Visual aids are a general term for “devices to reduce difficulty in seeing.” They include optical and electronic aids prescribed to assist low vision patients (with visual acuity approximately between 0.02 and less than 0.3) in daily living, reading, academic, and occupational activities.
Low vision aids eligible for public benefits include two types: “assistive devices” and “daily living aids.” Eligibility is limited to holders of a physical disability certificate or those with designated intractable diseases.
Assistive devices (independence support benefits under the Comprehensive Support for Persons with Disabilities Act):
Daily living aids (community-based living support services under the Comprehensive Support for Persons with Disabilities Act):
Note: Large-print textbooks for compulsory education have been provided free of charge since the 2010 amendment of the Act on Promotion of Distribution of Specified Books for Children with Disabilities. Tablet devices (such as iPads) may be covered as daily living aids by some local governments.
To receive public benefits for assistive devices and daily living aids, you must either hold a Physical Disability Certificate or be designated as having a specified intractable disease. Please consult the welfare office of your municipality regarding the requirements and application procedures for obtaining the certificate.
The required assistive devices differ depending on the location and nature of the visual impairment.
Central Visual Field Defect
Causes: Macular degeneration, macular disease, diabetic macular edema, etc.
Main difficulties: Difficulty reading and performing fine manual tasks
Suitable aids: Magnifying reading device, monocular telescope, low-vision glasses
Peripheral Visual Field Defect
Causes: Glaucoma, retinitis pigmentosa, etc.
Main difficulties: Difficulty walking, spatial recognition, and avoiding obstacles
Suitable aids: White cane, orientation and mobility training, magnifying reading device (for reading support)
Photophobia (Light Sensitivity)
Causes: Albinism, congenital aniridia, corneal disease, intraocular disease, etc.
Main difficulties: Reduced visual function in bright places, limited outdoor activities
Suitable aids: Light-filtering glasses (short wavelength light cut)
Reduced Contrast Sensitivity
Causes: Cataract, optic nerve disease, etc.
Main difficulties: Difficulty recognizing outlines, difficulty reading text
Suitable assistive device: Typoscope (reading slit)
Before selecting an assistive device, objectively evaluate the patient’s reading ability and visual function.
MNREAD-J is a chart for quantitatively evaluating reading efficiency in low vision patients. It measures the following three indicators.
As a typical developmental standard, the reading speed of first-grade elementary school students is approximately 200 characters per minute. This indicator can also be used to evaluate the effectiveness of assistive devices and to set magnification guidelines.
The selection of assistive devices proceeds through the following five steps.
| Step | Content |
|---|---|
| 1 | Evaluate in detail “in what situations and to what extent it is difficult to see” |
| 2 | Detailed assessment of visual functions such as visual acuity, visual field, and contrast sensitivity |
| 3 | Trial use of low vision aids (loan for 1–4 weeks) → confirmation of suitability |
| 4 | Instruction on how to use the device by an orthoptist (for the patient and their family) |
| 5 | Report on home use and follow-up |
The MNREAD-J is a test that uses a Japanese reading chart with gradually changing character sizes to measure three indicators: maximum reading speed, critical print size, and reading acuity. It is used as a basis for selecting the magnification of low vision aids and for evaluating the effectiveness of rehabilitation.
The characteristics of the main low vision aids prescribed to patients with low vision are shown below.
| Low vision aid | Main use | Magnification/Features | Precautions |
|---|---|---|---|
| Desktop magnifier (loupe) | Reading and handwork at close range | Start at 3–4x | Use of a book stand recommended |
| Monocular telescope | Intermediate to distance viewing | 6–8x | For elementary school age and older. Requires training in focusing. |
| Low vision telescope (spectacle-mounted) | Near, distance, or bifocal | High magnification (3x or more possible) | Expensive; may cause psychological resistance |
| Video magnifier (CCTV) | Reading, writing, blackboard observation | Variable magnification | Requires learning magnification adjustment and black/white inversion |
| Light-blocking glasses | Reduction of photophobia | — | Short-wavelength light cut type |
| Typoscope | Reading aid | — | Useful for reduced contrast sensitivity |
A Cochrane systematic review found that electronic magnifiers tend to provide faster reading speeds than optical magnifiers, with stationary models outperforming head-mounted ones, but the quality of evidence is moderate to low, and device selection should be individualized based on patient characteristics and tasks (Virgili, 2018). A randomized crossover trial comparing portable electronic vision enhancement systems (p-EVES) with optical magnifiers found no difference in maximum reading speed, but p-EVES allowed access to smaller print, and about 70% of subjects preferred p-EVES for leisure reading (Taylor, 2017). A prospective randomized trial adding a stationary video magnifier to standard visual rehabilitation showed that the video magnifier group outperformed the control group in continuous text reading speed and spot reading tasks (Jackson, 2017).
