Low Vision Center

The Low Vision Center at ABVI-Goodwill is a state of the art facility that is staffed by experienced doctors with specialty training in low vision rehabilitation.  Our doctors will not diagnose or treat your eye condition in our setting; rather, they will work in consultation with your own eye doctor to evaluate your functional vision and recommend visual aids and devices to optimize your visual abilities. 
Before we evaluate you, we require a current eye report from your eye care professional indicating your diagnosis and visual acuity.  We will promptly contact you to describe our services and to schedule an appointment.  Transportation to your appointment is available if you live in our area.  A review of your eye and health history and an assessment of your needs will help us understand your individual goals for low vision rehabilitation.

During the low vision evaluation, the doctor will evaluate your visual acuity and contrast sensitivity on low vision charts and will determine the effects of any visual field defects.  The doctor often does a careful refraction using different techniques to determine if changing your glasses will improve your vision.  The doctor will then evaluate and recommend visual aids specific for your needs and goals.  The aids may include strong reading glasses, hand held magnifiers, illuminated stand magnifiers, prisms, telescopes, filters, special lights, or electronic magnifying devices. 

Our low vision optician can dispense the recommended aids and train you to use them properly.  Other vision rehabilitation service providers may then make recommendations for large print or talking devices and teach you new techniques to accomplish your tasks.  Our low vision doctors are part of our vision rehabilitation team who will help you meet your goals.

What is Low Vision?

Low vision is visual impairment that cannot be corrected by glasses, contact lenses, surgery or other treatments that makes everyday tasks difficult.  The impairment may limit your abilities and independence. 

What is Legal Blindness?

Statutory (Legal) Blindness in the United States was defined by the Social Security Administration in 1935 to be best corrected vision of 20/200 or less in the better eye, or visual fields constricted to no greater than 20 degrees.  With the use of new charts and visual field instrumentation, the definition has been interpreted as corrected visual acuity any worse than 20/100.  Humphrey Field Analyzers can be used for visual field determination using the 10dB stimulus.   

The World Health Organization describes visual impairment as normal, near-normal, moderate, severe, profound, near-total, or total visual impairment.  According to these definitions, low vision ranges between 20/70 and 20/400, and blindness ranges from 20/500 to no light perception. 

These definitions are used for diagnosis codes for insurance billing or to determine funding eligibility and tax exemptions.  The term legally blind is an arbitrary definition and does not indicate that you have no useful vision!

What Causes Low Vision?

You may notice normal changes in your eyesight as you grow older, such as needing more light to see and having more difficulty seeing things up close.  These changes generally do not lead to low vision.  Most vision loss is caused by eye diseases and health conditions, trauma or birth defects.  Routine comprehensive dilated eye exams allow eye doctors to not only prescribe glasses or contact lenses, but to also check for eye diseases that become more common with age.  The most common causes of vision loss include: 

• AMD:  Age-related macular degeneration is a disease that damages the macula, the center part of the retina.  It causes a blurred or wavy spot in your vision that can progress to a blind spot and cause difficulty reading or seeing detail.  AMD is the leading cause of vision loss for Americans age 50 or older. Risk factors for AMD include age, genetics, cigarette smoking and nutrition. There are two kinds of AMD.  "Dry" AMD is the most common form, which progresses slowly.  More rapid and severe vision loss comes from exudative, or the "wet" form of AMD, where abnormal blood vessels develop under the macula and leak fluid and blood.  New treatments are available for AMD and continue to be developed.  The good news is that AMD almost never causes total blindness, since it usually does not impair side vision.
• Diabetic Retinopathy:  This disease is caused by diabetes, and can lead to blindness if not treated.  Anyone with diabetes is at risk for diabetic retinopathy.  Vision loss is caused by weak vessels leaking fluid or blood, or by the growth of abnormal blood vessels.   Macular edema results from fluid swelling and leads to distorted vision.  Unhealthy new blood vessels, called neovascularization, can grow and bleed into the clear, jelly-like vitreous that fills most of the eyeball, causing dark spots and strands in your vision.  These blood vessels can form scars that cause retinal detachments and serious vision loss or blindness.  Diabetic retinopathy is treated by injections, laser, or surgery.  Vision loss from diabetic retinopathy can be prevented by watching and controlling your blood sugar, taking care of yourself, and seeing an eye doctor at least once a year. 
• Cataracts:  A cataract is a clouding of the lens that causes a loss of vision.  Most cataracts are caused by aging, but they can occur at birth or following trauma or other conditions. Risk factors include long-term exposure to the sun's ultraviolet rays, smoking, and use of steroids.  If the eye is healthy, cataract surgery has a high success rate in restoring normal vision. 
• Glaucoma:  Glaucoma causes progressive loss of sight by damaging the optic nerve.  Increased eye pressure and insufficient blood flow to the optic nerve causes visual field defects and loss of peripheral vision.  More than 2.2 million Americans age 40 or older have glaucoma.  Risk factors include age, being black or Hispanic, being very nearsighted (myopic), having a positive family history, history of high eye pressure, thin corneas, history of eye injury or eye surgery, long term use of steroids, having diabetes or high blood pressure.  Glaucoma is usually treated with eye drops to lower eye pressure, laser, and/or glaucoma surgery.  Regular examinations and early glaucoma treatment is important to preserve eyesight.
• Retinal Detachment:  The retinal may separate from its underlying layer and result in total impairment in the detached area.  It may be caused by a retinal hole, eye trauma, infection, blood vessel disturbance or a tumor.  Early diagnosis and surgical reattachment may restore vision. 
• Retinitis Pigmentosa (RP):  RP is an inherited disease that gradually destroys night vision, severely reduces side vision, and may result in total impairment. 
• Retinopathy of Prematurity (ROP):  ROP may occur in infants born prematurely and is caused by high oxygen levels in incubators during the neonatal period.
• Traumatic Brain Injury (TBI):  Vision can be lost or damaged as a result of head injuries, brain damage and stroke.  

