Coping With Low Vision
If you think the only aids for people with low vision are books on tape and large-print playing cards, you're only seeing part of the picture. For the one out of 20 Americans with partial vision, there's everything from low-tech tricks, such as using contrasting colors for a placemat and plate, to high-tech devices capable of reading books aloud.
Most people with low vision have ]]>macular degeneration]]> . "The disease is so common in people over 70 that it used to be called ‘aging eyes'," says Robert Christiansen, MD, Chairman of the Vision Rehabilitation Committee of the American Academy of Ophthalmology.
Increasingly the term "vision rehabilitation" is replacing "low vision services." Christiansen says the focus today is not just on low vision devices but also on training patients to use their remaining sight and other senses so they can function as independently as possible and continue to enjoy things that give them pleasure.
When and How to Seek Help
The definition of low vision is vision impairment that interferes with everyday activities and is not correctable with glasses, contact lenses, surgery, or medicine. That's when a low vision specialist and/or low vision clinic can help. Your state's department of services for the visually impaired can tell you where to find them.
Why Visit a Low Vision Clinic
Too often, people buy first one magnifier, then another, only to become frustrated and give up trying to read, says Kathy Von Dollen, RN, coordinator of Low Vision Rehab at the University of Nebraska Medical Center.
"People must be taught to read with their remaining sight. Just using a magnifier won't let them read again," she says.
Patients who come to the clinic are first interviewed to see how partial sight has affected their lives and what their goals are for rehabilitation. One person may want to be able to cook and read the newspaper again, while another may want to attend college.
Patients are then examined by a doctor who can prescribe optical devices, such as magnifiers. During rehabilitation, patients can borrow devices from the clinic to practice with before purchasing their own.
Adapting Your Home
Patients and their families also learn about adaptations they can make at home. Lighting is a very important consideration. In general, someone with low vision needs more light evenly flooding a room and extra light in task areas. Glare, shadowy dark areas, and pools of light should be avoided. The type of bulb—halogen, fluorescent, or incandescent—can also make a difference. Simply using contrasting solid colors can improve a home's safety and enhance independence.
Some tips from the experts:
- Pour coffee into a white mug.
- Avoid glass plates and drinking glasses because they'll appear invisible.
- Wrap colored tape around pot handles.
- Put safety tape on edges of stairs; paint landings a color that contrasts with stairs.
- Set a dark colored chair against a light colored wall.
- Give away the coffee table or drape it with a brightly colored cloth.
- Float a bright yellow rubber duck in the bathtub to see when the tub is full.
Von Dollen says that one of the most essential adaptive devices is the felt tip pen, but not just any felt tip pen. She recommends the 20/20 pen by Sanford and says that it's easy to write with and easy to read, doesn't bleed through paper the way markers do, and has a white barrel and black cap so you can find it on any surface.
Common household items can even become adaptive devices: rubber bands, tape, sandpaper, craft paint, etc. For example, paint or tape can indicate an oven's 350 degree setting, and a rubber band can distinguish one pill bottle from another.
A host of devices are available from specialty catalogs. These include talking clocks, TV screen magnifiers, giant remote controls and guides, or templates for writing letters or checks. In addition, banks can provide oversized, large-print checks with raised lines. Von Dollen says these tools are very important because they enable people to handle their own financial affairs.
Some of the most popular optical aids are magnifiers that provide battery-powered illumination. Magnifiers come in hand-held models for reading and in hands-free models mounted on stands for doing needlework or other close work. Another magnification option is microscope spectacles.
Computer technology incorporated into optical aids is a new trend. Self-focusing telescopes worn like eyeglasses adjust automatically for close or distance vision. For example, as a student looks from a chalkboard to his notes, a computer chip adjusts the focus accordingly.
Several optical readers, some of them portable, are also available. One type uses closed circuit TV technology (CCTV), but that doesn't mean it needs special wiring or network hook-ups. Just plug it in, and set a book or photo or letter on the platform, and a TV camera projects the magnified image onto a screen. There are also readers that can connect to a computer using special software, and even CCTV goggles.
Machines that can read text aloud are now also possible using a computer, scanner, and speech recognition software. Prices are continually falling and the quality of synthesized speech improves.
For computer users, magnified type on the monitor is just one option. You can also have the computer read back what you type and respond to voice or keyboard commands.
If you have macular degeneration, evidence suggests that the right mixture of ]]>supplements]]> may help. According to a large study published in the prestigious journal Archives of Ophthalmology , a combination of zinc (80g), copper (2mg), vitamin C (500 mg), vitamin E (400 IU), and beta-carotene ( 15 mg) taken daily can slow the progression of the disease. A smaller study published in Optometry found that use of the supplement lutein at 10 mg daily might even help reverse symptoms of macular degeneration. Lutein might also help people with cataracts. However, check with your eye doctor and your primary doctor before starting any supplement.
Paying for Services and Devices
Although Medicare coverage for vision rehabilitation services and devices is spotty at best and more often non-existent, there are sources for help."Veterans can get help paying for devices from the Veterans Administration," says Von Dollen. "And state agencies for the blind or visually impaired will help."
Christiansen hopes that the reimbursement guidelines his committee helped to develop will improve Medicare coverage and establish national policies to eliminate the inequities that he says currently exist. "Whether you live in Omaha or Boston, you should have the same chance for reimbursement," he says.
American Academy of Ophthalmology
National Eye Institute
Canadian Association of Optometrists
Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS Report no.8. Arch Ophthalmol . 2001;119:1417–1436.
Flax M, Golembrewski D, McCaulley B. Coping With Low Vision . Singular Publishing Group; 1993.
National Eye Institute. Available at: http://www.nei.nih.gov
Neal H. Low Vision: What You Can Do To Preserve and Even Enhance Your Usable Sight . Simon and Schuster; 1990.
Olmedilla B, Granado F, Blanco I, et al. Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study. Nutrition . 2003;19:21–24.
Richer S, Stiles W, Statkute L, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry . 2004;75:216-30.
Last reviewed November 2009 by ]]>Brian Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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