Access to mentorship in low vision rehabilitation isn't always readily available. Mentorship from afar can make a lifelong impact on a clinician's practice despite a lack of proximity.

In this episode of Low Vision Beyond the Clinic, host Erika Andersen Ko sits down with retinal disease ophthalmologist Dr. Donald Fletcher to talk about what nearly 40 years and 35,000 low vision patients have taught him about multidisciplinary vision rehabilitation, clinical humility, and asking thoughtful questions.

Dr. Fletcher calls himself "a salesperson for the team": using his physician credibility to elevate the work of occupational therapists, orientation and mobility specialists, physical therapists, vision rehabilitation counselors, and even Buddy the security guard at the front desk. His humility extends to challenging his own clinical assumptions, including once incorrectly believing that patients with age-related macular degeneration didn't have mobility problems; a belief overturned through conversations with orientation and mobility specialists at the Smith-Kettlewell Low Vision Rehab Study Group.

Dr. Fletcher's advice to any clinician who wants to grow: ask thoughtful questions, and make friends with a researcher.

A conversation for low vision practitioners, vision rehabilitation therapists, occupational therapists, orientation and mobility specialists, ophthalmologists, optometrists, and anyone interested in multidisciplinary approaches to age-related macular degeneration and vision loss.

TIMESTAMPS

TOPICS

00:05 "If I make it into heaven, it's because I push the team approach"

01:05 Welcome and host introduction

01:35 Thank you to CAER for the relaunch microgrant

02:14 A 2006 Envision moment: the ruler, the Likert scale, and an unknowing mentor from afar

04:32 40 years, 35,000 patients, and the friend who first suggested the team approach

07:30 "My role is to be a salesperson for the team"

08:38 Buddy the security guard and why first contact matters

10:26 An assumption Dr. Fletcher was wrong about: AMD and mobility

12:18 Trekking poles, AMD, and meeting clients where they are

14:11 Origins of the Smith-Kettlewell Low Vision Rehab Study Group

16:12 "What have you learned this past year?"—the democratizing opener

17:52 Priya Parker, gatherings, and designing for the outcome

19:17 Spicy discussions, bridging clinicians and researchers

21:12 "Make friends with a researcher"—and Art Jampolsky on asking the right questions

24:58 A pitch for "So What" groups at the Envision Conference

25:42 Erika's reflections: servant leadership and what's ahead this season

Thanks to Dr. Donald Fletcher for being on the show!

Dr. Fletcher is an acclaimed ophthalmologist and longtime advocate for team-based low vision care, currently practicing at Envision in Wichita, Kansas. He co-founded and continues to lead the Low Vision Rehab Study Group at the Smith-Kettlewell Eye Research Institute, where clinicians and researchers gather each February to share difficult cases, fresh ideas, and the occasional spicy debate. After nearly 40 years and more than 35,000 patients, he remains curious, humble, and impactful.

Thank you to CAER:

A big thank you to CAER, the Colorado chapter of the Association for Education and Rehabilitation of the Blind and Visually Impaired, for the microgrant that supported the relaunch of this podcast. A small grant with a meaningful message: asking questions about how we grow as practitioners is inherently valuable.

Envision (Wichita, Kansas) One of Dr. Fletcher’s clinical homes and an example of the team-based low vision rehabilitation model discussed throughout the episode.

The Envision Conference The annual interdisciplinary low vision conference, where Erika is co-facilitating a “So What” small-group discussion with Dr. Fletcher on central field loss. The 2026 conference includes a dedicated small-group track with CE, plus virtual gatherings continuing post-conference.

Smith-Kettlewell Eye Research Institute Home of the Low Vision Rehab Study Group Dr. Fletcher co-founded with Drs. Ron Cole and August Colenbrander roughly 20 years ago.

The Art of Gathering Parker, P. (2018). The Art of Gathering: How We Meet and Why It Matters. Riverhead Books. Referenced for its approach to designing meaningful, intentional gatherings—starting with the outcome you want and working backward.

