You’re losing your vision and there’s nothing more to be done

It’s devastating to hear that you’re losing your vision. Worse yet is being told, “There’s nothing more to be done.” Unfortunately, millions of Americans are given this sad news every year, and although medical treatment may not restore one’s vision, low vision rehabilitation can often help to increase visual function.

What is low vision rehabilitation?

Low vision rehabilitation refers to a field of optometry that focuses on making use of the remaining vision that you have. Often when patients lose vision, they do not become entirely blind, but rather lose only portions of their vision. For example, a patient with macular degeneration will lose their central vision whereas a patient who has suffered a stroke might lose all vision on their right visual field. If you or someone you know is suffering from low vision, it’s best to refer them to a low vision optometrist who can spend time uncovering the specific needs of the patient, and subsequently provide a thorough evaluation to determine what aids are best suited to meet those needs. To read more on low vision rehabilitation, click here.

Photo Courtesy of Optelec

Photo Courtesy of Optelec

Beyond having a low vision evaluation, there are a number of tips I often give my patients, which play an equally important role in improving vision function:

1. Increase lighting and use task lights: Lighting is crucial to seeing better. Even those of us who do not suffer from eye diseases know that we see better with brighter lighting. Patients who have eye diseases often have reduced contrast sensitivity, which means they have more difficulty seeing lighter colored objects. Increasing lighting will help with this. I often advise patients to read under a desk lamp and to replace any non-working light bulbs. Consider flashlights throughout the home for shining into pantries or closets that are more dimly lit. Dark hallways may need lighting for night trips to the restroom. Portable flashlights are also helpful for menus (magnifiers with illumination are even better). You may need to experiment with various color lights to determine which gives best illumination without causing too much glare.

2. Increase contrast: As mentioned earlier, poor contrast sensitivity will affect one’s ability to see lighter colored objects. A method for improving this

Photo Courtesy of ies.org

Photo Courtesy of ies.org

is to pair dark colored objects alongside lighter colored ones. For example, when plating meals, consider serving greens and beef on a white plate, and potatoes, rice and fish on a dark plate. Also, place a dark rug against lighter colored floors at the bottom of stairs to indicate the last of the steps. Write or print in dark bold markers on white paper and increase contrast.

3. Increase size: This option is self-explanatory. The larger it is, the easier it would be to see, and the closer you are to an object, the larger it will be. Therefore, if viewing television is difficult, sit closer or invest in a larger television. Some of my patients sit as close as to 2 feet away from the television. Optics plays a tricky part in the distance change though, so you may need your optometrist to help with glasses for a particular viewing distance. Increase computer monitor sizes or increase screen magnification. Some of my patients prefer two monitors, one to display the magnified image and the other to scroll around. For printed materials, increase the size of fonts and limit visual disturbance by avoiding irrelevant images and words. Your bank can also help by providing large print checks.

4. Make use of your tactile sense: Use raised dot stickers on commonly used items. For example, place one raised dot on the low heat setting on the stove dial and two raised dots on medium. Or place dots on commonly used microwave buttons. Occupational therapists have been able to help low vision patients significantly in this area.

5. Read at the right distance: Glasses are commonly prescribed for a certain viewing distance. For example, driving glasses are for 20 feet and further. Reading glasses are typically clearest around 16 inches. If you have low vision however, you will probably need a stronger pair of reading glasses, which may require you to read at ten inches or closer. If you are unsure, ask your optometrist. A tip that often works is to hold your reading material up close against your nose and find a word or letter to focus on. Bring the reading material out until it becomes clear and this will be the correct distance to read at. Any closer or further than that and the print will not be as clear.

6. Be patient and rely on others: I know this is easier said than done, but patients who do best with limited vision are those who understand that they need to relearn how to “see”. This requires adequate lighting, contrast, size, and viewing distance, which essentially depends upon one’s patience. Having a strong support system and relying on others are key to improving one’s function and outlook. Join a support group, see a counselor or confide in a trusted friend or family member. There are numerous support groups, some often found in a community senior center.

Losing one’s vision is a devastating, life-altering experience, but it’s not entirely hopeless. A recent blog article by Dr. Lisa Weiss, OD has some great resources for those suffering from vision loss. A great place to begin is to see a low vision optometrist. Check with the California Optometric Association’s http://www.eyehelp.org to find one.

 

~ Cindy P. Wang, OD, FAAO
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

What is low vision?

In this blog article, we’ve asked our guest writer, Gary Asano, OD, Chair of the California Optometric Association’s Low Vision Rehabilitation Section to address common concerns of patients suffering from disease-related debilitating vision.

What is Low Vision?

When you have reduced vision as a result of an eye disease, you can be classified as having low vision.  Those with low vision usually complain of difficulty reading small text, recognizing faces or reading street signs.  An optometrist with a sub-specialty in low vision seeks to maximize the best functioning area of the eye.  This can be done with the use of low vision aids and devices.

MacDegI have just been treated for “wet” macular degeneration by a retinal specialist who said that my vision has now improved from the original 20/200 to 20/60. But my new pair of glasses isn’t allowing me to see as clearly as I would like. Why can’t my vision be corrected to 20/20 with regular glasses? Was my eye treatment/surgery not successful?

When the retina (the part of the eye that receives visual information) is distorted as a result of an eye disease, treatment can improve your vision, but will not restore it to normal. Therefore, you may notice that straight lines may still appear wavy, or that you have dark spots in your vision. Glasses can improve the vision, but will not be able to resolve any distortion or dimming of vision you may already be experiencing. This is where a consultation with a low vision optometrist is helpful to determine what adaptations and aids besides glasses will help you to function better.

“But I have never heard of a low vision optometrist. What can you do to help me with how I see every day?”

dangerous roadsA visit with a low vision optometrist will begin with a complete history of your visual problems and a discussion of your visual goals. For example, your goal may be to read price tags or to view photos of family members. From there, your doctor will determine the low vision aids most appropriate for you to accomplish these goals. The aids can range from standard spectacles to magnifiers and telescopes. Some patients will function better with a particular tint in their lenses to reduce debilitating glare while other patients would benefit simply from increased lighting or working with an occupational therapist to make changes to compensate for visual deficits. Low vision specialists can utilize telescopes and even electronic and computerized magnification aids to help you get through your day. The number of these devices is growing and the timing could not be better with more and more people needing help.

Counseling is also often needed for patients who are grieving and cannot be easily helped at first. We always recommend that you bring along a supportive friend or family member to the evaluation so that we can address all areas of difficulty.

There are few low vision specialists to meet the demand –  it has been estimated that there are only 150 experts in low vision in the entire U.S.  Fortunately, the California Optometric Association Low Vision Rehabilitation Section has 49 optometrists who have a special interest in this field and are ready and willing to help you!

~Gary Asano, OD
Low Vision Specialist