 Effects of Low Vision

Many times, those around you do not understand the effects of your vision loss on your every day activities.  Although your eyes may look normal to others or you may be able to see small objects to the side, you may need to explain how you see to your friends and family. 

• Loss of central vision – the loss of central vision creates a blurred or blind spot, making it difficult to read, recognize faces and distinguish details.
• Loss of peripheral vision - the inability to see things to one side or both sides, causing difficult mobility and a slow reading speed. 
• Blurred vision – causes both near and far to appear to be out of focus, even with glasses. 
• Hazy vision – causes the sensation of a film or glare that extends over the entire viewing field, causing difficulty seeing low contrast print. 
• Light sensitivity – produces a washed out image and/or glare disability that can cause discomfort and interfere with driving.
• Poor stereo acuity – loss of depth perception leads to risk of falls and difficulty pouring liquids.
• Poor color vision – difficulty distinguishing different shades of colors.
• Night blindness – results in inability to see outside at night or in dimly lighted area such as movie theaters or restaurants.
• Brain injury can cause a host of symptoms relating to vision, including reduced visual acuity, visual field, poor contrast sensitivity, blurred vision, eye misalignment, poor depth perception, glare sensitivity, confusion when performing visual tasks, difficulty reading, double vision, headaches, dizziness, abnormal body posture, and balance problems. 
• Charles Bonnet Syndrome (CBS) – describes visual hallucinations seen when you have lost vision. Although you know that the images are not real, you may see detailed patterns of people or objects.  The effects often occur during quiet times and may disappear after a year or two.
• Feeling depressed or overwhelmed by loss.  Vision loss is a significant personal loss that frequently leads to depression.  Seeking help to cope with these feelings is an important step to learning to live well with low vision. 

Driving with Low Vision

The ability to drive is a privilege that affects quality of life through freedom of mobility.  Vision is not the only factor that should be taken into consideration for driving ability; cognitive ability, reaction time, experience and judgment are equally important.  Each state has unique vision requirements to obtain a driver's license.  New York State vision requirements for a passenger vehicle license (Class D or DJ) are as follows:

• If your visual acuity uncorrected or corrected is 20/40 or better in one eye, you may be tested at DMV or by your eye doctor to obtain a license for 8 years.
  
  
• If your visual acuity in the better eye is corrected to less than 20/40 and 20/70 or better, and you have a binocular visual field no less than 140 degrees, your doctor needs to complete a MV-80L form for you to obtain a license for 8 years.  You may have restrictions on the license, and you will need to submit an updated MV-80L form to the Medical Review Unit in Albany once a year to keep your license valid. 
• If your visual acuity in the better eye is corrected to less than 20/70 and 20/100 or better, and you have a binocular visual field no less than 140 degrees, you may be able to drive with a bioptic telescope.  The telescope is mounted above your line of sight in glasses and allows you to briefly view signs and traffic lights at a distance.  There are training requirements and usually DMV requires a road test before granting an 8-year license.  You will also need to submit yearly vision reports on a MV-80L form to Albany.   The ABVI-Goodwill Low Vision Center routinely prescribes bioptic telescopes and provides training for you to renew or obtain a driver's license with low vision. 

Living Well with Low Vision

Vision loss, whether gradual or sudden and unexpected, can be a difficult loss to adjust to.  When faced with this challenge, it is important to know that ABVI-Goodwill wants to help.  If your primary eye care provider can't offer any more assistance medically, ABVI-Goodwill can help you adapt to your change in vision.  Our comprehensive vision rehabilitation services will enable you to be self sufficient and contribute to your family and community.