Rehabilitation and Prosthetic Services
About Blind Rehabilitation Services
The Department of Veterans Affairs provides blind and vision rehabilitation programs to eligible Veterans and active duty Servicemembers who are visually impaired. Veterans Health Administration is the first national healthcare system to completely and seamlessly integrate rehabilitation services for patients with visual impairments into its health benefits. This ensures that patients receive the finest medical and rehabilitation care, as well as cutting-edge assistive technology.
There are approximately 130,428 Veterans in the United States who are legally blind, and more than one million Veterans who have low vision that causes a loss of ability to perform necessary daily activities. Those figures are expected to increase in the years ahead as more Veterans from the Korean and Vietnam conflict eras develop vision loss from age-related diseases such as macular degeneration, diabetic retinopathy and glaucoma.
Beginning in 2008, the VA implemented a progressive plan to expand vision and blind rehabilitation to Veterans and eligible active duty Servicemembers with visual impairments, ranging from earliest vision loss to total blindness. New programs in BRS provide opportunities to keep those with early vision loss active and integrated in their families and communities.
Blind Rehabilitation Service Model of Care
The VA Blind Rehabilitation Service model of care encompasses an array of rehabilitative services, extending from the patient's home to the local VA care facility, and to regional low vision clinics and lodger and inpatient training programs. Blind rehabilitation services may be provided through a variety of programs:
- Intermediate and Advanced Low Vision Clinics
- Vision Impairment Services in Outpatient Rehabilitation (VISOR) Programs
- Inpatient Blind Rehabilitation Centers (BRCs)
- Visual Impairment Centers to Optimize Remaining Sight (VICTORS) Programs
Intermediate and Advanced Low Vision Clinics
When basic low-vision services available at VA eye clinics are no longer sufficient for Veterans with low vision, VA intermediate and advanced low vision clinics provide clinical examinations, a full spectrum of vision-enhancing devices, and specialized training. Eye care specialists and Blind Rehabilitation Specialists work together in interdisciplinary teams to assure that Veterans and active duty Servicemembers with low vision are provided with the technology and techniques to enhance their remaining sight and facilitate their independence.
Each patient attending the program receives a comprehensive eye examination by a low vision eye care specialist, and a thorough visual skills assessment.
The Intermediate Low Vision Clinics focus on effective use of remaining vision through the development and use of visual motor and visual perceptual skills. Assessment and instruction with special optical and electronic devices is provided. Ergonomic equipment such as special lighting and positioning devices are provided to assist Veterans in using vision effectively. Therapy may employ the use of visual and ergonomic equipment and new visual skills to address routine daily tasks such as reading, writing, managing medications, cooking, locating and reading signs.
In the Advanced Low Vision Clinics, patients are also provided with orientation and mobility training. Principles of independent travel are taught using the long white cane, when appropriate, to enhance the user's safety and independence. Maximum use of any remaining vision to assist travel is evaluated, and in many cases low vision devices are provided and made an integral part of mobility training. Sensory training classes teach the Veteran how to more effectively use remaining senses, particularly hearing, as an aid in travel. In addition, exercises in mental mapping serve to enhance the Veteran's orientation while traveling through different kinds of environments. Orientation and mobility instruction in relatively simple routes to increasingly complex routes builds confidence in the ability to travel independently.
Intermediate Low Vision Clinics:
- Albany, NY
- Albuquerque, NM
- Cincinnati, OH
- Columbia, SC
- Detroit, MI
- Fort Harrison MT
- Hampton, VA
- Las Vegas, NV
- Loma Linda, CA
- Madison, WI
- Martinsburg, VA
- Memphis, TN
- Montrose, NY
- Ocala, FL
- Oklahoma City, OK
- Pittsburgh, PA
- Sioux Falls, SD
- Spokane, WA
- St. Louis, MO
- Temple, TX
- Ukia, CA
- White River, Junct, VT
Advanced Ambulatory Low Vision Clinics:
- Baltimore, MD
- Brooklyn, NY
- Dallas, TX
- Dayton, OH
- Decatur, GA
- Des Moines, IA
- Jamaica Plains, MA
- Kansas City, MO
- Las Angeles, CA
- Little Rock, AR
- Martinez, CA
- Milwaukee, WI
- Nashville, TN
- Philadelphia, PA
- Phoenix, AX
- Portland, OR
- Saginaw, MI
- Salisbury, NC
- Salt Lake City, UT
- San Diego, CA
- Syracuse, NY
- Tampa, FL
- Wichita, KS
Vision Impairment Services in Outpatient Rehabilitation (VISOR) Program
These programs provide short-term (about 2 weeks) blind and vision rehabilitation. They provide comfortable overnight accommodations for Veterans and active duty Service Members who are visually impaired and require lodging. Those who attend VISOR must be able to perform basic activities of daily living independently, including the ability to self-medicate.
