How a Functional Vision Assessment Can Help You Maintain Independence
When vision changes, everyday activities that once felt routine—reading mail, preparing meals, managing medications, using a smartphone, or navigating your home—can become more difficult.
But experiencing low vision does not necessarily mean giving up the activities that matter to you.
A functional vision assessment can help identify how a person is using their remaining vision and determine tools, strategies, and adaptations that may make everyday tasks easier and safer.
At The Lighthouse for the Blind, Inc., Dr. Jennifer Crown, an optometrist specializing in low vision, works with patients to understand their individual vision challenges and, most importantly, what they want to continue doing independently.
What Is a Functional Vision Assessment?
Most people are familiar with a standard eye exam. An optometrist or ophthalmologist evaluates the health of the eyes, measures visual acuity, and may prescribe glasses or contact lenses or provide treatment for an eye condition.
A functional vision assessment has a different purpose.
“The assumption is that they have some deficit, some loss of vision that’s causing a problem in their life,” Dr. Crown explains. “If we can help address that by utilizing their remaining vision to be able to meet their goals, that would be what we would look at during the functional vision exam.”
In other words, the question isn’t simply “How well can you see?”
It’s also “What do you want or need to be able to do?”
That distinction can make a significant difference for someone living with low vision.
Looking Beyond the Eye Chart
Visual acuity is only one part of how someone experiences vision.
For example, a person may also experience decreased contrast sensitivity, making it difficult to distinguish an object from its background. This can affect something as important as identifying the edge of a curb or seeing stairs, particularly in dim lighting.
Glare, lighting, field of vision, the size of an object, and the amount of contrast can all influence whether someone can successfully complete a task.
That’s why Dr. Crown starts with the individual.
Perhaps someone wants to read a restaurant menu without asking another person for help. Another person might want to read medication labels, identify food in the refrigerator, use a smartphone, manage finances, or continue a favorite hobby.
A functional vision assessment looks at those real-world goals and explores ways to make them possible.
Simple Changes Can Make a Big Difference
Not every low vision solution involves sophisticated technology.
Sometimes relatively simple environmental changes can improve safety and make everyday tasks easier.
Dr. Crown recommends strategies such as keeping walking paths clear, creating designated places for frequently used items, adjusting blinds to reduce glare, increasing lighting, and adding targeted task lighting in areas where someone reads, cooks, or works.
Special filters or glasses may also help improve contrast or reduce glare.
These changes can be particularly useful in the home, where maintaining independence is often one of a person’s biggest priorities.
Low Vision Tools for Everyday Activities
Depending on a person’s vision and goals, a functional vision assessment may also identify assistive devices that could help.
Handheld magnifiers with built-in lighting are one common option. Electronic video magnifiers, sometimes called CCTVs, can enlarge printed material onto a larger screen, making them useful for reading books, newspapers, letters, and other documents.
Smartphones can provide similar functionality on a smaller scale through cameras, magnification, and accessibility features.
Technology has also created new ways for people with low vision to perform everyday tasks using audio, magnification, voice commands, and other accessibility tools.
Online banking, for example, can allow someone to enlarge information on a computer screen rather than trying to read a small handwritten check. Smart speakers can help people create grocery lists, control lights or thermostats, and even make phone calls.
The goal isn’t technology for technology’s sake. It’s finding the tool or strategy that works for the individual.
Supporting Safety and Independence at Home
Functional vision assessments can also uncover areas where adaptations may improve safety.
Moving through the home without tripping or bumping into objects is one consideration. Others include safely preparing food, using knives or tools, taking the correct medication at the correct time, and being able to call for assistance in an emergency.
For people who want to continue hobbies such as woodworking, adaptations may even make it possible to safely continue activities involving tools and equipment.
Understanding exactly how someone’s vision is changing can also build confidence.
Rather than simply knowing that something has become difficult to see, a person may learn whether the challenge involves central vision, peripheral vision, contrast, glare, or another aspect of functional vision.
With that understanding can come practical strategies: changing contrast, increasing magnification, adjusting lighting, or learning how to look around an area of reduced vision.
You Don’t Have to Wait Until Vision Loss Becomes Severe
One misconception Dr. Crown frequently encounters is that someone needs to have significant vision loss before visiting a low vision clinic.
That’s not the case.
If vision is preventing you from doing something you want or need to do, a functional vision assessment may be helpful.
In fact, learning to use adaptive tools and strategies earlier can sometimes make the transition easier, particularly for someone with a progressive eye condition.
The objective is to help people remain as independent as possible for as long as possible.
A Small Tool Can Restore an Important Piece of Independence
Dr. Crown recalls working with a woman living in an assisted living community who attended the dining room for her meals.
