Low Vision Services

Treatment Options for  Low Vision

Regrettably, there are still retinal diseases that can’t be effectively treated or cured. There are conditions for which no effective treatments have been discovered. Other conditions exist for which there are treatments, but they are not effective if the condition is diagnosed late in the course of the disease. Patients often ask some of the following questions.

Can I have a retina transplant?

Unfortunately, we are not able to transplant the retina. Similarly, whole eye transplants are not possible. The retina is a very complex neurological structure similar to the brain. Many doctors think of the retina as a piece of brain tissue that is extruded into the eye during formation of the embryo. We are not yet capable of transplanting a piece of brain tissue that has been damaged and this is similarly true of the retina.

 

What about stem cells? Can’t my retina be repaired with stem cells?

The sad truth is that there are a number of “stem cell” clinics that have sprung up around the country offering hope to patients for which there is no effective treatment. Because these “stem cell” clinics use cells derived from the patient’s own body, the clinics have not, until recently, been regulated by the government. This is changing. Stem cell therapy is a promising avenue of research, but it is still in its infancy. Please refer to our blog article on “Stem Cell Therapy” for a more complete discussion. There is still a lot of work to be done. Most of the stem cell clinics offering treatment are unregulated and offer no scientifically validated therapy for retinal diseases. They are also usually expensive with no coverage by insurance. Currently, we would recommend that our patients only become involved in a “stem cell” research study if it is registered at www.clinicaltrials.gov, and if it is at no cost to the patient. Any legitimate clinical trial that is testing the safety and efficacy of a treatment will be free of charge to any patient involved. There was a tragic case in which a patient had “stem cells” injected into both eyes by a “stem cell clinic” and subsequently went completely blind in both eyes. Buyer beware.

I have heard about an “artificial retina”. Would that help to restore my vision?

There has been some very impressive work done on the artificial retinal prosthesis over the last few years. The Argus II is the only device currently approved by the FDA in the United States. This device is surgically implanted on the retina. A special pair of glasses is worn by the patient that captures images, transmits them to the implant, which then stimulates the undamaged cells of the retina. This can allow some patients that are nearly totally blind from degenerative retinal conditions, such as retinitis pigmentosa, to detect large objects and navigate around their environment better than they did before the procedure. However, it does not provide good detailed vision. As a matter of fact, patients with severe, end stage retinal disease such as age-related macular degeneration or diabetic retinopathy, have better vision than patients that have had the Argus implant. This may improve as the technology gets better, but it is not a viable treatment for patients that have only poor central vision.

What about gene therapy?

This is another very promising avenue of retinal research. Recently, there have been a few clinical trails using gene therapy for retinal diseases. As a matter of fact, the first gene therapy treatment was FDA approved for a retinal disease in 2018. However, these treatments are restricted to very specific genetic mutations, so most patients with hereditary retinal diseases would not qualify for the treatment. Undoubtedly, more treatments will be developed. One way to determine whether a patient will qualify for treatment is to have genetic testing performed. Unfortunately, most insurance companies do not cover genetic testing. At Retinal Consultants of Southern California, we offer genetic testing.  Please ask your physician for more information about the cost and benefit of testing.​​

Am I legally blind, and if so, do I qualify for any benefits?

  • Legal blindness is defined as a vision of 20/200 or worse in both eyes with glasses. You cannot be declared legally blind if you have not had a recent refraction (checking your glasses).

  • There is a big difference between being “legally blind” and totally blind. Total blindness means that a patient cannot even see light with either eye. A person that is legally blind can still function well enough to navigate around a room without tripping over furniture and can sometimes function well enough to live independently without daily help. However, they are not able to legally drive and will have a lot of difficulty reading small print, such as directions on a prescription, and recognizing faces.

