MUSC Health Specialists Empower Patients with Low Vision

What is low vision? Having low vision means that your visual impairment cannot be corrected by glasses, surgery or medication. This visual reduction may affect peripheral vision, central vision and or contrast sensitivity. We spoke with Dr. Kristen Gayeski Tinkler, an MUSC Health Storm Eye Institute optometrist who, in addition to seeing primary care patients, specializes in low vision and specialty contact lenses.

Read on to learn more about the causes of low vision, available resources and how MUSC's low-vision specialists work with patients to help them manage their conditions.

What is legal blindness?

Are all patients with low vision considered legally blind?

Legal blindness is defined as central visual acuity of 20/200 or less in the better-seeing eye with the use of a correcting lens. Not all patients who have low vision meet this definition. Patients seen in our low-vision clinic have difficulty performing everyday tasks because of their eyesight. Many causes of low vision are progressive, so their condition may progress to this designation later in life.

What conditions may cause low vision?

Age-related macular degeneration, glaucoma and diabetic retinopathy are some of the most common causes of visual reduction. Low vision can also be caused by retinal detachment, stroke, injuries to the brain or the eye and congenital disorders such as retinitis pigmentosa or ocular albinism.

What is the goal of a low-vision exam?

Our goal in our low-vision clinic is to improve the lives of our low-vision patients by giving them tools, therapy and referrals for services when needed.

We start our exams by determining what specifically the patient is having difficulty with because of their limited eyesight. We determine how we can maximize their eyesight and help them adapt to the vision that they have. We also provide some counseling about what they can expect as their disease progresses. We demonstrate various magnification devices and discuss training and therapy that will help them use their limited eyesight more efficiently to achieve their goals.

What are common tasks that low-vision patients have difficulty with?

Difficulty reading is one of the most common complaints we address in low vision. Patients with macular degeneration or other diseases affecting the macula may find distortion in the center of the page when reading a book, newspaper or menu. Magnification devices are used to increase image size.

Difficulty with orientation and mobility is common among patients with diseases like glaucoma, which affects peripheral vision. Training with orientation and mobility specialists can improve their comfort getting around their house and in unfamiliar places.

Another problem noted by patients with low vision is difficulty cooking. Cutting boards with increased contrast, safer knives and larger-print measuring cups may all be helpful tools. We can also use tactile markings called "bump dots" to highlight frequently used buttons on the microwave.

Other patients with low vision are interested in getting back to work. South Carolina offers vocational rehabilitation services to help assist motivated patients providing classes and connections to help reestablish themselves in the workforce.

Having reduced vision can also be isolating and cause depression. Through local organizations we can help connect these patients to other patients with similar conditions to help them adjust to their new normal.

Are there resources available to help patients with low vision drive?

Patients who do not meet general requirements to drive in our state may benefit from a bioptic telescope, which attaches to their glasses and helps them to read street signs. To meet the requirements to drive, these patients require 30 hours of on-the-road training with a bioptic driving specialist.

Is the number of patients with low vision increasing?

Yes, the number is growing as the population ages. Studies in South Carolina show that the need is much greater than the number of patients served. In many cases, people live in rural areas and have limited access to transportation or a weak support system.

What enhancements/tools/training are available to patients to help low vision patients?

We prescribe and recommend a variety of tools/devices depending on the patient's visual reduction and needs. Some common visual aids/enhancements include:

• Filters: Tinted filters can be placed in eyeglasses to improve contrast sensitivity and help letters, numbers and words stand out.
• Near Vision Only Spectacles: Many patients with low vision benefit from glasses with higher magnification to help them when reading.
• Dome, Handheld, and Stand Magnifiers: These vision-enhancement aids are helpful to individuals having difficulty reading fine print with their conventional glasses.
• Digital Magnifiers: Made in different sizes and portability, these devices offer much higher magnification and varying color and contrast options.
• Monoculars: These telescopic devices magnify objects at a distance. They can be held up to one eye and are convenient to carry, pocket-sized and lightweight.
• White Cane: The National Federation of the Blind provides a free white cane to ensure anyone with visual impairment who needs one can travel safely.
• Apps and Websites: Seeing AI app is free and available for iPhone and Android devices. It narrates the world for blind and vision patients using the camera on their mobile devices. Hadley.edu is a website containing workshops, audio podcasts and discussion groups meant to offer practical help, connection and support free of charge to anyone with visual impairment and their families.
• Audio Books: South Carolina Talking Book Services serves as the regional library of the National Library for the Blind and reading disabled. This free program brings reading materials in digital audio and braille formats to eligible patrons.

What other therapies are recommended?

We often recommend home therapy visits from an occupational therapist as a lot of our patients are unable to travel independently and are considered homebound. We also refer to orientation and mobility specialists who can help patients with limited peripheral vision learn to navigate their environment.

What programs do you refer patients to?

We refer patients to the South Carolina Commission for the Blind, the Association for the Blind and Visually Impaired South Carolina, Tel-A-Ride CARTA program, NFB's White Cane program, Sight Saver's Technology Assistance, I Can Connect program and more.

What would you tell someone recently diagnosed with low vision?

We are here to help! A low-vision exam is the first step in getting you the assistance you need to optimize your remaining eyesight and improve your visual function.

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Dr. Kristen Gayeski Tinkler sees low-vision patients at MUSC Health Ophthalmology only at Nexton Medical Park in Summerville, 5500 Front Street. She also practices at MUSC Health Storm Eye Institute at 167 Ashley Avenue on MUSC's main campus. To make an appointment at either location, call 843-792-2020.