Macular degeneration and diabetic retinopathy. Strokes and traumatic brain injuries. Glaucoma, cataracts and retinitis pigmatosa.
Those are just a few of the conditions that can leave a person with low vision, which is defined as any level of vision loss that can't be corrected with glasses, contact lenses, surgery or medications. Low vision can interfere with a person's quality of life, making it impossible to read, write checks, cook, enjoy regular activities or even get around the house safely.
Low vision can affect a person of any age, but most often the patient is a senior citizen, which means there are many people affected in the Pittsburgh area.
"I see the range from newborns to patients in their three digits," said optometrist Paul Freeman, head of Low Vision Rehabilitation at Allegheny General Hospital. "But the bulk of patients are seniors because our population is very skewed toward that demographic."
U.S. Census Bureau figures from 2010 show that in Allegheny County, 16.5 percent of the population is older than 65. That compares to 15.4 percent in Pennsylvania overall and 13 percent nationally.
According to the Senior LAW Center, a Philadelphia-based nonprofit dedicated to improving the lives and protecting the rights of older Pennsylvanians, Allegheny County is ranked 12th nationally in population over age 85.
Fortunately, services for those with low vision abound in this area.
Mr. Freeman, who also provides low vision rehabilitation services at Keystone Blind Association in Sharon, Mercer County, and local schools, estimates he sees 500 or 600 patients a year.
Last year, optometrist Erica A. Hacker and her staff provided low vision rehabilitation to 557 persons at Blind and Vision Rehabilitation Services of Pittsburgh in Homestead. The nonprofit association opened another low vision office one day a week in Brentwood in February.
UPMC optometrist Will Smith, who began offering low vision services part time at Eye and Ear Institute and Mercy Hospital a few months ago, estimates he sees eight or nine patients a day.
Occupational therapist Kristy Ondriezek, who opened the tiny Low Vision Rehabilitation Center of Allegheny Valley Hospital in Natrona Heights on a $15,000 grant from the hospital auxiliary in July, saw about 15 patients in her first six months of operation. All of her patients must have a referral from a physician and, because she works without an eye doctor, must have had a recent exam by an optometrist or ophthalmologist.
The centers operate pretty much the same way.
With the patients' eye health determined and any necessary corrective lenses changes prescribed, the optometrists and Ms. Ondriezek evaluate how much vision the patients have available and what can be done to help them reach their vision goals. Many patients come in wanting to be able to see well enough to read, write checks, watch TV or discern faces.
"We look at whatever vision they have left and help them use that to effectively to do their daily activities," said Ms. Ondriezek, who completed the two-year Low-Vision Rehabilitation Graduate Certificate Program at the University of Alabama-Birmingham.
Next comes a chance for the optometrists and Ms. Ondriezek to determine whether the patients could benefit from the wide array of optical and nonoptical devices on the market.
The difference between optical and nonoptical senses is big. An optical device enhances existing vision. A nonoptical device allows you to compensate for low vision with other senses. Good examples of non-optical devices, Ms. Hacker said, are talking clocks and telephone keypads made so the patient can feel tactile markings to dial.
"Optical devices [for close-up use] are microscopic lenses -- very thick lenses and people hold them close to themselves; hand magnifiers; stand magnifiers," Dr. Freeman said. There also are high-powered reading glasses and loops like jewelers wear that attach to the patient's glasses. For distance, there are telescopic lenses, closed-circuit television that comes in varying sizes and high-tech devices called electro-optic lenses.
For people who have trouble discerning contrast, there are low-tech solutions like very, very dark pens; dark, textured place mats on which patients can sort their medications; cutting boards that are black on one side and white on the other; and black and white "scoop plates," rimmed plates that not only provide contrast to various colors of food but also prevent the food from spilling onto the table. Different types of lighting, filters and sunglasses also can be used.
More nonoptical devices include a needle threader; raised dots that can be placed on dials to mark temperatures and timers on the furnace thermostat and washer, dryer and microwave oven dials; templates for writing and signing checks on straight lines; and a device equipped with an electronic eye that senses the color of socks the patient is sorting and announces it out loud.
Optometrists must prescribe and order the optical devices.
The low-vision centers teach the patients how to use the devices prescribed for them. That is done in anywhere from one to three sessions following the initial evaluations, depending on the center. Ms. Hacker uses an occupational therapist; Mr. Freeman sometimes does, too.
Insurance companies pay for the rehabilitative therapy but not for the devices, which can range from bargain-basement to very expensive. A check signature guide is $2.50, but the closed-circuit TVs that magnify very large can run between $2,000 and $4,000.
Financial aid can be obtained from agencies like the Pennsylvania Bureau of Blindness and Visual Services.
Because it is community-supported, Blind and Vision Rehabilitation Services of Pittsburgh also can help Ms. Hacker's patients. "Being a nonprofit, that's a luxury we have," she said. "The community has supported us for 101 years, and that gives us the ability to help the people who do not have the resources themselves."
Pohla Smith: firstname.lastname@example.org or 412-263-1228. First Published March 19, 2012 4:00 AM