  • If a patient is legally blind, we will provide them with a letter declaring them legally blind. This may qualify many patients for government sponsored benefits. Legally blind patients less than age 65 may still qualify for Social Security benefits. Some of the benefits available to low vision patients are listed below:

  • Social Security Disability(SSD):  disabled workers under 65 years of age and their families are eligible for Social Security Disability provided the worker has worked long enough to be insured and is no longer gainfully employed.  Contact your Social Security office at: 800-772-1213 or www.ssa.gov

  • Local Transportation: local city bus companies offer discounts to the legally blind and may be helpful in suggesting alternative transportation such as Dial-A-Ride.

  • Handicap Parking Permit: this identification plate is available to those who are legally blind and can be used in any car they travel in.  Apply to the Department of Motor Vehicles at:  800-777-0133 or www.dmv.ca.gov

What other assistance can be offered for patients with low vision?

  • For those patients that have no other treatment options, we can offer low vision services. A low vision evaluation with a low vision specialist will not restore normal vision to a permanently damaged eye, but it might help to allow a patient with limited vision to use their damaged vision better. These services can include the use of magnifying aids, as well as instruction on techniques to improve an individual’s function in certain specific areas of trouble due to poor vision. Some patient’s respond very well to this and others find it unhelpful. It is important to understand that low vision training is not intended to improve vision, but to improve a patient’s daily function with their poor vision.

Low Vision Services We Offer

  • ​The Braille Institute. The evaluation is free, but you may be charged for any devices that you find helpful after evaluation. The Braille Institute does not only work with completely blind individuals. It offers services to patients with poor vision as well. They have a van that comes to various areas in the Inland Empire. We can provide you with a referral form to arrange a consultation.

  • Private low vision services: There are a number of options for private low vision services depending on the area. Please ask your doctor about the availability in your area. It is important to keep in mind that low vision services are usually not covered by your insurance, so any expenses incurred may be out of pocket.

Implantable telescopic lens

  • One of the newest technological innovations for patients with irreversible low vision is the implantable miniature telescope. The device that is currently FDA approved is called CentraSight.

  • This is a device that is surgically implanted into the eye of patients with end stage macular degeneration, who have lost their central vision in both eyes.

  • It is important to know that this lens does not cure macular degeneration or restore normal vision to the eye. In some patients it can allow them to use the eye with the implanted lens to see objects that would normally be too small to make out by magnifying the image without the use of external magnifying lenses. This is not for everyone and only certain patients qualify.

  • These lenses can only be implanted by specially certified centers, most of which are academic institutions. Locally, Loma Linda University department of Ophthalmology is the closest center.

  • For more information you can call 1-877-99-SIGHT or go to the web site www.CentraSight.com. Your doctor will be happy to discuss this with you to see if you might be a good candidate for this procedure.

  • Department of Rehabilitation:  This department provides vocational training and retraining, counselors and teachers for the blind, and may assist a legally blind person in acquiring visual aids to maintain the persons present job.  They also assist in acquiring visual aids and large print materials for students.  The department also advocates for the client in a work situation.

    • San Bernardino County (909) 383-4401

    • Riverside County (951) 782-6650

  • Homemaker services through Medi-Cal: Legally blind persons receiving Medi-Cal may qualify for homemaker services, caseworker will determine eligibility and number of hours of help.

  • Social Security Income:  Social Security income is available to many people over 65 years or older, who are legally, or disabled who have little or no income and limited resources.  Contact your local Social Security office for your Medi-Cal caseworker for additional information and application.

  • Tax Benefits:  By being certified legally blind, you are eligible for an extra deduction on your federal and state income taxes.  You can also have vision aids considered as a medical expense.

  • Free Phone:  There is a California Telephone Access Program (CTAP) that can provide a special phone which can help those who are visually impaired. Contact CTAP at: 800-806-1191 or visit www.ddtp.org

Riverside: 9041 Magnolia Ave, Suite 207

Redlands1895 Orange Tree Lane, Suite 204

Victorville15413 Anacapa Road, #6B

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