LOW VISION AIDS Low vision, also known as partial sight, visual impairment and subnormal vision is broadly

defined as uncorrectable vision loss that interferes with daily activities. Definitions normally incorporate an estimate of visual loss in terms of impairment (for example measuring visual acuity or visual fields), or in terms of disability (measuring the ability to perform a certain task). One such definition states that low vision is the inability to read a newspaper at a normal reading distance (40 cm) with best refractive correction24. The World Health Organization (WHO) has established criteria for low vision which are used in the International Classification of Diseases25. Low vision is defined as a best-corrected visual acuity worse than 0.5 logmar (Snellen 6/18 or 20/60) but equal to or better than 1.3 logmar (3/60 or 20/400) in the better eye or a visual field of <10 from the point of fixation, but who is potentially able to use, vision for the planning and execution of a task loss with best possible correction.The most effective way to reduce the degree of handicap associated with low vision is to provide low vision aids (LVAs) as a part of a comprehensive low vision rehabilitative service. A low vision aid (LVA) is any device that enables a person with low vision to improve his/her visual performance. They enhance visual performance by causing image magnification and improving contrast. They make things larger ,brighter and clearer and thus improves the vision quality.Low vision aids can be optical such as aspheric glasses, hand held magnifiers, stand held magnifiers, dome magnifier etc or non optical such as large print books, reading stand and illumination devices. Low vision aids have been useful in home activities and activities involving social interaction like shopping, banking, travelling. They help in maintaining reading ability and motility of these patients, thereby affording an increase in independence, communication, mental agility and better quality of life.

CLASSIFICATION OF LVA

Optical
Telescopes Aspheric glasses Hand held magnifier Stand held magnifier Fresnel prisms Prismospheres Paper weight Bar magnifier Pocket magnifier Electronic aid(CCTV) Dome magnifier

Non Optical
Large print books Reading stand Illuminated devices Writing devices as typoscopes Medical devices as capsule container Sensory substitutes as talking calculators

For near vision:

Magnifiers Can be Illuminated or non-illuminated. Illuminated magnifiers are either battery-powered or rechargeable. Magnifiers may be hand-held or stand held or spectacles;
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Hand held magnifier may suffice quick simple tasks that are conducted at arms length eg adjusting a gas dial, reading labels of medicine.

Stand magnifier consist of a mounted lens that will remain in focus if placed on reading material so that its focal point corresponds to the focal point of patients near correction.

Electronic aids - These include primarily closed-circuit television and television readers which provide improved contrast and magnification. Closed circuit television (CCTV) has an inbuilt special camera which focuses on what patient wants to see eg. a pill bottle, a check, a book, a photograph and displays it onto a large screen. This provides binocular viewing and reading material can be placed at a comfortable distance unlike magnifiers which require the same material to be placed very close to the patients head. These electronic visual aids provide high magnification with a wide field of vision and can be used for longer duration, whereas optical magnifiers though have restricted field of vision which make reading difficult. Major problem with these aids are that they are very expensive as compared to optical aids.

Other newer vision aids: o o o Large button remotes Talking calculator Low Vision Phone : This has extra large numbers with high contrast, which enables easy viewing. A talk back keypad numbers or talking caller-ID may be incorporated. o Large Button Cell Phone : is another modification where the button size is enlarged, Since low vision patients can't see the numbers on the small buttons, they encounter difficulty in viewing and pressing the right one. Large button improvisation makes cell phone easy to use for these patients. o Low Vision software technology: It incorporates electronic magnifiers and special computer screen magnifying software. It allows the patient to use the

computer with voice commands instead of typing and will read out loud to emails, the weather, stock reports or other information found on the web. o Low Vision Aids for Writing:- Writing becomes more difficult as vision deterioration progresses. A few simple low cost aids help in writing things such as to write a check or a special note. These are cheque guides which have a slot for signing names on cheque. Financial records and bill writing with large print checks and check register are some other helpful devices .Other aids are bold felt pens, large lined books, typoscopes etc. o Low Vision Clocks: They offer bold, bright numbers with LED lighting and some even state the time. o Low Vision magnifiers : range from desk top magnifiers to pocket magnifiers or TV screen magnifiers o Low Vision Lighting: Good lighting requires less demand of magnification. In addition it also improves reading performance. However light should fall short of causing glare. Increase in luminance leads to improvement in contrast sensitivity and near vision. Thus provision of good lighting is an important aspect of low vision rehabilitation o Low vision Electronic Reading Device: This device reads books, magazines, newspapers and blogs. It also has options to magnify the font and adjust the contrast. o Cooking aids: Bold numbered measuring cups, talking microwaves, and timers can keep the patients retain their independence in kitchen. o Large Print Books

Low vision games.