Staff members were happy to read the menu aloud to her—but she wanted to read it herself.
During her assessment, she brought the actual menu with her. Dr. Crown was able to test different magnification levels and find a handheld magnifier with built-in lighting that allowed her to read the menu independently at the dining table.
It may sound like a small thing.
But independence is often found in exactly these kinds of everyday moments.
Dr. Crown says reading is one of the abilities people are frequently surprised to discover they may be able to continue with the right tools. That could mean reading a menu, a Christmas card, a piece of mail, or information on a medication bottle.
Low Vision Services at the Lighthouse
A functional vision assessment can also be a starting point for additional services.
At The Lighthouse for the Blind, Inc., occupational therapists can help people learn how to use low vision devices and adaptive strategies for specific everyday activities.
An occupational therapist may also conduct an assessment in someone’s home, evaluating lighting, potential fall risks, and other environmental factors that could affect independence and safety.
For people experiencing difficulty navigating because of vision loss, orientation and mobility training may also be recommended.
Together, these services can provide practical strategies tailored to the person’s goals, environment, and vision.
Helping a Loved One With Low Vision
Family members can play an important role, too.
It can be tempting to immediately step in when a loved one begins having difficulty seeing. But Dr. Crown encourages families to allow people to continue doing as much as they can independently.
Family members can attend a low vision assessment, learn how recommended devices are used, and understand which adaptations may be helpful.
Then, as Dr. Crown puts it, they can try to “step back and help when asked” while remaining available when assistance really is needed.
Adapting to Vision Loss Is Possible
For someone who has recently experienced vision loss, adjusting can feel overwhelming.
There may be new tools to learn, new ways of completing familiar tasks, and changes that take time to get used to.
But there are resources available.
“There’s a lot of help out there,” Dr. Crown says. “You have to learn how to do things in a new way and adapt, but it’s possible.”
If you or someone you know is having difficulty completing everyday activities because of vision, you don’t have to wait until those challenges become severe.
A functional vision assessment can help identify what is happening, what strategies may help, and what tools or services could make it easier to continue doing the things that matter to you.
The Lighthouse for the Blind, Inc. Low Vision Clinic is here to help people with low vision explore practical ways to maintain independence, safety, and confidence in everyday life.
VIDEO TRANSCRIPT
Dr. Jennifer Crown — Low Vision Functional Vision Assessment Interview
Adrienne: We are here today with The Lighthouse for the Blind, Inc. doctor, Dr. Jennifer Crown, our in-house expert for low vision. Hello!
Dr. Jennifer Crown: Hi, Adrienne.
Adrienne: Jennifer, could you please tell us your background and what inspired you to specialize in low vision care?
Dr. Crown: I am an optometrist, and that’s usually somebody who’s looking at the ocular health of the eye and prescribing glasses and contacts. I did that for a number of years.
While I was doing that, I was volunteering at a nonprofit out in Yakima to keep up my low vision skills. Recently, I joined the team here at the Lighthouse to specialize in low vision. I’m here three days a week and happy to join the team.
Adrienne: What attracted you to the Lighthouse? Was there something specific about serving our community that was of interest?
Dr. Crown: The Lighthouse is the only nonprofit low vision clinic in King County and the greater Seattle area. I am attracted to nonprofit work, having done that for many years out in Yakima, and it’s a very necessary and needed service in all parts of the state.
Adrienne: Many people are familiar with a standard eye exam, but not a functional vision assessment. Can you explain the difference and why a functional vision assessment is so important to people with low vision?
Dr. Crown: The standard eye exam will cover the health of the eye, glasses, contacts, and trying to treat diseases. For people who have low vision, they have a team who is working on that.
Here at the Lighthouse, with the functional vision exam, we look at utilizing the remaining vision. The assumption is that they have some deficit, some loss of vision that’s causing a problem in their life. If we can help address that by utilizing their remaining vision to be able to meet their goals, that would be what we look at during the functional vision exam.
Adrienne: What are some of the most common challenges that functional vision assessments reveal that some patients may not even realize they’re experiencing?
Dr. Crown: I would say most people know if they’re not seeing clearly, which we would call visual acuity. Having decreased visual acuity is something people realize pretty regularly, or it’s easy to recognize.
The thing they may not realize is if their contrast sensitivity is decreased. That’s being able to tell foreground from background, and that can make it really hard to see stairs or see where the edge of the curb is. It can make it hard to see in dim lighting.
In the exam room, when you’re having your vision tested, it’s usually a bright screen with black lettering on a white background, so you may not notice that as much or have it tested.
Adrienne: Why is it important to focus on how someone uses their vision in daily life rather than just measuring visual acuity?
