“It’s not what you look at that matters,
it’s what you see.”
-Henry David Thoreau
A little cornea, I know,
But… the point is that a group of people looking at an identical image can see and feel different things. An avid runner who wakes up in the hospital from a car wreck to a double BKA will likely see things differently than before her injury. Her accident may not have directly affected her vision, but it definitely will change the way she sees, perceives, and interprets things. Key point is that our clients, with or without impaired vision, may see something completely different than we see when looking through our typical healthcare professional “lens”.
Be empowered to SEE from the client’s perspective.
—–>Did you know that you can be an occupational therapist (OT) and work in an eye clinic or vision center? Or better yet get certified in this specialty area? OT is everywhere. What a time to be alive.
—–>Did you know that there are ophthalmologists from an osteopathic (rather than allopathic) background? It takes a special person to go through medical school with the intention of becoming an ophthalmologist. It takes an even more special person to graduate from an osteopathic medical school and be accepted into a traditionally allopathic ophthalmology residency. But it’s possible. It has been done before. And I have a friend in DO school who will pursue a residency in a few years in ophthalmology and pursue it well. War eagle, I digress.
Before diving into the job duties of different healthcare professionals including MD/DOs, ODs, OTs, and more, first I want to discuss some general vision components as well as a few eye conditions related to low vision.
According to the American Academy of Ophthalmology, “Low vision is a loss of eyesight that makes e v e r y d a y tasks difficult. A person with low vision may find it difficult or impossible to accomplish activities such as reading, writing, shopping, watching television, driving a car or recognizing faces.”
Clients with low vision are more inclined to rely on others to perform a variety of ADLs and IADLs….hmm I’m pretty sure those are two of the several occupation areas under an OT’s scope of practice. Sounds to me like occupational therapy services can definitely benefit a client who fits this definition in order to address how visual barriers are hindering occupational performance in a variety of contexts.
Not sure what OT is? Click for more details on the occupation who works to help you live a meaningful and purposeful life at —> OT: the art and science therapy
But what is Low Vision?
Less than normal vision that cannot be corrected by lenses, medication, or surgical procedures
Is different than blindness (an individual with low vision will have residual vision-a blind individual will not)
Is a loss that is not a natural part of normal aging
Is a giant umbrella term that includes many disorders or conditions
characterized by impairments in visual field or visual acuity
For videos of hope and empowerment directly from clients who have low vision, click to view from the National Eye Institute.
Key Terms-Visual Components
- Visual Field: This is the range of vision that we have. Try it. Look straight ahead and focus on one object. Can you see 60 degrees up and down (central field) and 180 degrees side to side (peripheral field)?
- Visual Acuity: The sharpness of an image.
- Contrast Sensitivity: Can you distinguish the different contrasts? Black to grey to white?
- Visual Perception: Can you process the image? If a client cannot process the image, maybe there are problems with the neuron folds-the eye is intact but the brain is not receiving the message.
a few of the most common conditions related to LV
- Cataracts: clouding of lens
- Age related macular degeneration: damage to central part of retina-two types-wet or dry
- Diabetic retinopathy: secondary to diabetes-results from change in blood vessels in the retina
- Glaucoma: damage to the optic nerve-normal fluid pressure in the eye rises and results in vision loss
To learn in depth about these conditions and several other eye conditions, click here.
Why are these team members so intelligent?
Cause they are good pupils.
OPHTHALMOLOGISTS (MD or DO)
These are the guys (or girls of course!!) who break up with
Med School the Mistress after 4 years of ups and down and trials and triumphs and meet their >>>perfect prescription<<<–an ophthalmology residency for X amount of years.
According to American Academy of Ophthalmology, “ophthalmologists differ from optometrists and opticians in their levels of training and in what they can diagnose and treat. As a medical doctor who has completed college and at least eight years of additional medical training, an ophthalmologist is licensed to practice medicine and surgery”.
He or she comes from either an allopathic (MD) OR an osteopathic (DO) medical school background. Don’t worry there was also a time I didn’t know that there were two types of physicians, (cue eye rolls) but it’s a real thing people and they (the doctors that DO) have been around longer than you think. I did the research for you though so click for more information on the differences and similarities of both types of physicians here —> MD vs. DO: DO your research
Some ophthalmologists who have a h e a r t for a specific area of medical eye care may choose to become subspecialists by completing more in-depth training. This training is known as a fellowship and can be in a variety of areas such as retina, cornea, glaucoma, and others…
(aka lots of school but they get through it by keeping their eyes on the prize, literally and figuratively).
These are the guys and gals who treat refractive error with glasses, contacts, or magnifiers. Yes, you (as a patient) address them as Dr. ____ . Rightfully so because they worked hard for their doctorate, butttttttt just remember they are different than an MD or DO ophthalmologist because they do not go to medical school and are not medical doctors.
Optometrists concentrate mainly on structure and function of the eyes. These are frame gurus who are licensed to practice optometry which is typically primary vision care. ODs may perform vision exams, prescribe and dispense corrective lenses, detect eye abnormalities and prescribe some medications for some eye diseases. They receive a four year doctoral-level degree in optometry post-undergrad. Optometrists do typically receive advanced clinical experience in the field under a mentor after graduating. If you are interested in learning more about optometry, click here !
