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Low Vision: A Unique Niche of Optometry

Hannah giving eye exam to a patient.

As a third-year optometry student, post-graduate career discernment has constantly been on my mind. What services can I provide the community? What patient needs are unmet? Luckily, the classes I’ve taken at NECO have given me a solid foundation in specialty areas such as vision therapy, contact lenses, and low vision.

When I started optometry school, I never thought that I would consider low vision as a part of my post-grad plans. Fortunately, taking Dr. Ross’s Low Vision Rehabilitation Throughout the Life Span course this semester has really opened my eyes to a specialty of optometry that is incredibly fulfilling and in high demand, yet many shy away from. 

In Massachusetts, the incidence of low vision patients is nearly 10,000 and according to the Massachusetts Society of Optometrists (MSO), only 96 Massachusetts- based optometrists indicated that they practice low vision care. Considering that 21% of people over 65 experience some type of vision impairment and that the 65-84 year old population is expected to increase 1.5x’s by 2030, there is certainly a need for optometrists to integrate low vision services into practice. 

Dr. Ross’s course has given my classmates and I the confidence and techniques to perform a low vision exam. We just finished taking our clinical skills exam, during which we measured acuity with ETDRS or Feinbloom charts, contrast sensitivity with Pelli Robson or MARS charts, performed trial frame refractions, and assessed reading using MNREAD. Many of these clinical skills are unique to the low vision population, and hopefully, our proficiency in these skills will encourage us to manage our primary care patients with visual impairments after graduation. 

We’ve also learned how to take thorough case histories on our low vision patients. Compared to the “normal” case history, the questions we ask our low vision patients are focused on functional domains, like driving, reading, mobility, and activities of daily living. We learned that in order to understand the patient and their goals, it’s important to consider: 1) What can’t the patient do now that was possible before?and 2) What are tasks they want to accomplish that they couldn’t do prior to the appointment?

Low vision is also unique in how multi-disciplinary low vision rehabilitation is. Members of the low vision care “team” include: the primary care optometrist, the low vision optometrist/MD, occupational therapist, vision rehabilitation therapist, orientation and mobility (O & M) specialist, and the community. While each member of the team has unique purposes, the team has the collective goal of enhancing quality of life. 

One common misconception of the low vision population is that they are totally without sight. But the reality is that most people who are legally classified as “blind” have remaining sight. The low vision exam is highly tailored to the patient’s visual needs. It requires a conversation with the patient about their vision loss and how their vision loss affects them on a day-to-day basis. Based on the patient’s goals, optometrists can prescribe low vision devices, like a CCTV or telescope, that can help the patient perform tasks they never thought they would be able to perform again. There are also new low vision technologies, such as apps and devices, that are being introduced on a daily basis. Optometrists are also responsible for determining appropriate referral to O & M services and to other members of the rehabilitation team. Low vision care truly aims to maximize the remaining sight they have and thereby, improve their quality of life.

While low vision exams can be challenging and complex, they remind us of our optometric oath to serve our patients with compassion, and that there is so much more to optometry than 20/20 vision. With low vision patients, the approach to care is directed towards rehabilitation and functionality, and “successful” management is much more goal-centric rather than on reaching certain acuity levels. Although I have not yet had any low vision experience in clinic so far, one of my 4thyear rotations will be at a blind rehabilitation center at a VA! I look forward to experiencing such a unique niche of optometry and am excited to work alongside patients to enhance their vision and their experience of the world. 

Hannah is a third year Korean American student who is originally from Rochester, NY. She is a 2016 graduate of Boston College, where she studied Behavioral Neuroscience and minored in Medical Humanities. Some of her most formative experiences at BC include volunteering weekly at a children’s hospital, traveling to Nicaragua on a service and cultural immersion trip, and studying the neurobiology of eating and eating disorders through an undergraduate research fellowship. Hannah's decision to pursue optometry wasn’t completely made until the summer before her senior year at BC. Despite this relatively late start, she believes that her Jesuit education at BC has cultivated a deep sense of social responsibility to serve communities as an optometrist, perhaps by participating in vision science research adapted towards treatments for rare ocular conditions or by providing basic eye exams to underprivileged communities in the US and Latin America. She is thrilled to be spending another 4 years in the historically rich city of Boston, but this time, as a graduate student and living in the heart of Boston with 2 other roommates! She cannot wait to see where the next four years at NECO will lead her, as well as her classmates in the class of 2020!