Low Vision Counselling

Investigations

Vision rehabilitation is a comprehensive set of services, including optometric, counselling and rehabilitation programmes that help people with low vision regain a sense of independence, and perform activities to the best of their ability, despite the handicap.

Low vision optometrists help those with vision loss to see better, even when surgery, medications, and conventional glasses no longer improve sight, by prescribing optical aids to help the person read, write, watch television and manage daily living activities.

The vision loss is permanent but the ability to perform daily living tasks with impaired vision is learned or relearned through our rehabilitation program.

Low vision examination

A low vision exam focuses on prescribing specialized glasses and low vision devices to enhance remaining vision. A low vision exam, sometimes called a functional vision assessment, evaluates vision functioning and the effect it has on daily living activities, such as reading the newspaper or cooking.

After an interview helps to determine the person’s visual goals, a low vision specialist performs a detailed visual analysis. Distant vision is evaluated using telescopic aids. High-powered spectacle lenses, hand or stand magnifiers may be used to evaluate near vision skills, like reading. Special eye charts are used and lighting levels are evaluated. Instruction in the proper use of devices can take ½ hour and may be repeated before aids are prescribed by the counsellor.

Management / treatment

The patient is treated with the low vision devices. The low vision devices comprise of optical and non optical devices. Optical devices include high add bifocals, prism glasses, aspheric glasses, hand magnifiers, stand magnifiers and telescopes. Non optical devices include reading stand, writing guide, typoscope, notex and cane. Based on the patients need and the visual acuity the low vision device is prescribed by the doctors.

Rehabilitation

• Children rehabilitation
• Educational rehabilitation
• Vocational rehabilitation
• Social rehabilitation

Children rehabilitation

Vision stimulation

Encouraging the use of vision is vital for children with low vision as it enhances their development, education and experiences. Use of vision in children having minimal amount of vision needs stimulation. Vision stimulation is the use of strong visual stimuli like colorful lights and toys to make an infant or child aware of the vision. These children usually have very limited visual capabilities and no visually guided functions.

Vision stimulation activities can help children use their remaining vision more effectively. The theory is that by performing these activities, the visual areas of the brain are stimulated to maximize the development of vision. They are not exercises that strengthen eye muscles, or cure eye disease or abnormalities in the brain.

Parental counselling

Parenting has no tried and tested formulas. Every child is unique, and so is every parent. What can help in the difficult task of parenting a child with visual impairments is sharing of experiences and applying them to your very own unique situation. Parents have a big role to play in helping their child gain the organisational skills necessary for success, both at school and in later life. Parenthood is all about nurturing and looking after your offspring. It is never too early to start helping your child toward eventual independent decision making, be it grooming, self-care or self-image.

Educational rehabilitation

Finding appropriate educational opportunities for visually impaired children can be quite a challenging task. Should the child be enrolled in a normal school, special school, or an integrated education? The counsellor plays an important role to find out the appropriate educational mode for the children with visual impairment.

Educational care for children with low vision includes training children directly in the effective use of their best vision. This can involve their learning to write at closer distance, to use magnifying devices, or to use creative strategies to determine what is written on a blackboard (such as asking a child seated nearby to read aloud while the teacher writes). This training is important, as it enables children to attend normal schools.

Integrated education

The integrated education programme creates an appropriate learning and teaching environment for blind and low vision students. Specially trained teachers visit to 'regular' schools and provide useful guidance to blind students, their teachers, principals and staff in conducting educational and co-curricular activities. They also provide Braille, large print, magnifiers and audio books to these students.

Special education

Special education is a form of education provided for those who are not achieving or are not likely to achieve through ordinary educational provisions, the level of educational, social and other attainments appropriate to their age, and which has the aim of furthering their progress towards these levels.

Vocational rehabilitation

It is carrying out vocational training, establishment of special workstations, vocational adaptation and playing in a job. People who are blind and visually impaired work with a rehabilitation team to develop an employment goal and achieve success in employment. This team might include a rehabilitation counsellor, a rehabilitation teacher and/or mobility specialist. Blindness does not have to be a barrier to successful employment.

Vocational Rehabilitation (VR) services assist persons who are blind in preparing for obtaining and retaining employment. Applicants are made eligible based upon their visual disability, their need for VR services, and their eagerness to work.

Social rehabilitation

Social rehabilitation is a process the aim of which is to attain functioning ability. This ability means the capacity of a person to function in various social situations towards the satisfaction of his or her needs and the right to achieve maximum richness in his or her participation in society. In low vision counselling, the counsellor will give guidelines for the visually impaired person to carry out daily living activities and orientation and mobility.

