Dr. Tammy Labreche
Associate Clinical Professor, School of Optometry and Vision Science, University of Waterloo
As Canada’s population ages, more adults are experiencing vision loss from conditions such as glaucoma, macular degeneration, and diabetic retinopathy. While many assume declining vision is inevitable, greater awareness of eye health services and low vision rehabilitation can help older Canadians maintain independence and quality of life.
Q: From your perspective as a clinician and educator, what are the most common vision challenges affecting Canadians as they age, and why are they often overlooked?
As Canada’s population continues to age, older adults increasingly face a range of vision-related health challenges, including glaucoma, macular degeneration, diabetic retinopathy, cataracts, and visual impairment resulting from stroke. Compounding these challenges is a gap in public awareness regarding the breadth of eyecare services available to support individuals. Many older adults are familiar with glasses, contact lenses, and surgical or medical interventions, yet remain unaware of the critical role low vision rehabilitation can play in helping individuals adapt to vision loss, maintain daily functioning, and preserve autonomy. Enhancing awareness of these services is essential to supporting healthy aging and improving outcomes for older adults living with visual impairment.
Q: How does vision loss impact everyday independence, particularly when it comes to mobility, fall risk, and overall quality of life?
Low vision refers to a permanent reduction in visual function that cannot be corrected with conventional glasses, contact lenses, or medical/surgical intervention. This irreversible vision loss limits an individual’s ability to perform visually guided tasks essential for daily living and has broad implications for emotional, social, and economic wellbeing. Older adults with low vision often experience greater difficulty completing routine activities such as personal care, meal preparation, shopping, and managing finances. They have an increased risk of falls and face earlier admission to long-term care facilities. Additionally, depression affects older individuals with visual impairments at more than twice the rate observed in the general population.
Q: What role does low vision care play in helping patients maintain independence, even when vision cannot be fully restored?
Low vision rehabilitation provides a holistic care approach, with the primary goal of helping individuals continue participating in everyday activities, maximize independence, and improve overall quality of life while reducing the risk of vision related depression, injuries, and falls. It should be considered as soon as a person notices difficulty when performing any visually guided tasks.
A comprehensive low vision assessment, conducted by an optometrist or ophthalmologist with training in low vision care, focuses on evaluating an individual’s functional vision and determining which strategies or devices are best suited to support their visual goals. Depending on the person’s needs, a wide range of interventions may be considered. These can include simple optical aids such as hand magnifiers, as well as more advanced systems like spectaclemountedtelescopes and microscopes (high powered reading glasses), prisms, filters, or headmounted videobased technologies. The low vision assessment may also extend to include an evaluation, or referral for evaluation, of tools such as electronic video magnifiers (CCTVs), computer-based adaptations, and mainstream assistive technology features. When appropriate, individuals may also be referred for counseling or for orientation and mobility training, which can provide additional support in managing daily challenges related to vision loss.
These devices and strategies can significantly enhance an individual’s ability to perform visually demanding activities such as reading, watching television, recognizing faces, shopping, and completing other essential daily tasks that support independence.
In some cases, low vision rehabilitation can also help explore whether adaptive strategies or devices may support an individual’s potential return to driving, where appropriate and permitted by licensing regulations.
Q: You work closely with older adults and patients with complex visual needs. What are some early signs of vision decline that people should not ignore?
Some earlier signs of visual decline that should not be ignored include reduced, blurry or wavy vision, the appearance of new blurry spots or patches, flashes of light, and symptoms such as eye pain. Unfortunately, many eye diseases develop with no noticeable early visual symptoms, making regular eye examinations essential for early detection and prevention of vision loss.
Q: How can optometrists better support patients in understanding that vision care goes beyond simply updating a prescription?
Continue patient education efforts.
Q: What advancements or approaches in low vision rehabilitation are making the biggest difference for patients today?
The integration of mainstream technology has become one of the most significant advancements in enhancing low vision rehabilitation services.
Q: What advice would you give to patients and caregivers about being proactive with eye health and seeking support earlier rather than later?
It’s important to have your eyes checked regularly. If you are ever told that you have a vision problem that can’t be fully corrected with glasses, contact lenses, medical treatment or surgery, know that you still have options. Low vision rehabilitation can help you make the most of your remaining vision so you can stay independent and continue doing the things you enjoy.
If you or a loved one are experiencing changes in vision, speak with your optometrist about early detection and low vision rehabilitation services that can help support independence and daily living.
References:
- Jutai JW, Strong JG, Russel-Minda E. Effectiveness of assistive technologies for low vision rehabilitation: a systematic review. JVIS 2009; 103(4): 210-222.
- National Eye Institute. National plan for eye and vision research: low vision and blindness rehabilitation. 2006. Website. https://nei.nih.gov/strategicplanning/np_low
- Burmedi, Becker, Heyl, Wahl, Himmelsbach. Emotional and Social Consequences of Age Related Low Vision. Visual Impairment. 2002; Vol 4(1).
- Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the Blue Mountains Eye Study. JAGS 1998; 46(1): 58-64.
- Kempen GIJM, Ballemans J, Ranchor AV, Van Rens GHMB, Zijlstra GAR. The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services. Qual Life Res. 2012;21(8):1405-1411.
- Centre of Eye Research Australia. Centrally Focused: The Impact of Age Related Macular Degeneration. Prepared by Access Economics for the Centre of Eye Research Australia, Melbourne, 2006.