II. Epidemiology

  1. Incidence of Low Vision increases with age
    1. Prevalence: 3.3 million in U.S. over age 40 years (3-4%)
    2. Age over 80 years: Accounts for 70% of blindness

III. Symptoms: Normal changes related to aging

  1. Presbyopia
  2. Decreased contrast sensitivity
  3. Decreased dark-light adaptation
  4. Delayed glare recovery

IV. Symptoms: Abnormal

  1. See Acute Vision Loss
  2. Loss of central vision
    1. Age-Related Macular Degeneration
  3. Loss of peripheral vision
    1. Glaucoma
  4. Generalized loss of vision
    1. Cataract
    2. Diabetic Retinopathy

V. Causes: Common (over age 40 years)

  1. See Acute Vision Loss
  2. Age-Related Macular Degeneration (54% of all blindness in U.S.)
  3. Cataracts (most common cause of blindness worldwide)
  4. Glaucoma
  5. Diabetic Retinopathy (present in up to 10% of diabetes patients at time of initial diagnosis)

VII. Interpretation

  1. Mild Vision Loss
    1. Vision 20/30 to 20/70
    2. Visual field <30 degrees
  2. Moderate Vision Loss
    1. Vision 20/80 to 20/160
  3. Severe Vision Loss
    1. Vision 20/200 to 20/400
    2. Visual field <20 degrees
  4. Profound Vision Loss
    1. Vision 20/500 to 20/1000
  5. Near Total Blindness
    1. Can detect hand motions
    2. Light perception intact
  6. Total Blindness
    1. No light perception

VIII. Evaluation: Indications for eye care specialist referral

  1. Acute Vision Loss (emergent)
  2. Uncorrected vision <20/50 or
  3. One line difference (on Snellen Chart) between eyes

IX. Management: Vision Enhancing Devices

  1. See specific conditions
  2. Magnification Devices for reading
    1. High powered prismatic spectacles
    2. Handheld magnifier
    3. Stand magnifier
  3. Magnification Devices for more intricate activities
    1. Telemicroscopes (spectacle-mounted telescopes)
    2. Telescopes
  4. Adjunctive vision devices
    1. Filters to enhance contrast
    2. Filters to reduce glare
  5. Electronic vision Assistive Devices
    1. Video magnifiers
    2. Computer voice synthesizers to read text
  6. Other options
    1. Large print books
    2. Audiobooks

X. Prevention

  1. See Preventive Eye Examination
  2. Low Vision may be preventable in up to 40-50% with periodic Vision Screening
  3. See Home Modifications for Vision Impaired Patients
  4. General measures
    1. Tobacco Cessation
    2. Sunglasses (limit ultraviolet light exposure)
    3. Control comorbid conditions
      1. Diabetes Mellitus
      2. Hypertension
      3. Hyperlipidemia

XI. Complications

  1. Depression
  2. Social withdrawal and isolation
  3. Increased fall risk
  4. Hallucinations
  5. Higher risk of older adults being institutionalized
  6. Higher risk of medication errrors

XII. Resources

  1. American Council of the Blind
    1. http://www.acb.org
  2. American Foundation for the Blind
    1. http://www.afb.org
  3. Jewish Guild for the Blind
    1. http://www.jgb.org
  4. Lighthouse International
    1. http://www.lighthouse.org
  5. National Federation of the Blind
    1. http://www.nfb.org
  6. Prevent Blindness America
    1. http://www.preventblindness.org
  7. VisionAWARE
    1. http://www.visionaware.org

Images: Related links to external sites (from Google)

Ontology: Visual impairment (C0042798)

