Low Vision Telescopic Glasses and Video Magnifier Dispensing for Macular Degeneration

Here is a case study including a dispensing visit with Holly, our lead low vision technician. Mr. B is 50 years old and was referred by his ophthalmologist who is giving him anti-VEGF injections in each eye for wet macular degeneration. His low vision evaluation took place recently at our satellite office in Clarksville, Indiana (just across the river from Louisville) and the dispensing visit took place at our main office in Bloomington, Indiana.
With best glasses correction, Mr. B sees 20/300 in the right eye and 20/50 in the left eye. His goals are driving, reading, seeing his laptop computer, and overhead projections at work. I prescribed Ocutech Sport II bioptics for driving and seeing overheads, reading telescopic glasses for hands-free reading and using his laptop computer, and an Explore 12 portable video magnifier.

Additionally, we ordered an IRD (inherited retinal disease) genetic test kit at no additional charge to Mr. B and prescribed an evaluation with a Certified Driving Rehabilitation Specialist for him to obtain nighttime driving privileges. Of note, the telescopic glasses and video magnifier Holly dispensed to Mr. B are exactly the things she uses on a daily basis to help her function with Stargardt disease. So, she truly knows how to use these glasses and devices!

The Discussion

What a patient is always thinking, but sometimes only shares when the low vision doctor leaves the room.
Yes, you need different pairs for different goals.
Yes, they look funny.
Yes, they are complicated.
Yes, they are more expensive than regular glasses.
…and Yes, they are heavier too.
But, we agree, reading and TV are pretty important when you live alone.

Traumatic Brain Injury (TBI) and Binasal Occlusion (BNO)

Binasal occlusion is a method of partially, or fully, blocking the visual field toward the nose in each eye. It can be effective for patients who have had a traumatic brain injury (TBI) and now suffer from visual motion sensitivity and/or other conditions related to Post Trauma Vision Syndrome. This patient’s “trauma” was due to brain surgery for cancer. How and why it helps these patients, and some with other related conditions, is not fully understood. But, a provider of advanced low vision services can evaluate and help symptomatic TBI patients. Contact us at Midwest Low Vision today!

Who is Midwest Low Vision?

W. Jarrod Long, OD, FIALVS

Dr. Jarrod Long is the owner and founder of Midwest Low Vision. He has been serving patients since 1997. In addition to his role at our practice, Dr. Long has been a Fellow in the International Academy of Low Vision Specialists since 2006. He is currently a candidate for Fellowship in the American Academy of Optometry and will pursue the distinguished Low Vision Diplomate Status.

Before establishing our practice, Dr. Long completed a one-year Ocular Disease Residency at the SUNY Optometry-affiliated, FDR VA Hospital in Montrose, New York. He also earned a Comprehensive Clinical Low Vision Care Certification from The Lighthouse Incorporated in New York, New York, in 1997. From 1997 to 2000, he was part-time Clinical Faculty and a Low Vision Case Consultant at the Indiana University School of Optometry.

Holly Hart, ABOC

Holly Hart, our Lead Low Vision Technician, joined our team in 2021. She is American Board of Opticianry Certified since 2022. Holly brings a unique perspective to our team as she is a low vision patient herself, diagnosed with Stargardt Macular Degeneration. This personal experience gives her a deep understanding of the challenges our patients face, making her an invaluable member of our team.

Prior to joining us, from 2006 to 2021, Holly held various roles in eye care offices, ranging from technician to leadership and management positions. She is also an Indiana-licensed Bioptic Telescopic Driver, as well as a Bioptic Glasses Trainer. In addition to her professional accomplishments, Holly is an active volunteer with the Foundation Fighting Blindness.

Casey Beckman, ABOC

Casey Beckman is our Office Manager at Long Family Eye Care and Midwest Low Vision, a position she has held since 2021. Casey graduated from the IU School of Optometry in 2008, where she served as Class President. She has been American Board of Opticianry Certified since 2008.

Before assuming her current role as Office Manager, Casey was our Lead Low Vision Technician from 2008 to 2021. Her experience, skills, and dedication to patient care make her an essential part of our team.

Our team at Midwest Low Vision is passionate about helping our patients achieve the best possible vision and quality of life. With our combined expertise and commitment, we are confident in our ability to provide exceptional care to all our patients.

We specialize in providing comprehensive and personalized care for patients with unmet functional vision needs. We understand the challenges that come with low vision conditions and strive to provide solutions that improve our patients’ quality of life. With extensive experience and a diverse selection of prescription low vision aids, we are equipped to meet the vision demands created by wide range of eye conditions.

Why Refer to Midwest Low Vision?

What distinguishes us is not just our depth of experience and education, but also our personalized, goal-oriented approach to patient care and education. We are committed to providing the time and attention necessary to address each patient’s individual vision needs.

What is the Process?

The Referral

The first step in our patient care process is referral. As a healthcare provider, you can identify patients with unmet vision needs and educate them about the options available at Midwest Low Vision. This step involves sharing office notes and patient contact information with us.

