Low Vision

By Helen Neal

Simon & Schuster, 269 pp., $16.95

There are approximately 11.4 million Americans, young and old, who cannot fully see, even with the aid of conventional eyeglasses and contact lenses.

The contemporary term for this affliction is "low vision" -- meaning the vision is severely blurred, or there is only tunnel vision with loss of peripheral sight, or there is loss of vision in the central field, making it hard to read or do close work. As those with low vision struggle with such routine tasks as reading a newspaper, watching television, driving at night or recognizing friends' faces, their world becomes obscured and isolated.

Many people with low vision, especially the elderly and those trying to keep a job, become depressed and incapacitated. Eventually, some feel they may as well be blind or dead.

"Low Vision," by health writer Helen Neal, offers information needed by those who are diagnosed as having one of the major contributing diseases to low vision: glaucoma, macular degeneration, diabetic retinopathy, retinitis pigmentosa, cataracts and detached retina.

While there are no miracle cures for this myriad of eye problems, Neal claims there are ways to enhance usable sight by properly employing optical and non-optical aids, which are offered through low-vision services and special treatment programs.

Unfortunately, the terms "optical aids" and "low-vision services" are relatively new and not in every ophthalmologist's vocabulary.

"Every week, at least one patient being admitted to our low-vision clinic says that an eye doctor has told them they're going blind and that nothing can be done for them," Neal quotes Robert Cope, a counselor at the William Feinbloom vision Rehabilitation Center at the Pennsylvania College of Optometry in Philadelphia.

According to Neal, despite this "open and covert resistance from eye-care practitioners and agencies for the blind," low-vision services have been "putting down strong deep roots" and now have the respectful attention of numerous organizations, such as the American Academy of Ophthalmology and the National Institutes of Health.

For the consumer, a more major problem remains: "Few health- and medical-insurance policies pay for low-vision assessments or for visual aids and training in their use," says Neal.

Consequently, the "hardest hit are older people living on small incomes, and they're the ones most afflicted by visual disorders" that could be helped, Neal says.

But this is not a book that dwells on the awkward maturation of visual health care. Laying politics aside, Neal gives an intelligent, clear description of how the eye works, how emotions affect normal sight, what causes low vision, what the symptoms and treatment of each affliction are and how the condition can psychologically affect people.

Based on interviews with medical personnel and patients in Canada, Britain and the United States, Neal gives a detailed account of the various types of low-vision services available, ranging from the private practitioner who specializes part-time in low-vision assessment to the hospital clinic with a fulltime staff of eye doctors, social workers and psychologists. The book's appendix also lists vision computer services, publications, clinics and organizations, and ways to find low-vision clinics in your area.

The process of aiding and enhancing existing sight should involve a thorough evaluation of the patient's medical history and physical environment, observes Neal. Practitioners can't just prescribe low-vision aids; they have to spend time to train and often retrain the patient in how to use the aid and cope at work and in the home.

Acting as the low-vision clinician, Neal considers every aspect of a low-vision patient's home -- from floors to burglar alarms -- with practical tips on how to plan and maintain a safe and visually efficient environment.

This book is itself a visual aid to the reader. Though the print and spacing between the lines is purposely larger (but not as big as the large-print books) for the low-visioned reader, Neal is also addressing the concern of friends and family. There are dramatic photographs of how a visually impaired person sees the world, and the message is clear: Without proper aid, low vision can be life endangering when driving a car or crossing the street.

There are also photos of patients using some of the optical aids, such as a telescopic lens that is mounted in the top part of regular eyeglasses and various types of electronic magnifying systems that attach to television screens, computer terminals and cameras.

Neal recognizes that one of the biggest drawbacks to the advance of optical aids is that they are often socially and psychologically unacceptable to the patient.

Children and teen-agers "resist wearing bizarre-looking aids" for fear of ridicule. Adults fear optic aids may jeopardize their jobs. And the elderly are often intimidated by having to learn how to use something so "new and strange."

Elderly patients, who are reluctantly brought to a low-vision center by their adult children, are not likely to succeed, warns Neal.

Nor can patients expect miracles when asking the general question, "How can I see better?" They must decide what it is they want to see, such as close work for sewing or peripheral vision for driving.

Once that is established and the patient is motivated and willing, says Neal, the more likely it is that the treatment will succeed.

Neal is the author of "The Politics of Pain," which won the book award of the Mid-Atlantic Chapter of the American Medical Writers Association. She worked in communications for the American Red Cross, the National Health Council and the National Institutes of Health. She died of cancer the week "Low Vision" was released.

Barbara Mathias is a Washington writer.