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

Color blindness – the causes and the effects

When we think of someone being color blind, we may think that he sees the world in black and white, or shades of gray.  But that is extremely rare.  In fact, almost 8% of men have some form of color vision deficiency where certain colors are more difficult to distinguish, or do not appear as vivid as other colors.  (Perhaps that explains the questionable wardrobe choices my husband sometimes makes.)

What causes it?

Most cases of color vision deficiency are inherited and passed down from the mom.  The photoreceptors in the retina responsible for color are called cones.  Each cone is sensitive to a certain color, in particular, red, green or blue.  If a person has inherited a recessive gene that causes one or more of the cones to be absent or to not function properly, then he will have abnormal color perception.

Photo courtesy of entirelysubjective on Flickr

Photo courtesy of entirelysubjective on Flickr

Some cases of color vision deficiency are acquired later in life as a result of a disease.  More common causative diseases are glaucoma, macular degeneration, and diabetes.  If you notice a change in your color vision, make sure to be evaluated by your optometrist. For eyecare providers, we tend to distinguish color vision deficiency into two broad categories.  Red-green and blue-yellow.  Red-green is inherited and the most common deficiency.  Those with this defect can still see red and green, but the colors are more difficult to distinguish and they may not appear as vivid as to the normal eye.  For example, red and green signal lights may look the same.  One may appear brighter but the lights may both look white.  (For this reason, I’m not a fan of the horizontal traffic lights in some smaller towns.)  Most people who have color vision deficiency have a mild form and are not disabled by this condition.

The other form of color deficiency is blue-yellow where patients have a difficult time distinguishing blue from green or yellow from violet.  This is less common and is usually caused by certain eye diseases.  Unfortunately, for many of these patients, color deficiency is just one visual problem among others.  These patients may also suffer from dimming of vision or distortion of vision.  Often times, bright lighting is helpful for these patients, and occasionally tinted lenses. 

How can I help someone that’s color deficient?

Of course, a comprehensive eye examination is important to rule out any causes of color vision deficiency other than genetics.  This also helps to determine the severity.  Most color deficient individuals carry on like normal without it interfering with their daily lives.  A helpful tip would be to not use the colors red and green as markers because the two colors may appear very similar.  Blue and red will be easier to distinguish.  Unfortunately, those with color vision deficiency should avoid careers that require distinguishing color differences such as airplane pilots, paint mixer, interior designer, etc.

Recently, new developments in tinted lenses have been able to allow some color vision deficient patients be able to see colors they have never seen before.  Sounds promising!

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

Quick Tips for Sports Vision

To do well in sports, you need to have your eyes working at the top of their game. Here are a few quick tips to help you or your athlete perform better:

  • Make sure you have a proper prescription on, whether it is contact lenses or glasses. Having your vision dialed in correctly is the most important step to get your eyes working their best.
  • Be sure to protect your eyes! Polycarbonate or other protective plastic lenses can keep your eyes protected while you play as well as keeping dust or wind from getting in your eyes while you play the sports you love. This table can help you determine which types of eye protection are best for the sport you play. (http://www.allaboutvision.com/sportsvision/eyewear.htm )

    Photo Courtesy of Morgan Burke on Flickr

    Photo Courtesy of Morgan Burke on Flickr

  • Consider color filters for your field of play. Certain types of filters or tints can increase your contrast sensitivity and thereby increase your reaction times. Allaboutvision.com has an excellent table for different tints to help in different sports (http://www.allaboutvision.com/sportsvision/lens-tints-chart.htm ). Remember, the faster you can recognize that curve ball, the easier it will be to adjust your swing!

~Ranjeet S. Bajwa, OD