For the 3.4 million visually impaired and blind Americans 40 and older, a diagnosis of low vision used to be a sentence to a life of stumbling, fumbling and increasing isolation in the growing darkness. But occupational therapists (OTs) are opening their eyes to the many ways they can help these patients learn to use their remaining sight, develop coping skills and maintain independence. Whether they opt for a traditional rehab role, one in an emerging field or an entrepreneurial venture, OTs should find no shortage of patients, since the number of Americans with age-related eye disease and the resulting vision impairment is expected to double in the next three decades.

Where the Work Is

"The largest population with vision loss is older Americans, who can be served through general rehabilitation facilities, outpatient departments at hospitals or assisted-living or nursing centers," says Anne Riddering, OTR, director of OT at the Visual Rehabilitation Program at Henry Ford Eye Care Services. Such opportunities for OTs are growing as rehab hospitals add low-vision centers to their roster of spinal cord, head trauma and other centers, and hospital outpatient facilities launch low-vision programs.

OTs can also treat low-vision patients in private practice or by working for private agencies that serve the blind, says Riddering, a dually certified low-vision therapist and orientation and mobility specialist (CLTV/COMS). Since private agencies typically depend on funding from sources such as the United Way, they have an incentive to hire OTs whose Medicare reimbursement would represent another source of revenue for them.

Low-Vision Focus on the Home Front

In rural Louisiana, nurse Lisi Coleman and occupational therapist Mary Towry formed HomeSight, which may be the nation's first and only home health agency exclusively devoted to the needs of low-vision patients. HomeSight's founders created and then copyrighted their own forms, assessment tools, treatment protocols and training manual.

Today, the agency employs more than 20 full-time and contract OTs and physical therapists. Two keys to their success: Ongoing in-house staff education and professional networking. The agency's Wendy Elliott Foundation, which is dedicated to maximizing independent living by combining OT and universal designs for low-vision patients, will use grant money to create a network of practitioners in Louisiana who treat low-vision patients; it is planning a summer conference to that end.

For OTs who want to establish themselves in this emerging field, Towry offers the following advice: "It will take a lot of marketing and continuing education. And, you have to network. You may even have to create a network."

Entrepreneurial Options

A truly untapped niche is the growing demand among ophthalmologists for OTs to assist their low-vision patients. Fueled by the American Academy of Ophthalmology's SmartSight education campaign, physicians are realizing the need to link low-vision patients to rehabilitation services, yet many have difficulty finding qualified OTs to do so. Since hospital rehab departments are often unable to fill this need, Riddering suggests that qualified OTs market themselves to physicians, optometrists and rehab department directors through letters, personal visits and word of mouth. "You must continue to remind doctors of your services so you get the referrals," she says.

Essential Education

Whether you opt for a full-time job or venture out on your own, proper training is essential. Fortunately, low-vision training for OTs is becoming more widely available. In 2001, the University of Alabama at Birmingham created the nation's first graduate certificate program in low-vision rehabilitation. The eight-semester program can be completed online except for a brief on-campus stint, says Mary Warren, the program's director and an assistant professor of OT. Salus University also offers a graduate certificate and master's program in low vision.

Other education options include a self-paced clinical study course, books, such as Low Vision Rehabilitation: A Practical Guide for Occupational Therapists, and conference workshops.

In addition, you can earn the AOTA's specialty certification in low vision, introduced in May 2006.