Low Vision Rehab Referrals Miss Patients With Visual Field Loss

March 2, 2026 – A new study highlights a potential gap in care for individuals with glaucoma and other conditions leading to low vision: referrals for low vision rehabilitation (LVR) appear to be significantly lower among those whose vision loss is primarily due to visual field defects, rather than reduced visual acuity. The findings, published in Life, suggest that clinicians may be overlooking eligible patients, potentially delaying access to services that could improve quality of life.

The study, led by David J. Ramsey, MD, PhD, MPH, of Lahey Hospital & Medical Center in Massachusetts, analyzed data from 522 patients with severe open-angle glaucoma treated between March 2021 and February 2022. Researchers found that whereas 88.1% of patients were classified as having low vision, only 2.7% were referred for LVR evaluation. A key finding was that low vision status defined by visual acuity significantly increased the odds of referral (P < .001), but visual field loss did not have a significant impact. In fact, 85% of patients with visual field-defined low vision were not referred for evaluation.

Understanding Low Vision and Rehabilitation

Low vision isn’t simply about blurry vision; it encompasses a range of visual impairments that cannot be fully corrected with glasses, contact lenses, or surgery. It can stem from various conditions, including glaucoma, macular degeneration, diabetic retinopathy, and stroke. Visual acuity refers to the sharpness of vision – how well someone can see details at a distance. Visual field, describes the entire area a person can see when looking straight ahead. Loss of visual field can result in blind spots or tunnel vision.

Low vision rehabilitation aims to maximize remaining vision and teach individuals strategies to cope with visual impairment. Services can include assistive devices (magnifiers, telescopes), training in eccentric viewing (using remaining vision), and environmental modifications. As David J. Ramsey, MD, PhD, MPH, explained to Healio, the goal is to address the “enormous psychosocial and economic burden imposed by glaucoma” and similar conditions.

Study Details and Limitations

The study at Lahey Hospital & Medical Center involved a retrospective review of patient records. Researchers categorized patients based on best-corrected visual acuity (BCVA) and visual field testing. Referral rates for LVR were then analyzed in relation to these measures. The study found that of the 13 patients who completed their LVR visits, 38% experienced an improvement in BCVA in their better-seeing eye, averaging a –0.18 ± 0.24 logMAR improvement. This suggests that even with advanced vision loss, rehabilitation can yield measurable benefits.

It’s important to note the study’s limitations. The sample was drawn from a single institution, which may not be representative of all populations. The retrospective design means that referral decisions were made independently of the study, potentially introducing bias. The study did not explore the reasons behind the lower referral rates for patients with visual field loss – whether it’s due to clinician awareness, patient preferences, or other factors. The study, originally published in Life, acknowledges these limitations.

Implications for Clinical Practice

The findings underscore the need for clinicians to consider both visual acuity and visual field loss when assessing patients for LVR. Current referral practices may be inadvertently prioritizing patients with clearer vision loss while overlooking those whose peripheral vision is compromised. This is particularly concerning given that visual field defects can significantly impact daily activities like navigating spaces, reading, and driving.

Ramsey suggests that improved clinical decision support tools, potentially leveraging artificial intelligence, could help facilitate referrals. These tools could flag patients who meet specific criteria for LVR, prompting clinicians to consider a referral. He also emphasizes the importance of raising awareness among both healthcare professionals and patients about the benefits of low vision rehabilitation.

The Broader Context of Low Vision Care

The underutilization of LVR services is a recognized problem in the United States. Despite evidence supporting its effectiveness and growing availability, many eligible individuals do not receive these services. This is partly due to a lack of awareness among both patients and clinicians, as well as logistical barriers such as cost and access to specialized care. The Supreme Court of Georgia recently issued an email scam alert, warning of fraudulent emails claiming to be from the court, which highlights the need for vigilance and verification of information, even within healthcare settings.

Efforts are underway to address these challenges. Organizations like the American Academy of Ophthalmology and the American Optometric Association are promoting awareness of LVR and developing resources for clinicians. Research is also ongoing to identify effective strategies for improving access to care. The National Eye Institute supports research into new treatments and rehabilitation techniques for low vision.

What Comes Next

Ramsey and colleagues plan to conduct further research to explore the barriers to LVR and identify strategies for improving referral rates. This includes directly surveying patients and healthcare professionals to understand their perspectives. They are investigating the potential role of telehealth in delivering LVR services, which could improve access for patients in rural or underserved areas. Ongoing surveillance of LVR utilization rates will be crucial to monitor the impact of these efforts and ensure that all eligible patients have the opportunity to benefit from these valuable services. It’s also important to stay informed about potential scam emails, as highlighted by the Wappinger Town alert, to protect personal information.