The Call

Upon receiving a referral, we will contact the patient directly. This call serves to gather additional information, discuss the patient’s needs, and schedule an appointment. If for any reason an appointment is not scheduled, we will inform your office and provide an explanation.

The Evaluation

The evaluation is an in-depth process that includes a detailed history, a “wish list” of the patient’s vision goals, measurements, expectations, trials, tests, and education. Each patient will receive a personalized care plan based on their unique vision goals. After the evaluation, we send you a summarized report of our prescriptions and recommendations to keep you updated on the patient’s progress.

The Dispense

The final step in our process is the dispensing of the prescription low vision aids. We ensure the fit, adjust as necessary, educate the patient on proper use, and confirm that the patient’s goals and expectations are met. We encourage our patients to, not only follow-up with us as needed, but to follow-up with their referring healthcare provider as scheduled to ensure continuity of care.

For referrals or inquiries, call us at 877-577-2040, fax us at 812-332-5092, or email our lead low vision technician, Holly, at holly@midwestlowvision.com.

Empower your patients and enhance your practice by partnering with Midwest Low Vision. Together, we can provide access to life-changing low vision care!

Your Trusted Low Vision Specialist: Serving Bloomington, Clarksville, and Evansville, Indiana.

map showing the areas that Midwest Low Vision covers, primarily southern Indiana
Dr. Long’s current primary area of coverage.

Hello to our dedicated patients and esteemed referring physicians,

At Midwest Low Vision, our commitment has always been to ensure specialized eye care reaches as many individuals with low vision as possible. While our mainstay is in Bloomington, Indiana, it’s important to highlight and remind our community that for years, Dr. Jarrod Long has been serving the wonderful people of Clarksville and Evansville, Indiana and surrounding communities.

Our consistent presence in these locations underlines our commitment to making expert care accessible. We understand that not everyone may be aware of our reach in Clarksville and Evansville, and we want to ensure that everyone, especially potential patients and referring doctors, is informed.

Dr. Jarrod Long’s approach at Midwest Low Vision entails using specialized tools and techniques to assess remaining vision and craft personalized solutions like telescopic and microscopic glasses designed to counter conditions such as macular degeneration. Our recommendations might also encompass non-optical aids, always aiming to enhance our patients’ quality of life no matter the extent of their vision loss.

To our respected referring optometrists, ophthalmologists, and others, if you have patients in these regions who could benefit from specialized vision care, please remember that we are conveniently located in all three areas.

Thank you for your enduring trust in us. For further insights into our work and care, feel free to explore our YouTube channel and other social media outlets. And as always, contact Holly or Dr. Long directly at 877-577-2040.

To clearer visions and lasting bonds!

Warm regards,

The Midwest Low Vision Team

Choroideremia. What is it? Can Low Vision Help?

While choroideremia is rare, affecting only 1 in 50,000 to 100,000, I’ve seen several patients with this condition for low vision care over the years and they can be helped. Let’s divide the newsletter into two parts: a current overview of the disease…and typical low vision treatment plans.

retinal photo of a patient with choroideremia
Choroideremia:
an X-linked chorioretinal dystrophy characterized by the progressive degeneration of photoreceptors, choroid, and retinal pigment epithelium; it is caused by mutations in the CHM gene.

Choroideremia (CHM) Overview:
CHM mostly affects males due to its X-linked inheritance pattern, but female carriers can have mild symptoms. Symptoms are similar to retinitis pigmentosa and typically start with night blindness during childhood, leading to peripheral visual field loss and eventually total blindness later in life. Currently, there are no approved treatments for CHM, but several therapeutic strategies are under investigation.

Gene replacement therapy using adeno-associated virus (AAV) vectors is one of the most advanced, and promising, treatment strategies. Other emerging therapies include stem cell treatment, small molecules, retinal prosthesis, and optogenetics, which aim to replace damaged retinal cells, target specific molecular pathways, or use light to control cells in living tissue to restore vision.

Although substantial challenges remain, including understanding the exact pathogenesis of CHM and improving gene editing and cell transplantation methods, these therapeutic developments provide hope for future treatment options. For more information, here are a few of the articles I referenced for this brief overview of choroideremia:
Update on Gene Therapy Clinical Trials for Choroideremia and Potential…
Choroideremia: Update On Clinical Features And Emerging Treatments
Progress in the development of novel therapies for choroideremia

Low Vision Care for the Choroideremia Patient:
Vision Aids: Depending on the stage and nature of vision impairment, magnifying aids may be helpful for reading and other near work. However, I have found that most patients with CHM are more in need of filters to enhance contrast/reduce glare and visual field enhancers for mobility.

Enchroma filter glasses
Enchroma Lx series, CPF’s, NoIR’s, and other companies have a variety of excellent filters that often make an incredible difference to a patient’s visual comfort and function.

reverse telescope fitting set
Reverse telescopes, image minifiers, field expanders, and sometimes prisms are all considered if the acuity is adequate and the visual field is in the ideal range. In my experience, to be effective, the visual acuity needs to be 20/40 or better and the ideal visual field is between 5 to 20 degrees.

