Low Vision Rehabilitation

Supervisors

• Dr. Samuel N Markowitz, Fellowship Director
• Dr. Monica Nido

Contact Information

Dr. Samuel. N. Markowitz
1225 Davenport Road
Toronto, Ontario, Canada M6H 2H1
Tel: 416-531-5425
Fax: 416-531-6728
Email: snm@on.aibn.com

Locations

• UHN - Toronto Western Hospital

Fellowship Objectives

1. To gain exposure to comprehensive low vision clinical practice.
2. To prepare a candidate for an academic career with subspecialty training in low vision rehabilitation.
3. To gain exposure to clinical and basic science low vision research in the Department of Ophthalmology, University of Toronto.

General Description

Service

Service for low vision assessment, prescribing of devices and training, fitting and dispensing of low vision devices is taking place in the clinic at the Toronto Western Hospital and in the private office of the supervisor. We receive consultations requests from colleagues from our hospital as well as from ophthalmologists from our community and beyond. We cover all aspects of low vision rehabilitation including assessment, prescribing low-tech low vision fitting and dispensing and training for rehabilitation of skills.

The following medical conditions were covered by us in the past:

• Pediatrics: anisometropic amblyopia, cataract, pseudophakia, nystagmus
• Genetics: retinitis pigmentosa, cone dystrophy, Stargardts disease, albinism
• Neurology: stroke, multiple sclerosis, optic neuritis, nystagmus, cerebral palsy, ataxia
• External diseases: Keratoconus, corneal dystrophies, corneal scarring.
• Retina: Macular degeneration wet, dry and dystrophic, diabetic retinopathy, glaucoma

We use the following techniques for vision rehabilitation on a routine basis:

1. Image relocation from the center to the periphery (macular degeneration, optic neuritis and others) or from the periphery to the center (glaucoma, RP)
2. Peripheral field expansion (homonymous hemianopsia, tunnel vision)
3. Manipulation of contrast (corneal opacities, cataract)
4. Magnification (for targets at far, intermediate and near)
5. Macular stimulation (anisometropic amblyopia)
6. Glare control
7. Biofeedback 
8. Perceptual training and brain plasticity stimulation

Research

The following are areas of interest with completed or ongoing research:

• Assessment of residual color function.
• Macular perimetry in low vision.
• Fixation identification in macular degeneration with microperimetry.
• Fixation characteristics in macular degeneration based on eye tracking technology analysis.
• Enhancement of fixation maintenance and tracking with computer generated peripheral clues in macular degeneration.
• The use of prisms for image relocation and field expansion.
• Biofeedback therapy for PRL rehabilitation.
• Photobiomodulation for treatment of dry AMD.
• Restoration of vision with retinal prosthesis in retinitis pigmentosa
• High tech devices for indoor navigation and head worn CCTV units

Clinical Duties

The fellowship consists of a mixed clinical and research fellowship. Approximately 50% of the Fellow’s time is spent in clinical activities. These include assessment of referred subspecialty patients in an office setting with direct involvement in diagnosis and prescribing therapy for those patients. The candidate is expected to have adequate training in general ophthalmology including refraction, as this is not an emphasis in this fellowship. There is an opportunity for exposure in pediatric low vision. The Fellow will be expected to follow and be responsible for patients on the low vision service. 

Research

The Fellow is expected to spend 50% of his or her time on basic and/or clinical research. Research projects will be outlined for the Fellow and he/she will be expected to present results at the Research Day of the Department of Ophthalmology, or other venues as assigned. Final results are expected to be submitted for publication in an appropriate specialty journal.

Teaching

The Fellow will be expected to enhance resident teaching. The Fellow is expected to prepare lectures as assigned to be given in small group seminars to the residents during the year. Presentation of interesting cases at rounds is also expected.

Residents: All residents rotate through the low vision clinics. The teaching program in low vision rehabilitation was approved by the fellowship committee of the Department of Ophthalmology as qualified for fellowship training.

Lectures on low vision assessment and related basic sciences are covered during the first year introductory course. Clinical practice of low vision is covered during mid-year sessions.

The clinic is equipped with a variety of low-tech low vision devices for practice and clinical training. Low vision resident manuals and books are available in the clinic. We use routinely microperimetry as a tool for assessments and biofeedback training.

Vacation

2 weeks’ vacation per year.

Conference

Up to 2 weeks of conference time may be taken on approval from the supervisor.

Evaluation

Fellows are encouraged to provide feedback and express their comments on how their fellowship is progressing, including areas they would like to work on. An evaluation after 2 months of the fellowship will be held to determine performance. A mid-term evaluation will be held with the Fellow to evaluate his or her performance and to give feedback regarding his activities. Evaluations are communicated to the fellowship committee of the Department.

Duration

1 year.

Salary

$55,000 CAD/year

Application Process

Applications are available through the above contacts. All appointments have to be approved by the departmental Fellowship Committee. Fellowships normally run from July 1st to June 30th, but flexible start dates are considered. A personal interview is required. Applications are due on August 31st of the year prior to beginning the fellowship in July.