You have a client on your caseload with significant vision loss. They are 70 years old, retired, and mostly homebound. They missed their last two outpatient appointments — not because they didn’t want to come, but because getting there is genuinely hard. Their world has gotten smaller, and their risks have gotten bigger.
This scenario is not rare. It is the reality for a growing number of older adults with low vision across the United States. And it raises a critical question for home modification OTs: are we positioned to close this gap?
A 2023 pilot study published in the British Journal of Occupational Therapy says we should be — and the data backs it up.
What the Research Looked At
Tan et al. (2023) evaluated the Seniors’ Eye Rehabilitation (SEER) programme, a home-based occupational therapy intervention for older adults with low vision in Singapore. The study recruited participants from a tertiary hospital low vision clinic — adults aged 50 and older with a visual acuity of 6/18 or worse and/or a visual field less than central 10°.
This was an interventional, longitudinal cohort study. Forty-one participants completed the programme (mean age: 67; nearly equal numbers of male and female participants). Most were retired. Diagnostic groups included central vision loss (26.8%), mixed eye conditions (31.7%), peripheral vision loss (14.6%), homonymous hemianopia (14.6%), and diabetic retinopathy (12.2%).
The OT interventions included:
- ADL and IADL retraining
- Activity adaptations and home modifications
- Functional and community mobility training
- Patient and family/caregiver education
Each participant set two individualized priority goals collaboratively with the treating occupational therapist. Sessions were approximately one hour each, with most participants completing two to four home therapy visits. Outcomes were measured using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) and the Goal Attainment Scale (GAS) at baseline and six-month follow-up.
What the Data Shows
The results of the SEER programme were statistically significant across multiple domains — and clinically meaningful for those of us doing this work every day.
For Priority Goal 1 (typically functional walking, mobility, or carrying out daily life tasks):
- Significant reduction in activity limitations (1 median point change, p < 0.01)
- Significant reduction in participation restrictions (1 MPC, p < 0.01)
- Significant improvement in well-being (0.5 MPC, p < 0.01)
- Significant improvement on Goal Attainment Scale (1 MPC, p < 0.01)
For Priority Goal 2 (often IADL and community participation goals):
- Significant reduction in participation restrictions (0.75 MPC, p < 0.05)
- Significant improvement in well-being (0.5 MPC, p < 0.01)
- Significant improvement on GAS for both goals (p = 0.001)
Notably, impairment scores did not show statistically significant change — which is exactly what we would expect. Low vision is a chronic, progressive condition. We are not reversing the disease. We are restoring function and reducing the gap between what a person can do and what they want to do. That is precisely what occupational therapy is designed to accomplish.
Why Home-Based Matters: The Access Problem Is Real
The research context from Singapore is striking, and it translates directly to what OTs in the U.S. are seeing. The study notes that approximately half of clients at the low vision clinic missed outpatient appointments due to lack of caregiver availability or the sheer difficulty of traveling with significant visual impairment (Simon, 2008, as cited in Tan et al., 2023).
Transportation, mobility, caregiver burden, and care fragmentation are barriers we know well in the home modification space. For low vision clients specifically, these barriers compound. Standard clinic-based visual rehabilitation focuses heavily on optical devices and formal visual acuity assessments — but it does not evaluate the person within their own environment. The hazards are in the home. The mismatches between the person and their environment are in the home. That is where we need to be.
Liu and Chang (2020) conducted a systematic review, published in the American Journal of Occupational Therapy, and found strong support for occupational therapy as part of multidisciplinary low vision rehabilitation, particularly for improving performance of daily activities in older adults. Their review reinforced that multicomponent interventions — precisely what skilled OTs deliver — produce the most robust outcomes.
A 2020 Cochrane review by van Nispen et al. further substantiated that low vision rehabilitation interventions improve vision-related quality of life and functional outcomes compared to usual care, with the strongest effects seen in comprehensive, individualized programmes.
The Occupational Therapy Difference in Low Vision Care
Here is what makes our role distinct from what other low vision professionals provide.
Optometrists and ophthalmologists address the visual impairment itself — prescribing optical aids, managing disease, and measuring residual acuity. Orientation and mobility specialists address safe travel and navigation. What occupational therapists bring — especially those trained in home modifications — is the occupation-environment interface. We assess how a specific person, in a specific home, with a specific pattern of vision loss, struggles to manage specific daily tasks. And then we do something about it.
The SEER programme demonstrated this clearly. The most commonly targeted scales on the AusTOMs-OT were “Functional walking and mobility” (43.9%) and “Carrying out daily life tasks and routines” (19.5%). These are not abstract goals — they are the things your client needs to do to stay safe and maintain their quality of life at home.
