Seeing the world differently

17 March 2017


Natalia Kelly, a Vision Australia orthoptist, describes eccentric viewing training and its benefits for people with macular degeneration and other forms of central vision loss.

Orthoptist Natalia Kelly teaches people with central vision loss to look at the world in a different way.

She says that the fresh perspective offered by eccentric vision training can open up new horizons for people who have central vision loss.

It’s also some of the most rewarding work that she has ever done, she says.

Natalia has been an orthoptist with Vision Australia since 2003.

Orthoptists are eye care professionals who specialise in the detection, diagnosis and treatment of vision and eye disorders and offer interventions to optimise a client’s visual potential for independent living.

Central vision provides the best level of both detail and colour vision and allows us to perform activities that require fine detail vision such as to drive, seeing faces, reading or watching TV.

The tasks can be difficult for people who have lost their central vision because of  eye conditions such as age-related macular degeneration,  other forms of macular degeneration that begin earlier in life such as Best’s or Stargardt’s disease.

Eccentric viewing training is an alternative way for people with central vision loss to regain some vision and improve their quality of life by using the unaffected peripheral vision around the central loss, she says.

Training 'worth the effort'

Natalia says the training is intensive but is worth the effort.

“Every single one of my clients has had extremely positive results and are very happy about the improvements seen in their vision and every day function,” she says.

“They put in a lot of effort, and it can be exhausting for them, but they see the results. Their vision is getting better and they are able to do things they had given up. I can’t tell you how valuable this training is,” she says.

Under eccentric vision training, an orthoptist uses a standard vision field chart to map the client’s vision loss and pinpoint the area of undamaged retina closest to the client’s central vision.

Then, over a program of eight one-hour sessions (with homework exercises between sessions) clients learn how to move their eyes without turning their head to use the point in their peripheral vision closest to the centre as a substitute for their central vision.

Dedication required


The training is suitable for people with disease that affect central vision, Natalia says. It requires a level of dedication from clients, she says.

“The training doesn’t cause pain, but it can cause visual fatigue because the clients spend a lot of energy concentrating to shift their fixation point,” she says.

Together, clients and their orthoptist set progressive targets and ultimate goals to keep the training program on track.

“If the client can see progress and achievements along the way, and those achievements are specific to them, they are likely to continue with it. If the training and the goals aren’t meaningful to the client, we won’t be successful,” she says.

“At the beginning of the training we discuss and plan realistic goals that can be achieved along the program. This is to ensure client’s expectations are clear and we keep up the motivation throughout the training.”

Many clients experience a minor vision regression in the fourth or fifth week of the training, but Natalia says it’s her job to keep clients motivated to work through it until their vision improves and plateaus by the end of the training.

Natalia says she’s proud of the results that eccentric viewing training can produce.

Her last client was legally blind with central vision assessed at less than 6/60 – that is, they could see at 6m what a person with normal vision can see at greater than 60m.

“By the time we finished, he achieved almost twice as much vision using his eccentric viewing point. He achieved 6/38, so that was pretty impressive,” she said.

Other benefits

Anecdotally, Natalia says most clients have a clinical improvement in other visual functions. It’s not just detail that improves, but contrast and colour as well.

She says she’s never had a client who did not complete the program and achieve their goals.

“One thing that keeps me doing this is the results that I see and the clients’ satisfaction,” Natalia says.

“It’s overwhelming. It’s enormously satisfying.

“You see these drastic improvements from week to week as their vision improves, and you build a relationship with them. It’s wonderful.”

Vision Australia employs a vast range of eye health professionals including orthoptists.

For further information on how we can assist you, visit the 
Vision Australia eye health professionals page here or phone us on 1300 84 74 66 to discuss your needs and locate your local Vision Australia office.