Definition (AIR) Visual Loss: objective loss of visual acuity during a finite period attributable to an underlying disease.
Definition (MSH) Vision considered to be inferior to normal vision as represented by accepted standards of acuity, field of vision, or motility. Low vision generally refers to visual disorders that are caused by diseases that cannot be corrected by refraction (e.g., MACULAR DEGENERATION; RETINITIS PIGMENTOSA; DIABETIC RETINOPATHY, etc.).
Concepts Disease or Syndrome (T047)
MSH D015354
ICD9 438.7, 369.9
ICD10 H54.7
SnomedCT 271725002, 280117007, 267630002, 301982003, 267631003, 7973008, 246635007, 397540003, 155146008, 193698004, 40031005, 193755006
HL7 A5
English Vision, abnormal, DIMINISHED VISION, Subnormal Vision, Vision, Low, Vision, Subnormal, Unspecified visual loss, Visual loss, ABNORMAL VISION, VISION ABNORMAL, VISION DECREASED, VISION IMPAIRMENT, VISUAL IMPAIRMENT, Decreased vision, NOS, Low vision, NOS, Visual loss, NOS, Can't see properly, VISION DIM, Visual loss NOS, Impaired Vision, Reduced vision, Visual defects, Vision problem, visual impairment, vision disturbance, vision impaired, impaired vision, visual impairment (diagnosis), Impaired vision (disorder), Partial sight (finding), Impaired vision (finding), Vision problem (finding), Cannot see properly, Low Vision, Abnormal vision NOS, Vision abnormal, Vision abnormal NOS, Vision dim, Vision decreased, VISION PROBLEM, Diminished Vision, Vision, Diminished, Reduced Vision, Vision, Reduced, Visual loss NOS (finding), VISION, IMPAIRED, IMPAIRED VISION, Vision, Low [Disease/Finding], abnormal vision, dim vision, sight impaired, vision impairment, visual loss, vision disturbances, Decreased;vision, Defect;vision, Difficulty;vision, partially sighted, Disturbed;vision, Impairment;visual, cannot see properly, Poor;vision, Problem;vision, low vision, subnormal vision, vision problem, dimming vision, defects visual, Abnormal vision, Darkened vision, Dim vision, Abnormal vision (finding), Dim vision (disorder), Visual impairment (disorder), Low vision, Decreased vision, Impaired vision, Difficulty seeing, Partial sight, Reduced ability to see, Sight impaired, LV - Low vision, Poor vision, Problem seeing, Problem sight, Visual difficulty, defect; vision, defective; vision, disturbance; vision, low; vision, poor; vision, vision; defect, vision; disturbance, vision; low, vision; poor, Partially sighted, Vision problem (disorder), Visual impairment, Partially Sighted, Visual Impairment, Partial Sight, Vision impaired, Disturbances of vision, visual defect, decreased vision, difficulty with vision, disturbed vision, partial sight, poor vision, problem with vision
Dutch gezichtsvermogen verminderd, slecht gezichtsvermogen, gedeeltelijk gezichtsvermogen, niet-gespecificeerd gezichtsverlies, gezichtsvermogen afgenomen, afwijkend gezichtsvermogen, afwijkend gezichtsvermogen NAO, gezichtsvermogen zwak, gezichtsvermogen afwijkend, gezichtsvermogen afwijkend NAO, defect; gezichtsvermogen, gebrek; gezichtsvermogen, gering; visus, gestoord; visus, gezichtsvermogen; defect, gezichtsvermogen; slecht, laag; visus, slecht; gezichtsvermogen, visus; gering, visus; gestoord, visus; laag, Niet gespecificeerd verlies van gezichtsvermogen, Gezichtsvermogen, verminderd, Verminderde visus, Visus, verminderde, Visusdaling
French Mauvaise vision, Perte visuelle non précisée, Vue partielle, ANOMALIE DE LA VISION, ANOMALIE VISUELLE, VISION TROUBLE, Défauts visuels, Vision anormale SAI, Vision obscurcie, Vision anormale, Vision basse, Vision diminuée, Vision faible, Vision réduite
German schlecht sehen, unspezifischer Sehverlust, partielles Sehen, Sehvermoegen vermindert, Nicht naeher bezeichneter Visusverlust, SEHKRAFT VERMINDERT, SEHSCHAERFEMINDERUNG, SEHVERMOEGEN ANOMAL, Sehen anomal, anomales Sehen NNB, Sehvermoegen anomal NNB, Sehverschlechterung, anomales Sehen, Sehen schwach, Sehschwäche, Sehvermögen, herabgesetztes, Sehvermögen, vermindertes
Italian Vista parziale, Perdita della vista non specificata, Vista scarsa, Visione ridotta, Compromissione della visione, Visione alterata, NAS, Visione alterata, Visione anormale, Visione anormale NAS, Visione indistinta, Ipovisione
Portuguese Visão diminuída, Visão deficiente, Défice visual NE, Visão parcial, ALTERACAO DA VISAO, DANO DA VISAO, DIMINUICAO DA VISAO, Insuficiência visual, Visão anormal, Visão anormal NE, Visão anómala NE, Visão obscura, Baixa Visão, Visão Reduzida, Visão Subnormal
Spanish Pérdida visual no especificada, Visión escasa, Visión disminuida, Vista parcial, Visual loss NOS, Impaired vision, Sight impaired, Vision problem, Partial sight, VISION ANORMAL, VISION DETERIORADA, VISION DISMINUIDA, Visión oscurecida, Visión anormal NEOM, Visión anormal, Alteración visual, alteración de la función visual, daño visual (trastorno), daño visual, poca visión, pérdida de la visión, SAI (hallazgo), pérdida de la visión, SAI, pérdida visual, visión alterada, visión anormal (hallazgo), visión anormal, visión disminuida, visión débil (trastorno), visión débil, problema de la visión (trastorno), problema de la visión, Baja Visión, Visión Reducida, Visión Subnormal, Baja Vision, Vision Reducida, Vision Subnormal
Japanese 部分的視覚, 視力低下, 視力不良, 詳細不明の視力消失, ブブンテキシカク, ショウサイフメイノシリョクショウシツ, シリョクフリョウ, シリョクテイカ, 視覚異常NOS, 視力障害, シカクイジョウ, ぼんやりとした視界, ボンヤリトシタシカイ, シリョクショウガイ, 視覚異常, シカクイジョウNOS, 亜正常視覚, 低視力, 低視覚, ロービジョン, 視覚-亜正常, 視覚-低
Czech slabozrakost, zrak subnormální, vidění snížené, Částečný zrak, Blíže neurčená ztráta zraku, Slabozrakost, Snížený zrak, Abnormální zrak NOS, Nejasné vidění, Abnormální vidění, Abnormální vidění NOS, Abnormální zrak, Postižení zraku
Finnish Heikentynyt näkö
Korean 상세불명의 시력 상실
Swedish Synnedsättning
Polish Obniżenie jakości widzenia, Wzrok słaby, Wzrok subnormalny, Widzenie osłabione, Widzenie obniżone
Hungarian Kóros látás k.m.n., Kóros látás, Nem meghatározott látásvesztés, Látás, gyenge, Partialis látás, Látáskárosodás, Látáscsökkenés, Rossz látás

