The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants’ narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.