Low Vision: Living Well With Reduced Sight

What counts as low vision

There is no single worldwide definition. In the US, low vision usually means:

• visual acuity (sharpness) of 20/70 or worse in the better-seeing eye with the best possible glasses, or
• a visual field narrowed enough to interfere with daily life

Legal blindness is a stricter category used for benefits: best-corrected acuity of 20/200 or worse, or a field of view of 20 degrees or less, in the better eye. Many people who are legally blind still have useful vision. See legal blindness and the broader overview of vision impairment.

Types of low vision

The pattern of vision loss determines which aids help most.

The low vision exam

A low vision exam is done by an optometrist or ophthalmologist with extra training in vision rehabilitation. It is different from a routine eye test. It typically includes:

• detailed questions about the tasks you find hard and what matters most to you
• acuity testing with special charts that measure very low levels of vision
• contrast sensitivity and glare testing
• mapping of the visual field and any blind spots
• trying magnifiers, telescopes, filters and lighting
• a plan for training, devices and referrals

Ask your eye doctor for a referral as soon as vision loss affects your daily life. You do not need to wait until vision is very poor.

Low vision aids and devices

Optical aids

• Hand-held and stand magnifiers, many with built-in LED lights
• High-power reading glasses (microscopes) that let you hold print close
• Telescopes: small hand-held or spectacle-mounted devices for seeing signs, faces or the TV at a distance
• Filters and tinted lenses that cut glare and improve contrast, especially useful outdoors

Electronic aids

• Video magnifiers (CCTVs): a camera displays enlarged text on a screen, with adjustable contrast and colors
• Portable electronic magnifiers for shopping and travel
• Smartphones and tablets: built-in zoom, large text, high contrast, voice assistants and screen readers (such as VoiceOver on Apple and TalkBack on Android)
• Apps that read text aloud, identify money or describe scenes using the camera
• Audiobooks and talking devices: watches, scales, thermometers and blood glucose meters

Non-optical tools

• bright, task-focused lighting, such as a gooseneck lamp aimed at the page
• large-print books, checks, calendars and phone keypads
• bold felt-tip pens and dark-lined paper
• typoscopes, black card with a slot that isolates one line of text
• bump dots and tactile markers for appliance dials

Low vision rehabilitation

Vision rehabilitation teaches you to use your remaining sight more effectively and to do tasks in new ways. It may involve:

• Eccentric viewing training: learning to use a healthy part of the retina just off center when central vision is lost
• Scanning training for people with field loss after stroke or glaucoma
• Occupational therapy for cooking, medicines, money and personal care
• Orientation and mobility training, including use of a white cane
• Training in assistive technology

In the US, Medicare and many insurers cover low vision evaluation and some rehabilitation services when prescribed by a doctor, though devices are often not covered. State vision rehabilitation agencies and nonprofits provide services, training and sometimes equipment.

Making home safer

People with low vision fall more often. To reduce the risk of falls:

• increase lighting, especially on stairs and in hallways, and add night lights
• mark step edges with bright contrasting tape
• remove clutter and loose rugs
• use contrasting colors: a dark cutting board for light foods, colored tape on light switches
• keep furniture in consistent places
• organize medicines with large-print labels, tactile marks or a talking pill reminder

Emotional health

Losing vision often brings grief, frustration and loss of confidence. Depression is about twice as common in people with low vision. Peer support groups, counseling and rehabilitation all help. Some people with significant vision loss see vivid, silent images of patterns, faces or scenes they know are not real. This is called Charles Bonnet syndrome and is a result of the brain filling in missing input, not a mental illness.

Driving

Driving rules depend on your state. Most require at least 20/40 vision in the better eye for an unrestricted license, with restricted licenses sometimes available with lower vision or bioptic telescopes. Your eye doctor can advise on whether your vision meets the standard.

Frequently asked questions

What is considered low vision?

In the US, low vision usually means best-corrected vision of 20/70 or worse in the better eye, or a narrowed visual field, that makes everyday tasks difficult. It cannot be fixed with regular glasses, contact lenses, medicine or surgery. It is less severe than legal blindness.

Is low vision the same as blindness?

No. Most people with low vision have useful sight and can learn to use it well with aids and training. Legal blindness is a defined level of severe impairment, 20/200 or worse or a field of 20 degrees or less, and many legally blind people still see some things.

What are the best low vision aids for reading?

It depends on your eye condition and how much magnification you need. Common choices are lighted stand magnifiers, high-power reading glasses, video magnifiers and tablets with zoom or text-to-speech. A low vision specialist will test several to find what suits you.

Can low vision be improved?

The underlying vision loss usually cannot be reversed, but treatment can prevent further loss, for example injections for wet macular degeneration or glaucoma drops. Low vision rehabilitation, magnifiers, lighting and technology can greatly improve how well you function with the vision you have.

Who should I see for low vision?

Start with your ophthalmologist or optometrist, who can confirm the diagnosis and refer you to a low vision specialist for a low vision exam. They can also connect you with occupational therapists, orientation and mobility instructors and state vision rehabilitation services.