Low Vision Rehabilitation is a unique specialty within the department of Ophthalmology due to its mandate to enhance how a patient functions in daily activities by providing an alternative treatment mode in a curriculum which is otherwise defined by drug and surgical interventions.
The service was initiated by August Colenbrander, MD, who joined the Department of Ophthalmology in 1971. As a graduate and faculty member of Leiden University Medical School in Holland, he had served as a visiting professor of Ophthalmology at the University of Iowa Medical School in 1969 where he met Dr. Bruce Spivey, who subsequently invited him to move to San Francisco. In 2020 August Colenbrander was named an Unsung Hero by the American Academy of Ophthalmology for his scholarly activity in low vision and vision rehabilitation.
Colenbrander’s work has centered on the proposition that perception is interpretation and that sight is a brain function. The Low Vision program was enriched by Colenbrander’s international committee work as well as his position as an affiliate Scientist at the Smith-Kettlewell Eye Research Institute.
Initially Dr. Colenbrander instructed residents by working with patients along with an occupational therapist without a formally defined curriculum. He increased residents’ assessments and interactions with patients until it became a full-fledged element of the curriculum. Nationwide there are few Low Vision programs, although the needs of an aging population have put a high premium on low vision therapies which makes the CPMC residency program particularly worthwhile.
Canadian Donald Fletcher, MD was named Chief of Low Vision in 2004 upon Colenbrander’s retirement. Fletcher had trained as a Fellow with Colenbrander in 1986 after completing a Retina Fellowship in Denver, Colorado. He went on to teach and practice at the University of Alabama, the University of Missouri Kansas City and in a private retinal practice in Fort Myers, Florida. He was instrumental in securing funding for low vision services in 2006 when The Frank Stein and Paul May Center for Low Vision Rehabilitation was named in honor of two generous donors.
Fletcher was instrumental in initiating a system of occupational therapists for training in the use of residual vision and adaptations of activities of daily living. In 2008 he created the Smith Kettlewell Reading test for evaluation of scotoma influence on reading performance along with the California central Visual Field Test for dense and relative scotoma identification in low vision rehabilitation. In 2013 he brought a Scotoma Awareness Training Module to market to give patients physical interactions with their scotomas.
Fletcher’s interest in research at the Smith Kettlewell Institute has resulted in many resident research projects and presentations at national meetings. Notably, many residents have contributed to scientific research papers, often authored in partnership with Colenbrander and Fletcher.
Under Fletcher’s leadership, residents and fellows have also experienced the development of low vision aids and the creation of international training programs in China, the Philippines, Chile, El Salvador, Columbia and Mexico. Fellows trained by Fletcher now practice across the US and internationally.
“The time I spent for my fellowship with Don Fletcher in San Francisco is a memorable time, a time when a young doctor in search for his path would meet an incredibly inspiring mentor who would later become also a friend. Don would share anything he had – his knowledge, his office, his car, even his place – just for free, with the greatest simplicity that you can imagine. He told me once: You can use my name at any time to support your career in this field of low vision rehabilitation.
San Francisco was just the perfect place for anything like that: a melting pot of different people, cultures and languages, where practicing low vision rehabilitation really meant crossing barriers, showing inclusiveness, and “meeting people”, not just patients, face to face.”
GM Villani, MD, Low Vision Fellow 2007 Adjunct Professor, University of Verona and University of Rome for Master Courses about Low Vision Rehabilitation
Tiffany Chan, OD, was named Low Vision Chief in 2019, continuing the practice of teaching and collaboration with both Fletcher and Colenbrander. Chan is a graduate of the University of California Berkeley School of Optometry, completing a fellowship at the Lions Low Vision Center at the Wilmer Eye Institute of Johns Hopkins University where she also served as an Associate Professor.