For distance vision o Telescopes They can be mounted on a spectacle frame. These aids give a longer working distance. These have a relatively smaller field of view and shorter depth of focus than a simple high plus reader of comparable magnification.

Calculation of dioptric power required Dioptric power (D) requirement can be calculated by Kestenbaum formula which is the inverse of distance visual acuity, for example if snellen visual acuity was 2/60 then the reciprocal will be 60/2, so patient will require 20D add. The power of magnification required was calculated to be 5x by using formula D=4 x where x is magnification calculated.

Dioptric power (D) requirement is also calculated by near visual acuity.The smallest print size for fluent reading would give the magnification power, which indicates by how much newspaper text in standard print size has to magnified in order to be read at a distance of 25 cm.
Magnification(x) is standard print size to be read at a distance of 25 cm smallest print size patient able to read at a distance of 25 cm

For each print size, the number of dioptres (D) of necessary reading add was calculated using the same formula D=4 x (Magnification calculated).

Factors affecting prescription of a low vision aid Age : In elderly tremolos patient handling of aids such as hand held is difficult. They should be prescribed with other LVA such as stand held, dome magnifier etc. Visual acuity : Patients with better visual acuity > 20/200 require lower power resolution for a print size and achieved a better print resolution with a lower power visual aid than eyes with poor visual acuity. Occupation and socioeconomic status : In developing nations like India expensive visual aids such as CCTV is an issue. Affordability should be kept in mind while prescribing LVA. Type of disease : In visual impairment caused by diseases as diabetes, reading ability is easy to restore in majority of patients using optical low vision aids, while in patients with macular pathology as AMD, it is not easy to restore reading ability because of absolute central scotomas and also they require expensive visual aids as CCTV. Density of scotoma : Patients with absolute scotoma develop eccentric viewing and could only be improved by combining low vision aids with training of eccentric viewing, while patients who do not have absolute central scotoma can have significant improvement in their reading ability following provision of low vision aids. Besides the level of magnification, there are other factors that are important when choosing an optical device such as ease of use and cosmetic appearance. Devices that have an unusual cosmetic appearance that call attention to the person's disability may be rejected despite their optical benefit.

Evaluation of LVA Reading speed : For a person with low vision, reading has been identified as one of the major problem. In the everyday use of their reading ability, it is important for people to achieve their optimal reading rate (measured usually in correctly spelled words per minute).For low vision patient, a speed that is sufficient to complete the task within an acceptable amount of time is required. The effect of slow reading on the understanding of the message is variable and has been found to decrease comprehension .Calculation of reading speed (words/min) before and after LVA can evaluate improvement in fluency with LVA. Visual acuity : Use of LVA improves reading of specific letter sizes both during distance and near work. Smallest print size patient able to read at a distance of 25 cm with LVA measures the near work performance. Quality of life : . Quality of Life is considered as a basis to measure the effectiveness of vision rehabilitation and is an integral part of low vision rehabilitation. To identify appropriate outcome measures for low vision patients who seek out low vision rehabilitation,a vision-specific HR QoL instrument is more justified. A 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) is also available to assess vision-specific HRQoL for low vision patients. Patients self reported dependence has a significant correlation with quality of life. Vision related questionnaire are thus better guides to assess the impact of LVA on quality of life of these patients. It can quantify the impact of low vision and low vision aids on patients daily activities such as reading, motility and thus their quality of life. For the less literate patients near work which they

perform at home can be evaluated with activities like sewing, reading devotional symbols, playing cards etc. Thus,visual performance after LVA thus can be assessed by visual acuity, ability to read small print, reading speed, duration of reading or performing the visual tasks, ability to do their routine work and questionnaire related to vision specific quality of life. These aids improve quality of life positively of such patients by allowing them to pursue their daily activities without relying on outside help like reading of newspapers, medicine labels, identifying street signs, watching television, doing sewing or cooking etc. Rehabilitation, including low vision aid (LVA) provision and training, peer support and education, can improve functional and psychological outcomes.