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All About Vision

Low Vision

Seniors with Low Vision Enjoying Life

Low vision is considered significant vision impairment that usually results from serious eye disease or an injury. The vision loss, which is characterized by either reduced visual acuity (to 20/70 or worse) or reduced field of view, can’t be fully corrected with glasses, contact lenses, medication or surgery.

Low vision can affect both children and older individuals, but is more common in the elderly, who are at greater risk of eye diseases such as glaucoma, macular degeneration and cataracts, which are some of the most common causes of the condition.

What causes low vision and how does low vision affect eyesight?

Among the leading causes of low vision are heredity, eye injury or brain injury, or eye diseases such as glaucoma, macular degeneration, cataracts, diabetic retinopathy, or retinitis pigmentosa. Depending on the severity and type of vision impairment, the patient may have some useful vision. Typically the impairment includes a significant reduction in visual acuity to worse than 20/70, hazy, blurred vision, blind spots or significant visual field loss and tunnel vision. Sometimes the extent of vision loss is considered to be legal blindness (20/200 or less visual acuity in the better eye) or almost total blindness.

How does low vision affect daily life?

With significant vision loss it can become challenging to complete common daily tasks including reading, writing, cooking and housework, watching television, driving or even recognizing people.

When low vision is diagnosed it can come as a shock. Initially, it is an adjustment to learn how to function with impaired vision but the good news is there are numerous resources and products available to assist. Because low vision often results in one’s inability to work, function independently, drive and resume normal life, many patients feel isolated and depressed.

Visual Rehabilitation and Visual Aids

Low vision means that a minimal amount of sight remains intact. There are millions of people who suffer from the condition and manage to function with the remaining vision available to them through the use of visual rehabilitation or visual aids.

What are visual aids?

These are devices that help people with low vision function by maximizing their remaining eyesight. This often involves the use of magnifiers (handheld, mounted or stand-alone), telescopes and other tools to enlarge the images of objects to make them more visible. Some visual aids reduce glare and enhance contrast which makes it easier to see. Other low vision aids act as guides to help the person focus on non-visual cues, such as sound or feel. Finding the right visual aid is a matter of consulting with a professional and experimenting with what works for you and your daily needs.

How to make life with low vision easier

  1. Ensure that you have adequate lighting in your home. This may require some trial and error with different lights and voltages to determine what works best for you.
  2. Use a magnifier. There is a vast selection of magnifiers available, ranging from hand-held to stand magnifiers. Binoculars and spectacle mounted magnifiers are also an option.
  3. Your optometrist or low vision specialist can recommend specialized lens tints for certain conditions such as retinitis pigmentosa or cataracts, which enhance vision or reduce light sensitivity.
  4. Use large print books for reading. Alternatively, try digital recordings or mp3’s.
  5. Make use of high contrast for writing. Try writing in large letters with a broad black pen on a white piece of paper or board.
  6. Adding a high-contrast stripe on steps (bright color on dark staircase, or black stripe on light stairs) can help prevent falls in people with low vision, and may enable them to remain independent in their home.
  7. Find out by researching what other technology is available to help make your life simpler.

If you or a loved one has low vision, don’t despair. Consult with our eye doctor about the best course of action to take to simplify life with low vision.

How to Cope with Low Vision

adjusting the lighting can help with low vision

Reduced vision is defined as vision that can not be corrected completely using either contact lenses, eyeglasses, or surgery, and is blurry (at the level of at least 20/70), or limited in its view field. Low vision is sometimes caused by injury to the eye or brain, and it can be inherited. However the main cause of low vision is eye disease, including diabetic retinopathy, glaucoma and macular degeneration.

If you have low vision you have some sight. However completing normal activities, including driving and reading, can be hard or even impossible.

Low vision is a condition that the elderly suffer from, although it is possible for children and middle-aged patients to have low vision. After a life of seeing normally, losing your vision can be hard, or even traumatic, and can potentially lead to frustration, or even depression.

