What do you do when a randomized controlled trial finds no benefit from a clinical practice you've used with success for years? Host Erika Andersen Ko, certified low vision therapist, shares how the aftermath of the EFFECT study on eccentric viewing training led her to Psychologically Informed Practice, and what she hopes the framework can do for the field of blindness and low vision.

This is the first episode of Practitioner Diaries, a recurring format that goes behind the scenes with a low vision practitioner working on implementing a specific strategy over time. Erika goes first.

You'll hear Erika Andersen Ko's insights on:

• Why the EFFECT study protocol looked so different from clinical practice, and why the study was needed anyway
• Why “eccentric viewing training” claims a mechanism the evidence cannot support, but that doesn’t invalidate the need for individualized support for central field loss
• What the difference between the biomedical and biopsychosocial models of rehabilitation looks like in the context of support for central field loss
• How Psychologically Informed Practice, a framework from rehabilitation medicine, organizes psychosocial support across care pathways and can help the field of blindness and low vision shift more fully towards a biopsychosocial model of care

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.

Host Erika Andersen Ko talks with Dr. Donald Fletcher, retinal disease ophthalmologist and longtime advocate for team-based low vision care, about what nearly 40 years and 35,000 low vision patients have taught him about multidisciplinary vision rehabilitation, clinical humility, and professional growth.

In this episode:

• Why Dr. Fletcher calls himself "a salesperson for the team" and uses his physician credibility to elevate the work of the rehabilitation team
• How challenging his own clinical assumptions about age-related macular degeneration and mobility changed his practice
• How the Low Vision Rehab Study Group brings clinicians and researchers together to share difficult cases and fresh ideas
• Dr. Fletcher's advice for clinicians who want to grow

More from This Episode

For timestamps, references, resources, and more, visit the podcast page: lowvisionbeyondtheclinic.com/podcast.

Connect with the Podcast

Have a story of clinical growth—a mentoring experience, conversation, or piece of research that helped you rethink your practice? Share it with Erika through the contact form at lowvisionbeyondtheclinic.com/contact.

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

Host Erika Andersen Ko talks with Dr. Michael Crossland, optometrist, professor, researcher, and one of the lead authors of the EFFECT study—the first randomized controlled trial evaluating eccentric viewing training.

They examine the study's unexpected findings and what they may mean for clinical practice and patient selection.

In this episode:

• The role of therapeutic alliance and "connective labor" in outcomes
• Why the EFFECT study found no significant improvements in any group
• How clinicians are rethinking selection criteria for eccentric viewing training
• The link between fixation stability and real-world functional tasks

More from This Episode

For timestamps, references, resources, and more, visit the podcast page: lowvisionbeyondtheclinic.com/podcast

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.