Community Eye Health JOURNALVOLUME 25 | ISSUE 77 Low vision: we can all do more Hasan Minto Regional Director for the Eastern Mediterranean, International Centre for Eyecare Education. Karin van Dijk Clare Gilbert Co-director, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Clinical Advisor, Sightsavers. Despite all the treatments, operations, and medication at our disposal, there is still a significant number of people whose sight we cannot fully restore. What happens to these patients once they leave our care? Without the neces- sary support, advice, and low vision devices, their remaining vision will not be very good; this can make life a struggle. Support may be difficult to find, as low vision services are often inadequate or Use real tasks to inaccessible in many low- and middle- assess near vision. income countries. Professionals, such as TANZANIA rehabilitation workers, ophthalmologists, mid-level eye care workers, optometrists/ and/or optical) have been given. The people’s lives. People with low vision may refractionists, and special education definition also emphasises the importance struggle to look after themselves without teachers, may not know what to do about of vision for day-to-day functioning. help. Having low vision affects their people with low vision, leaving them with People who may be able to benefit from status in the eyes of others and can make no-one else to turn to. low vision care will want to do a range of social situations difficult. It reduces the Individuals who can only see light or different things. In many low- and middle- ability of people to pursue an education, movement of large objects will need income countries, for example, many to look after their children, and to earn rehabilitation that focuses on non-visual people with low vision are aged over an income. People with low vision are also strategies for learning and daily tasks. 50 years and cannot read or write. They at greater risk of falls and death. However, there are many people who will have different needs, and require With our support, people with low have slightly better vision, but are still different services, compared to children vision can make better use of their sight classified as blind, who have the potential or adults in employment. to do the things they want and need to to use their sight. These people could Low vision has a significant impact on do. We hope this issue will show you how. benefit from low vision care, which may include refraction, provision of magnifiers, In this issue and/or environmental modifications. 1 Low vision: we can do more 16 Low vision services for children in The World Health Organization defines Hasan Minto and Clare Gilbert Tanzania a person who needs to be assessed for 2 Understanding low vision Paul Courtright and Elizabeth Kishiki low vision care as someone “who has Clare Gilbert 16 Comprehensive low vision services in Sri Lanka impairment of visual functioning even 3 Low vision: the patient’s perspective Sumrana Yasmin after treatment and/or standard refractive Karin van Dijk 11 PRACTICAL ADVICE correction, and has a visual acuity of less 4 When someone has low vision How to predict the near magnification than 6/18 down to and including light Clare Gilbert and Karin van Dijk needed perception, or a visual field of less than 12 Making life easier for someone with 15 USEFUL RESOURCES 10 degrees from the point of fixation, but low vision 17 FEEDBACK who uses, or is potentially able to use, vision Clare Gilbert From our readers for the planning and/or execution of task.” 13 How to make an eye clinic more 18 TRACHOMA UPDATE The important part of this definition is accessible for people with low vision Trachoma: the beginning of the end? that people should only be assessed for low Jaya Srivastava Danny Haddad vision interventions once all other treat- 14 Low vision care: who can help? 19 CPD: TEST YOURSELF: Picture quiz ments the person needs (surgical, medical Karin van Dijk 20 NEWS AND NOTICES © The author/s and Community Eye Health Journal 2012. This is an Open Access article distributed under the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial CEHJ | VOLUME 25 ISSUE 77 1 use, distribution, and reproduction in any medium provided the original work is properly cited. Community Eye Health LOW VISION JOURNAL Supporting VISION 2020: The Right to Sight Understanding low vision Volume 25 | Issue 77 Clare Gilbert Co-director, International Centre for Eye Health, Editor London School of Hygiene and Tropical Elmien Wolvaardt Ellison [email protected] Medicine, Keppel Street, London WC1E 7HT, Editorial committee UK; Clinical Advisor, Sightsavers. Nick Astbury Allen Foster Who is likely to have low vision? Clare Gilbert Ian Murdoch As a rule of thumb, the following people are GVS Murthy likely to need low vision services and must be Daksha Patel referred wherever possible: Figure 1. Blurred vision. People with Richard Wormald blurred vision (right) have difficulty David Yorston • All children who have undergone bilateral Serge Resnikoff seeing details, both at distance and cataract operations, both those with nearby; they often have problems with Consulting editors for Issue 77 pseudophakia and those with aphakia Karin van Dijk and Hasan Minto glare. Printed materials and colours • People with diabetic macular oedema whose might seem faded. Regional consultants vision remains poor despite laser treatment Sergey Branchevski (Russia) Miriam Cano (Paraguay) • People with age-related macular Professor Gordon Johnson (UK) degeneration Susan Lewallen (Tanzania) • Children with oculocutaneous albinism Wanjiku Mathenge (Kenya) Joseph Enyegue Oye (Francophone Africa) • People with optic atrophy, whatever the cause Babar Qureshi (Pakistan) • Any person who still has difficulty performing BR Shamanna (India) their daily activities because of their vision, Professor Hugh Taylor (Australia) Min Wu (China) even after treatment and refraction. Andrea Zin (Brazil) What does low vision look like? Figure 2. Loss of central vision. “Is Advisors the man sitting down my husband, and Catherine Cross (Infrastructure and Technology) People with low vision are affected in different is there a seat for me?” Pak Sang Lee (Ophthalmic Equipment) ways. They may suffer from some or all of the Dianne Pickering (Ophthalmic Nursing) following: Editorial assistant Anita Shah Design Lance Bellers • Severely reduced visual acuity Proofreading Mike Geraghty • Blurred vision Printing Newman Thomson • Visual field loss: central or peripheral Online edition Sally Parsley • Loss of contrast sensitivity Email [email protected] • Increased light sensitivity. Exchange articles Anita Shah [email protected] Many people with low vision suffer from blurred vision (Figure 1), for example if they have Figure 3. Loss of peripheral vision. CEHJ online edition scarring on their corneas. “How many other people are there in Visit the Community Eye Health Journal online! the room?” All back issues are available as HTML and PDF. People with optic atrophy or age-related www.cehjournal.org macular degeneration will have loss of central To download our pictures, go to visual acuity (Figure 2), which means that tasks www.flickr.com/communityeyehealth requiring good central vision will be difficult. For How to subscribe example, reading, writing, threading a needle Readers working in low- and middle-income and sewing, putting on make-up, recognising countries get the journal free of charge. To people, seeing where their food is on the plate subscribe, send your name, occupation, and postal and whether they have finished eating, seeing if address to the address below. French, Spanish, and Chinese editions are available. their clothes are clean, finding their own pair of shoes. If they have a full field of peripheral Figure 4. Loss of contrast sensitivity. Yearly subscription/donation rates for high-income countries: UK £20 for your own vision then mobility will be less of a problem. With normal contrast sensitivity (left), subscription, or £40 for your subscription and to pay Someone with glaucoma or retinitis it is easy to recognise faces. With for four other eye care workers in low- and middle- pigmentosa will have constricted visual fields, reduced contrast sensitivity (right) income countries to receive the journal free of this becomes more difficult. charge. Send credit card details or an international i.e. loss of peripheral vision (Figure 3). This cheque/banker’s order payable to London School of makes it difficult to move around without Hygiene & Tropical Medicine to the address below. bumping into objects on the floor. People may Address for subscriptions have difficulty finding things they have dropped. Community Eye Health Journal, International Centre Reading may still be possible, but difficult. for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Loss of contrast sensitivity (Figure 4) can Tel +44 207 612 7964/72 have a very big impact on someone’s visual Fax +44 207 958 8317 function, making it difficult to recognise faces or Email [email protected] find food on a plate of similar colour. © International Centre for Eye Health, London Articles may be photocopied, reproduced or translated provided these Increased light sensitivity makes it very Figure 5. Increased light sensitivity. are not used for commercial or personal profit. Acknowledgements should be made to the author(s) and to Community Eye Health Journal. difficult for people to see detail or make sense This is how a street scene in bright Woodcut-style graphics by Victoria Francis. of what they see if they are in bright light, or sunlight would look to someone who ISSN 0953-6833 glare (Figure 5). has increased light sensitivity. © The author/s and Community Eye Health Journal 2012. This is an Open Access article distributed under 2 CEHJ | VOLUME 25 ISSUE 77 the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.