Low Vision, Working and Independence

What is especially hard about low vision is that many people are unable to work, and lose their existing jobs. In 2010 the U.S. Census Bureau’s American Community Survey showed that the employment rate for Americans with low vision was 24 percent.

If you have low vision, you probably feel disconnected from the rest of the world. With low vision, it’s hard to read, see images on television or a computer screen, and impossible to drive. You may not be able to be independant and run your own errands, shop for food, or visit friends and family. Sometimes people with a vision impairment suffer with this burden alone, while others must rely completely on friends and relatives on a daily basis.

There are many devices and ways to manage low vision, which can help people suffering with low vision to continue leading productive and independent lives. Some of the devices that can help make the most out of remaining vision are magnifiers, both handheld and mounted on eyeglasses, and telescopes.

Symptoms of Low Vision

Signs that it is time to see an eye doctor include loss of peripheral vision, blurry vision, sensitivity to light, night blindness, needing more light to see, spots or floaters, and reading difficulty. This symptoms could indicate that a cataract is beginning in your eye. Or these problems could be signs of an eye condition such as glaucoma, retinitis pigmentosa, or macular degeneration. Make sure to see your eye doctor before any eye condition becomes so serious that vision loss occurs.

If it’s not possible to correct your vision loss with surgery, medical treatment, or eyewear, your eye doctor will send you to a specialist in low vision care. A low vision specialist, who is usually an optometrist, will evaluate your vision loss. Once he or she determines the type and degree of vision loss you are suffering from, this specialist can create a treatment plan including low vision aids, and guidance in using devices that help you to live with vision loss.

Additionally, a low vision specialist has knowledge of many different types of aids for low vision, including large-print and audio books, specially-designed lights, and signature guides that are used to sign checks and other documents. Sometimes eye care professionals that are treating vision loss recommend counseling to help their patients learn to live with the changes that low vision brings.

Low Vision Aids for Computer Users

Concerned Business Man at Desk with Computer

Low vision is a condition, often caused by a number of eye diseases which damage parts of the eye, in which individuals have significantly reduced vision. Individuals with low vision have some sight, but usually it is not sufficient to get by in daily life without some assistance. Often they are not able to read, drive, cook or work on a computer without a visual aid. Today there are many low vision aids available on the market to help those with low vision to function independently in performing daily tasks.

Computer use is one activity that often requires assistance and the good news is the technology to aid computer users with low vision is always improving.

Here are some devices and programs on the market to help:

Text Magnifying:

There are a number of ways to enlarge the text on your computer screen in addition to handheld magnifiers.

Via Your Computer Operating System: Both newer generation Windows and Mac operating systems have screen magnifiers built in. These do not have as many capabilities as purchased screen reader programs but for many with mild low vision, they may be sufficient.

Via Browser: When using the Internet most browsers (Chrome, Safari, Firefox and Internet Explorer) allow you to change the size of the page or text on the screen to suit your needs. To enlarge the text on a PC simply hold down the Control (“Ctrl”) key on your keyboard and either tap the “+” key or roll the wheel on your mouse. To reduce the size tap the “-” key or turn the mouse wheel in the opposite direction. On a MAC, you press command and shift at the same time along with the “+” or “-” keys.

Additionally, the browser might have a drop down option under the “view” tab that allows you to Zoom the screen in or out or make the text larger or smaller. Keep in mind that if you are using a larger higher quality screen, this will enable you to see bigger and more clearly as well.

Screen magnification programs: there are a number of free and paid software programs that will enlarge the text, picture and images on your computer screen.

Screen Readers and Text to Speech Programs:

There are a number of programs that enable you to “read” what is on the computer without needing to see it – these are designed for people that are totally blind as well. These programs work by scanning the text and icons on a page and converting it to speech which is read aloud. Some of these programs also have a cursor on the page that moves along with the voice.

Up to date Microsoft and Apple operating systems do have simple, built in screen readers but they may be limited. The Chrome browser and Android devices do as well. Nevertheless depending on your abilities, you may prefer to purchase a program with more comprehensive options and usability.