Barriers to accessing low vision rehabilitation services have been well-documented in the United States. Khimani et al. (2021) found that patient-reported barriers include mental health challenges, denial of need, poor physical health, and lack of transportation — and that care provider barriers include the patient’s overall health status, older age, and low likelihood of follow-up. Home-based OT addresses nearly every one of these barriers by bringing the service to where the person is.
Practical Application: What Does Low Vision Home Therapy Look Like?
If you are thinking about how to integrate low vision services into your home modification practice, the SEER programme offers a replicable framework. Here is what the interventions actually addressed:
Environmental Modifications
- Improving lighting levels and placement (task lighting, eliminating glare)
- Increasing contrast at step edges, door thresholds, and countertops
- Labeling appliances, medications, and household items with high-contrast markers or tactile cues
- Reorganizing kitchen and bathroom layouts to reduce reliance on fine visual discrimination
- Removing or securing trip hazards (loose rugs, cords, low furniture)
Adaptive Strategies and Device Training
- Training in use of magnifiers (handheld, stand-based, electronic)
- Eccentric viewing techniques for those with central vision loss
- Establishing consistent object placement routines to compensate for search difficulties
- Teaching scanning strategies for stair descent, curb navigation, and community mobility
Caregiver and Family Education
- Guiding family members on how to modify communication and the environment to support the person’s safety and independence
- Teaching caregivers when to assist versus when to allow the person to problem-solve independently
Goal-Directed Planning
- Using individualized goal setting (Goal Attainment Scale or Canadian Occupational Performance Measure) to drive the intervention — not a generic low vision checklist
This is OT at its core. And most home modification specialists already have many of these skills. The question is whether you are applying them to this population intentionally.
Connecting to the Broader Scope: Falls, Isolation, and Mental Health
Low vision does not exist in a clinical silo, and our intervention planning should not either.
Smallfield et al. (2013) highlighted the significant relationship between decreased vision and fall risk in older adults, noting that strategies addressing vision are an essential component of multifactorial fall prevention. For home modification OTs, this is not a new concept — but explicitly screening for vision as a contributing fall risk factor during home assessments and connecting clients to low vision services when appropriate is a practice gap worth examining.
The psychosocial dimension matters just as much. The elderly with low vision frequently withdraw from meaningful occupations, reduce social participation, and experience significant emotional distress as their vision declines (Boey, 2022, as cited in Tan et al., 2023). Lamoureux et al. (2007) found meaningful improvements in emotional well-being when low vision rehabilitation programmes incorporated skilled psychosocial support. In the SEER programme, social workers contributed to well-being outcomes alongside the occupational therapists — a reminder that warm handoffs and multidisciplinary collaboration strengthen our client outcomes.
Limitations Worth Noting
The Tan et al. (2023) study is a pilot study conducted in Singapore, which means generalizing directly to U.S. practice requires care. The sample size was modest (n = 41), investigators were not blinded, and there was no control group. Cultural, healthcare system, and reimbursement context differ significantly between Singapore and the United States.
What the study does offer is a structured, replicable care model and preliminary evidence that home-based OT visual rehabilitation is effective across multiple outcome domains. It builds on a growing body of literature (Liu & Chang, 2020; van Nispen et al., 2020; Selivanova et al., 2019) pointing in the same direction. We need more U.S.-based randomized controlled trials with larger samples — and until those exist, this pilot adds meaningfully to the evidence base guiding our practice.
Action Steps for OT Home Modification Specialists
You do not need a specialized low vision certification to begin shifting your practice — though additional training is worth pursuing. Here is where to start right now:
1. Add a systematic vision screen to every home assessment.
Ask about vision changes, last eye appointment, glasses prescription currency, difficulty with specific tasks (reading, medication management, recognizing faces, navigating stairs in low light). This alone will identify clients who need referral or more targeted intervention.
2. Establish a referral network with low vision optometrists in your area.
Know who provides low vision evaluations and optical device prescription in your region. A warm referral from you — with a note about what you observed in the home — is far more powerful than a generic handoff.
3. Implement the environmental modifications you already know.
Lighting, contrast, clutter reduction, and consistent organization are within your scope and your skillset right now. Apply them deliberately and document them with a low vision lens.
4. Develop a library of low-vision adaptive equipment you can recommend.
High-contrast tape, large-print labels, talking clocks, stand magnifiers, and non-glare table lamps are low-cost, high-impact tools that you should be comfortable recommending.
