Low Vision Aid Dispensing and Training

By: Michael R. Politzer, O.D., F.A.A.O., F.C.O.V.D.

The ultimate success of the low vision patient will be determined by many factors. Many are obvious, such as the thoroughness of the examination, appropriateness of goals chosen and the availability of a variety of low vision aids designed to meet those goals.

However, many factors are not so obvious such as the effects of prior low vision exams, the patient’s psychological, educational and cognitive levels and if they were properly trained in using their low vision aids.

This is why it is so very important to give adequate and appropriate time to the dispensing and training of low vision aids. Do not assume that the patient or their family understands the use, care and handling of the low vision aids you prescribe.

It cannot be overstated, patience and repetition during the dispensing and training session will allow the patient to effectively and consistently use their new low vision aids.

The following steps and guidelines are helpful in achieving these goals:

Hand and Stand Magnifiers:

Begin by teaching the patient on how to turn the magnifier on or off.  Do not   assume that the patient will be able to do this without instruction.  Remember that the patient is visually impaired and probably cannot see how to do this.  Let the patient practice turning the magnifier on and off.

Then teach the patient how to change the batteries.  Show the patient how to open the handle to change the batteries, how many batteries are needed and what size battery to use.  The life of a standard battery is 12 hrs. of continual use.  If the patient will remember to turn the magnifier off when not in use, the batteries will last a long time. And as simple as it may seem, if the magnifier has an electrical cord, show the patient how to plug it correctly into the wall receptacle.

Then teach the patient how to cleaning the magnifier.  Spray windex or a mixture of alcohol and water on a soft cotton cloth and wipe the lens and handle.  Never spray directly onto the magnifier because the liquid will seep into the handle and corrode the batteries. Explain to the patient that a clean lens is easier to see through!

Instruct the patient on how to properly use their new low vision aid. For a hand magnifier
have the patient view the reading material through their distant Rx.  Show the patient how to hold the magnifier at the appropriate focal distance away from the print to keep the type clear and in focus.  For a stand magnifier have the patient view the reading material through their near or bifocal Rx.  Show the patient how to hold the magnifier directly on the reading material to keep the type clear and in focus. 

Spectacle Magnifiers:

Begin by properly adjusting the frame to the patient’s facial characteristics.  The patient needs to be seated before putting on the spectacle magnifier. Walking with the spectacle magnifier could cause the patient to stumble or fall. 

Have a good light coming over the same shoulder as the dominant eye or the eye with the best visual acuity. The light should be on an adjustable arm and should be brought in no closer than the side of the frame on the glasses.  A 75-watt frosted or 60 watt soft white bulb is recommended.  If the light source is brought into this position, the illumination is quadrupled (4X) without the glare or heat created from a higher wattage bulb. 

Give the patient a reading card and instruct the patient to hold it against the tip of their nose. Then push the card away from their nose until the words come into focus.  The focus distance will depend on the type size and power of the spectacle magnifier. 

Encourage the patient to practice daily for short periods of time.  The patient should not read for more than 20 minutes at a time without taking a 5-minute break.  The break gives the eyes time to recover and rest.    For cleaning spray a soft cotton cloth with Windex and wipe the lenses clean.  Do not use tissue or paper towels that may scratch the lenses. 

Video Magnifiers or Electronic Scanning Magnifiers:

Instruct the patient on how to connect the system to their monitor, if the monitor is not self-contained.  All manufacturers provide an excellent instructional booklet and video on installing and using their systems.  Refer the patient to the portion of the instruction booklet where a diagram of the installation is shown.  Review installation using the diagram and your office system for demonstration. Use your office system to review use, care and handling as wellRemember that the patient is already familiar with the system through the trial testing in the office.  Review the on/off switch, viewing modes, changing magnification, and attachments.

Hand Held Telescopes:

The patient begins by holding the telescope up to the dominant eye or the eye with the better visual acuity.  The soft part of the telescope goes toward the eye.  With the other hand, have the patient turn the front barrel, which will adjust the focus.  Some telescopes have a short focus, which means they are focusable for close as well as far distances.  Remind the patient that they will need to point, or aim, the telescope at the object they want to see.  Being mindful of where the object is in space will help to locate the object through the telescope.  Use the included cleaning cloth to clean the lenses of the telescope.  Never put the telescope under water.  Water will condense behind the optical lenses and they will become foggy rendering the telescope useless. Remember that a clean lens is easier to see through!  Wipe the lenses clean daily.

Spectacle Mounted Telescopes:

The optician begins by adjusting the frame to the patient.  The bottom of the telescope housing should be just above the upper eyelash line.  This way the patient can see out from under the telescope for normal viewing and into the telescope with a slight head tilt down and eye movement up for spotting purposes.  A strap is provided to relieve the pressure on the nose when wearing the telescope and to keep the telescope securely in place.

Instruct the patient on how to use the telescope.  No focusing instruction is needed for a fixed focus system. However, for focusable systems, the focusing wheel or barrel is on the front of the telescope.  Note: if the telescope is an autofocus model, refer to the manufacturers instruction manual for set-up and alignment. The patient will need to refocus the telescope depending on the working distance.  Have the patient point, or aim, the telescope at the object he wants to see.  Using the nose as a guide, or pointer, is a great idea.  With a slight head tilt down and eye movement up, the patient should see the object through the telescope.  Being mindful of where the object is in space will help to locate the object through the telescope.

If the patient is part of the driving program, he will receive a thorough rehabilitative training program on using the telescope.

The carrier lenses can be cleaned by spraying alcohol and water onto a soft cloth and wiping the lenses clean.  Do not spray directly onto the glasses.  Wiping them with a cleaning cloth can clean the telescope lenses.  Should the telescope need a more thorough cleaning, the lenses can be cleaned with a very, very slightly moistened Q-tip and dried with the dry end of the Q-tip.  Drops of water on the lens will result in permanent damage to the telescope.  Never put the telescope underwater.

NoIR  and Glare Filters:

Instruct the patient on how to use the filters. No adjustments are required as they are made to fit over the patient’s glasses and are used by the patient whenever he thinks they are needed to control light and glare. The NoIR filter lenses are very easily scratched.  For this reason, clean only with mild soap and warm water.  Shake the lenses dry or blot gently with a soft cloth.  Never wipe the filters with a tissue or cloth.  Always store in the case for protection when not in use.

Sector Prism Glasses:

The optician begins by adjusting the frame to the patient.  The glasses should be adjusted so that the corner of the prism is at the outer edge of the pupil (horizontal and vertical) on the patient.  This keeps the prism from getting into the central vision but is easily found when the patient looks into the prism.

Have the patient look down and over into the prism.  Ask him to fixate on an object through the prism.  While the patient is looking at the object, lift the glasses up so that the patient is no longer looking through the prism.  The patient should see the object shift out of his visual field or move so that it is barely visible.  The patient will receive a thorough rehabilitative training program on using the sector prism.

The lenses can be cleaned with mild soap and warm water.  This will not hurt the sector prism at all.  However, leaving the glasses in extreme heat or extreme cold may cause the prism to separate from the carrier lenses. 

Finally, all charting should include the date of dispensing and the visual acuity achieved with each aid dispensed. Give the patient a case in which to store their new low vision aid and inform the patient that you will call in about 2 weeks to see how they are doing with their low vision aids. This gives the patient the assurance and confidence that you care and will be available to help them during their period of adjustment.

By following these steps and guidelines; your patient’s chance for success will be improved and the quality of care you provide will be enhanced.