Low Vision Services
Located within the School of Optometry's Optometry Clinic, Low Vision Services provide a comprehensive range of vision rehabilitation services, including assessment, prescription, instruction and rehabilitation; information and referral for medical, social, educational, vocational and financial services; liaison with applicable government programs and services, and groups serving the low vision population; consultation with and referral to other specialty clinics within the School of Optometry and to community services; and basic and clinical research into various aspects of low vision.
Appointments are required. Appointments can be booked directly by people with low vision or their advocates. Referrals are also accepted from ophthalmologists, optometrists, other rehabilitation professionals, or specialist teachers. Before an appointment is finalized, people will be asked to provide some preliminary background information to ensure that all of the necessary equipment, services and personnel are available the patient’s visit. For more information call the CSE at: (519) 888-4708 or University of Waterloo ext. 4708.
Eligibility for Low Vision Rehabilitation Services
The Centre for Sight Enhancement has no fundamental eligibility criteria for its service provisions. Low vision services are provided to anyone who has a functional visual impairment that cannot be ameliorated by routine medical/surgical intervention or by conventional refraction. The CSE operates without discrimination as to age, gender, race, sexual orientation, religion, nationality, preconditions, nature and extent of impairment, or other conditions.
Making an Appointment for a Low Vision Assessment
To book an appointment, please contact Linda directly by telephone. Appointments by email are not feasible. Please contact the CSE clinic at: (519) 888-4708 or University of Waterloo extension 84708.
Hours of Operation
The Low Vision Clinic maintains the same hours as the rest of the School of Optometry Clinic. The Primary Care clinic operates daily 8:30am to 5:00pm. During the fall and winter terms, there are periods when the primary care, contact lens and dispensing areas offer evening hours. Clinical low vision appointments are scheduled for three days of the week during the teaching term (Mondays, Wednesdays, and Fridays) with two doctors seeing patients concurrently on most days. Tuesdays and Thursdays are generally reserved for case conferences, clinic tours, report writing, emergency follow-up, administration, teaching, vendor presentations, research, and committee work. The Rehabilitation Counsellor, Low Vision Therapist and High Technology Assessment specialists also use this time to follow-up with patients and to catch up on their administrative activities. Additional counselling appointments and/or partial assessments are often arranged during this time.
Preparation for CSE Assessment Appointments
A comprehensive information package is sent out in response to all service inquiries, including all referrals and self-referrals. The contents of this information package have evolved over the past twenty five years. It provides useful information to prospective patients concerning the breadth and depth of services being provided at the CSE. It also solicits sufficient background information and clinical documentation to ensure that the planned visit correctly anticipates the unique service demands for each individual client. Completed appointment information packages are reviewed carefully by CSE clinicians and professional staff. Travelling to the CSE clinic often poses a significant challenge for many low vision patients. Our initial concern is to confirm that our services are relevant. In some cases, such as with patients who have been lost to routine eye/vision care, the requested low vision consultation is premature. In other cases, such as when people describe problems that are clearly related to binocular vision anomalies or learning disorders, they are redirected to alternative services that are better equipped to deal with their seeing problems. Having confirmed the appropriateness of the requested low vision consultation, our next concern is to contemplate the content, duration, and sequencing of services that may be necessary for each patient presentation. Some CSE services, such as low vision counselling, are self-selected by patients through the pre-appointment package. The primary purpose of this organized review of the pre-appointment package is to anticipate any needs for specialized services, such as electrodiagnostic testing or high technology assessments, prior to the patient’s visit. The pre-appointment review also provides an opportunity to identify any need for patients to bring special material with them to the examination (including vocational, educational, or avocational materials that will enhance the relevance and efficacy of the low vision assessment). The appointment planning process remains flexible to respond to any new information that is received prior to the low vision assessment. This flexibility persists throughout the patient visit. Mindful of the significant effort required to attend the low vision clinic, CSE service professional are responsive to any new or emerging realities that require changes to tentative assessment and treatment plans. Inter-professional communications are maintained throughout the patient’s visit, and are coordinated with the low vision clinician responsible for the case. A follow-up review occurs when all of the reports and paperwork is completed and submitted for the patient record.