If you are looking for something simpler, text-to-speech programs exist in which you select a portion of the text you want to read and the program reads it for you.

Screen Contrast

Adjusting your screen to the highest contrast will enable the letters and images on the monitor to stand out. Font should be adjusted to achieve a dark text on a light background. Further it is advisable to reduce glare as much as possible. This may require adjusting window shades and indoor lights or even purchasing an anti-glare screen to reduce glare that can’t be eliminated.

Hardware

You can purchase special keyboards, mice and monitor magnifiers made specifically to enhance usability for those with low vision. Purchasing a large LCD screen for your monitor will also help to enhance visibility.
Computers can be a window to open our world to information, connections, work and play. Individuals with low vision can access all of this as well with the assistance of specialized software, devices and programs using the strengths and senses that they do possess.

Ask your eye doctor for more information about how we can help.

Vision Therapy for Children

As a child’s eyes develop, it is not uncommon for a number of problems to occur. Beyond blurred vision due to refractive error including nearsightedness (myopia) and farsightedness (hyperopia), children can develop a number of other visual and perceptual problems that are often not detected by a simple vision exam. Even a child with 20/20 vision, can have underlying vision problems!

Some of these issues are functional vision problems having to do with the actual eyes, how they move individually and as a pair, as well as their ability to focus. Functions such as eye teaming, tracking, focusing, and hand eye coordination, all affect a child’s success in school, sports or general functioning. Often children that have difficulty with these functions will suffer physical symptoms as well such as headaches, eye fatigue or short attention spans. With these critical visual skills lacking, tasks such as reading and writing can be extremely difficult and exhausting which can lead to frustration and behavioral problems.

Just like we are able to train our bodies to build strength, speed and agility, our vision skills can be strengthened. Vision therapy offers a doctor-supervised program to guide children to develop these skills.

What is Vision Therapy?

Vision Therapy is a program of progressive eye exercises individualized for each patient designed to retrain or help the patient develop or improve upon particular visual skills or to improve processing and interpretation of visual information. It is used to treat conditions like strabismus (crossed eyes) and amblyopia (lazy eye) as well as eye movement, focus and coordination problems.

Typically, the sessions take place in the optometrist’s office weekly or bi-weekly and utilize a variety of tools such as therapeutic lenses or prisms. Often the patient will be asked to practice certain exercises or activities at home as well in order to reinforce the skills that are being developed. Through repetition of these tasks, the ultimate goal is to strengthen the skills such as focusing, and improving eye movement and alignment, to the point where the eyes and vision are working efficiently and comfortably. The duration of the therapeutic program usually lasts about 6-9 months.

Vision therapy has been scientifically proven to improve functional vision skills and is approved by the major optometric bodies such as the American Optometric Association and the Canadian Association of Optometrists. It does not improve refractive error and should not be mistaken for some of the alternative self-conducted eye exercises out there that claim to improve your vision.

Vision therapy has also been shown to be effective in adults. If you think that vision therapy could be right for your child or yourself, it is worthwhile to have an assessment by a trained vision therapist to determine whether it could help resolve the vision problems that are present.

Are Contact Lenses a Good Choice for Kids?

Many children who wear glasses want to switch to contact lenses, especially older children who are concerned with their appearance.  So, how do you know if and when contact lenses might be an option for your child?

Contact lenses may not only improve a child’s confidence in their appearance but they can also be very convenient for active children who play sports or those who tend to lose or break their glasses.

Yet before you jump to schedule an appointment with the optometrist, it’s important to know that while contact lenses are a great solution for many, they are still medical devices that require care and responsibility. Carelessness with contact lenses can lead to infections, irritation, scratched corneas, pain, and sometimes even vision loss. So if you want to know if contact lenses are a good choice for your child, read below and think about whether your child is mature and responsible enough to take proper care of his or her eyes.

At What Age Can a Child Start Wearing Contact Lenses?