Dr. Crown: There’s a definition for low vision that is a certain visual acuity, but it could be that you’re seeing better than that and still the task that you’re trying to do isn’t possible because the visual acuity isn’t good enough.
We want to know what somebody is trying to accomplish. I’ll say the classic one is coin collectors. They’re trying to read teeny-tiny letters, there’s no contrast to the letters against the background, and usually it’s pretty small, so you can’t even feel the difference with your hands. There’s no feedback. If it’s a shiny coin, there’s all this glare from the coin.
Even if you have really good vision, you may find that it’s hard to see and you need a tool. That’s different than somebody who’s trying to read the letters on a Snellen chart.
Adrienne: Do you come across many coin collectors?
Dr. Crown: They come out during the low vision exams! They might be like, “I’m fine except for this one thing.”
Adrienne: During these assessments, what are some of the most common barriers to independence that you identify?
Dr. Crown: We’re in a tech world, so being able to navigate your smartphone is one. There are Siri and VoiceOver commands that are very helpful, but sometimes you’re trying to tell it something and it’s not understanding what you’re asking for.
Independence is also being able to get around, navigate, and make phone calls if there’s an emergency. Then there’s being able to cook, starting with getting into the refrigerator and identifying the foods you’re trying to take out, slicing, chopping, preparing the food, and then cooking it.
Adrienne: Is medication sometimes an issue, too?
Dr. Crown: Yes. Those labels are really small sometimes, and the numbers on them can be really small. If you’re trying to get your refills and you need the number off of it, we have large-print labels and talking labels for medications as well, which is a really wonderful part of our technology now.
Adrienne: Are there some simple changes people can make in their homes after a functional vision assessment to improve their confidence and safety?
Dr. Crown: Clearing the paths in the home and asking everybody not to leave things in the paths, or to be conscious of the need to keep the paths clear.
On counters, have a designated space for things so that you can go back to it and find it later.
Sometimes it’s controlling the lighting in the house with your blinds so you’re not having too much light come in and creating glare. Or it can be increasing the lighting through different light bulbs, adding lighting, or adding targeted lighting to areas you’re trying to work in.
Adrienne: What are some low-tech solutions that you frequently recommend to help with daily activities?
Dr. Crown: One is what we call filters, or sunglasses. There are indoor filters to increase the contrast. It’s very low-tech—adding a pair of glasses on top of your glasses that would increase the contrast.
Changing the lighting and moving the lighting around the home can also help.
Adrienne: What types of assistive devices or tools do you commonly recommend to help people continue reading, managing finances, or enjoying hobbies?
Dr. Crown: We recommend handheld magnifiers quite a bit. We recommend ones that have lighting in them and have a very good coating on them so they don’t get all scratched up.
We also recommend lighting and changes in your lighting quite a bit.
Adrienne: I’ve seen the really big magnifiers that I think we sell at our Low Vision Store. Are those common for people to get?
Dr. Crown: I think you’re referring to a CCTV, which is a machine that has a camera pointed down at the print material you’re trying to read, and then it projects it onto a big screen.
A miniature version of that is in your phone with your camera. You can take a picture of something and then zoom into it. But the screen is only so big, so you only have so much space to work with when you’re trying to magnify and look at something.
CCTVs have a larger screen, so they’re better for a whole page of a newspaper, a book, or a letter you might receive in the mail. They’re wonderful and very versatile.
If you have the space, because they’re not portable and they’re as big as a desktop computer, they’re wonderful if you can dedicate the space to one.
Adrienne: Are there common misconceptions people have about vision loss that a functional vision assessment helps address?
Dr. Crown: People think that they don’t have bad enough vision to come into our clinic. But if they’re having a problem seeing something that they want to be able to do, please come in. We would love to be able to help you.
Adrienne: So you don’t have to wait until it’s really dramatic. There are smaller steps, tools, and tactics that can be employed well before it becomes critical?
Dr. Crown: Yes. Sometimes it’s a little easier to learn how to use the devices before you’re at a critical stage.
We want to keep you as independent as possible for as long as possible. If it’s a progressive disease, or if it’s not progressive and you’re still having problems, we still want to help you.
Adrienne: One of the main goals is helping people remain in their homes. That’s really a goal of the functional vision assessment, correct?
Dr. Crown: For sure. We use our eyes a lot in our lives. To be able to continue managing your finances and moving around your house safely—the things that you need to be able to be independent—so many of those things involve your vision.
If we can help you continue doing them, then that’s our goal.
Adrienne: What safety concerns do you evaluate when assessing how someone functions within their home environment?
Dr. Crown: Moving around without tripping over something or bumping into things.
Also, anything with knives or sharp blades. Some people continue to do hobbies like woodworking that involve sharp blades, and with some adaptations, there are ways to do that safely.