In addition to the low vision and orientation and mobility services already described, VISOR also provides training in communication, activities of daily living and computer use.
Communication instruction is designed to enhance and restore abilities in written and spoken communication. Strategies and tools for communication are offered, such as typing, handwriting, telling time, management of financial records, Braille, recording devices and other electronic equipment. These skills help the Veteran to maintain effective communication with others, and keep up with current events, correspondence and personal files.
Patients learn strategies to accomplish tasks ranging from routine (e.g., telling time, making a cup of coffee) to complex activities (e.g., arranging an entire wardrobe, shopping, kitchen organization, preparing complete meals). The emphasis is on learning by doing; techniques and methods are taught and then integrated into the individual's daily routine. By the completion of the program the Veterans should be capable of handling daily living tasks with complete or greatly enhanced independence.
The computer equipment issued by VA is state-of-the-art technology with all necessary peripherals and accessible hardware/software to meet the patient's identified needs. Computer training may include an adaptive needs assessment, recommendation of appropriate computer equipment, training on recommended equipment, issuance of equipment upon successful completion of training, and follow-up technical support as required. Individualized training may further include instruction on accessible hardware/software, computer literacy, familiarization to computer keyboard, fundamentals of disk operating systems and fundamentals of word processing, internet access and email.
VISOR Program Locations:
- Battle Creek, MI
- Buffalo, NY
- Denver, CO
- Houston, TX
- Lebanon, PA
- Lyons, NJ
- Minneapolis, MN
- Richmond, VA
- Washington, D.C.
Inpatient Blind Rehabilitation Centers
A residential inpatient program that provides comprehensive adjustment to blindness training and serves as a resource to a catchment area usually comprised of multiple states. BRC's offer a variety of skill courses designed to help blinded veterans achieve a realistic level of independence. These skill areas include orientation and mobility, communication skills, activities of daily living, manual skills, visual skills, computer access training and social/recreational activities. The veteran is also assisted in making an emotional and behavioral adjustment to blindness through individual counseling sessions and group therapy meetings. There are thirteen (13) Blind Rehabilitation Centers throughout the United States and Puerto Rico.
Blind Center locations:
- American Lake, WA
- Augusta, GA
- Biloxi, MS
- Birmingham, AL
- Cleveland, OH
- Hines, IL
- Long Beach, CA
- Palo Alto, CA
- San Juan, Pr
- Tucson, AZ
- WACO, TX
- West Haven, CT
- West Palm Beach, FL
Special Programs at the Blind Rehabilitation Center
Special programs for training in the use of innovative technology generally fall into the areas of visual skills, communication, and orientation and mobility. Visual skills devices include special electronic viewing devices that supplement optical low vision devices. Communication devices include electronic reading machines for the blind, computers, and other similar special devices. Electronic orientation and mobility devices are designed to supplement the usual protective travel devices such as the long cane. New and innovative devices may be added as they are developed and become available.
Training in the use of these special devices is complex, requiring a great deal of hard work and persistence. Such training may not be suitable for everyone. While these innovative devices are not a substitute for basic blind rehabilitation training or other more traditional assistive devices, they serve as an important tool for many.
Special programs are usually 2 to 4 weeks in length and focus on specific technology. Several hours per day are spent working on that device, which can limit participation in the regular rehabilitation program. Qualified Veterans and active duty Servicemembers may apply for programs that provide assessment and training in the use of these specialized devices. Specific criteria for admission and for issuance of the devices have been established. Questions concerning eligibility and suitability for training, as well as issuances of devices, should be directed to the Chief of the appropriate Blind Rehabilitation Center.
Research and Clinical Evaluation Programs
The VA has consistently been a leader in development of sensory and prosthetic research, and each Blind Rehabilitation Center is actively involved in research, development and evaluation of devices. Many devices that were involved in research programs in past years are now part of the regular and special rehabilitation programs at the Blind Rehabilitation Centers. As new devices are developed that may assist blind persons, the VA will be among the first to evaluate them.
Visual Impairment Centers to Optimize Remaining Sight (VICTORS) Program
The Visual Impairment Center to Optimize Remaining Sight (VICTORS) concept was developed to complement existing inpatient Blind Rehabilitation Centers (BRCs) to care for Veterans with significant visual impairment (20/70 to 20/200 or worse visual acuity and/or significant visual field loss). The interdisciplinary VICTORS outpatient program represents a unique team approach to vision rehabilitation using the disciplines of optometry, ophthalmology, social work, psychology and low vision therapists. VICTORS provides rehabilitation through definitive medical diagnosis, functional vision evaluation, prescribing and training in use of low vision aids, counseling and follow-up.
