CSE Mission Statement

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Mission Statement

The Centre for Sight Enhancement (CSE) is a clinical, teaching (undergraduate and graduate), and research unit within the School of Optometry at the University of Waterloo that is primarily concerned with all aspects of low vision and its rehabilitation. "Low vision" is the term used to describe the condition where a person has vision loss and is unable to perform age-appropriate visual tasks even with medical or surgical treatment and/or using conventional spectacles or contact lenses. Low vision rehabilitation seeks to redress this condition through the effective use of assessment, training, counselling, and assistive devices in accordance with evidence-informed standards and protocols that are routinely articulated during a meticulous self-study process and explicitly by an on-site peer review process. 

Established in 1984, the CSE is Canada's first and only vision rehabilitation service to be accredited by the National Accreditation Council for Agencies Serving People with Blindness or Visual Impairment. It was first accredited in 1989, and subsequently re-accredited every five years thereafter. The Centre's mission is to promote Canadian excellence in all facets of blindness and low vision rehabilitation (with particular emphasis in the areas of clinical services and device technology). Specific initiatives within the Centre include the Low Vision Clinic and the Sight Enhancement Equipment Pool and Assessment Centre (SEEPAC). These activities are supported by the Waterloo Wellington Local Health Integration Network (WWLHIN) and the Assistive Devices Program, Ministry of Health and Long-Term Care.

CSE Organization and Infrastructure

The Centre for Sight Enhancement (CSE) does not exist as a wholly independent entity, but as an identifiable "research group" within the University of Waterloo’s School of Optometry. It carries out the following activities in the area of vision rehabilitation:

  • Clinical low vision teaching,
  • Clinical low vision rehabilitation services, and
  • Low vision research.

The CSE is managed by an Executive Committee that is composed of the CSE Director (Strong), the CSE Associate Director (Plotkin, Head LV Clinical Services), the CSE Administrator (Snell), and the Head of Low Vision Clinical Services or designate (LaBreche). This Executive Committee is a semi-autonomous body that is responsible to the School of Optometry administration through the CSE Director.  This reporting structure is consistent with that of all other Centres within the School. “Low Vision Services” is the term used to identify all service components included in the provision of clinical low vision rehabilitation.

Ongoing CSE low vision rehabilitation activities include the following component services:

  • Clinical low vision assessment services (this is the pivotal service that is provided at the CSE);
  • Prescriptive services (assessment leading to the prescription of assistive devices and related services for people with low vision);
  • Referral services (assessment leading to referrals for specialized optometric and non-optometric services as required --- including diagnostic, treatment, and other intervention services that are not available within the CSE);
  • Counselling services (including adjustment to low vision and other psychosocial adjustments, family issues, educational and vocational issues);
  • Advocacy service (related to legal, social, educational, vocational, and funding issues that may be identified in the course of our patient interactions);
  • Dispensing services (including specifying, ordering, receiving, and delivering assistive devices to CSE clients);
  • High technology services (assessment, prescribing, and implementation of high technology device solutions that are fully integrated with other low vision services being provided);
  • Itinerant low vision services (Although there is no funding support for these activities, the CSE provides some services to people with unmet low vision needs. These include outreach low vision services to vulnerable populations living in regional institutions and itinerant high technology services to a service-isolated low vision population in Windsor, Ontario).

The day to day operation of Low Vision Services is overseen by a full time faculty optometrist with the designation "Head, Low Vision Services".  The "Head, Low Vision Services" and the other low vision clinicians working in the area are ultimately accountable to the School of Optometry's Clinic Director.

CSE services are carried out by personnel in each of the following position categories:

  • Low vision clinicians (Full time faculty) - Full time faculty optometrists who are primarily involved in the provision of clinical low vision services.
  • Low vision clinicians (Part time clinical associates) - Part time faculty optometrists who provide clinical low vision services.
  • Low vision residents (Funding dependant) – Full time post-degree optometrists who provide clinical low vision and geriatric services under the supervision of Optometry faculty.
  • Optometry student interns – Senior (Yr IV) Optometry undergraduate students assigned to low vision clinic rotations under the direct supervision of CSE clinicians (or residents as necessary).
  • High technology assessment specialists – Full time staff with specialized training and experience in the assessment and authorization of high technology low vision devices and services.
  • CSE administrator – Full time senior staff member with overarching administrative responsibilities.
  • Low vision rehabilitation counsellor – Full time staff member primarily responsible for social work and counselling services.
  • Low vision therapist – Full time staff member with specialized training and experience in vision rehabilitation who assists with assessment, training and counselling activities.
  • Clerical staff – Full and part time staff members responsible for reception, appointment scheduling, billing, accounting, filing, and patient information services.
  • SEEPAC personnel – (Sight Enhancement Equipment Pool and Assessment Centre (SEEPAC) is a contract held by CSE with the Ontario Ministry of Health and Long Term Care. SEEPAC personnel are responsible for all related technical services (service and repair), shipping and receiving, inventory management, and inventory database management.
  • Optical services personnel – Full time licensed ophthalmic dispensers provide ophthalmic fabrication and dispensing services support for Low Vision Services.

Outcome Assessments

Systematic file reviews (individualized service audits) are conducted to review the quality and consistency of CSE low vision services. Evaluating the functional outcomes provides a tangible validation of the integrity of the component assessment, prescribing and dispensing activities.  Clinical services also are evaluated somewhat informally for individual outcomes, using correspondence provided by patients, verbal communication from patients or family members, feedback from collateral agencies, feedback from vision resource personnel and from other support service providers. More formal evaluations include independent on-site reviews by NAC and ACOE accreditation teams.  Additional consumer feedback has been solicited through the High Technology Service Audit of the Ministry of Health Assistive Devices Program. 

The CSE also uses a Consumer Satisfaction Survey instrument that was developed under the guidance of a professional research consultant with extensive research expertise in service quality metrics. This survey was formally evaluated and found to have face, contingent, and discriminative validities.  Feedback from these surveys provides early notice of any patient concerns with respect to their individual care at the Centre and it sensitizes us to more generalized areas of concern (such as parking and building access).

A procession of research collaborations with researchers from The University of Western Ontario, The University of Ottawa, the Toronto Rehabilitation Institute, and the University of Buffalo also looked at outcomes assessments for CSE patients. These initiatives have included assessments of the impact of device-assisted rehabilitation services on functional vision status (using VFQ-25) and perceived psychosocial status (using Psychosocial Impact of Assistive Devices Survey - PIADS). In addition to significant and positive changes in functional vision status, CSE patients consistently enjoy substantial psychosocial benefit immediately after receiving their devices. These positive psychosocial benefits endure for several years and begin to wane somewhat during the third year (which we believe to constitute a recalibration phenomenon).

CSE Patient Profile

The low vision clinic maintains a fairly consistent patient load, providing comprehensive low vision rehabilitation services to approximately 600 - 650 patients each year. Although appointments can be made directly by anyone experiencing low vision problems, the majority of appointments are third-party referrals (from ophthalmologists, optometrists, specialist teachers, employers, insurance companies, WSIB, Veterans Affairs, other rehabilitation services, and agencies such as the CNIB). Approximately 48% of all patients seen in the CSE clinic live in communities within the Waterloo-Wellington Local Health Integrated Network (WWLHIN) boundaries. See Map. The Waterloo Wellington LHIN boundaries include all of the County of Wellington, the Region of Waterloo, and the City of Guelph. This LHIN also contains part of Grey County, which is split with the South West and the North Simcoe Muskoka LHINs.