The EFFECT Study Rubin, G. S., Crossland, M. D., et al. (2023). Eccentric Viewing Training for Age-Related Macular Disease: Results of a Randomized Controlled Trial. Ophthalmology Science, 4(2), 100422. The trial that sparked the “spicy discussions” at the study group and helped catalyze Erika’s evolving approach to central field loss—covered in the prior pilot episode interviewing Dr. Michael Crossland.

Note: Several people referenced in conversation—Stan (Dan) Wineapple, Drs. Ron Cole and August Colenbrander, Dr. Walter Wittich, and Smith-Kettlewell founder Art Jampolsky (“the key to good research is asking the right questions”)—are part of Dr. Fletcher’s personal and professional history rather than linked resources.

Have a story of clinical growth—a piece of research or an insight that helped you pivot in your practice? Erika would love to hear it. Reach her through the contact form at lowvisionbeyondtheclinic.com.

If this episode was useful, share it with a colleague, send Erika a note, or write a review.

Is eccentric viewing training still a valuable tool in low vision rehabilitation?

Today’s episode explores the findings of the EFFECT study—the first randomized control trial evaluating eccentric viewing training. Erika Andersen Ko sits down with Dr. Michael Crossland, one of the study’s lead authors, to unpack the surprising results, why no significant outcomes were found across groups, and what it means for clinical practice. They also delve into the broader implications of progressive vision loss, therapeutic alliance, and how we can better identify patients who will truly benefit from this intervention.

Dr. Michael Crossland is a prolific researcher, optometrist, and professor who brings both clinical wisdom and warmth to this discussion. When not leading major studies, he’s walking through London’s parks listening to 99% Invisible after school drop-off.

Topics explored in this episode:

[07:50] The structure and goals of the EFFECT (Eccentric Fixation From Enhanced Clinical Training) study

[14:30] What PRL and TRL training involve—and how they differ

[23:10] Why the study showed no significant improvements in any group

[11:15] The role of therapeutic alliance and “connective labor” in outcomes

[30:10] Mental health challenges tied to progressive vision loss

[28:00] How clinicians are rethinking selection criteria for EV training

[21:55] The link between fixation stability and real-world functional tasks

[44:30] New directions in low vision research and digital accessibility tools

Thanks to Dr. Michael Crossland for being on the show!

Learn more about his research: https://profiles.ucl.ac.uk/6705-michael-crossland/publications

Erika Andersen Ko is a certified Low Vision Therapist with over 20 years of experience. A recognized leader in the low vision community, she has contributed through speaking, writing, and national leadership roles. Her work emphasizes interdisciplinary collaboration with professionals in optometry, ophthalmology, occupational therapy, orientation and mobility, and education. Her areas of expertise include low vision driving, PRL training, optical devices, wearable tech, driving retirement, and the impact of vision loss on mental health.

To learn more about Erika’s work, visit her Low Vision Beyond the Clinic website: https://www.lowvisionbeyondtheclinic.com/

A message from Erika:

“I have helped thousands of people with vision loss and visual impairment do more in their daily lives and feel more supported, hopeful, and confident. My coaching services combine evidence-based and holistic practices to create a safe space to heal from grief and loss while learning the skills needed to live well with low vision and making room for joy.”

Produced by Story On Media - https://www.storyon.co/

Welcome to Low Vision Beyond the Clinic, the biweekly podcast for low vision professionals seeking nuanced discussions on clinical care.

Hosted by Erika Andersen Ko, a dedicated low vision therapist, this show goes beyond routine care to explore the heart of modern vision rehabilitation. Each episode brings you thoughtful conversations on interdisciplinary collaboration, mental health integration, and the evolving tools and practices shaping the field.

You’ll hear from leading researchers, clinicians, and individuals with lived experience — all sharing insights that challenge, inform, and inspire.

Plus, connect beyond the audio through our virtual and in-person gatherings, and be part of a growing community focused on holistic, impactful care.

Subscribe today and visit LowVisionBeyondTheClinic.com to join the community.