Low Vision Rehabilitation for Occupational Therapists

The World Health Organization estimates that there are 2.2 billion people around the globe that live with visual impairments. Furthermore, low vision is one of the 10 leading causes of disability for people living in the United States. With the graying of one of the largest living generations, the Baby Boomers, the Center for Disease Control and Prevention (CDC) estimates that by year 2050, vision impairment and blindness could increase by as much as 150%.   

Recommended course: An Introduction to Low Vision Rehabilitation for Occupational Therapists 

Quality of vision, visual acuity, visual stability, and visual field functions are noted as body functions within the scope of occupational therapy per the American Occupational Therapy Association’s (AOTA) Occupational Therapy Practice Framework, Fourth Edition. Due to the fact that vision plays a multi-faceted role in completing everyday activities and occupations, occupational therapy practitioners play a significant role in the interprofessional team for individuals with low vision.   

Defining low vision 

Low vision describes a type of vision loss that glasses, medicine, or surgery cannot correct. The American Academy of Ophthalmology and the American Optometric Association state that low vision includes vision loss that cannot be corrected and interferes with activities. Acuity is worse than 20/40. The patient also has visual field loss, which is when a person has lost an area of vision in their visual field, in one or both eyes.  

Although age-related changes to sight are closely associated with visual impairments, low vision can occur to individuals across the lifespan. For instance, cortical visual impairment (CVI) is a vision problem that is caused by a brain disorder. It has nothing to do with poor eye function and is common in premature or babies that have low birth weight. On the other end of the lifespan, about 15% of Americans over the age of 65 are affected daily by vision loss.  

Occupational therapy and visual functioning 

In alignment with ongoing interdisciplinary research, the AOTA has promoted the distinct value of occupational therapy within chronic care management such as low vision since 2014 (Arbesman et al., 2014). 

Occupational therapy practitioners have generalist knowledge about visual functioning and impairments, as well as can pursue advanced/specialty training. During entry-level education, occupational therapy students learn about eye anatomy and general eye functioning as well as various age-related eye diseases such as macular degeneration, diabetic retinopathy, glaucoma, and cataracts.  

These conditions are the leading causes of low vision and blindness in the United States. They can have progressive impact on occupational performance in activities of daily living (ADL) and instrumental activities of daily living (IADL). Visual problems can also result due to central nervous system disorders such as stroke, brain injury, Parkinson’s Disease or Multiple Sclerosis. 

Testing and interventions 

Occupational therapy generalist practitioners are trained to perform basic oculomotor and vision-perception testing across the lifespan. This training allows them to design and implement interventions to remediate or compensate for basic visual problems.  

Generalist interventions might include: 

  • Environmental modifications (including organization of living spaces and minimizing/removing fall hazards) 
  • Adaptations and encouraging use of other senses (such as putting tactile markers on knobs/handles to serve as a tactile cue) 
  • Enlarging objects (such as communicating with the patient’s pharmacist to use large print on medication bottles)  
  • Training on basic mainstream technology such as recommending adjustments to display size, text size, zoom features and more with handheld devices such as phones, tablets, etc. 

Specializations for OT practitioners 

The generalist OT practitioner has multiple opportunities to acquire specialty knowledge and skills beyond the initial academic training. However, they must be able to recognize when the needs of the patient are outside their knowledge base. In such cases, they should refer to a specialist practitioner.  

Occupational therapy practitioners can pursue additional training in low vision such as a Specialty Certification in Low Vision (SCLV), which is a voluntary certification provided by AOTA or a Certified Low Vision Therapist (CLVT), a certification provided by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP).   

A CLVT provides the practitioner training in higher-level skills to evaluate, remediate and/or adapt situations for individuals with low vision. These include low vision evaluation and eccentric viewing techniques. Such techniques may involve retinal location and fixation to maximize remaining vision. This will also give the practitioner a deeper knowledge basis for a braille instruction referral.   

Practitioners with in-depth knowledge and training in low vision can also recommend and train patients in specialized technology such as illumination and lighting with different wattages and bulbs and specialized optical and electronic devices which might include spectacle-mounted telescopes, stand magnifiers, high-add reading glasses, electronic video magnifiers, lamp magnifiers, and monocular telescopes. 

Interprofessional collaboration 

Understanding roles and responsibilities is the key to promoting interprofessional education and collaborative practice. In their systematic review, Liu and Chang (2019) wrote that the inclusion of occupational therapy as part of the interprofessional team has been proven to effectively promote independence in older adults with low vision.  

Other providers that an occupational therapy specialist might interact with on the low vision rehabilitation team include: 

  • Certified Vision Rehabilitation therapists (CVRT) are professionals who instruct individuals with visual impairments in the use of compensatory and communication skills, adaptive independent living skills, leisure activities, mobility, educational and vocational opportunities, and utilization of assisted technology (computers and other electronic devices). This enables people with vision loss and blindness to live safe, productive, and independent lives. CVRT’s are also skilled in teaching braille.   
  • A Certified Orientation and Mobility Therapist (COMS) is a professional skilled in sequential instruction to individuals with visual impairments in the use of their remaining senses within the environment for safe movement and travel. This includes systematic training in safe and independent mobility. These trainings may include use of a long white cane, trailing, and using traffic-controlled devices.   
  • Opticians are professionals who may or may not require licensure to practice depending on their location. They are trained to fit individuals for eyeglasses and contact lens following prescription from an ophthalmologist or optometrist. 
  • Ophthalmologists are medical doctors who are trained to evaluate, perform medical and surgical treatments and to prescribe for all eye disorders.  
  • Optometrists are trained to examine, diagnosis and treat problems with the eyes.  


Due to their client-centered approach, holistic view and emphasis on quality of life, occupational therapy practitioners play an important role across the lifespan for individuals with low vision. However, occupational therapy practitioners are ethically responsible to be knowledgeable about their State Practice Act and scope of practice parameters which permit if they are able to receive referrals directly from eye professionals. 


  • Arbesman, M., Lieberman, D., & Melzter, C.A. (2014). Using evidence to promote the distinct value of occupational therapy. American Journal of Occupational Therapy, 68(4), 381-385.  https://doi.org/10.5014/ajot.2014.684002 
  • Kaldenberg, J. & Smallfield, S., (2020). Occupational therapy practice guidelines for older adults with low vision. American Journal of Occupational Therapy, 74(2), 7402397010p1–7402397010p23.  https://doi.org/10.5014/ajot.2020.742003 
  • Liu, C. J. & Chang, M. C. (2020). Interventions within the scope of occupational therapy practice to improve performance of daily activities for older adults with low vision. A systematic review. American Journal of Occupational Therapy, 74(1), 7401185010p1–7401185010p18. https://doi.org/10.5014/ajot.2020.038372 
  • Smallfield, S. & Kaldenberg, J. (2020a) Occupational therapy interventions for older adults with low vision. American Journal of Occupational Therapy, 74(2), 7402390010p1–7402390010p5.  https://doi.org/10.5014/ajot.2020.742004 
  • Smallfield, S. & Kaldenberg, J. (2020b). Occupational therapy interventions to improve reading performance of older adults with low vision: A systematic review. American Journal of Occupational Therapy, 74(1), 7401185030p1-7401185030p18. https://doi.org/10.5014/ajot.2020.038380