lecture 3
Causes ,symptoms and signs of low vision
Common causes of LV
Major symptoms& signs
Management options
By Gizachew T.
11/17/2025 09:50 PM Gizachew T. 1
Major Causes of low vision
AMD
Cataract
Refractive Error
Glaucoma
Diabetic Retinopathy
Retinitis Pigementosa
Nystagmus
Albinism
Aniridia
11/17/2025 09:50 PM Gizachew T. 2
How a patient develops low vision?
• Reduced Visual Acuity
• Contrast Sensitivity
• Visual Field Loss
• Photophobia
• Glare
• Diplopia
• Visual Distortion
• Visual Perceptual Difficulties
• Any Combination Of The Above
11/17/2025 09:50 PM Gizachew T. 3
Refractive error
• Globally the leading cause of visual impairment
Functional effects
• Reduce VA (D and/or N)
• Glare
• Eye strain
• headache
11/17/2025 09:50 PM Gizachew T. 4
Management
• Spectacle Correction
• Contact lens
• Refractive surgery can avoid VI
• LVAs may be needed if RE is not corrected by
optical correction due to amblyopia, fundus
degeneration…
11/17/2025 09:50 PM Gizachew T. 5
AMD
leading cause of severe central VA loss in people over
the age of 50 in the United States.
Types
1) Dry/ non-exudative AMD (85%-90%)
Cxed by:
progressive atrophy of the RPE
accumulation of retinal metabolic products/drusen
loss of retinal photoreceptors function
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AMD cont..
Dry AMD:
look for yellowish,
whitish or pigmented patches
i.e drusen, RPE changes,
geographic atrophy (late)
11/17/2025 09:50 PM Gizachew T. 7
AMD cont..
2) Wet (neovascular) AMD (10%- 15% )
depending on findings:
early or late
Wet AMD is characterized by bleeding underneath the
retina and CNV.
11/17/2025 09:50 PM Gizachew T. 8
AMD….. Risk factors
Age Race
Positive Family history Obesity
Smoking Light iris colour
Hypertension female gender
Sunlight exposure cardio- vascular
Diet disease
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AMD cont..
Diagnosis
1. History
2. Vision loss: gradual or sudden
3. Distortion
4. Visual acuity/ Central
• 6/18 or better: dry or early wet
• 6/60 or worse: wet or advanced dry (GA)
5. Fundoscopy
6. FA
7. Amsler grid test
• Distortion
11/17/2025 09:50 PM Gizachew T. 10
AMD cont..
SYMPTOMS
Central loss of vision
Bending of objects
Straight lines seem wavy
Progressive/ Sudden vision loss
Black patch in the central FOV/Scotoma
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AMD cont..
Associated Disabilities
Difficulty reading
Inability to recognize faces
Distortion or disappearance of central vision
Reduced color vision
Reduced contrast sensitivity
Mobility difficulties related to loss of depth and
contrast cues
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AMD cont..
Management Goals
Improving distance, intermediate, or near vision
Improving print reading ability
Improving the ability to perform ADL
Maintaining independence
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AMD cont..
Management strategies
Magnification for near
Magnification for distance
Use of tints, filters, lens coatings
Eccentric viewing training
Teaching awareness of the scotoma
Moving the reading material rather than the eyes
or head
Using prism relocation
11/17/2025 09:51 PM Gizachew T. 14
Cataract
Cataract is the leading cause of blindness and the second
leading cause of VI in the world.
Risk factors
Aging
Diabetes
Smoking
Exposure to sunlight
Trauma
11/17/2025 09:51 PM Gizachew T. 15
Cataract
Congenital cataract
One or both eyes
Surgery depends on severity of VA reduction
Associated with Nystagmus, squint, amblyopia
Px with congenital cataract may be
– phakic
– pseudophakic
– aphakic
11/17/2025 09:51 PM Gizachew T. 16
Cataract cont…
Symptoms
Clouding or blurring of vision.
Colors that may appear dimmer
Glare
Poor night vision
Signs
Whitish opacity is seen on the crystalline lens
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Cataract cont…
Associated disabilities
difficulty with detail vision
difficulty with bright and changing light levels
reduced color vision
decreased contrast sensitivity
mobility difficulties related to loss of depth and
contrast cues
11/17/2025 09:51 PM Gizachew T. 18
Cataract cont…
Management Goals
Improving distance, intermediate, or near vision
Improving print reading ability
Improving the ability to perform ADL
Maintaining independence
11/17/2025 09:51 PM Gizachew T. 19
Cataract cont…
Management strategies
Prescribe appropriate magnification
teach visual skills
Near (Prescribe glasses, microscopes, hand or stand
magnifiers, appropriate lighting )
Distance (Prescribe glasses, telescopes)
bifocals/reading add
Optimum lighting (ambient, task, or use of
illuminated devices)
Use of tints, filters, lens coatings, etc.
Electronic devices.
11/17/2025 09:51 PM Gizachew T. 20
Glaucoma
It is a progressive optic neuropathy.
