Wilmer's Vision Rehabilitation department is aimed at the treatment of vision impairment that cannot be corrected with glasses, contacts, medication or surgery. Typically, this loss of vision is caused by age-related eye conditions such as glaucoma, macular degeneration or diabetic eye disease.
Vision rehabilitation services at Wilmer are made possible, in part, through the generosity of the Lions Clubs of Maryland, Delaware, and the District of Columbia, as well as the Lions Vision Research Foundation.
Conditions We Treat
Age-related macular degeneration is the most common cause of severe loss of eyesight among people 50 and older. Only the center of vision is affected with this disease. It is important to realize that people rarely go blind from it.
We help people with AMD maximize their visual function and maintain independence. Improvements in function and engagement in activities can be made through:
- strong or specialized glasses
- hand-held or spectacle-mounted magnifiers
- electronic/digital magnification
- low vision occupational therapy, which can include eccentric viewing training, assistance with developing and teaching skills to manage activities of daily living, and training with the recommended devices and assistive technology.
A low vision evaluation is a good first step to getting educated on vision loss and initiating new strategies to enhance function. Vision rehabilitation services are designed to assist patients and manage the continuum from the very early stages of visual loss.
Diabetic Eye Disease encompasses a number of eye conditions, including diabetic retinopathy, and it is the leading cause of blindness among working-age Americans.
Many people with vision loss from diabetes describe fluctuating vision. This can vary day to day or even within a single day. People with diabetic eye disease have difficulty adapting to varying lighting conditions, such as coming inside from the sun or entering dark subway stations. Diabetic eye disease can lead to increased glare sensitivity indoors (fluorescent and other lighting) and in the sun.
In some cases, central vision loss occurs and magnification can be the best option to maximize reading fluency. Environmental modifications such as changes to lighting or enhancing contrast of everyday objects (i.e. in the kitchen and for medication/blood sugar management) is recommended.
Recommendations for maximizing mobility safety including appropriate glasses, mobility aides or referrals for mobility assistance can help enhance independence. Working with the patient, and when applicable, we develop a rehabilitative plan to maintain employment and to maximize independence at home.
Glaucoma is a chronic, progressive eye disease caused by damage to the optic nerve, which leads to visual field loss. It is the leading cause of irreversible blindness.
Our Vision Rehabilitation services help people manage their glaucoma through:
- contrast enhancement
- glare control and lighting techniques
- occupational therapy training to maximize the use of the residual visual field
- referrals for services such as orientation and mobility
Additionally, glasses, magnifiers and image minifiers may play a role in enhancing the function of patients with glaucoma.
Albinism and ocular albinism are inherited conditions where a person is lacking melanin pigment. In ocular albinism, only the eyes are affected, while the skin and hair color have normal melanin. The lack of pigment causes reduced central vision, but patients generally have good peripheral vision. In addition, most patients with ocular albinism experience involuntary, rhythmic eye movements and may have significant refractive errors, requiring glasses or contact lenses.
Even with glasses, most patients with ocular albinism are moderately to severely visually impaired. It is common for those with albinism to hold material close to read, leading to visual fatigue. The lack of pigment can also lead to increased glare sensitivity, especially in the sun.
Because ocular albinism is present at birth, our team works with schools and teachers to ensure that patients are meeting academic goals. Our physicians and therapists assess each person to determine the appropriate recommendations for tinted lenses to manage glare concerns, telescopic lenses for distance viewing in the classroom, and community integration (i.e. reading street signs, bus numbers and addresses).
Reading assessments to determine appropriate print size and form of material are part of the low vision evaluation and can be critical in navigating a child’s needs. Ongoing counsel and prescribing of patients as they advance through their school and careers can be of great value to patients and their families.
The level of visual impairment is variable with ocular albinism. Some with albinism require orientation and mobility training, while others are able to maintain a restricted driver’s license. The Vision Rehabilitation service provides individualized plans based on specific goals and levels of visual impairment.
Retinitis pigmentosa (RP) is a progressive retinal degeneration which causes night blindness and loss of peripheral (side) vision. Over time, patients with retinitis pigmentosa can develop “tunnel vision” with only the central vision remaining and in many cases, RP can cause total blindness. Early in the disease, people with retinitis pigmentosa often retain excellent central vision for reading; they notice the true of effects of the peripheral vision loss in dimly lit environments. In these dimly lit and/or unfamiliar environments, individuals may benefit from the use of a mobility aid.
Learning safe travel is a part of orientation and mobility (O&M) instruction and an important part of the rehabilitative process. Many individuals notice that their vision fluctuates or varies depending on the environment. Rehabilitative strategies can include recommendations for appropriate lighting as well as tinted glasses to manage different types of glare, both indoors and outdoors. Our occupational and rehabilitative therapists can develop strategies for the slower adaptation from light to dark that is often associated with RP.
