1380 Spahn Avenue, York, PA

Let’s talk about getting around when you are visually impaired, and I don’t mean by way of a vehicle- I mean, simply, just walking around and moving about in your space; moving from point A to point B. With visual impairment, this does become a concern.

Orientation & Mobility (O&M) is a discipline within the field, a science, if you will, that teaches the principles of mobility (traveling). A definition provided by William Henry Jacobson, from his book, The Art and Science of Teaching Orientation and Mobility to Persons with Visual Impairments states, orientation is the ability to use one’s existing senses to understand one’s location in the environment at any given time. Mobility is the capacity for or facility of movement. So then, Jacobson defines orientation and mobility as the teaching of the concepts, skills, and techniques necessary for a person with a visual impairment to travel safely, efficiently, and gracefully through any environment and under all environmental conditions and situations.

Often times, O&M is associated with the white cane, and can sometimes be referred to as white cane training in lay terms. Professionals, called Orientation and Mobility Specialists have specific education and credentials to teach O&M. O&M can be taught with or without a white cane. Some people must travel with a white cane, and some simply choose to or choose not to travel with a white cane. For example, a person with macular degeneration typically has some functional vision remaining. I have worked with many macular degeneration patients; some have had O&M training and choose not to use a cane. Having the instruction and learning strategies and techniques for mobility, and how to navigate their space safely, was enough for them to feel confident moving around. While others with macular degeneration may have had the same training, but choose to learn with the white cane, so they can alert others in their environment, that they have a vision loss and can have that extra sense of knowing they will be understood as needing, perhaps, a little more room for navigation, or more time to cross the street, etc..

Orientation and Mobility is a unique and freeing skill. If you feel you would like more information about O&M training, or would like to be referred for training, please contact me at ForSight Vision.

Jennifer C. Zack, M.S., CLVT

Clinical Director / Certified Low Vision Therapist

1. Hand held minus lenses:  Just like a hand held magnifier will magnify images (make them appear larger), this device will minify images (make them smaller).  A higher power minus lens equals greater minification.
2. Reverse Telescopes:  This device will also create the effect of minifying an object or image.  The patient looks through the objective lens instead of the ocular lens- allowing for more of his/her environment to be placed in the healthy part of vision.  Detail, objects, etc… that are typically outside of his viewing area will now be visible by using a revers telescope.  Telescopes can be hand held or spectacle-mounted.
3. Mirror Systems:  With this system, a small mirror (usually plastic) is mounted at the nasal area of a pair of glasses.  It is mounted and angled toward the side of the eye experiencing the field loss; this provides a temporal or side view of the blind area.
4. (Fresnel) Prisms:  A series of prisms compressed into a 1mm plastic lens, which can be affixed to a portion of the back of spectacle lens; patient is able to glance behind the prism and see objects in his non-seeing area. 

If you have a visual field loss, please visit us at ForSight Vision to explore the possibilities of Field Enhancement Systems.

Jennifer C. Zack, M.S., CLVT

Clinical Director / Certified Low Vision Therapist  

Visual Field Enhancement Systems (FES)

What are Visual Field Enhancement Systems?

Visual field enhancement systems (FES) are minification devices; mirror systems and prisms allowing one with reduced fields to gather more information in their remaining field.  More commonly, in low vision therapy, magnification is the focus.  However, when one has low vision due to visual field loss (as opposed to visual acuity loss), we focus on minification.  Instead of making objects larger, the idea is to make them smaller, enabling more detail to fit into the small field of view.  Or, with mirrors and prisms, they act as early detection for environmental objects (increase safety and efficiency with mobility).  FES helps the patient develop better scanning skills to compensate for a peripheral field loss.  Similar to many types of magnification devices, minification devices are available in many different sizes/ power levels.

Which Low Vision Conditions Could Benefit From FES?

Retinitis Pigmentosa:  due to the progressive nature of this disease, one will gradually continue to lose peripheral vision.  Some may experience tunnel-like vision, while others may experience a mid-peripheral field ring of vision loss with remaining islands of vision.  Many RP patients will stabilize with a remaining small central circle of clear view; these individuals are the best candidates for FES.  These patients often have difficulty with night vision, crowds, bumping into things, and difficulty with side awareness.  An FES system would bring objects and environmental details from the side that they are unable to see, into view.

Glaucoma: Peripheral field loss caused by glaucoma has similar functional effects as peripheral loss from retinitis pigmentosa.