The symptoms are:
visual field defects
decreased dark adaptation/difficulty in low illumination
reduced contrast sensitivity function
glare
difficulty seeing steps, curbs ,bumping into objects
11/17/2025 09:51 PM Gizachew T. 21
11/17/2025 09:51 PM Gizachew T. 22
Glaucoma cont…
Associated disabilities
Mobility problems due to restricted visual fields
reading problems
Objects suddenly appearing in the VF
In severe cases, total blindness can occur
11/17/2025 09:51 PM Gizachew T. 23
Glaucoma cont…
Management goals
Expanding the visual field
Improving the ability to travel independently
Improving the ability to perform ADL
Maintaining independence
11/17/2025 09:51 PM Gizachew T. 24
Glaucoma cont…
Management strategies
Low vision aids if needed
Prescribe prisms, mirrors
reverse telescopes
minus lenses
teach scanning
visual skills
Manage:
• glare
• poor near VA
• field loss (advanced)
11/17/2025 09:51 PM Gizachew T. 25
Diabetic retinopathy
A frequent cause of blindness in the United States,
20-64 years is leading cause blindness.
DR can be a complication of diabetes type1 or type 2.
Risk factors associated with DR include:
duration of diabetes
poor blood sugar control
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Diabetic retinopathy
Symptoms of DR include:
Seeing spots or floaters in the field of vision
Blurred vision
Having a dark or empty spot in the center of your
vision
Fluctuating Vision/RE
Loss of Central Sharp Vision
Profound Loss of Vision
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cont.…
Color Vision Impairment
Reduced Side Vision After Laser
Night Blindness After Laser
Diplopia or Double Vision
Loss of Contrast Sensitivity and Glare Problems
Hemianopia
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Diabetic retinopathy cont…
Associated disabilities
Difficulty with tasks requiring fine-detail vision
distorted central vision
fluctuation of vision
loss of color vision
mobility problems due to loss of depth and contrast
cues.
In severe cases, total blindness can occur
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Diabetic retinopathy cont…
Management strategies
Consider low vision aids as needed
For hemianopia: Prism can be Rxed
shift image from non seeing field to seeing field
Prism base towards field defect
Binocular to avoid diplopia
Rarely prescribed
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Nystagmus
Nystagmus is a repetetive, involuntary oscillations of
the eye.
VA related to extent of movement & other pathologies.
associated with high WTA.
Types
Physiological
Congenital
Acquired
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Nystagmus cont…
Related disorders with congenital nystagmus
Amblyopia
Albinism
Strabismus
Optic Nerve Hypoplasia
Aniridia
Congenital cataract
11/17/2025 09:51 PM Gizachew T. 32
Nystagmus cont…
Symptoms
Light-sensitivity
Difficulty in darkness
Oscillopsia (sensation of object shaking or moving)
Dizziness, etc.
head turn/tilt
11/17/2025 09:51 PM Gizachew T. 33
Nystagmus cont…
Treatment
1-Maximize vision by refraction
2-Treat amblyopia
3-If small face turn; prescription of prism in glasses
4-If large face turn; muscle surgery
11/17/2025 09:51 PM Gizachew T. 34
Nystagmus cont…
Low vision management strategies
Options for distance
Monocular or binocular telescope
Sit close to board
Null position:
ask during case history
encourage its use
Sit with board on the side comfortable to use null
position
11/17/2025 09:51 PM Gizachew T. 35
Nystagmus cont…
Options for near
Enlarged print/handouts
Simple magnifier e.g. bright field, low plus
Encourage to use the near null position.
11/17/2025 09:51 PM Gizachew T. 36
Albinism
Absence or reduced pigment in RPE and choroid.
excess light enters to eye through iris and sclera as
well as pupil
discomfort and disability glare
associated with reduced VA, nystagmus, squint
high refractive error( WTR astigmatism.)
Mgt
Correct refractive error
Manage nystagmus
Manage glare
11/17/2025 09:51 PM Gizachew T. 37
Albinism
Managing glare problems
modify environment
school, home, window blinds
wide brimmed hat, visor,
typoscope
CCTV: try white print on black
tinted contact lens and sunglasses
may still need additional task lighting
11/17/2025 09:51 PM Gizachew T. 38
Aniridia
No iris
Associated with cataract, nystagmus, glaucoma, high
refractive errors
Can be congenital/traumatic
Management
Control glare
Improve cosmetic
contact lens
11/17/2025 09:51 PM Gizachew T. 39
Retinits pigmentosa
Group of hereditary retinal disorders
Affects rod photoreceptors
Ring scotoma in the VF, spreads out and inwards
Advanced- small central island of field left
11/17/2025 09:51 PM Gizachew T. 40
Retinitis pigmentosa cont…
Symptoms
Decreased vision at night or in low light
Loss of side (peripheral) vision, causing "tunnel vision"
Loss of central vision (in advanced cases)
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Retinitis pigmentosa cont…
Associated disabilities
Mobility problems due to restricted visual fields
reading problems
Night vision problem
In severe cases, total blindness can occur
11/17/2025 09:51 PM Gizachew T. 42
cont.…
Management strategies
Low vision aids if needed
Prescribe prisms, mirrors
reverse telescopes
minus lenses
teach scanning
visual skills
11/17/2025 09:51 PM Gizachew T. 43
ANY QUESTION ???????
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