5. Use individualized goal setting to drive your intervention.
The GAS data from Tan et al. (2023) was consistently strong — even when standardized outcome measures showed mixed results. Goals that matter to the client produce better functional engagement and stronger outcomes. Let them set the priority.
6. Consider pursuing low vision rehabilitation training.
AOTA offers continuing education in low vision. The Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) credentials low vision therapists. For OTs whose caseload includes significant numbers of older adults with visual impairment, formal training in low vision OT practice is a clinical and professional investment worth making.
7. Advocate for home-based low vision services in your setting.
Use the evidence — including Tan et al. (2023) and the Liu and Chang (2020) systematic review — to make the case to referral sources, administrators, and payers that home-based OT visual rehabilitation is both effective and necessary. Your clients who cannot get to the clinic need you to make this argument on their behalf.
The Challenge for You
Here is the question I want you to sit with after reading this:
How many clients on your current caseload have low vision that is affecting their safety and participation — and how deliberately are you addressing it?
The evidence is there. The need is there. The skill set is largely there. The gap is in whether we are applying what we know to this population with the same intentionality we bring to grab bars and ramp specifications.
Low vision home therapy is not a niche specialty only for the most credentialed therapists. It is a natural extension of what excellent home modification OTs already do. The SEER programme showed us what is possible with a few intentional home visits and a skilled, trained occupational therapist. Now it is our turn to build on that evidence and close the gap for the clients who need us most.
References
Boey, D., Tse, T., Lim, Y. hui, Chan, M. L., Fitzmaurice, K., & Carey, L. (2022). The impact of low vision on activities, participation, and goals among older adults: a scoping review. Disability and Rehabilitation, 44(19), 5683–5707. https://doi.org/10.1080/09638288.2021.1937340
Khimani, K. S., Battle, C. R., Malaya, L., Zaidi, A., Schmitz-Brown, M., Tzeng, H. M., & Gupta, P. K. (2021). Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice. Journal of ophthalmology, 2021, 6122246. https://doi.org/10.1155/2021/6122246
Lamoureux, E. L., Pallant, J. F., Pesudovs, K., Rees, G., Hassell, J. B., & Keeffe, J. E. (2007). The effectiveness of low-vision rehabilitation on participation in daily living and quality of life. Investigative ophthalmology & visual science, 48(4), 1476–1482. https://doi.org/10.1167/iovs.06-0610
Lee, I., Kaldenberg, J., & Leland, N. (2012). Watching their steps: Integrating vision intervention into daily practice to limit fall risk at skilled nursing facilities. American Journal of Occupational Therapy, 66, 210–218. ⚠️ [VERIFY: Volume, issue, and page numbers — confirm via AJOT]
Liu, C. J., & Chang, M. C. (2020). Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults With Low Vision: A Systematic Review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 74(1), 7401185010p1–7401185010p18. https://doi.org/10.5014/ajot.2020.038372
Nastasi J. A. (2020). Occupational Therapy Interventions Supporting Leisure and Social Participation for Older Adults With Low Vision: A Systematic Review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 74(1), 7401185020p1–7401185020p9. https://doi.org/10.5014/ajot.2020.038521
Selivanova, A., Fenwick, E., Man, R., Seiple, W., & Jackson, M. L. (2019). Outcomes After Comprehensive Vision Rehabilitation Using Vision-related Quality of Life Questionnaires: Impact of Vision Impairment and National Eye Institute Visual Functioning Questionnaire. Optometry and vision science : official publication of the American Academy of Optometry, 96(2), 87–94. https://doi.org/10.1097/OPX.0000000000001327
Smallfield, S., Clem, K., & Myers, A. (2013). Occupational therapy interventions to improve the reading ability of older adults with low vision: a systematic review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 67(3), 288–295. https://doi.org/10.5014/ajot.2013.004929
Tan, Y., Tan, A. C. S., Hui, J. H. S., Tang, L. L., & Chen, L. W. (2023). Low vision home therapy service by occupational therapists: The effectiveness of the Seniors’ Eye Rehabilitation programme, a pilot study. British Journal of Occupational Therapy, 86(5), 359–366. https://doi.org/10.1177/03080226231153340
van Nispen, R. M., Virgili, G., Hoeben, M., Langelaan, M., Klevering, J., Keunen, J. E., & van Rens, G. H. (2020). Low vision rehabilitation for better quality of life in visually impaired adults. The Cochrane database of systematic reviews, 1(1), CD006543. https://doi.org/10.1002/14651858.CD006543.pub2
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