision problem affected your employment or educational studies?
• If you're a diabetic, can you see to fill your insulin syringes?
• Can you differentiate between your medications?

The questions are broad ranging, but they are all designed to gather information about your day-to day functional needs, and to explore possible options for addressing those needs. A typical low vision examination is not rushed but it is thorough, and for this reason can take 2-3 times longer than a regular eye examination. A key part of the examination is for you and your doctor or his/her social worker to discuss how you are adapting emotionally to your vision loss, whether you are motivated to learn a different way of doing things, and if you have family and friends to support you.

Again, before you go to your low vision examination, it would be a good idea to make a list of those things you really want to do (such as sewing, playing cards, watching ball games or going to the theater) and to list the types of things you want to read. This information can help focus your discussions with "your partners": your low vision doctor and his or her professional staff!

Low Vision Devices

It's important to remember that low vision devices are different from regular glasses. Some devices can be used with your glasses on and others can be used without them. Since low vision devices are task-specific, your doctor may prescribe different devices for different tasks. One device can be for reading the paper, another for watching TV, another for spotting bus numbers or street signs, and still another for watching a football game or a play. Some doctors recommend starting with one device to see how you manage, and then recommend additional devices as you become used to working with the device you have. It is extremely helpful to both you and your doctor if you can think about the tasks or activities that are the most important to you and share that information with him/her.

The low vision service is incomplete unless you've been taught how to use the devices you have been prescribed. After you've been prescribed a low vision device, such as a magnifier, it's important to learn how to use it when you get home. Many Low Vision Therapists and Vision Rehabilitation Therapists, otherwise known as Rehabilitation Teachers, work in eye care clinics and can teach you to use different types of optical and non-optical low vision devices. They are an invaluable resource in helping you to gain access to other helpful vision rehabilitation resources.

Additional Services

If your vision loss can't be corrected and interferes with your everyday living, vision-related rehabilitation services can help maintain or restore your independent living skills.