Daily living activities

Activities of daily living comprise everything entailed in human life and relationships. These are the basic activities necessary during an ordinary day. Sighted person normaly learn to perform these activities by themselves by observation and imitation. But the visually impaired person cannot learn the same on his own. The counsellor will guide the visually impaired persons and make them do all the activities independently and safely with the least possible external assistance.

Orientation and mobility

Movement is a building block for learning. As a child explores his world and has physical contact with it, learning takes place. Children with visual impairments typically need encouragement to explore their surroundings. To them the world may be a startling and unpredictable place, or it may not be very motivating.

Orientation and mobility training (O & M) helps a blind or visually impaired child to know where he is in space and where he would like to go (orientation). It also helps him to carry out a plan to get there (mobility). Orientation and mobility skills development should begin in infancy starting with basic body awareness and movement, and continuing on into adulthood as the individual learns skills that allow him to navigate his world efficiently, effectively would like and safely.

Support services

The counsellor will guide blind persons to attain various concessions (bus pass, railway concessions, disability pension, scholarships) from the district rehabilitation office.

Role of counsellor in low vision

• The counsellor has to empathise with the patients problem and help him/her come to terms with the fact that their vision loss is permanent and beyond repair.
• Though visual loss is permanent, the patient with low vision can still function with the remaining vision to continue his profession and daily activities, within certain limits. The counsellor encourage the patent to understand this.
• The counsellor can cite various examples of people with low vision/blindness who have achieved so much, despite their handicap and gently try to inspire the patient.
• The counsellor also puts forward the various options available to the low vision patients, in terms of low vision aids and profession and help them select whatever is suitable to their needs.
• The counsellor can guide the persons to get various concessions, scholarships etc. available for them.
• When it comes to parents of children with low vision/blindness the counsellor has to assume the role of a caring friend who helps the family come to terms with their children’s disability. She also encourages them to be positive and assist the child’s development, through various rehabilitation programmes available.

Counselling a permanently blind person

In the case of a person who had good vision but has lost vision due to disease, the counsellor gently but persistently assists him/her to accept reality and start rehabilitation. The counsellor may have to work with the family of the patient to make the patient achieve the maximum possible independence. The social surrounding of the patient also has to be involved, to assist the patient, so that they can resume some mobility, daily activities, and some income generating work.

Rehabilitating a blind person is a team work which should involve the patient, the counsellor, the patients family and the community.

Frequently asked question

1. Does the low vision device is harmful to my eyes?

No, it doesn’t harm your eye. These are the devices which will help you to work independently.

2. Does my vision will deteriorate in future days?

Based on the diagnosis the doctor will explain to the patient regarding the prognosis.

3. Does it affect my future generation?

The counsellor will get the information about blood relationship between the father and the mother (if it is consanguineous or non consanguineous marriage) and the he/she will counsel the patients weather it will affect their future generation or not.

4. How far the vision stimulation is going to help my child?

Through the vision stimulation we are not going to improve the child’s vision. By performing these activities, the visual areas of the brain are stimulated to maximise the development of vision. It will help the child to use their vision more effectively.

5. Is the low vision device is helpful in my vocation?

To some extent it will help in your work. Based on the visual acuity the counsellor will refer the patient to the NGO to get the vocational training.

Key points to remember

• Low vision is a condition, where medical or surgical intervention will not further help to improve vision. A revised WHO definition of low vision states that patients with vision less than 6/18 to perception of light in the good eye will be included in low vision category.
• The low vision patients are treated with the low vision devices which consist of optical and non optical devices.
• The vision rehabilitation includes children rehabilitation, educational rehabilitation, vocational rehabilitation & social rehabilitation.
• Parental counselling is much more important in children rehabilitation.
• The selection of educational mode is based on the child’s visual acuity, previous academic performance and the parent’s literacy level.
• It is the counsellor’s responsibility to assist the person with visual impairment in obtaining and regaining appropriate vocation.
• The aim of social rehabilitation is to make the visually impaired person to attain self independence and functioning ability.
• Vision rehabilitation is a multi disciplinary team approach which should involve the patient, the family members and other professionals.

Student exercise

Write short answer

1. How do you counsel the parents of 8 month old baby who doesn’t have light fixation?
2. Explain: educational rehabilitation
3. Briefly explain the role of counsellor in counselling the person who lost his vision in between their life time. (acquired visual loss)