Vision loss , whether gradual or sudden, profoundly disrupts the daily lives of patients affected by it. These visual disorders are often irreversible despite the best medical care. They do not lead to total blindness (most of the time) but cause a major impairment of functional abilities. Reading, moving, recognizing faces or even perceiving one's environment become painful, sometimes impossible.

 

Faced with these limitations, ocular rehabilitation is essential as a functional therapeutic response. Far from being a palliative method, it allows patients to develop alternative visual strategies, reorganize their residual abilities, and regain satisfactory autonomy.

 

Understanding Low Vision

 

Low vision refers to a severe visual impairment that cannot be corrected by conventional corrective lenses, medical treatments, or surgical procedures. It is defined by the WHO as visual acuity less than 3/10 in the better eye with correction or a visual field restriction of less than 20°, significantly impairing the patient's independence.

 

In France, approximately 2 million people are affected by a vision disorder ⁽¹⁾. These are mainly elderly people, but also younger people with hereditary retinal pathologies. Among the most common etiologies are:

 

  • Age-related macular degeneration ( AMD );
  • Pigmentary retinopathies (such as Stargardt disease);
  • Optic neuropathies (Leber, compressive, toxic);
  • Advanced glaucoma;
  • Proliferative diabetic retinopathy.

 

Each pathology causes specific visual impairments . For example, AMD induces a central scotoma (a black spot in the central part of the field of vision), while glaucoma (a chronic eye disease due to damage to the optic nerve) causes peripheral impairment of the visual field. Hereditary pathologies, on the other hand, can cause diffuse or progressive deficits.

 

Patients suffer from reading difficulties, spatial disorientation, and social withdrawal which contributes to anxiety-depressive disorders.

 

From this observation, doctors will favor a functional approach, centered on the enhancement of residual vision .

 

Foundations of ocular rehabilitation

 

Ocular rehabilitation is based on a fundamental principle: the brain's ability to adapt to sensory deficiencies through cerebral plasticity (the brain's ability to remodel itself). In other words, when part of the retina is damaged, the patient can learn to use another functional area. In particular, the patient will use the retinal area.

 

Through repeated exercises, this area can be trained to allow partial recovery of certain visual functions, particularly reading.

 

In this context, rehabilitation aims to improve fixation stability, saccade precision, visual scanning fluidity and hand-eye coordination.

 

The role of orthoptists is central here, with protocols adapted according to the patient's functional profile. For example, in cases of glaucoma or concentric narrowing of the visual field, the work will focus more on spatial exploration, reorganization of the field of perception, and obstacle anticipation. In addition, visual stimulation can also include technology-assisted techniques. Augmented or virtual reality, in particular, allows for the creation of immersive environments to work on locomotion, reading, or object recognition.

 

In all cases, success is based on a detailed initial assessment of the patient's visual and cognitive profile, personalized planning and a strong therapeutic alliance.

 

Therapeutic education of visually impaired patients

 

Patient therapeutic education ( TPE) is an integral part of any ocular rehabilitation approach. It aims to empower the patient to take an active role in their own care, to strengthen their knowledge, and to support them in learning new behaviors. In the context of low vision, TPE is organized around several axes:

 

  • Understand the evolution of your pathology;
  • Identify your remaining visual abilities;
  • Learn how to correctly use prescribed visual aids;
  • Adopt new routines in your environment.

 

The professionals involved (orthoptists, occupational therapists, locomotion instructors, specialized psychologists) provide structured monitoring, within the framework of programs validated by the High Authority of Health . The patient learns, for example, to:

 

  • Choose the lighting best suited to your activities;
  • Organize your living space to maximize contrasts and minimize the risk of falling;
  • Smoothly operate an electronic magnifier or magnification software;
  • Visual memory training;
  • Eye strain management;
  • Learning safe gestures in the kitchen or when traveling in town.

 

This work sometimes extends to caregivers . They also benefit from support to better understand the needs of the visually impaired person. The goal for them will be to promote autonomy without over-assisting, and to maintain positive communication.

 

Specialized rehabilitation structures in France

 

Low vision rehabilitation facilities are located throughout France. Some hospital units , such as the low vision department at the CHNO des Quinze-Vingts in Paris or the retina unit at the Dijon University Hospital, have a team of specialists (ophthalmologists, orthoptists, occupational therapists, mobility instructors, psychologists, and social workers) capable of handling complex cases.

 

Other centers, such as those of the Valentin Haüy Foundation, offer care more geared toward social and professional reintegration. Patients benefit from practical workshops, training in visual aids, indoor and outdoor mobility sessions, and support groups.

 

Support is often partially financed by health insurance , supplementary health insurance or Departmental Houses for Disabled People (MDPH).

 

Finally, new digital solutions, some of which integrate augmented reality or artificial intelligence, now make it possible to carry out some of the exercises at home, via tablet or mixed reality headset, making rehabilitation more accessible.

 

Clinical results and benefits demonstrated by research

 

Numerous scientific publications have validated the effectiveness of visual rehabilitation programs, particularly in the elderly population with AMD. They have demonstrated a significant improvement in quality of life in patients who followed a structured program, compared to follow-up without functional intervention.

 

The use of technological aids, such as augmented reality electronic glasses , also helps to amplify certain effects, particularly on facial recognition and indoor navigation. Finally, patients report a subjective improvement in their confidence, their security and a reduction in the need for assistance in their movements (including in unfamiliar environments). These results, combined with clinical observations, confirm the legitimacy and effectiveness of ocular rehabilitation as a therapeutic tool.

 

From this observation, we can affirm that ocular rehabilitation is a rapidly expanding discipline, supported by advances in neuroscience , technological innovations and the growing demands of patients for autonomy. It represents a concrete response, based on solid scientific foundations, to the functional challenges posed by low vision. For ophthalmology professionals, it is not only a therapeutic lever , but also a vector of interdisciplinary cooperation between medicine, optics and health technologies. The active involvement of the prescriber in identifying needs, coordinating with rehabilitation structures and evaluating results is essential to guarantee a coherent and effective care pathway.

 

⁽¹⁾ Source: Blind people of France