Overview of Low Vision Examinations 400 Freedom Drive Newtown, PA 18940 (215) 968-1035 Click on each screen to move ahead to the next slide

What is a low vision examination? Not the same as annual eye examination Performed in a doctor’s office by an ophthalmologist or optometrist who specializes in low vision (corrected vision no better than 20/70 or a visual field less than 20 degrees) Focuses on functional vision - how does the patient’s visual impairment affect their day to day living Does not treat the cause of vision loss – instead helps the patient learn to maximize remaining vision

What does the doctor do during a low vision examination?

Step 1: A review of your health and medication history You will be asked questions about Your overall health Your family’s medical history Any medications you are taking Any medical conditions you may have including a history of smoking, high blood pressure, diabetes etc.

Step 2: Your Vision History You will be asked for The name and contact information for your referring optometrist or ophthalmologist The date of your last eye examination A diagnosis of your eye disease or disorder Family history of eye diseases Any previous eye treatments, surgeries or injuries Any recent changes you have noticed in your vision

Step 3: Low Vision History The doctor will want to know When did your vision problems begin? What daily living tasks are you having difficulty completing because of your vision? (ie. cooking, watching TV, walking outside) Are there things you would like to do that are challenging because of your vision? Have you received any vision rehabilitation services in the past?

Step 4: Determination of Eyeglass Prescription You should bring any prescription eyeglasses with you to your low vision examination. The doctor can use a lensometer during the examination to determine your current eyeglass prescription. Remember – the doctor is trying to help maximize your functional vision and proper glasses play a large part in your ability to see.

Step 5: Visual Acuity Testing Your near and distance vision will be tested both with and without using your glasses. The doctor uses a special low vision eye chart that is different than an eye chart used in a regular eye examination. This low vision eye chart contains different sized letters and numbers that helps determine the clarity and sharpness of your near and distance vision.

Sample of a Low Vision Eye Chart For Distance Vision For Near Vision

Step 6: Visual Fields Testing The doctor will use a Tangent Screen (a non-computerized visual field test) to determine how much side vision you have and how much of the surrounding area you can see. This test involves the patient looking at a black chart with a series of circles (like a bullseye) and identifying where they can see the dots on the chart. From this test the doctor can identify the extent of your visual field (measured in degrees)

Step 7: Color Vision Screening The doctor may screen for color blindness if appropriate. The Ishihara Color Vision Test consists of a booklet, each page containing a circular pattern (or "plate") comprising many dots of various colors, brightness and sizes. The seemingly random colored dots are arranged in such a fashion that a person with normal color vision will see a single-digit or two-digit number within the array of dots. A person with a color vision deficit will either be unable to see a number or will see a different number than the one seen by a person with normal vision.

Step 8: Eye Examination The doctor will examine both the external and internal parts of your eyes to identify any concerns. The exam includes use of: An opthalmoscope to view the retina and optic nerve (can be used to identify retinal problems such as diabetic retinopathy ) A slit lamp to view the front and back sections of the eye (to evaluate overall eye health) A tonometer to measure pressure within the eye (for example increased pressure is a common symptom of glaucoma)

Step 9: Refraction During the low vision examination, if the doctor determines a different eyeglass prescription would maximize your vision she may complete a refraction to identify the appropriate prescription. She uses a phoropter - equipment that contains a series of different strength prescription lenses that can be adjusted to determine the optimal prescription to use. You would then receive a prescription for new eyeglasses that can be filled by a local optician.

Step 10: Low Vision Aids Based on the information gathered during your eye examination, the doctor may recommend prescription low vision aids to assist you in maximizing your vision. Recommendations are based on your vision, the tasks you are interested in doing and what level of technology you are comfortable with.

Low Vision Aids continued It is important to realize that low vision aids prescribed by the doctor after a low vision evaluation are very different than the types of magnifiers or glasses you can buy in a drug store. Most hand held magnifiers or glasses sold in stores can only increase magnification by up to three times (3x). The doctor can prescribe aids with fourteen times (14x) magnification.

portable electronic readers Max Detail Binocular glasses Samples of Prescription Low Vision Aids handheld magnifiers monocular portable electronic readers Max Detail Binocular glasses

Non- Prescription Low Vision Aids The doctor may also recommend some non- prescription aids that can be found in stores to help with daily living tasks. Talking Watches Large Button Telephones Talking Scales

Step 11: Low Vision Aid Training Low Vision Aids can be very helpful in increasing independence for patients, but can take some practice to use them effectively. If the patient selects a low vision aid, it is recommended that they receive training to use the aid properly. The doctor or her assistant provides some initial training on how to use a low vision aid, but many times more training is needed for a patient to be comfortable.

Low Vision Aid Training continued In these cases, the doctor can make a referral to an Occupational Therapist (OT) certified in low vision to help teach patients to use aids. Training can be provided either at the Low Vision Clinic or in the patient’s home setting. If a patients does not find their low vision aids helpful even after training, they can return to the clinic for a follow up appointment to explore other options.

Step 12: Other Services The Low Vision Clinic is one of many services offered by the Bucks County Association for the Blind and Visually Impaired (BCABVI). As a final piece of the low vision examination, we will give you information about other services we can provide that may be helpful either now or in the future. There is no pressure to use any additional services, but they are there if you need them.

Meet our optometrist Dr. Denise T. Wilcox, O.D., Ph.D Has specialized in low vision for over 25 years Provides low vision services for Veterans Administration Hospital in Philadelphia Is an adjunct professor at Gwynned Mercy College Was featured in “Women of Optometry” for her work in low vision

How do I schedule a Low Vision Evaluation with Dr. Wilcox? To schedule a low vision evaluation you can: call (215) 968-1035 to speak with our scheduler send an email to suestubbs@bucksblind.org

Things to know when scheduling The low vision evaluation lasts for approximately 90 minutes A follow up visit (30 minutes) may be needed Dr. Wilcox is only available for appointments Mondays and Thursdays 9:00 am – 3:00 pm Transportation may be available

What should I bring to my appointment? The day of your appointment you should bring Your prescription glasses Any visual aids you are currently using A list of current medications Your insurance card and copay (if applicable) When possible, it is helpful to have a family member or friend come with you to your appointment. They can take notes, help ask questions and listen to the doctor’s recommendations.

Costs for Low Vision Services Most insurances cover the cost of low vision examinations and occupational therapy Patient is responsible for any copayments No one is refused services based on an inability to pay

Resources for financial support Pennsylvania Bureau of Blindness and Visual Services (BBVS) or the Office of Vocational Rehabilitation (OVR) Patients who are eligible for services through BBVS or OVR can have their low vision services and equipment paid for with no copayment (with prior approval) If you are not currently connected with BBVS or OVR but meet the eligibility requirements, we can make a referral for services on your behalf

Other Financial Resources Many local community organizations such as Lions Clubs, Rotaries, Exchange Clubs and church groups are willing to provide financial assistance for people without resources. We have established relationships with these groups and can often work with them to purchase low vision aids for members of their communities.