A Comprehensive Approach to Low Vision

More than 250 million people worldwide live with low vision or blindness. Low vision is defined as moderate to severe vision impairment with visual acuity worse than 20/60 that cannot be corrected with medical treatment, surgery or glasses. Most have some useful sight, but everyday actions like reading, cooking, recognizing faces or differentiating color can be challenging.

Kellogg takes a multidisciplinary approach to low vision, combining individualized care, novel research, and training for providers from around the world.

One-on-One Strategies and Support

At Kellogg’s Low Vision and Visual Rehabilitation Service, specialists in optometry, ophthalmology, occupational therapy, social work and more collaborate to design personalized plans to maximize sight and independence for people with low vision.

“Every patient is unique, and we are dedicated to helping them perform their specific activities with greater independence,” say program co-directors Sherry Day, O.D., and Donna Wicker, O.D. “We work with adults pursuing law degrees, seniors who want to continue making art or music, and kids who need help reading or seeing the blackboard. Their goals become our goals.”

After a thorough evaluation, patients spend time in the clinic’s Low Vision Technology Center, where they can try out the latest devices, technologies and techniques, including magnifiers, lighting options, adaptive TVs, audio smartwatches, timers, and medical devices.

Patients also meet with occupational therapist Ashley Howson, M.S., O.T.R./L., in the Independent Living Skills Center, to use low vision-adapted lighting, appliances and cookware. “They learn and practice skills to help stay safe and autonomous in their own homes,” she explains. Michigan Medicine’s certified orientation and mobility specialist, Russ Ellis, C.O.T.A., also works with patients in locations around Ann Arbor, helping them learn to navigate challenges like curbs, steps and public transportation. 

A New App for Low Vision 

University of Michigan researchers in ophthalmology, mathematics and neurology, led by Kellogg associate professor Kwoon Wong, Ph.D., are making everyday tasks like reading labels, price tags and menus easier for people with low vision.

They have developed the Android mobile app LVFree Vision Enhancer, which can now be downloaded for free from the Google Play store.

LVFree uses mathematical algorithms to process in real time the scene captured by the Android device’s camera, and shows the user a digitally enhanced version that is easier to see. It can be used with a smartphone or tablet alone, or with a smartphone mounted on a low-cost virtual reality headset.

A few similar devices are commercially available. But they are often difficult to use and, at costs exceeding $1,000, unaffordable for many.

To combat that, Dr. Wong says, “We focused on the most critical functions for low vision users—magnification, brightness enhancement and reverse contrast.”

LVFree was written by research fellow Olivia Walch, Ph.D., and tested by Kellogg patients, who gave valuable feedback. This project was funded in part by the Promobilia Foundation in Sweden. 

Low Vision Research 

Vision impairments make daily living more difficult. Yet researchers don’t have all of the tools to specifically measure vision-related disability.

“We use eye charts to assess visual acuity, and surveys to determine if a person can read a label or recognize someone across the street,” says Kellogg health services researcher Joshua Ehrlich, M.D., M.P.H. “But neither paints a complete picture of how individuals with low vision are getting by in their daily lives.”

In response, Dr. Ehrlich is undertaking several large-scale projects to improve the measurement of visual function. One of these, funded by the National Eye Institute, aims to develop a survey instrument that will measure functioning among those with severe peripheral vision loss, a patient population for which there are few evidence-based vision rehabilitation options. In another project funded by the National Institute on Aging, Dr. Ehrlich, along with an optometrist and a team of survey researchers, developed a series of tablet-based vision measures that can be administered in-home by a trained facilitator. “Data from a pilot study with 400 participants shows that these measures perform well. When implemented on a large-scale, we anticipate that they will provide much-needed data on the vision health of the U.S. population,” he says.

In fact, these measures will soon to be used to track vision within one of the nation’s most robust studies of aging and disability.

The National Health and Aging Trends Study (NHATS), conducted through the U-M Institute for Social Research, follows a nationally representative group of more than 8,500 adults 65 and older. The study focuses on trends in late-life disability in areas such as cognitive impairment and falls. The tablet-based vision tests will become part of the annual NHATS protocol starting in early 2020, and will provide much-needed data on the vision health of older U.S. adults and on the role of vision in late-life disability.

Glaucoma specialist and health services researcher Joshua Stein, M.D., M.S., is another Kellogg faculty member involved in low vision research. Dr. Stein’s work, funded in part by the Lighthouse Guild, focuses on improving access to eye care for disadvantaged and at-risk populations.