The recommended age for kids to start considering contact lenses varies, however, it is generally accepted that sometime between 11 and 14 is ideal. Some doctors will recommend them even for children as young as 8 years old who have shown that they are responsible enough to use them. There is also a possibility that contact lenses can be appropriate for kids of all ages if there is medical reason such as lazy eye, aka amblyopia.

Contact lens use requires good hygiene and cleanliness so if your child shows those traits, she may be ready. Additionally, if he is highly motivated to wear contacts and if he has the support of his parents, this will help in ensuring that the daily regimen is a success.

What is the Process of Getting Fitted for Contacts?

The first step is to schedule an appointment for a contact lens exam with your optometrist.  The eye doctor will perform a vision exam and go over the different options for contact lenses, depending on the prescription, the health of the eye and lifestyle and personal preferences. Contact lenses are designed with a number of options including the lens materials used (soft or rigid gas permeable), the replacement schedule (if disposable, how often you replace the pair - daily, weekly, biweekly or monthly) and the wear schedule (daily or extended overnight wear). Often doctors will recommend daily lenses for children because they are thrown away after each use so there is less care involved, less buildup and less risk for infection.

Then the doctor will give a training on inserting and removing the lenses as well as instructions for proper care.  Your child will probably be given a schedule for wearing the lenses for the first week or so in order to allow their eyes to adapt.  During this time you may have to be in touch with your eye doctor to assess the comfort and fit of the lenses and you may have to try out a couple of options in order to find the best fit.

Purchasing Contact Lenses

As a medical device, contact lenses require a prescription and should only be purchased from a licensed distributor such as an eye doctor. Unauthorized or unmonitored contact lenses can cause severe damage to your eyes that could result in blindness. This is true also for cosmetic lenses such as colored lenses or costume lenses. Any time you are putting a lens in your eye, you must have a proper prescription.

Following are some basic contact lens safety tips. If your child is responsible enough to follow these guidelines, he or she may be ready for contact lens use:

  1. Always follow the wearing schedule prescribed by your doctor.
  2. Always wash your hands with soap before applying or removing contact lenses.
  3. Never use any substance other than contact lens rinse or solution to clean contacts (even tap water is a no-no).
  4. Never reuse contact lens solution
  5. Follow the eye doctor’s advice about Don’t swimming or showering in your lenses
  6. Always remove your lenses if they are bothering you or causing irritation.
  7. Never sleep in your lenses unless they are extended wear.
  8. Never use any contact lenses that were not acquired with a prescription at an authorized source. Never purchase cosmetic lenses without a prescription!

Contact lens use is also an ongoing process. As a child grows, the lens fit may change as well, so it is important to have annual contact lens assessments. Plus, new technology is always being developed to improve comfort and quality of contact lenses.

Contact lenses are a wonderful invention but they must be used with proper care. Before you let your child take the plunge into contact lens use, make sure you review the dangers and safety guidelines.

Controlling Nearsightedness in Children

Childhood myopia or nearsightedness is a common condition that causes blurred distance vision and can usually be easily corrected with either glasses or contact lenses. Unfortunately, simply getting a pair of glasses doesn’t always solve the problem, because often myopia is progressive which means that every year the vision gets worse. This usually continues until sometime around the child’s 20th birthday when his eyes stop growing and eyesight levels off.

It can be worrisome and quite disconcerting for both the parent and the child when each visit to the eye doctor results in a higher prescription. There could be a number of factors involved in progressive myopia, involving hereditary factors as well as possible environmental or behavioral factor such as frequent close-up tasks such as reading or using an electronic device. In fact, studies show that children that spend more time outdoors playing have a lower incidence of myopia.  Much research is currently being done into treatments for slowing or stopping myopia progression in children.  Here are some of the treatment options currently being offered:

Orthokeratology (Ortho-k)

Ortho-k is a process that uses specially designed rigid gas permeable contact lenses worn at night to gently reshape the cornea, eventually allowing clear vision during the day. The lenses are worn every night or every couple of nights depending on the results of the individual.  Ideal for mild to moderate myopia, ortho-k usually takes a few weeks to show results, during which time the patient may need to temporarily continue wearing glasses or contact lenses.