As for many with low vision, orientation and mobility training can teach individuals to use their remaining vision and other senses to navigate environments confidently and safely, including the use of white canes and public transportation. Rehabilitation services like occupational therapy can further assist in maintaining independence by focusing on daily living skills. Importantly, psychological support through support groups and counseling can help manage the emotional aspects of living with CHM. Finally, the use of technological solutions, including screen reading software and smartphone apps, can additionally aid those with vision impairments such as CHM.

choroideremia patient wearing special glasses
reverse telescope glasses
the view through a reverse telescope
a patient wearing reverse bioptic telescopes
Both patients above have CHM, but their symptoms and goals were quite different. The first patient above had extreme light sensitivity and needed a filter and a goggle-like seal to block as much light as possible. He wanted a small reverse telescope mounted high, while the patient below had very little light sensitivity and he wanted a wider reverse telescope mounted directly ahead. As I’ve said before, advanced low vision care requires a thorough history, including patient goals, as well as plenty of time for trial and error!

Most of our patients are by referral, but all calls are welcome to see if we can help.  Call 1-877-577-2040 and speak with me or our lead low vision technician, Holly.  Thank you.

Dr. Jarrod Long

Top Ten Tips to Promote Low Vision Independence

Promoting INDEPENDENCE for Low Vision Patients.

Independence is at the heart of what I do for patients as a low vision provider. So with no more introduction needed, let’s jump right in to the Top 10 Ways to Promote Independence for Low Vision Patients!

#1) Leverage Technology: Smartphones and tablets come with built-in accessibility features such as text-to-speech, large fonts, high contrast modes, and voice commands. Additionally, many specialized apps can further aid in tasks like reading, identifying objects, or navigating. Search “best apps for low vision

#2) Use Assistive Devices: There are many non-optical, non-prescription assistive devices available, such as talking clocks, large-print keyboards, and color identifiers. For a wide selection of aids, I like Maxi-aids, LS&S, and Independent Living Aids. They were able to make conversions from catalogs (when I started practicing) to successful online stores.

#3) Modify Home Environment: Make simple modifications at home like using high-contrast colors for critical items, improving lighting in commonly used areas (see this recent newsletter covering lighting), and organizing and labeling items in a consistent manner.

#4) Embrace Vision Rehabilitation Services: Low vision doctors (like myself), occupational therapists, orientation and mobility specialists, and other therapists can provide prescription and non-prescription glasses, aids, and training to help manage daily activities and navigate both familiar and new environments.

#5) Stay Active: Regular physical activity can enhance overall well-being and help maintain independence through fitness. Consider activities that are safe and enjoyable, such as walking, swimming, or guided exercise programs. Also, inactivity can amplify many disease states, including those in the eyes — so stay active!

#6) Learn New Skills: Skills such as touch typing, using a long cane, or learning Braille can help maintain independence and open up new opportunities for work and leisure. Also, patients committed to life-long learning can adapt more easily when unintended changes in health and vision occur.

#7) Maintain Social Connections: Staying socially active is crucial for emotional well-being. Joining a support group or participating in community activities can provide companionship and practical advice from others who are facing similar challenges.

#8) Use Public Transportation Services: Many cities, and even rural areas, offer special transportation services for people with disabilities. These services can provide door-to-door transport and help maintain independence and social connections (see #7 above).

#9) Prioritize Mental Health: Dealing with vision loss can be challenging. Consider seeking support from a mental health professional if feelings of sadness, frustration, or anxiety become overwhelming. Practicing mindfulness and relaxation techniques can also be beneficial. Again, maintaining social connections can be helpful in this area as well.

#10) Stay Informed and Advocated: Stay updated about new technologies, treatments, and resources. Advocacy is also important – know your rights, communicate your needs clearly, and don’t be afraid to ask for the accommodations you require to maintain your independence. Don’t allow your vision disability to limit your opportunities!

Dr. Long discussing topics of independence with a low vision patient who is wearing special glasses
Dr. Long discussing independence with a patient who is wearing bioptic telescopic glasses.

That last tip, advocacy…whether it’s driving, taxes, accessibility, or simply being on a level playing field, we always help advocate for your/our patients to the extent allowable by law.
For more information call 1-877-577-2040 to discuss your situation with us.  Thank you, Dr. Jarrod Long

Low Vision and Blindness Accessibility in Hospitals

Holly, our lead low vision technician, and also a patient with Stargardt Disease, was invited along with another individual with low vision to evaluate low vision and blindness accessibility in our new local hospital.  See her comments below.

Holly and another individual with low vision in our local hospital

“I was invited to join a patient for a walk-through of IU Hospital in Bloomington. The purpose of this walk-through was to help answer questions and provide insight regarding some of the struggles a person who is partially-sighted might experience in an unfamiliar environment. Hospitals, along with other large buildings, can induce a lot of anxiety for many reasons, and having low vision is one that is easily overlooked. I love when people ask me questions about my low vision because it’s an opportunity for others to gain understanding about the obstacles that come with the territory. This sweet patient was so helpful and gave a first-hand look at what she experiences in her day-to-day life. Big thanks to IU Hospital for inviting me to share my insight!”