Many other agencies and services are involved in multidisciplinary vision rehabilitation including optometric practices, state services, services for veterans, driving rehabilitation services, talking-book libraries, transportation services, counseling and support groups. Devices are provided in some jurisdictions, such as certain European countries, and by some agencies such as the US Department of Veterans Affairs. Orientation and mobility training is offered by some agencies to provide instruction in using visual cues, telescopes, long white canes, and GPS devices for safe and independent ambulation. Vision loss also affects the patient’s spouse and family. Referral to psychological counseling and support groups may be part of the rehabilitation team’s approach to helping patients, and their families, cope and adapt. Social workers and other counselors may be called upon to contribute to this rehabilitation process. A model of a continuum of care encouraging referral from ophthalmologists to vision rehabilitation consultation and to other multidisciplinary services has been published (Fig 9-15). The goal of multidisciplinary vision rehabilitation is collaboration among services to best address patients’ goals and achieve optimal clinical outcomes.
Pediatric Low Vision
Although vision loss is less frequent in the pediatric population, this cohort is an important group requiring the ophthalmologist’s attention. Every child with loss of vision needs to be recognized, and the ophthalmologist’s response should include recommending vision rehabilitation. Most adults with low vision have lost vision because of an ocular disease incurred later in life. Thus, they have already acquired many of the vision-aided skills (eg, reading, understanding social cues, cooking, self-care tasks) that are important for functioning in society. Children with low vision, however, need to learn these skills despite poor or no vision.
The most prevalent causes of visual impairment in children in the US are cortical visual impairment, retinopathy of prematurity, optic nerve hypoplasia, albinism, optic atrophy, and congenital infections. Many of these children have coexisting physical and/or cognitive disabilities that create further challenges to successful integration into society.
In addition, skill acquisition is developmentally linked to vision, thus requiring different interventions at different ages. It is important to be aware of the needs of each age group and tailor the assistance to those needs. Rehabilitation of infants and children requires a team approach, often involving occupational and physical therapists, special educators, and physicians working with the child and family from the earliest stages possible. Ophthalmologists may be one of the most consistent contacts over many years for the parents of a visually impaired child, and, as such, they need to be aware of and support the rehabilitation process. (See BCSC Section 6, Pediatric Ophthalmology and Strabismus, for a more detailed discussion of pediatric vision rehabilitation.)
Figure 9-15 A model of vision rehabilitation developed by representatives of a range of collaborating vision rehabilitation professions. Vision rehabilitation can be part of the continuum of care for patients with vision loss when patients are diagnosed, referred for low vision evaluation, and then referred to other services, as indicated. CVRT = certified vision rehabilitation therapist; CLVT = certified low vision therapist; COMS = certified orientation and mobility specialist.
(From Jackson ML. Addressing core competencies in ophthalmology resident education: what the vision rehabilitation setting offers. J Acad Ophthalmol. 2010;3:20.)
Schwartz T. Causes of visual impairment: pathology and its implications. In: Corn AL, Erin JN, eds. Foundations of Low Vision: Clinical and Functional Perspectives. 2nd ed. New York: American Foundation for the Blind Press; 2010.
Excerpted from BCSC 2020-2021 series : Section 3 - Clinical Optics. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.