Washington State Department of Services for the Blind

Low Vision Services*

Definition of Low Vision Services

Low vision services emphasize optimal utilization of residual vision and reduction of disabling effects of vision impairment. Visually impaired persons receiving low vision assessment training in the utilization of residual vision and appropriate assistive devices.

Low vision services go beyond the clinical findings of the eye physicians. Their identification of visual impairment (the actual damage to the eye or visual system) help low vision professionals direct their services and monitor their efforts. However, the goal of low vision specialists is to determine how a person is disabled by their visual impairment and then try to reduce the debilitating effects of that disability for that particular individual.

Scope of Low Vision Services

Low vision services for individuals begins with a recognition by the Vocational Rehabilitation Lead Counselor (VRLC) or Rehabilitation Teacher (RT) that participants with residual vision might benefit from an evaluation of their visual functioning and services to reduce any disabling effects of their visual impairment.

The VRLC/RT may refer the participant for low vision services to help determine eligibility; help determine vocational potential; or help carry out services of an Individual Plan for Employment (IPE).

Comprehensive low vision services includes the following three elements – some of which may be utilized by the VRLC/RT to assess or improve the visual functioning of participants:

1. Functional Evaluation: Functional evaluation is typically done in non-clinical settings such as the participant’s residence or place of work. Depending upon the low vision service provider selected by the VRLC/RT, these evaluations may be provided entirely or in part by a number of professionals if they are specially trained to contribute to the vision rehabilitation of visually impaired people. Typical professionals who may have specialized training in low vision include: low vision specialists, educators, orientation and mobility specialists, rehabilitation teachers, counselors, occupational therapists, psychologists, social workers, and nurses. Information gathered in the evaluation can include: the individual’s activities at work, home, and leisure; psychological adjustment to visual impairment; independent travel skills; perceptual problems, including specific measurements of functional acuities, fields, color vision, contrast sensitivity, reaction to glare, dark adaptation, illumination requirements; family dynamics; financial needs; access to medical care; the person's expressed needs and goals.
2. Clinical Evaluation: This evaluation consists of making structured clinical assessments, including those of acuities, fields, refractive error, and magnification needs. Professionals capable of providing useful clinical low vision evaluations include specially trained ophthalmologists, optometrists, and low vision specialists. The VRLC/RT may select from among those service providers who offer these skills.
3. Instruction and Training: The data collected in the functional and clinical evaluations are combined in the formation of an instruction and training service. The purpose of training and instruction is twofold:
   1. The participant is given the opportunity to use recommended adaptive devices and to develop proficiency. Also complimentary instructional services, such as mobility and training in reading, may be provided at this time.
   2. As problems arise during instruction and training, further clinical evaluations may be arranged and the instruction and training services modified so levels of frustration are kept to a minimum

Visual Functioning Elements in Low Vision Utilization and Services

The following terms and descriptions are used in the field of low vision and indicate the variety of elements of concern in optimal visual functioning and in the selection of services which may be needed to achieve it.

General Ocular Motility Skills:

• Light/Dark Adaptation: Ability to adjust to changes in illumination without significant temporary loss of visual functioning due to the time of adjustment or pain.
• Accommodation: Ability to view material close to eyes.
• Fixation Skills: Ability to move eyes from object to object.
• Tracking Skills: Ability to follow a moving object with eye movement.
• Binocularity: Ability to see with both eyes relatively equally and with experiencing double vision.
• Convergence: Ability to focus both eyes at the same time on a near object.
• Scanning: Ability to use eye and head movement for systematic search for objects in the environment.
• Visual Fields: Ability to see throughout full normal field of view of both eyes, includes both central and peripheral vision.
• Eccentric Viewing: Ability to discern information normally viewed by ineffective portions of the retina by using other parts of the retina.

Visual Perceptual Skills:

• Visual-Motor Coordination: Ability to point at objects; ability to function in a non-clumsy fashion in sports and other daily physical activities including writing, drawing, cutting.
• Figure-Ground Perception: Ability to visually locate and differentiate among items and objects from among the environment.
• Depth/Space Perception: Ability to distinguish the relative distance to and among objects by stereopsis, gauging relative size, effects of shadowing and coloring, and height in plane.
• Visual Memory: Ability to remember how an object looks after it is no longer visible; involving both short-term and long-term memory.
• Color Vision: Ability to identify and differentiate among colors correctly.

Visual Environment Skills:

• Near Task Functioning (usually within 16 inches). Distance for optimum or typical performance of such tasks as reading, writing, work activities, recreational activities. Typically enhanced by use of adaptive skills and aids such as magnifiers, reading stands, typoscopes, controlled illumination, bold print, line guides, filters, special pens/paper.
• Intermediate Task Functioning (from 16 inches to 3 feet). Distance for optimum or typical performance of such tasks as typing, computer use, writing, drawing, hobbies. Typically enhanced by use of adaptive skills and aids such as magnifiers, reading stands, typoscopes, bold print, line guides, filters, special pens/paper.
• Distance Task Functions (beyond 3 feet). Distance for typical performance of such tasks as orientation and mobility activities (recognizing faces, signs, lights, avoiding objects); indoor activities (television or movie watching, classroom or job tasks. Typically enhanced by use of adaptive skills and aids such as field enlargers, field minifiers, telescopes, filters, visors, mobility devices (night vision scopes, high intensity flashlights).

Comparable Services and Benefits

Comparable services and benefits must be investigated and used prior to use of any agency funds when providing low vision services.

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