Tinted glasses selectively cut short-wavelength blue light (below 500 nm), which is the main cause of glare. While sunglasses uniformly reduce the overall amount of reflected light, tinted glasses can reduce photophobia without significantly decreasing the amount of light entering the eye, thus minimizing changes in brightness perception.
Indications: Photophobia due to albinism, congenital aniridia, corneal diseases, or intraocular diseases.
Prescription process:
Main types of lenses:
Required items for tinted lens prescription opinion form:
Sunglasses uniformly reduce the amount of visible light, whereas tinted lenses selectively cut short-wavelength light (blue light below 500 nm), which is the main cause of glare. Therefore, tinted lenses do not significantly reduce the amount of light entering the eye, and the sensation of becoming too dark is minimal. Indications include photophobia due to albinism, congenital aniridia, corneal diseases, and intraocular diseases, and they are eligible for public subsidy as assistive devices.
The provision of assistive devices is implemented by municipalities based on the Comprehensive Support for Persons with Disabilities Act. The user’s share is 10% co-payment (however, high-income households are not eligible). In principle, one device per category is provided, but up to two devices may be provided if necessary for occupational or educational reasons (e.g., distance and near corrective glasses).
The following shows the maximum price and durable years for each category of assistive devices.
| Category | Type | Maximum price | Durable years |
|---|---|---|---|
| Eyeglasses (for correction) | Less than 6D | 16,900 yen | 4 years |
| Eyeglasses (for light shielding) | Apron type | 22,400 yen | 4 years |
| Eyeglasses (contact lenses) | 1 lens | 13,000 yen | 2 years |
| Eyeglasses (for low vision) | Spectacle type | 38,200 yen | 4 years |
| Eyeglasses (for amblyopia) | Focus-adjustable (monocular telescope) | 18,600 yen | — |
| Artificial eye | Ready-made | 17,900 yen | 2 years |
| Artificial eye | Custom-made | 86,900 yen | — |
| White cane | Standard | 2,700–4,200 yen | 2–5 years |
| White cane | Portable | 3,300–5,200 yen | 2–4 years |
Video magnifiers are provided not as assistive devices but as “daily living aids” through community-based support services. The provision criteria are as follows:
To apply for a subsidy for light-filtering glasses as an assistive device, a prescription opinion prepared by an ophthalmologist is required. The opinion must include the following three points: ① photophobia is present, ② there is no treatment more effective than light-filtering glasses for reducing photophobia, and ③ the effectiveness of wearing them is recognized. After that, submit an application for assistive device provision at the municipal counter, and purchase the glasses after receiving the approval.
When selecting assistive devices, it is recommended not to decide on a purchase immediately after prescription, but to have a trial period of 1 to 4 weeks to confirm suitability at home before purchasing or applying. During this period, users learn tips for use and evaluate usefulness in daily life.
To maximize the effectiveness of assistive devices, continuous guidance by an orthoptist is essential.
Prescribing assistive devices is not the end. Changes or additions should be considered based on changes in visual function, living environment, and skill improvement. Patients should report home usage at the next visit to identify issues and continue guidance. A multicenter prospective observational study in the US (28 facilities, 468 participants) found that about 47% of patients showed clinically meaningful improvement in visual ability after outpatient low vision rehabilitation, with a large effect size (Cohen d = 0.87), and the highest improvement rate (44%) was in reading (Goldstein, 2015). Regarding training after new magnification device prescription, a multicenter randomized controlled trial comparing telerehabilitation and in-person groups found no significant difference in reading ability improvement (mean 0.61 logits at 1 month, additional 0.44 logits by 4 months), indicating the usefulness of remote guidance (Bittner, 2024).
Yes, a trial is recommended. Especially for devices requiring skill acquisition such as video magnifiers and monocular telescopes, it is standard to have a loan trial of 1 to 4 weeks before deciding to purchase or apply. An orthoptist will guide the usage, and the final decision should be made after confirming actual ease of use at home.
補助具の給付基準・給付額は制度改正により変更される場合があるため、最新情報は市区町村の福祉窓口または厚生労働省の通知を参照されたい。