Clinical Low Vision Assessment
The Low Vision Clinic provides comprehensive low vision assessment services, utilizing contemporary protocols and state-of-the-art instrumentation. The clinic boasts two well-equipped low vision examination rooms, a large low vision training room, a common fields room, a private rehabilitation counselling room, a CCTV assessment and training room, a high technology assessment and training room, and a common reading and work room for case discussions and other student interactions. Clinicians have access to more specialized assessment equipment, including electrodiagnostic and high technology imaging equipment, interferometers, automated perimeters, glare testers, contrast sensitivity charts, specialized acuity charts, and photographic equipment for documentation and patient education. A comprehensive array of optical low vision devices are available in the CSE, ranging from simple magnifiers to sophisticated lens systems, video magnifiers, and head-mounted display systems. There is also an extensive assortment of adapted computer systems, capable of customized large display, voice output, and optical character recognition. Electro-optical assistive devices, such as closed circuit television systems, are available to provide high levels of magnification and contrast for printed or written material. More specialized devices and custom low vision kits are housed centrally, so they can be shared by both clinic rooms.
CSE researchers have described our assessment model in terms of using “competitive enablement” as a process for evaluating the suitability of various non-generic device options. “Competitive enablement” is a conceptual approach wherein the functional impact of competing device interventions is evaluated by individual consumers while performing a series of self-identified problematic tasks having high functional relevance to the individuals themselves. Although many different devices may be available to provide individual users with reasonable task proficiency, it is often possible to differentiate between these devices by considering other factors such as cost, ease of use, versatility, safety, universality, cosmetics, availability, serviceability, innovation, practicality, and adaptability. The significance of these various attributes varies from consumer to consumer. Taken alongside the performance attributes of the different devices, these considerations make it possible to identify the best device for each individual consumer. The function of the assessment process is no longer to identify a device that works for a given set of tasks, but rather to identify the one that works best for the individual client doing these tasks. This approach has been extremely effective with respect to the assessment for high technology devices and closed circuit television (CCTV) systems.
This approach has evolved over many years. The following publication provides a current description of this approach: Strong G, Jutai J, Plotkin A, Bevers P (2008) Competitive enablement: A consumer-oriented approach to device selection in device-assisted vision rehabilitation. (Ed.) Mann WC. Aging, Disability and Independence: Selected Papers from the 4th International Conference on Aging, Disability and Independence (2008). University of Florida. pp 175-195.
Low Vision Devices (Video-Based and Computer-linked Devices)
In the areas of high technology and CCTV assessments, the CSE has developed some novel protocols for individualized service delivery. Many service providers routinely demonstrate CCTV devices to their patients, but this simply demonstrates the device’s capacity to provide high levels of magnification for people with severe vision loss. Few clinicians systematically demonstrate the other co-adjustable enhancements that are unique to all of these devices, including zoom magnification, image polarity, image contrast, and selective chromaticity. Stable image localization, a large field of view and exceptional depth of focus are other unique generic attributes of these systems. Mindful of these significant differentiations from optical “reading” devices, we routinely demonstrate CCTV systems to people with all levels of acuity impairments. In addition to appreciating the aforementioned generic features of these devices, many consumers are also sensitive to other more particularized and subtle features that may improve their comfort, speed, facility, and endurance while using a CCTV. These non-generic options can only be evaluated by comparing different types of CCTV systems. A basic in-line CCTV unit serves as a benchmark product. Compared to this basic system, all others have additional features that will make them more or less useful for each individual consumer. These added features may include portability, monitor placement, monitor size, masking and isolation options, shared display options, underline features, color display, and ease of set-up, control and operation. Whether these added options are flaws or features depends on their demonstrated utility when the individual attempts the various activities that prompted her to consider a CCTV device in the first place. If the added features can’t be used for any reason, or if they don’t achieve the desired effect, they may simply add needless cost and complexity to the system. These assessment protocols recognize the important distinction between verified utility and presumed utility. Someone who wants to read a newspaper or a book must use each device for this express purpose, rather than reading a test card with different print samples on it. Some systems may work very well with sample test materials, but fail miserably when used for reading the real material of interest. This process also allows consumers to see how each device functions for prolonged reading tasks, if this is how they intend to use the system. Similarly, if the person wishes to use the CCTV for reading foreign language material, household bills, or written correspondence, it is important to use real samples for evaluating each device. The consumer should be required to locate and use each control feature to allow him to compare any operating differences. This hands-on approach is particularly important for evaluating hand-operated camera systems or other out of line systems, where some consumers may experience considerable difficulty with tracking and alignment. The bottom line is to provide consumers with an opportunity to use each system in the way that they expect to use it after they purchase it. Follow-up interviews and confidential patient surveys monitor the functional results of our prescribing protocols. We find abandonment rates to be consistently less than 5% per year, and fewer than 2% of our clients abdicate their initially selected devices in favour of other competing devices.