As the disease progresses, vision rehabilitation can integrate “visual field expanders” or “minifiers” to maximize residual vision. Additionally, we explore non-visual techniques to obtain information such as scanning technology, text-to-speech conversion and contrast enhancement. We will also coordinate services with schools, places of employment and rehabilitative services to ensure appropriate accommodations.
Retinopathy of Prematurity (ROP) is an eye condition that affects premature infants. ROP is a common cause of childhood vision loss and can lead to blindness. Not all premature infants develop ROP and not all infants with ROP have lasting visual consequences or require treatment.
In more severe cases, infants may require extensive treatment such as laser and cryotherapy. These treatments decrease the oxygen demand in the retina in an attempt to save the vision. Vision loss from ROP is variable and patients may experience central or peripheral vision loss. ROP can lead to retinal detachments requiring more invasive surgery with more significant effects on the vision.
Vision rehabilitation for patients with ROP is specific to the type of vision loss and the age. Early on, we often assist with making recommendations for the Individualized Education Plan (IEP) while the patient is in school. Determining the visual potential is an important part of the rehabilitative process and it helps to make informed decisions on the best learning style.
After completion of school, we can offer assistance with vocational and independent living goals. Patients with ROP may have central visual impairment and thus would require magnification. Many patients with ROP have significant peripheral visual impairment and require mobility aids such as a white cane, and we will often refer for orientation and mobility training.
In more significant cases of visual impairment, patients with ROP may require Braille instruction or sensory substitution such as text to speech conversion and auditory input for extended reading even if some vision is preserved.
Stargardt maculopathy is a familial eye condition with symptoms and clinical findings that can begin as early as the first decade of life. It affects the central vision and causes difficulty with vision such as reading overhead signs when driving or walking, reading small print and recognizing faces. Early on, patients may notice significant vision changes with an apparently healthy retina, or with subtle retinal changes. Progression of macular changes is typical, often leading to severe central visual impairment and the classification of legal blindness. Stargardt's does not affect the peripheral retina and the side vision remains intact. Stargardt's alone does not lead to total blindness and vision enhancement strategies are often very successful.
Much of the management of Stargardt's is focused on enhancement of central visual function. We help patients maximize their visual function through the prescription of strong or specialized glasses, telescopes, hand-held or spectacle-mounted magnifiers, electronic/digital magnification and low vision occupational therapy. This can include eccentric viewing training, assistance with developing and teaching skills to manage activities of daily living and training with the recommended devices and assistive technology.
Because Stargardt maculopathy commonly affects younger individuals, adaptation to new visual strategies is often successful. The technology of text to speech software and screen-readers are very effective.
We work closely with employers, schools and disability services to ensure that patients are receiving the appropriate accommodations to maintain or gain employment. Some patients with Stargart’s maculopathy continue to drive through specialized driving licensure programs available in many states. Our physicians work closely with patients, families and the motor vehicle administration to assess the potential to initiate and maintain driving.
Vision is dependent on two factors: having a healthy eye to receive the visual information and having healthy visual processing centers in the brain to interpret and process the information. Visual processing occurs in the occipital, temporal and parietal lobes. The effect of stroke on vision loss is variable and often depends on the location and extent of the brain injury.
The occipital lobe processes what we think of as “vision” in terms of the visual image, but the temporal and parietal lobes are essential for visual-spatial awareness, object identification and categorization, as well as facial recognition. In general, patients who have strokes or other brain injuries that affect the vision centers on the right side of the brain will have vision loss to the left in both eyes. Patients who have strokes that affect the vision centers in the left side of the brain will have vision loss to the right in both eyes.
The goal of vision rehabilitation in patients with stroke is to maximize visual function during reading, mobility, or other activities of daily living. Stroke can often affect the processing of information, and the cognitive and psychological aspects of a patient are commonly assessed and integrated into rehabilitation. We perform functional visual field assessments and provide education regarding visual field loss and visual processing deficits. We also evaluate prism lenses that can expand the visual field and improve awareness into the missing area of vision.
After a stroke or brain injury, the changes that a patient experiences can be permanent or there can be improvement over time. Patients can be evaluated immediately after the injury and we continue to follow the them closely to monitor for improvement and develop strategies allowing for return to work, independent living, or other goals.
Vision rehabilitation services can help you or a loved one manage a spectrum of eye diseases and conditions. Explore these resources to learn more about low vision and vision rehabilitation services.
- Low Vision and Vision Rehabilitation FAQs
- American Academy of Ophthalmology on Low Vision and Vision Rehabilitation
- Audio-description in Movie Theaters - Disability Rights Section, Civil Rights Division, U.S. Department of Justice
- Blind Industries and Services of Maryland
- Hadley Institute for the Blind and Visually Impaired
- Maryland Department of Rehabilitative Services
AddressLions Vision Research and Rehabilitation Center
The Wilmer Eye Institute at Johns Hopkins
600 North Wolfe Street, 3rd Floor
Baltimore, MD 21287