There are currently 4 VICTORS programs:
- Chicago, Illinois
- Kansas City, Missouri
- Lake City, Florida
- Northport, New York
Visual Impairment Services Team (VIST) Coordinator
The Visual Impairment Services Team (VIST) Coordinators are case managers who have responsibility for the coordination of services for severely disabled visually impaired Veterans and active duty Service Members. VIST coordinator duties include providing and/or arranging the provision of appropriate treatment in order to enhance functioning; for example, referrals to Blind Rehabilitation Centers, Blind Rehabilitation Outpatient Services, VICTORS, VISOR, and low vision clinics. Other VIST coordinator duties include identifying newly identified individuals who have severely disabling visual impairment, providing counseling, problem resolution, arranging a review of benefits and needed services, and conducting educational and outreach programs relating to VIST and blindness.
VIST Teams are established at the local VA medical centers and community based outpatient clinics. These VIST Teams are comprised of a VIST Coordinator, healthcare and allied healthcare professionals. The team ensures that blind and visually impaired individuals are identified, evaluated, and provided health and rehabilitation services to maximize adjustment to sight loss. Members may include, but are not limited to, representatives from Social Work, Ophthalmology, Optometry, Prosthetics, Primary Care, Geriatrics, Physical Medicine and Rehabilitation, Nursing, Audiology, Podiatry, Nutrition, Psychology, Patient Administration and Financial Services and Veterans Benefits Administration.
Blind Rehabilitation Outpatient Specialists
BROS are multi-skilled professionals who perform a wide array of blind rehabilitation services including assessments and visual skills, living skills and orientation and mobility training. BROS serve visually impaired patients in their homes, VA medical centers or clinics, colleges or universities, work sites, and long-term care environments. The BROS offer pre/post Blind Rehabilitation Center training, and also instruct those who may not be able to travel to a Blind Rehabilitation Center. BROS also provide training to family members.
The BRS continuum of care provides capacity to serve Veterans and Servicemembers returning from service in Iraq and Afghanistan with wounds and trauma that result in blindness and visual impairment. The VA has a longstanding memorandum of agreement with the Department Defense to provide specialized rehabilitation for active duty Service Members who become visually impaired and are in need of specialized care. Traumatic brain injury (TBI), often referred to as the signature injury of combat in Iraq and Afghanistan, may affect the visual pathway, visual cortex, and/or pathways that connect the eyes to cortical visual centers in the brain. Injuries to either the eyes or brain may result in vision loss.
Every VA Medical Center has an Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) care management team to assist returning Servicemembers and OEF/OIF Veterans and help coordinate their care. Case managers coordinate patient care activities and help our newest Veterans navigate through the VA system. VA Transition Patient Advocates (TPA) act as personal advocates while Veterans move through the VA Health Care System. You can learn more about the OEF/OIF Program, including how to contact the team at your nearest medical center, on our Returning Service Members website
Technology and Guide Dogs
Patients are provided with the technology they need to regain their independence and return to full activity. Approved technology required by Veterans is provided by VA Prosthetics Service at no cost to the Veterans.
While VA does not provide guide dogs, VA coordinates with non-VA agencies that provide guide dogs. Training methods have been adapted and breeding requirements modified to provide dogs more suited to working with an older population, as well as those with multiple disabilities and health difficulties.
Family Centered Care
Families are valued members of the interdisciplinary treatment team and Blind Rehabilitation Service is committed to providing compassionate family-centered care. Family members provide unique perspective on the history, values and goals of the individual, and are critical in the adjustment and rehabilitation process.
How to Get Help for Your Vision Loss
Veterans and eligible active duty Servicemembers should contact the VIST Coordinator in the VA medical center nearest their home. VIST locations can be found on the Blind Rehabilitation Service website or by contacting the Blind Rehabilitation Service Program office at:
Department of Veterans Affairs
Veterans Health Administration
Blind Rehabilitation Service (117B)
810 Vermont Ave. N.W.
Washington, D.C. 20420
To schedule an eye exam, contact your nearest VA medical facility. To find the VA medical center closest to you, use VA's facility locator. Simply enter your ZIP code and a list of the nearest health care facilities will be at your fingertips.
For additional information about vision care services provided by VA, visit the VA Optometry/Ophthalmology Website for an overview of the services that are provided.