Studies show that the use of ortho-k can permanently reduce the progressive lengthening of the cornea which is responsible for nearsightedness and can, therefore, slow or stop the childhood progression of the condition.  Therefore, in addition to being used for myopia correction, it is now also being offered as a therapeutic treatment to halt myopia progression in children.

Multifocal Eyeglasses or Contact Lenses

Bifocal or multifocal soft contact lenses or glasses have been shown in some studies to slow myopia progression.  This therapy is based on the idea that the eye is strained from accommodating to see close up and that by providing multiple focusing powers, this allows the eye to relax when doing near work, which reduces the progression of the refractive error. This treatment has been shown to delay or slow the advancement of myopia in some children.

 

Children’s Vision – FAQ’s

Most parents believe that if their child had an eye or vision problem they would know. However, this is far from the truth for a number of reasons. First of all, children often can’t express or don’t realize the difficulty they are having, and often vision problems will be overlooked by the associated behavioral issues that come as a result of frustration. Further, many eye or vision problems don’t show symptoms until they have progressed significantly which often makes the condition harder to treat.

Conditions such as amblyopia (lazy eye) or strabismus (crossed-eyes) can be corrected more effectively when they are diagnosed and treated early at a young age. Further, the sooner you diagnose and correct a vision problem, the sooner your child will be able to achieve his or her potential without struggling with these difficulties. This is why it is critical to have your child’s eyes examined by an eye doctor at regular intervals. Here are some FAQ’s and answers about Children’s Vision that every parent should know:

Q: At what ages should children have their eyes examined?

A: The official recommendations for the American and Canadian Optometric Associations are that infants should have their first eye exams at 6 months. Following that, children with no known vision issues should have another exam at 3 years and then prior to entering kindergarten. Children who do not require vision correction or therapy should have a vision checkup every year or two years and those who use vision correction should have an annual eye exam. Of course if your child is experiencing difficulty in school or after school activities that may be due to a vision problem schedule an eye exam immediately.

Q: My child passed a vision screening by the nurse at school. Does he still need an eye exam?

A: Yes. Many schools implement a basic vision screening test to assess whether the child sees clearly at a distance, however these tests are limited in scope. They do not assess functional vision such as the child’s ability to focus, track words on a page or the eyes’ ability to work in tandem. They also do not look at the health of the eye itself. These tests are essential to know the comprehensive picture of how healthy the eyes are and how well they are doing their job. In fact, studies shown that up to 43% of children with vision problems can pass a vision screening test! A comprehensive eye exam will assess all of these functions as well as color vision, depth perception, and eye coordination.

Q: My child was diagnosed with strabismus and amblyopia. Can this be treated and if so, what are the options?

A: Especially when diagnosed early, chances of a complete correction for strabismus and amblyopia are good when treated properly. The optimal age for this to occur is before 8-10 years old. Depending on the severity of the strabismus (crossed-eye), surgery may be required to straighten and properly align the crossed eyes. Amblyopia (lazy eye) can then be treated using eyeglasses, eye patching, or vision therapy to strengthen the weak eye and train the eyes to work together. A doctor that specializes in pediatric optometry can assess the condition and discuss treatment options on an individual basis.

Q: What is vision therapy?

A: Vision therapy is a doctor-supervised, individualized program of exercises to strengthen the functions of the eye. It is used to correct issues with eye alignment, focusing, coordination, tracking and more. Vision therapy often utilizes tools such as specialized lenses or prisms and involves exercises both during office visits and at home to reinforce the changes. The process usually takes about 6 months to see lasting improvement.

Q: My son’s nearsightedness keeps getting worse – he needs a new prescription every year. Is there a way to stop this?

A: There is research that shows that progressive myopia can be stopped or slowed during the childhood years. There are a number of therapies that are used for what is called “myopia control” including multifocal eyeglasses or contact lenses, orthokeratology (ortho-k) or atropine eye drops. Speak to a pediatric optometry specialist to learn more about the options and what might work best for your child.