Why do optometrists live long lives you ask????
Because they di-late.
This vision team member uses prescriptions supplied by ophthalmologists or sometimes optometrists to design and fit frames, glasses, and contact lenses. They do not test vision and do not diagnoses or provide treatment for eye diseases.
CERTIFIED LOW VISION THERAPIST (CVLT)
This certification was created due to the diversity of professions with interest in working with the low vision client population. To meet this demand, a committee comprised of individuals representing the different disciplines active in low vision established this interdisciplinary certification. Some of the committee members represented orientation and mobility, optometry, special education for the visually impaired, rehabilitative counseling, and others. The first low vision certificates were issued in 1997 to eligible therapists who achieved passing scores. This exam was revised in 2005 by the Academy for the Certification of Vision Rehabilitation and Education Professionals (ACVREP).
Occupational therapists are among the professionals who are active in attaining this certification. Perhaps what makes OTs attracted to this certification is the fact that the CLVT does not just address a client’s visual impairments (visual fields, contrast sensitivity function, color vision, visual acuity, visual perceptual skills, visual motor skills, the list goes on…) but also evaluates a client’s ADL, IADL, educational, and work performance which are all areas of occupation that OTs address with their clients. In addition, CLVTs also evaluate a client’s quality of life and address psychosocial aspects that may be hindered due to vision loss/low vision.
CERTIFIED ORIENTATION AND MOBILITY SPECIALISTS (COMS)
These members of the low vision rehabilitation team provide educational instruction to visually impaired individuals in hopes to teach their clients to “utilize their remaining senses to determine their position within their environment and to negotiate safe moment from one place to another”(acvrep.org).
COMS may teach an assortment of skills including training individuals with low vision to use canes, guide dogs, or electronic devices for safer travel.
Including… specifically for OCCUPATIONAL THERAPISTS (OT) the SPECIALTY CERTIFICATION IN LOW VISION (SCLV)
The SCLV is for occupational therapists only. (There is also a SCLV-A for occupational therapy assistants.) It was established in 2006 by AOTA in order to provide a formal recognition of OTs who have both specialized knowledge and clinical expertise with the low vision population.
An OT with this specialty certification is experienced in collaborating with ophthalmologists, optometrists, and other vision team members in addition to experience in the use of optical devices and assistive technology in this area. Basically, you are a huge deal in the OT world if you achieve this recognition by fulfilling all of the requirements, passing the exam, and moreeeeeee-minimum of 600 hours delivering OT services in the certification area to clients in the past 5 calendar years-it is pretty intense.
the OT vision
- 1990–Health Care Finance Administration expanded the meaning of “physical impairment” to also include low vision
- 1999–The Balanced Budget Refinement Act of 1999… I repeat since the year 1999 physicians have had the go-ahead to refer clients with a sole diagnosis of low vision to receive occupational therapy services. Hashtag blessed from all occupational therapists who receive referral sources from our MD/DO friends.
mOTivated to intervene-OT interventions for Low Vision
OT focus is on the assessment and intervention of the PERSON, ENVIRONMENT, and OCCUPATION.
“Many older adults experience age-related vision changes that can’t be corrected with eyeglasses, contact lenses, or surgery. Occupational therapy practitioners help people with low vision function at the highest possible level by preventing accidents and injury (e.g., improving lighting), teaching new skills (e.g., eccentric viewing, visual tracking), modifying the task or environment (e.g., recommending magnifiers), and promoting a healthy lifestyle (e.g., ensuring they can participate in their daily activities).”
-American Occupational Therapy Association
***many of these objectives listed below can be addressed by multiple members of the team; however, an occupational therapist -uniquely- provides intervention to address these items with the goal of facilitating occupational adaptation to improve occupational performance… this is just a preview of how awesome and useful OTs can be as members of the lv rehab team***
- Encourage the client to use the area of her retina that has not been damaged
- Practice locating an object of interest in the environment-perhaps have client locate a list of items from the pantry for meal preparation (IADL) task
Residual vision practice
Increase coping strategies
- Decrease fear of unknown or fear of progressive vision loss-provide psychosocial support to facilitate development of coping skills
- *be aware of signs of depression and refer to mental health practitioners as needed
- Safety recommendations-reduce clutter in home
- Color landing areas at top and bottom stairs to provide high contrast to increase visibility and decrease risk of falls
- Use white plates on a dark tablecloth
- Wrap brightly colored tape onto pot handles to increase visibility
- Recommend better lighting sources-possibly adaptive equipment-change lighting placement
- Ex: a home health OT trains client on tactile markings on frequently used appliances-can simply use puff paint from a local craft store to mark specific knobs or buttons on a stove, microwave, etc to help client foster independence
- Encourage client and caregiver/significant other to have objects in their house placed in a manner that is routine and easiest for client to remember and navigate.
- Provide task adaptations or supports to continue engagement in as many previous occupations as possible
- Facilitate participation in new occupations of interest
- Give client resources to be active in her community
- Decrease social isolation by advocating for access to services
Envision the extraordinary.
If you or your loved one is experiencing low vision, you are not alone and deserve access to resources to enable participation in activities that you find to be meaningful. The National Eye Institute has a list of resources here!! What strategies work best for you?
Have any ideas for my next blog post, please comment below!!