Ontology: Blind Vision (C0456909)

Definition (MSH) The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of EYE DISEASES; OPTIC NERVE DISEASES; OPTIC CHIASM diseases; or BRAIN DISEASES affecting the VISUAL PATHWAYS or OCCIPITAL LOBE.
Definition (CSP) inability to see or the loss or absence of perception of visual stimuli; condition may be the result of eye, optic nerve, optic chiasm or brain diseases effecting the visual pathways or occipital lobe.
Concepts Disease or Syndrome (T047)
MSH D001766
SnomedCT 40031005, 139548004, 277675000
English Blindness, BLINDNESS, VISION LOSS, Blindness, NOS, Cannot see, Loss of vision, Unable to see, Blind, Loss Of Vision, UTS - Unable to see, Blind Vision, Blindness (finding), Vision loss, VISION, LOSS OF, LOSS OF VISION, Blindness [Disease/Finding], Blind (finding), sight loss, loss of vision, Loss (of);sight, blind, loss (of) sight, blind vision, loss sight, vision loss, Blindness NOS, blindness, loss; vision, vision; loss, loss of sight
French CECITE, Cécité SAI, Aveugle, Perte de la vue, Perte de la vision, Cécité, Non-voyance
Portuguese CEGUEIRA, Cegueira NE, Défice visual, Cego, Perda de visão, Cegueira
Spanish CEGUERA, Pérdida de la visión, Ceguera NEOM, Pérdida de visión, Ciego, Blindness, ciego, ciego (hallazgo), ceguera (trastorno), ceguera, Ceguera
German BLINDHEIT, Blindheit NNB, Verlust des Sehvermoegens, blind, Blindheit, Sehverlust
Dutch blindheid NAO, blind, verlies van gezichtsvermogen, gezichtsverlies, Blindheid, verlies; visus, visus; verlies, blindheid, Amaurose
Italian Cieco, Perdita della visione, Perdita della vista, Cecità NAS, Cecità
Japanese 視力喪失, 失明NOS, シリョクソウシツ, シツメイ, シツメイNOS, 視覚消失症, , 黒内障, 失明
Swedish Blindhet
Czech slepota, Nevidomý, Slepota, Nevidomost NOS, Ztráta zraku
Finnish Sokeus
Polish Ślepota
Hungarian Vakság, Amaurosis k.m.n., Látás elvesztése, Vak, Látásvesztés

Ontology: Optical low vision aid (C0730385)

Concepts Medical Device (T074)
SnomedCT 313024004
English Optical low vision aid, Optical low vision aid (physical object)
Spanish lentes para visión escasa (objeto físico), lentes para visión escasa