November 6, 2000
Volume XXXIII, No. 37


HSC Profile


Low vision doesn’t mean no vision


Going blind is one of the biggest fears people have; only mental or emotional illness is feared more, said a Health Science Center optometrist. According to Lighthouse International, an organization committed to advocacy on behalf of people who are blind or partially sighted, the large majority of middle-aged and older Americans fear blindness more than other physical impairments. Yet, Dr. Sandra Fox notes it shouldn’t scare those with low vision problems into thinking they won’t see a good quality of life.

Dr. Fox, who conducts clinical research and provides low vision services at University Hospital’s Low Vision Clinic, said there’s a tremendous need for low vision assistance in San Antonio, an excellent place to research the effects of low vision because of its prevalence among the city’s many retirees and diabetics.

An instructor in the Department of Ophthalmology, Dr. Fox "wants to spread the word—low vision doesn’t mean no vision," she said. "The number one priority is to make people aware that low vision services exist. While we can’t return people’s vision to the point it was at when they were younger, we can help."

Awareness about the availability of low vision rehabilitation services is seriously lacking, according to Lighthouse.

Dr. Sandra Fox, an instructor in the Department of Ophthalmology, measures the distance used by Bruce Hooper for reading. He can no longer drive due to his low vision; he employs a driver to make his sales calls.

"More than 35 percent of middle-aged and older Americans report they don’t know if there are local public or private agencies in their community that provide low vision services and another 21 percent report there are no services," said Dr. Fox. "It’s alarming so many people don’t know these services are available to them."

Lack of awareness is more pronounced among those who may need vision rehabilitation the most—the elderly, the least educated, those in poverty and those with severe vision impairments.

While Dr. Fox points out low vision problems are more common among the elderly, they also affect younger people. A Lighthouse survey of 1,219 people found vision impairment in 25 percent of respondents older than 75, but also in 17 percent of those ages 45-74. According to the 1998 census, the Texas population age 65 and older was 1,999,751. Lighthouse estimates the number of Texans with vision impairment is 419,948, or more than 20 percent of the population.

"In Bexar County, it’s estimated there are 56,000 people with vision impairment," said Dr. Fox, who also treats diabetic patients at the Texas Diabetes Institute. "Vision impairment is underestimated, underreported and certainly undertreated."

While she defines "low vision as a chronic visual deficit not correctible with eyeglasses, contacts or surgical services," Lighthouse’s definition includes blindness in one or both eyes, the inability to recognize a friend across the room, the inability to read regular newspaper print and self-reported poor or very poor vision.

The first step Dr. Fox takes in helping treat a patient with low vision problems is to give him a thorough evaluation. "Our evaluation is very different in that it helps determine what is left of a patient’s vision—his usable functional vision," said Dr. Fox. "Then we teach him to use what is left more effectively with magnifiers, high-power reading glasses, telescopic devices and new optical aides."

Vision impairment touches the lives of the majority of middle-aged and older adults; it is not an unusual or "hidden" disability in America. According to Lighthouse data:

  • 16 percent of Americans report having a close family member who is visually impaired, and 31 percent report knowing someone else with a visual impairment such as a friend, neighbor or co-worker.

  • 47 percent of the relatives who are visually impaired are parents or parents-in-law; 15 percent are spouses; 7 percent are siblings; 3 percent are grand-parents; 14 percent report having a child with impaired vision; and 15 percent are other relatives.

  • Overall, 53 percent of middle-aged and older Americans, representing nearly 42 million people nationwide, have had either a personal experience with vision impairment or know someone with impaired vision.

Dr. Fox believes there is hope for those plagued with low vision problems.

"First a person must adapt and use his remaining vision more effectively; instead of looking directly at the intended area, the person may need to adjust his eyesight a bit above or to the right or left to see the spot he is trying to see," said Dr. Fox. "Once his adaptations have improved, his skills improve and so does his quality of life."

Typically loss of vision is gradual. The majority of people with vision problems, 92 percent according to Lighthouse figures, report that they have adapted very well or somewhat well to their vision loss.

Awareness about the availability of services, which include counseling, can go a long way for those who believe low vision means no vision. Dr. Fox thinks the loss of self-esteem and self-importance that often accompanies the potentially disabling condition of low vision can be reversed.