Q: Every morning it is a fight to get my child to wear her glasses. What can I do?

A: It may take time for your child to adapt to the feel of the glasses and to be comfortable seeing with them. For little children, you can find glasses that come with integrated headbands that can help to hold the glasses in place. It helps to be consistent in putting them on to allow the child to adapt to the feel of the glasses.

Very often, especially for small children that can’t tell you what is bothering them, the reason for a child’s refusal to wear glasses is that something is not comfortable. It could be that the prescription is not right, that the glasses pinch or that are feeling heavy. It could be worthwhile to take the glasses back to the eye doctor to ensure that they are in fact a proper fit.

Q: At what age is it acceptable for a child to wear contact lenses?

A: Contact lenses can be a great convenience, especially for kids that are active or tend to break or lose their glasses. However, they are a medical device that must be treated with proper care and hygiene. If a child is not responsible enough to take care of them properly he could end up with a serious eye infection, a scratched cornea or worse. Most experts agree that the youngest age that contact lenses should be considered would be between 10-12 depending on the child’s maturity and cleanliness. Consult with your eye doctor about what would be best for your child.

Your Infant’s Visual Development

Your baby’s visual system is not fully developed at birth and continues to develop gradually over the first days and months of life. In fact, from your baby’s perspective at birth, the world is black and white, blurry and rather flat. As the days and months go on, they begin to focus, move their eyes and start to see the world around them. While each child will grow and develop on his or her own schedule, knowing an infant’s vision milestones will help you ensure that your infant is on track to achieving good vision and eye health and start treatment early if there is a problem.

Birth – 3 months

Because newborn babies’ eyes and visual system are underdeveloped, they can not focus their eyes on close objects or perceive depth or color. Babies need to learn to move, focus and coordinate eye movements to team the eyes (have them move together as a team). The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. In fact, until about 3 months, the optimal distance a baby can focus on is about 8 – 10 inches from their face, about the distance their parents face will be during feeding.

Your baby will start to be able to perceive color within the first 2-3 weeks, however it will take a few months to learn how to focus and use the eyes, to track objects, differentiate between two objects and shift from one object to the other. During this time you may notice that the eyes appear crossed and do not work together or team. This is quite common at the early stages of development, however if one eye appears to be constantly turned in or out, seek a doctor’s evaluation.

At around three months, as hand-eye coordination begins to develop, a baby should be able to follow a moving target with their eyes and reach for objects.

4-6 Months

By 6 months, your baby will begin to move his eyes with more speed and accuracy, seeing at farther distances and focusing well. Color vision should be fully developed and the eyes should be able to work as a team and follow moving objects with relative ease. Hand-eye coordination and depth perception should be greatly improved as your baby will begin to understand the 3-dimensional world around them.

At six months, you should take your baby for his or her first comprehensive eye exam to ensure that the eyes are developing on track and there are no signs of congenital or infant eye disease.

7-12 Months

At this stage of development babies will be coordinating vision and body movements by crawling, grasping, standing and exploring the surrounding world. They should be able judge distances accurately, throw a ball toward a target and pick up a small object with their fingers. Delays in motor development can sometimes indicate a vision problem.

The First Eye Exam

While at 6 months, your baby will not be able to read an eye chart, eye doctors can perform an infant eye exam through non-verbal testing to assess visual acuity (for nearsightedness, farsightedness or astigmatism), eye teaming abilities and eye alignment. The eye doctor will also be able to see inside the eye for any signs of disease or problems that could affect eye or vision health.

InfantSEE®

InfantSEE® is a public health program in which participating optometrists provide a free comprehensive infant eye exam to babies between 6 and 12 months of age. The program was initiated to provide accessible eye and vision care for infants to ensure they have the best chances for normal development and quality of life.

If your child has any unusual symptoms such as excessive tearing, constant eye misalignment, red or crusty eyes or extreme light sensitivity consult an eye doctor as soon as possible.