Certified Low Vision Therapist (CLVT) Handbook, Section 2 - Scope of Practice for Low Vision Therapists

The Certified Low Vision Therapist (CLVT) completes a functional low vision evaluation that identifies visual impairments related to:

• Performance of developmentally appropriate activities of daily living including dressing appropriately, personal health care and grooming, safe movement, care of orthotic, prosthetic and other health care devices.
• Performance of instrumental activities of daily living including care of self and family, effective literacy and communication, health management, home management, meal preparation, safety awareness training, and shopping.
• Performance of educational pursuits including life-long learning.
• Performance of vocational pursuits including job, retirement and volunteerism.
• Performance of leisure and social activities.
• Access and participation in community programs/events.
• Coping ability of the person with low vision.
• Impact of the vision disability on significant others.

The CLVT uses functional vision evaluation instruments to assess visual acuity, visual fields, contrast sensitivity function, color vision, stereopsis, visual perceptual and visual motor functioning, literacy skills in reading and writing, etc. as they relate to vision impairment and disability. The CLVT also evaluates work history, educational performance, ADL and IADL performance, use of technology, quality of life and aspects of psychosocial and cognitive function.

The CLVT shall work as part of an interdisciplinary team with an ophthalmologist (s) and/or optometrist(s) who manages ocular health, provides the clinical low vision examination, prescribes optical devices and approves treatment plans. The CLVT collaborates with these doctors who prescribe optical solutions such as spectacle and/or contact lens corrections, magnifying devices such as hand-held or stand magnifiers, telescopes, spectacle-mounted magnification devices, and field enhancing devices such as prisms, reversed telescopes, etc. In addition, the CLVT also collaborates with other team members who may include vision rehabilitation specialists, orientation & mobility specialists, rehabilitation counselors, educators, speech pathologists, occupational therapists, physical therapists, psychologists, social workers, nurses, orthoptists, opticians, other physicians, technologists, technicians, etc.

The CLVT trains the use of specific visual motor skills such as the identification and use of preferred retinal locus for fixation, accurate saccades, smooth pursuits, etc. The CLVT trains the use of vision in both static and dynamic viewing conditions. The CLVT trains the use of visual perceptual and visual motor skills in relation to overall perceptual and motor skills and coordination and the use of specific visual perceptual skills such as visual closure, part-to-whole relationships, figure-ground, etc. The CLVT trains the appropriate and safe use of low vision devices including component skills such as establishing and maintaining focal distance, compensation for reduced field of view and/or depth of focus, development of necessary manual and ocular dexterity and implementation of appropriate ergonomic strategies for effective and efficient positioning and elimination of fatigue. The CLVT provides instruction in the use of adaptive equipment that enhance visual function and/or compensate for loss of vision through tactual and/or auditory means: This can include use of large print, reading stands, lamps and other illumination control, writing implements, software, electronic devices, etc. The CLVT also provides and trains the use of appropriate environmental modifications such as positioning, organization, illumination control, marking, etc.: trains in the use of environmental cues such as signage, shadow, contrast, form, pattern, and use of non-visual techniques for safe and effective management of the environment such as audio or tactile markings, etc.??The CLVT provides instruction in efficient functioning to manage energy and to organize space and objects to enable goal achievement. The CLVT imparts knowledge of local, regional and national resources, trains consumerism, and teaches strategies for adaptation and coping with the stress of vision changes.

The CLVT works with the family and others significant to the rehabilitation/education process to assist them in understanding the functional implications of vision changes, how the person with low vision is expected to progress through habilitation/rehabilitation, environmental modifications that will be helpful for enhanced function, coaching for home/work/school/leisure exercises and adaptation to change when feasible.

Typically, CLVTs work with individuals whose vision has been affected by conditions such as macular degeneration, diabetic retinopathy, glaucoma, cataract, albinism, retinitis pigmentosa, brain injury, syndromes that include vision loss, and other causes of vision impairment. Visual conditions addressed by the CLVT include reduced visual acuity, impaired contrast sensitivity function, impaired central and/or peripheral vision, eye movement dysfunction, loss of depth perception, loss of color vision and combinations of these.

The CLVT makes appropriate referrals to other disciplines such as orientation and mobility specialists for advanced orientation and safe movement techniques, vision rehabilitation specialists for advanced non-visual techniques and in-depth ADL and IADL instruction, counseling professionals for adjustment disorders, physical medicine and rehabilitation professionals such as occupational therapists and physical therapists, hearing professionals such as audiologists and speech pathologists, and other health care professionals whenever important for the safety, health and independent functioning of the person with low vision.

The CLVT must be conversant in the language related to low vision and blindness and be able to communicate a client's or student's status and needs with the client or student and family members, and as well as professionals in the fields of ophthalmology, optometry, vision rehabilitation therapy, orientation and mobility, pediatrics, geriatrics, physical therapy, occupational therapy, speech therapy, audiology, psychology, social work, education, and industry.