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.
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.
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.
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 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 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.
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.
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 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
Here is a great example of why I continue to practice low vision care. Of course, there is no typical day in low vision, but success stories similar to Kathy’s are a regular occurrence. Kathy has Dominant Optic Atrophy and here is the full story she shared with us!
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.
“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!”
A refraction is the “one or two?” test. We use it to determine your glasses prescription.
What if you have low vision…is it still important?
YES, and to be accurate it is usually performed differently.
This sweet patient (see photo) brought her dulcimer, music stand, clip-on lamp, and sheet music so that we could accurately recreate her set-up. She has macular degeneration and sees 20/150 with her dominant right eye and 20/50 with her left eye with no basic glasses correction being necessary. Due to a “binocular rivalry” she actually sees better with her right eye occluded or fogged. She needs to see her strings at 14″ and her music at 22″ to 24″. Continue below for more on how we reached her low vision goal of seeing her instrument and music at the same time!
Macular Degeneration Patient using Special Telescopic Glasses to Play the Dulcimer
1. She was using enlarged music, or in her case “tabs” for the dulcimer, which she was writing out by hand in bold large print.
2. Even with her handwritten tabs and a +2.00 spherical glasses prescription (19.5″ focal length) she was not seeing adequately.
3. As seen in the photo, our solution was a pair of wide-angle bioptic telescopic glasses, left eye only, with a +2.75 spherical carrier (14″ focal length) and a +4.75 spherical telescope eyepiece (24″ focal length) and no angle of inclination (i.e., no upwards tilt).
4. “This is going to work! I can see at least three bars wide at a time!” We ordered a plano lens for the right eye and will supply a lens-clip that she can use as needed to occlude her right eye in case she is unable to suppress it.
Thank you and please share our information with your patients or loved ones with vision loss. While we see most of our patients by referral, 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.
Click the photo below to learn more about the kit Dr. Long designed to help himself and other doctors more effectively prescribe telescopic reading glasses.
Dr. Long’s patient using Reading Telescopic Glasses
Beyond the usual functional vision goals due to decreased visual acuity, these patients need help with various vision and other related symptoms.
TBI symptoms can include blurred vision, headaches, photophobia, reading difficulties, eyestrain, diplopia, eye movement disorders, visual field defects, color vision changes, impaired contrast sensitivity, perceptual difficulties, and vestibular dysfunctions such as visual motion sensitivity (VMS).
My Top 5 TBI Treatments:
Filters, Light Control
Prism, for Alignment/Binocularity, as well as Sectoral, Yoked, and Base-In
Increased Plus Power for Near
Selective Occlusion
Vision and Occupational Therapy Referral
LEARN MORE about how Dr. Long helps these patients