Low Vision Devices Loan Program
The CSE operates a Loan Program wherein patients may borrow various stock low vision devices over a two week period. This provides an opportunity for patients to develop the requisite skills to use their devices effectively and to experience the potential benefit that may accrue from using them. Prior to purchasing a device, patients have an opportunity to experience any altered working distance or other ergonomic adaptations that may be necessary to use their low vision aids. Patient feedback from this experience also provides clinicians with an opportunity to modify the power and/or the nature of any device that cannot be used effectively in the user's actual working environment. Whenever several devices seem equally effective, patients can make an enlightened comparison after using the devices in their own working or reading environment. Unfortunately, custom devices are not available for loan to patients. The Loan Program also allows patients to start using a low vision device immediately after their assessment visit, or as part of a training program to develop better utilization of their residual vision. A computerized Loan Program database facilitates efficient patient follow-up and ensures that we make the most effective use of our CSE loaner inventory. A follow-up telephone call is made to monitor their use of the device and to inquire about any problems that they have encountered while using it.
Vending of Low Vision Devices
Most CSE-prescribed low vision devices and spectacles are dispensed through the low vision clinic or the Optometry clinic dispensary. The CSE maintains a large "in-house" inventory of frequently prescribed stock devices, which allows many patients to obtain the devices they need immediately following their assessment. All low vision aids are dispensed on a fee for service basis, in accordance with the Ontario Association of Optometrist Fee Schedule Guidelines. There are several government programs that help offset the costs of prescribed low vision devices. These programs include the Assistive Devices Program (ADP), Ontario Disability Support Program (ODSP), Ontario Works (OW), Assistance for Children with Severe Disabilities (ACSD), the Department of Veterans Affairs, and the Worker’s Compensation Board of Canada. Some school boards, employers and private insurance companies also contribute toward the cost of low vision devices.
Ontario Ministry of Health Assistive Devices Program (ADP)
An important factor in our provision of low vision services is the Ontario Ministry of Health Assistive Devices Program (ADP). This is a unique provincial program that pays up to 75% of an approved maximum towards the cost of authorized devices for people who have long term disabilities. ADP-eligible devices include vision and hearing aids; wheelchairs; seating and mobility aids; prostheses, braces and splints; respiratory equipment; augmentative communication aids; and ostomy and incontinence supplies. The Centre for Sight Enhancement is involved in all aspects of ADP that are concerned with device-assisted vision rehabilitation. The CSE has an ongoing contract with the Ontario Ministry of Health for the provision of assessment and authorization services for high technology sight enhancement devices being funded under the ADP program. ADP funding is restricted to specialized equipment for use in the home or to assist with activities of daily living, and not devices whose use is restricted to school or work. Eligibility for the subsidized provision of low vision devices through ADP is determined exclusively by the following conditions:
The functional vision impairment must have existed for at least six months, and
Applicants must reside in the province of Ontario.
Supported by the Waterloo Wellington Local Health Integration Network (WWLHIN) and the Assistive Devices Program, Ministry of Health and Long-Term Care.
Multi-Sectoral Service Agreement with WWLHIN
Schedule to the Service Agreement