Hemianopsia: This condition is often the result of a stroke or traumatic brain injury (TBI), and causes the patient to lose half of the visual field, usually in each eye.  Sometimes, one may experience this loss the same way in each eye.  For example, he may lose vision on the right side in each eye- loss of temporal vision in the right eye and loss of nasal vision in the left eye.  Patient is left with only the left side of vision in each eye.  In other situations, a patient may experience other forms of hemianopsia, such as binasal- meaning that he has loss of vision at the nasal side of each eye.  However, hemianopsia can take on many forms.  Patients who have hemianopsia and some remaining islands of vision (macular sparing) are the best candidates for an FES; due to the visual acuity in the remaining islands of vision.

Overall, the best candidates for an FES are those with severe field restrictions, usually from advanced glaucoma or retinitis pigmentosa; because there is remaining macular vision.  Better acuity, no matter how small the field, is better than a larger field of view with poor acuity.

Stay tuned for the next installment of the Low Vision Blog, when we discuss the different kinds of Visual Field Enhancement Systems.

Jennifer C. Zack, M.S., CLVT

Non-Medical Multidisciplinary Approach to Low Vision Rehabilitation

 This week, I’d like to take time to tell you about the other specialty areas in the field of low vision.  As a certified low vision therapist, I always try to take the multidisciplinary approach with rehabilitation treatment plans.  There are such great qualified specialists available and ready to assist with skill training!  When converging multiple specialties and/or technologies, we are able to establish a comprehensive program for the patient that will increase his/her adjustment to low vision.

The very first profession in this multidisciplinary approach that I’d like to recognize is the Access Technology Specialist.  Our Access Technology Specialist is a team player here at ForSight Vision.  Tony Heath is an essential part of the Functional Low Vision Assessment.  Tony and I work as a team to assess the functional capabilities of each patient.  An Access Technology Specialist will evaluate the needs of an individual with low vision pertaining to any item, piece of equipment, or product system.  Most commonly, it is for the closed circuit television (video magnification) or adaptive computer software.  After Tony’s assessment, he is able to make specific recommendations that will be most suitable for the patient.  Access Technology Specialists can provide training in the home and work place as well.

Next, I’d like to recognize the Orientation & Mobility Specialist (O&M).  Some of you might be saying, what in the heck is an Orientation & Mobility Specialist?  Well, this professional is most commonly known for providing white cane training.  However, the O&M specialist in more general terms, assist someone to learn to travel safely in the environment- and not necessarily with a white cane.  They may provide training on specific travel techniques within the community, the use of a guide dog, or on how to use the public transit system.  But most importantly, the emphasis is on safe travel.

A Vision Rehabilitation Therapist (VRT) (not the same as a low vision therapist), is a professional who helps adults compensate for activities of daily living by teaching them new skills; whether that is through the use of a specific adaptive aid, such as a talking medication management system, or by way of altering something you have always done.  For example- using Braille instead of print, or using large print instead of standard size print.  VRT’s often assist people with learning new skills for cooking, cleaning, shopping, and money management/organization.  The VRT works largely in the home setting.

So far, I have spoken much about whom adults can turn to when needing training and assistance.  What about children?  Children are usually served through the school district or early intermediate unit.  The school district or intermediate unit will usually employ a Teacher of the Visually Impaired (TVI).  Most TVI’s work as itinerant teachers, and can also work with infants, and preschoolers in the home setting.  The main focus of a TVI is to teach compensatory skills such as Braille (or pre-Braille), communication skills, and study skills.  TVI’s also work with the classroom teachers to assist in obtaining material in an alternative medium to visual.   These professionals are also skilled in areas of educational assessments, writing educational plans, and working with families.  

The last area of specialization I’d like to present is that of Rehabilitation Counselor for the Blind (RCB).  Or, more commonly for our geographical area, this professional is known as the Vocational Rehab Counselor; available through the state Bureau of Blindness and Visual Services.  This person may work with visually impaired clients who are seeking employment.  The RCB may provide case management, evaluation of vocational goals, career counseling, rehabilitation plans, and job placement.  The main focus is to assist the vision-impaired client to return to an active and productive life.

At ForSight Vision, we are fortunate to have both a Certified Low Vision Therapist on staff and an Access Technology Specialist.  If you are interested in receiving assistance or training from other specialized professionals in the field, please contact me, and I would be happy to make that referral.

Jennifer C. Zack, M.S., CLVT

Clinical Director / Certified Low Vision Therapist