Low vision affects millions of Americans, including many older adults. Low vision can make it hard to do things like reading, shopping, cooking, or writing. And it can’t be fixed with eyeglasses, contact lenses, medications, or surgery.
The good news is that vision rehabilitation can help people with low vision stay independent and make the most of their sight. Low Vision Awareness Month is a time to raise awareness about low vision and spread the word about vision rehabilitation services.
Dr. John Metzger is one of Kansas City’s leading optometrists with more than 40 years of experience. Dr. Metzger works in the special areas of developmental optometry, vision therapy, low vision rehabilitation and neuro-optometry. He assists people of all ages whose vision restricts reading, learning, work tasks, hobbies, driving and enjoying daily life.
We asked Dr. Metzger if he could answer some of the most common questions he receives about low vision.
Eight Frequent Questions about Low Vision
WHAT IS LOW VISION?
Technically low vision is visual acuity less than 20/70 and better than 20/200 (with glasses on). Vision 20/200 or worse is “legal” blindness (in the USA) OR a visual field less than 20 degrees wide. So, legally you could have 20/20 vision and be legally blind if your visual field is really narrow!
WHAT DOES ALL THAT 20-SOMETHING MEAN?
Let’s take 20/60 as an example. The first figure (20) is you standing at 20 feet from the eye chart and reading the smallest letters you can see. The second figure (60) means that a normally sighted person can back up to 60 feet away from the chart and read the same size letters. So, you do not have sight as good as the “normal” person. On the other hand, if you have 20/15 vision, you are seeing the smallest letters you can on the eye chart which is 20 feet away and the “normal” person has to march up to 15 feet from the chart to read the same size letters. So, you have better sight than the “normal” person.
MY DOCTOR SAYS I AM 20/25 (NEARLY “PERFECT”) AND DON’T NEED GLASSES BUT I AM HAVING A TERRIBLE PROBLEM SEEING AT WORK. WHAT CAN I DO?
Low vision may technically start at less than 20/70 vision, but that doesn’t mean you aren’t struggling when you have better eyesight. I had a friend, Bob, who was an accountant back in the days when a spread sheet was a piece of paper spread across your desk. Bob was actually 20/20 in each eye, but did have just a trace of cataract and was complaining strongly about how hard it was to put the little numbers in the little boxes on the spread sheet grid. I finally agreed to chat with the eye surgeon, but who wants to operate on a 20/20, 100-percent set of eyes? The operation finally was agreed upon, completed and healed and Bob was ecstatic about his new 20/20 vision, the same as before… except that now Bob was 20/happy. The bottom line is that the numbers don’t tell as much as the need and the personal perception. So, you may have “good” vision, but it may be “low” vision to you, or you may have “low” vision and be perfectly satisfied.
I CAN’T DRIVE IF I’M LESS THAN 20/60, CAN I?
If visual fields are adequate, that is not true. The cut-off point for many states is typically 20/160, which is a big difference from 20/60. You could be legally blind (20/200, better eye) for social security or for tax purposes, but qualify for driving at 20/120, 20/140 or 20/160. It all depends on the eye chart used. The Social Security Administration authorizes a Snellen eye chart which does not have letters on it from 20/120 through 20/160. So, if you are worse than 20/100, but better than 20/200 you can be legally blind for benefits, but also qualify for a restricted driver’s license in many cases.
WHY CAN’T THEY JUST MAKE MY GLASSES STRONGER?
I hear this often. The job of glasses for distance vision (TV, driving, golf) is to put the image of what you are looking at precisely on the back of the eye (the retina). Once this is done, then making the lenses stronger will take the image back off the retina and that will make vision worse. But there are other solutions… read on.
WHAT DO YOU DO IF STRONGER GLASSES WON’T HELP?
Well, if we can’t make it stronger, sometimes making the image bigger helps. For that we use a variety of miniature telescopes. Some of these we cement into the eyeglass lenses, some are hand-held, some are electronic – there are a number of possibilities here.
THEY SAY MY BIFOCALS ARE THE STRONGEST THEY MAKE. WHAT NOW?
Many eye doctors do not get out of the “standard” range of bifocals. But there are low vision bifocals and reading glasses. The chief drawback is that the stronger the bifocal focus, the closer you must hold the reading material. Some patients prefer not to hold a book 12 inches from the eyes, or even 8 inches or 4 inches (or closer!). It all depends on how much it “hurts” to miss out on reading and how much you need to or want to read again.
I HAVE LOW VISION AND NO ONE CAN HELP ME. CAN YOU HELP ME?
The honest answer is I don’t know. But we work with people like “20/happy Bob” mentioned above to totally blind folks to make them more independent and to give some joy back. If the eye doctor can’t help, then she or he must have a team. To give the highest level of help you need an optometrist and occupational therapist who can also hand off the patient to a mobility specialist, the technology expert, job rehab specialists and youth support. You really need the whole team. We can provide that team at Alphapointe.