Low vision occupational therapy

June 7, 2011 9:37 AM

I am scheduled to have an evaluation with a low vision specialist for vision rehabilitation. I am excited to finally have someone that might help me with my year long floundering in dealing with severe vision loss in my right eye and destabilized vision in my left eye. Have you gone through this evaluation and therapy? If so, what can I expect?

A bit more than a year ago I experienced a giant retinal tear. After surgery for the tear and a year of complications (2 more surgeries on the eye), my retina specialist has referred me to the low vision specialist. My vision in my right eye is 20/400 and my left eye hangs @ 20/45 ranging from 20/35 to 20/50. I previously had 20/30 to 20/34 vision in both eyes.
I am still having issues with depth perception, reading, eye/hand coordination. We think I have lost some peripheral vision as well so it's not unusual for me to struggle when moving about in a crowd. I'm only allowed to drive locally. Prior to the last surgery, I had double silicone bubbles that were causing triple vision. In order to function and work _at all_ I wound up patching the eye. At this point I've no idea if patching is a good or bad idea, I assume the specialist will tell me things like that.
At any rate, we've gone through a set of glasses and Ive burns on both hands b/c I'm stubborn like that.

I know that lots of people have adapted to life with one eye. I know that lots of people have grown up with vision in just one eye and don't feel that it's a disability. However, it's obviously not working out that way for me.

At any rate -- what can I expect from the evaluation? What sorts of things might the therapy entail? (( use magnifiers for my left eye...). I don't want to expect too much. I know this person is not a miracle worker. Is it safe to say they can help me figure out how to cope so I'm not hurting myself and so I can can get my life back? (working and socializing/transportation)? Will they be taking into consideration that I'm severely hard of hearing so using audio instead of visual input is not really an option in a lot of cases?

Sorry if this is a bit more rambly than my usual writing.

Thanks for any feedback!

posted by Librarygeek to Health & Fitness (2 answers total)

My sister-in-law is an optometrist who is specializing in low vision patients. I forwarded your post to her, and this was her reply:

"First of all I want to preface this by saying that every low vision exam is different and given that I don't know all the details of your eye history and your doctor would, please if something I say contradicts what they say trust in their opinions over mine.

A low vision exam (in the US, at least) will try to address first getting you the best glasses for your eyes. It should include a refraction (glasses rx check) that should be a little bit more involved than one given during a normal exam. The low vision doctor will typically use a "trial frame refraction" that allows you to use your side vision or turn your head more than a refraction behind a phoropter (the big thing with all the lenses they normally use). Your case may be a little bit more difficult because of your asymmetric vision changes. Many people are monocular and do quite well. The difficulty for you will be adapting to it. It would actually be easier for you if you had no vision in your right eye at all, but because you still have some vision you will still use that eye. It could also have been that your right eye was the dominant eye, which might make it even more difficult. What might be best for you is occluding (patching ) that eye. The doctor might recommend "frosting" one lens which would allow light in but would blur the image so that you aren't really using that eye anymore. That won't solve your problems with depth perception, but unfortunately when you have such asymmetric vision you aren't really going to have depth perception anymore. You will likely learn to adapt to it, using other visual cues, like closer objects being larger, etc, but unfortunately it's not going to be like it was before.

Patching your right eye full time won't cause any problems to the health and may be a last resort if you continue to have that triple vision.

In terms of magnification, you will likely be able to read using just stronger reading glasses or maybe a very low powered magnifier. Your left eye is actually considered "near normal" in terms of vision loss.

Also with your vision being better than 20/40 (even in just one eye) that is generally good enough to have an unrestricted driver's license in most US states (although that does depend on your side vision in your left eye).

A lot of times simple things like increased lighting or using a ruler as a line guide can make a huge difference in reading. You need to make certain that you have goals for the exams (what things would you like to do, etc), it's better to ask for things and have the doctor tell you they aren't possible than for you to just not say them because you think they won't be possible. Generally the exams will be tailored to your given goals (i.e. difficulty with reading, seeing menus, looking at the aisle signs in the grocery store). The exam can last 2+ hours sometimes but is definitely worth it.
They will consider all factors, hard of hearing, shaky hands, cognitive issues, etc when deciding what to give you. If your hearing problems could be solved by hearing aids I would highly recommend getting those b/c with reduced vision having any other impairments will just confound your difficulty.
Hope this helps, and good luck with everything!

Dr. B"
posted by filthy light thief at 3:08 PM on June 7, 2011

Response by poster: flt -- please thank your sister in law for me :) That gives me some idea of what I will be walking into next week and what I can do to prepare.
I'm really hoping we can get me round my driving issues (estimating space/timing issues) so I can get back to unrestricted driving. My left eye vision was really wacked out to 20/70 and 20/80 for a bit. It finally has resolved to where it is now and has stayed there for the last 6 weeks so we are hoping that the vision is stabilized.

(I have hearing aids, have had since I was 5 but my loss is bad enough that using auditory alternatives don't work for me)

Thanks again!
posted by Librarygeek at 8:53 PM on June 7, 2011