Doctors Revision

Ophthalmology (Eye Conditions)

Low Vision and Vision Loss

Significant reduction in visual function that cannot be fully corrected by conventional glasses, contact lenses, medication, or surgery, impacting daily activities. Includes low vision and blindness.

Also known as: Visual Impairment, Blindness

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Referral and warning signs

When to refer

Refer patients with significant visual impairment not correctable by standard glasses to Low Vision Services / Specialist Eye Centre (H/RR) for comprehensive assessment, identification of cause, and rehabilitation.

Red flags

  • Sudden onset of vision loss.
  • Rapidly progressive vision loss.
  • Eye pain associated with vision loss.

Signs and symptoms

  • Difficulty performing everyday tasks due to poor sight (reading, recognizing faces, cooking, mobility).
  • Blurred vision.
  • Loss of central vision.
  • Loss of peripheral vision (tunnel vision).
  • Reduced contrast sensitivity.
  • Difficulty with depth perception.
  • Symptoms related to the underlying cause of vision loss.

Risk factors

  • Underlying eye diseases (Cataract, Glaucoma, Diabetic Retinopathy, Age-related Macular Degeneration - AMD, Trachoma, Corneal scarring, Onchocerciasis).
  • Uncorrected Refractive Errors.
  • Congenital/Hereditary conditions.
  • Eye trauma.
  • Neurological conditions (stroke, tumours affecting visual pathway).
  • Advanced age.

Diagnosis

Clinical assessment

Assessment based on patient's functional difficulties and visual acuity measurement.

Investigations

  • Visual Acuity Testing: Best corrected visual acuity (BCVA) measurement.
  • Visual Field Testing: Assess peripheral vision.
  • Comprehensive Ophthalmic Examination: To identify the underlying cause of vision loss (slit lamp, fundoscopy, IOP measurement, etc.).
  • Low Vision Assessment: Functional assessment of remaining vision and needs for assistive devices. Performed by Low Vision Specialist/Optometrist.

Diagnostic criteria

WHO Classification of Visual Impairment (based on BCVA in better eye): - Low Vision: BCVA <6/18 to >=3/60. - Moderate VI: <6/18 to >=6/60. - Severe VI: <6/60 to >=3/60. - Blindness: BCVA <3/60. *(Visual field criteria also exist)*

Management

Non-pharmacological management

  • Identify and Treat Reversible Causes: e.g., Cataract surgery, correction of refractive error, treatment of eye infections/inflammation.
  • Low Vision Rehabilitation:
  • - Optical Aids: Magnifiers (handheld, stand, electronic), Telescopes.
  • - Non-Optical Aids: Large print materials, task lighting, contrast enhancement, tactile markers.
  • - Orientation and Mobility (O&M) Training: For safe travel (e.g., using white cane).
  • - Activities of Daily Living (ADL) Training: Adapting techniques for cooking, personal care etc.
  • - Assistive Technology: Screen readers, magnification software.
  • - Counseling and Psychosocial Support: Addressing emotional impact, coping strategies.
  • - Environmental modifications.
  • - Referral to community-based rehabilitation (CBR) programs.

Pharmacological treatment

  • Treatment of underlying eye condition (e.g., glaucoma drops, anti-VEGF for DR/AMD).

Monitoring

Regular follow-up with low vision services to adjust aids and strategies as needed. Ongoing management of underlying eye condition.

Complications

  • Reduced independence and quality of life.
  • Difficulty with employment and education.
  • Increased risk of falls and injuries.
  • Social isolation.
  • Depression / Anxiety.

Prevention

  • Preventing underlying causes (e.g., cataract surgery, glaucoma treatment, DR control, trachoma SAFE strategy, refractive error correction).
  • Eye protection to prevent trauma.
  • Regular eye examinations for early detection.

Patient education

  • Explanation of the cause and prognosis of vision loss.
  • Realistic expectations about potential for vision recovery.
  • Introduction to low vision aids and rehabilitation services.
  • How to use prescribed aids effectively.
  • Strategies for adapting daily activities.
  • Importance of utilizing remaining vision.
  • Available support services (CBR, support groups).

Uganda-specific notes

Major causes include unoperated cataract, glaucoma, uncorrected refractive error, corneal scarring (trachoma, keratitis), and diabetic retinopathy. Access to low vision assessment, devices, and rehabilitation services is very limited, mainly concentrated in Kampala and regional centres.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 20, Section 20.2.5

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