How Low Vision Rehabilitation Can Help When You Have Geographic Atrophy

When you’re living with geographic atrophy (GA), or advanced dry macular degeneration, once-simple actions take a lot more work than they used to. Everything from making coffee and checking your phone to recognizing someone across the room requires more effort and patience than ever before.

It can feel like you’re losing parts of your life in slow motion, especially when you add in fears about your vision continuing to decline. But low vision rehabilitation may be able to help you feel more in control of your condition — and your life.

What is low vision rehabilitation for geographic atrophy?

Low vision rehabilitation is a type of occupational therapy that can help you learn to use your remaining vision more effectively and maintain independence.

“It won’t treat your geographic atrophy or restore the vision you’ve lost,” says low-vision occupational therapist Christina Duncan, OTR/L. “But you’ll learn to use techniques and devices that can help you function as independently as possible.”

In low vision rehab, you’ll learn to adapt tasks and make changes to environments to make everyday life easier. This often means learning to use assistive devices and other tools that help compensate for central vision loss.

“Our goal is to help you use your remaining vision to adapt to your environment,” Duncan says. “We want you to be able to maintain independence and continue to do the things you enjoy.”

What happens in low vision rehab for GA?

Your low-vision occupational therapist will develop personalized therapy focused on your daily activities and vision needs. And if your needs change as your disease progresses, your personalized therapy plan will evolve, too.

“We’re trained to evaluate the things you’re having trouble doing and figure out how you can do them with the vision you have left,” Duncan says.

That means there’s no one-size-fits-all version of low vision rehabilitation. But you may learn to address challenges like:

• Reading and writing
• Using technology, like your phone, computer and appliances
• Performing everyday tasks, like preparing meals and paying bills
• Navigating your environment (both at home and beyond)
• Enjoying leisure activities and hobbies

Here’s a look at what you may learn to do at low vision rehab.

Adjust lighting

When you have GA, lighting can make the difference between seeing something and struggling with it. So, your low-vision occupational therapist will likely talk to you about how to use different types of light and contrasting colors to make things easier to see.

“For example, we often discuss adding task lighting to reading places and increasing contrast of items to make them easier to see — like using white cups on a black countertop,” Duncan illustrates.

Stay organized

When you’re living with vision loss, staying organized at home can help you maintain your independence on a day-to-day basis. Your occupational therapist can recommend organizational techniques that can help.

“We talk about, for example, placing frequently used items in a specific area so you always know where they are,” Duncan says. Your therapist can also recommend:

• High-contrast or textured labeling systems that are easier for you to read
• Decluttering suggestions that will help reduce your risk of falling
• “Home hacks” for organizing your pantry, fridge, drawers and more so you can easily find what you need

Make the most of low-vision aids

A variety of low-vision aids for geographic atrophy can help you better navigate the world around you.

• Smartphone apps can help you identify objects and navigate spaces.
• Specialized low-vision aids, like magnifiers, telescopic devices and prismatic glasses, help make fonts and objects easier to see.
• Electronic and digital aids take things a step further. Closed-circuit TV devices project text onto a monitor or TV, and smart home devices perform various tasks.

“It’s not just about introducing new tools or equipment either,” Duncan notes. “We also talk about tools you may already have and how to look at them in a new light — like using your cell phone camera or a magnifier application to help with quick reading.”

Customize your smartphone settings

When you’re struggling to read your texts or see photos of your grandkids, adjusting your smartphone’s accessibility options can help. Your low-vision therapist can help you learn to adjust your setting to provide:

• Larger fonts
• Higher contrast
• Audio descriptions

Discuss driving and transportation

“Driving — or the inability to do so — is one of the biggest challenges people with GA face, and it can really affect your sense of independence,” Duncan acknowledges.

In the early stages of macular degeneration, you may still be able to drive under certain circumstances. But you may need a driving evaluation from a certified driving rehabilitation specialist. And eventually, as your geographic atrophy progresses, you won’t be able to drive anymore.

“In low-vision occupational therapy, we’ll help you navigate alternative transportation options,” Duncan reassures. “We can also help you figure out how to manage those logistics when driving is no longer an option.”

Learn about visual strategies

In low vision rehab, you may learn specific techniques to help you maximize your remaining vision.

For example, a technique called steady eye strategy (SES) can help make reading easier. You’ll learn to keep your eyes fixed in one location while moving the text in front of the parts of your eyes with the clearest vision.

Another technique, eccentric viewing, teaches you to look slightly away from the person or thing you actually want to see. This allows you to see with the undamaged parts of your eye.

But there’s not enough research to say whether eccentric viewing is beneficial to people with vision loss from geographic atrophy. Though some people find it helpful, studies suggest it may not be worthwhile for macular disease that continues to progress.

When to ask your doctor about low vision rehab

You don’t have to wait until you’re seriously struggling to start low vision rehabilitation for geographic atrophy — and in fact, you shouldn’t. You can seek a referral whenever your visual function starts to affect your everyday life.

Your healthcare provider may suggest low vision rehab if you:

• Have blind spots in the center of your vision
• Struggle with work, hobbies or self-care routines
• Are ineligible to drive because of low vision
• Have significant trouble with reading, even with vision correction
• Avoid certain activities because they’re too hard to do or because you’re no longer confident in your abilities

The sooner you can start low vision rehab, the better. Duncan says: “The earlier you’re referred to us, the earlier you can learn helpful strategies — before your vision loss becomes severe.”

So, if your healthcare provider doesn’t bring up the possibility of low vision rehabilitation, don’t hesitate to ask if it’s an option for you.

“As low-vision occupational therapists, we want you to be able to keep doing the things that you enjoy,” Duncan reiterates. “And we’re here to help you learn different ways of doing them.”