An Optometrist Apart: Blending Vision Care With Pediatrics And Education (Photo) -04/04/23
In the world of vision care, it’s common to find eye doctors who know how to treat adults with waning vision. It’s also common to find eye doctors who treat children with slight vision problems. But there are not many who specialize in treating children who experience moderate to severe vision loss.
When asked how many people in the state specialize in the field of pediatric low vision, John Lowery, an optometrist and professor at Pacific University who also heads up the Oregon Lions Statewide Low Vision Clinic, Dr. Lowery can’t come up with any names beyond his own.
“There’s just me,” he says.
He explains that eye doctors who specialize in low vision — meaning vision issues that cannot be corrected with glasses, surgery or medication — are typically treating older adults. They are not accustomed to working with preschoolers, he says. And on the flip side, pediatric optometrists or ophthalmologists do not usually manage the functional aspects of low vision. Their specialty is in helping children by correcting common vision conditions or treating eye disease.
Caption: John Lowery, an optometrist and professor at Pacific University who leads the Oregon Lions Statewide Low Vision Clinic, tests out a preschooler’s field of vision during a recent low vision clinic at Northwest Regional Education Service District. Photos by Tracey Goldner.
But there are an estimated 775 children across the state of Oregon who experience blindness or low vision. Most children are not completely blind, so the goal is to maximize the vision they do have. If their conditions are stable, and they expect to maintain their remaining vision for the rest of their lives, they often don’t learn braille. Rather, they use aids and adaptive techniques to maximize what they can see. Aids such as magnifiers, monocular telescopes, filtered lenses or screen readers can help children with low vision as they attend school along with their sighted peers. Adaptive techniques include learning how to use a cane to travel through life safely and using various types of assistive technology to access the world.
Several times a month, Dr. Lowery travels around the state to meet with these children, assess their vision and recommend aids and techniques to help fully participate in school. The Blind Visually Impaired Student Fund and the Oregon Lions Sight & Hearing Foundation funds his work. Education service districts or school districts typically coordinate the appointments.
Dr. Lowery sets up his mobile eye clinics in student’s homes, in their schools, at other educational buildings or at the Lions building in Portland. Every exam requires several cases of equipment. The optical lenses come in a hard case and enable him to build glasses on the spot to test out how students would see with certain prescriptions. The magnifiers, binoculars and monoculars are stored in a tan suitcase compliments of his great aunt that dates back to 1936. Some of the equipment is his, and some was provided by the Oregon Lions Foundation.
Caption: Rose tests out a glasses prescription while her mom, Chelsea, looks on.
Over his close to three decades doing this work, he comes prepared and always keeps additional equipment in his car. When a 16-year-old with Stargardt disease needed a monocular with higher magnification power, he ran out to his car to get him one.
TJ tests out his new monocular, which will help him navigate crosswalk signs and read other information that is far away. Children and young adults with low vision can see at 20 feet what a sighted person sees at 500, 1,000 or 2,000 feet.
Dr. Lowery estimates he has done more than 3,500 educational-focused eye assessments for students with low vision since 1995. In that time, he has become an expert on the functional aspects of rare eye diseases. He also specializes in cortical impairments, which are brain-based visual impairment. Essentially, a child’s eyes function, but their brain can’t interpret the information that is coming in. Perhaps the most challenging students are those who experience multiple disabilities at once. Children who are nonverbal can’t share what it is they see or can’t see. However, Dr. Lowery uses preferential looking techniques with specialized acuity tests to estimate vision potential for such children who are unable to provide verbal feedback.
On a recent Monday in February, Dr. Lowery evaluated four students at NWRESD’s Washington Service Center in Hillsboro. Just after lunch, an energetic 3-year-old named Rose with a rare genetic eye condition called achromatopsia arrived. Typically sighted people have two types of photoreceptors in their eyes that are involved in differentiating light and color: the rods and cones. The rods are used to see when light is low and work in grayscale. The cones require more light and are responsible for differentiating color.
Rose was born without any cones, so she experiences the world without any color. Without the cones there to moderate the light coming into her eye, she’s also very sensitive to light.
Dr. Lowery explained that when Rose is outside in the bright sun or when she’s under fluorescent lights, what she feels is equivalent to someone without her condition waking up in the middle of the night and suddenly turning on all the lights. It hurts.
In a few years, she’ll be old enough to get red-tinted contacts to cut the glare, he says.
Rose tries on some red-tinted glasses to help alleviate eye pain from trying to see in brightly lit rooms or when she’s outside. She let out a delighted squeal as Dr. Lowery placed the frames over her eyes.
Until then, red-tinted glasses can help her navigate the world and relieve that discomfort. When Dr. Lowery put red-tinted glasses over her eyes, Rose let out a pleased squeal. As Rose pranced around the room, Dr. Lowery adeptly conducted one assessment after another. He used a squishy red dolphin that lit up to track her eye movement.
He pulled out a depth perception test with a fly on it and asked her to point to the wings.
She quickly pointed to wings that appeared to move. The test showed she has some depth perception. Next he showed her a card with mini-shapes and asked her to tell him what she saw. She called out, “apple,” “circle” and “square.” He said he was able to ascertain much more information at this visit. Her last assessment took place at the start of the pandemic, and Rose was just 18 months old. In a few years she’ll be able to better verbalize what it is she sees and what she prefers to use to help her see better.
In the meantime, he seemed pleased with her progress.
During his 60- to 90-minute appointments, Dr. Lowery acts simultaneously as an eye doctor, an educator and a guide to parents and educators who are helping children navigate their vision loss. As his appointment with Rose came to a close, he switched out of doctor mode and shared a story with Rose’s mom, Chelsea. About 20 years ago, a woman named Rachael Scdoris who also has achromatopsia completed the Iditarod Trail Sled Dog Race in Alaska with the help of a visual guide and interpreter. She later wrote a book about her experience. Dr. Lowery called up the page and recommended the book to Chelsea.
As Chelsea and Rose walked out, Chelsea said she’s appreciative of the services her daughter receives through the low vision clinic.
There aren’t many providers who specialize in Rose’s condition in the U.S., she says. Eye doctors in Oregon don’t know much about it, so they can’t really help her see better, she says. So she says having Dr. Lowery advising and assessing Rose has been really helpful.
“Today felt really good,” Chelsea said. “I feel like we’re going to be good for a while.”
The Oregon Lions Sight & Hearing Foundation (OLSHF) was founded by Lions Club members in Oregon to engage Lions to deepen their impact in communities. The organization offers a range of community health programs based on its mission to screen, treat, save and restore sight and hearing in partnership with Lions Clubs. Read more about the work the Oregon Lions Sight & Hearing Foundation is doing in Oregon.
The Blind Visually Impaired Student (BVIS) fund was established in 2009 to support students who are blind or visually impaired attend schools in their communities. Although the fund was initially established by the Oregon State Legislature when Oregon’s School for the Blind closed in 2009 to assist students as they transitioned to their neighborhood schools, the purpose of the fund has now expanded to enhance learning opportunities for all blind or visually impaired students in the state. Read more about the Blind Visually Impaired Student fund.