Medication management is another one—making sure you’re taking the right pills at the right time. Even being able to tell time in that case could be considered a safety issue, as well as being able to call for help if something does happen.
Adrienne: How can technology and adaptive strategies help people continue performing household tasks independently?
Dr. Crown: There are so many ways to do things now. You used to have to write a check, but now you can bank online. If you can access that, instead of writing a check that’s only so big, you can blow the whole screen up to the size of your computer monitor.
That’s been really helpful with electronic technologies.
Adrienne: There are so many different apps nowadays, too—wayfinding and the ability to do things with audio. Smart speakers, for example.
Dr. Crown: Yes. With smart speakers, you can turn things on and off, check on things, control the temperature in your house, and make emergency phone calls through them.
Adrienne: What role does confidence play in maintaining independence, and how does understanding someone’s functional vision help build that confidence?
Dr. Crown: I’ll have patients come in and they’ll say, “I just can’t see.” We’ll break that down. Is it your side vision? Is it your center vision? Is it kind of patchy?
Sometimes it’s helpful to do a little training on looking around your blind spots. People learn how to do that subconsciously, but bringing it to the conscious level means you can think, “Hey, I’m not seeing this well.”
Instead of just getting frustrated and not being able to do it, you have some techniques for trying to look around it, changing the contrast, or magnifying so that you can continue to work on those things at home independently.
We also always encourage people, if you find something specific that wasn’t addressed before, but now something has changed or there’s a new task you need to be able to do, to come back.
We can address that particular piece of paper you’re trying to read or the task you’re trying to do.
Adrienne: What advice would you give family members who want to support a loved one with low vision while still encouraging their independence?
Dr. Crown: It’s hard. You want to step in and do everything, but you can’t—and you shouldn’t.
You should let the person do everything that they can. I would advise family members to come to the low vision exam and see the devices, see how they’re being used, and how they should be used.
Then try to step back and help when asked, while also being a caring, supportive person who’s willing and able to help when it is needed.
Adrienne: Once someone has finished a functional vision assessment at the Lighthouse, what types of Lighthouse services might you recommend?
Dr. Crown: We have occupational therapists who can train people on the devices. Especially if they have the actual piece of paper or whatever it is they’re trying to work with, they can actually go through the motions and work out any kinks that might come up.
We have an occupational therapist who can come to your home and do an assessment of the lighting, fall risks, and anything around the home that might make you more prone to falling, as well as provide training at the house.
That’s definitely recommended as a follow-up—to do an occupational therapy session.
We also have orientation and mobility training at the Lighthouse. We don’t always recommend that, but for people who are having trouble getting around because of their vision, we can refer them for that as well.
Adrienne: Do you have an example of a functional vision assessment where you identified a challenge and were able to help someone?
Dr. Crown: I had a patient who was living in assisted living. She wasn’t making her own meals anymore, partially because she was more elderly and partially because she couldn’t see, but she did go to the dining room for her meals.
She wanted to be able to see her menu instead of having somebody read it out loud to her. The people who worked there were very happy to read it to her, but she wanted to be able to read it herself.
Simple as that. That was what she needed for her independence.
We were able to use a handheld magnifier that had a light inside of it so she could use it at the dining table, where there isn’t a lamp reaching over her shoulder.
She brought her menu in with her, so we could test it right there and find the magnifier that would work for her.
Adrienne: What abilities are people often surprised they can continue doing after receiving the appropriate tools, training, and support?
Dr. Crown: Number one is reading.
They may have said, “I’ll never see these Christmas cards again. I’ll never be able to read my menu again. Somebody has to read it to me.”
We’ll say, “Let’s see what we can do.” Then they’ll say, “Oh, hey, I can read it.”
Or, “I’m able to manage my own medications again instead of having to have my spouse take all the pills and put them in a pill planner. I don’t have to have them do that anymore.”
Adrienne: If someone has recently experienced vision loss or low vision and is worried about losing their independence, what would you want them to know?
Dr. Crown: There’s a lot of help out there. It can be overwhelming at first, but there are a lot of people who want to help.
It will be different. You have to learn how to do things in a new way and adapt, but it’s possible.
Adrienne: How can someone determine whether they or a loved one might benefit from a functional vision assessment?
Dr. Crown: My opinion is almost everybody could benefit if they’re feeling like there are things they can’t do because of their vision.
Maybe call us here at the clinic and ask, because we’re happy to talk it over with family members.
There are probably quite a few people out there who are not receiving services. If you think somebody might stand to benefit, I would give us a call.
We’re here. We’re happy to help, and it’s definitely not a service that is overutilized.
Adrienne: Thank you. This has been really helpful.
Dr. Crown: Thank you.
