Technology for Vision

In just over 10 years, the technology that has been developed to help people see has been amazing. While medical research continues to move forward to find treatments and potential cures of the future, those with the technological know-how have created ways for people to see NOW. Here is a very brief look at some of these technologies.

Technology for Vision

Second Sight and the Argus II

One of the pioneers in the field of vision technology, Second Sight started in 1998, and they are now currently producing the second version of their device. It is made up of two parts:

The Implant: Requiring a 4-hour surgery, a device is surgically implanted in the eye on top of the retina, and along the outside of the eye. It includes an antenna, an electronics case, and an electrode array.
technology for vision
The External Equipment: It includes glasses, a video processing unit (VPU) and a cable.
technology for vision
In a healthy eye, photoreceptors (rods and cones) in the retina convert light into tiny electrochemical impulses that are sent to the brain, where they are translated into images. If the photoreceptors don’t function correctly your brain can’t produce images. The Argus II Retinal Prosthesis System (“Argus II”) is designed to bypass the damaged photoreceptors.

A miniature video camera housed in the patient’s glasses captures an object. The video is sent to the small VPU that the patient wears. It is then processed and transmitted back to the glasses via a cable. This information is sent wirelessly to the antenna in the implant and signals are sent to the electrode array, which emits small pulses of electricity. These pulses bypass the damaged photoreceptors and stimulate the retina’s remaining cells. The visual information is then sent to the brain to create the perception of patterns of light which patients can learn to interpret as objects. Significant training is required to use the system.

The implant is designed to give you a visual field of about 3.5 inches by 6.5 inches at arm’s length; however, the actual size of light you see may be larger or smaller. Since it is strictly based on light, there is no color perception.


Another system that relies upon the user wearing glasses is eSight which started in 2012. While the Argus II is for people that have very little or no vision, the eSight is for people with low vision or that are legally blind. eSight glasses require the individual to have a certain degree of sight remaining to be successful. If you can only see shadows you probably don’t have enough remaining sight for the glasses to work for them.

This system is also composed of two parts, but it does not require any surgery:

The Headset: It contains a high-definition camera, OLED screens, and the ability to capture and display a real-time video feed. The headset is mounted on carrier frames, which enables eSight’s “bioptic tilt” feature so the user can shift between viewing modes and engage their peripheral vision.
technology for vision
The Controller: A small, lightweight processing unit that adjusts every pixel of the video in real time. It also houses the battery, which powers eSight.
technology for vision
Because most legally blind individuals retain limited sight concentrated in their peripheral vision, their eyes do not receive an adequate signal for the brain to recognize what is being seen. This can create blind spots, blurriness, inability to detect contrast, and other symptoms that reduce vision. eSight is able to significantly corrects these issues by using a high-speed camera, video processing software, a computer processor and the high quality video OLED screens to project a real-time image on the inside of the glasses, allowing people to see.

eSight requires considerably less training than the Argus II. It is intuitive, but as with learning anything new, the more you use it the easier it is to use. It is best to practice on a daily basis.

CentraSight from VisionCare Ophthalmic Technologies

The CentraSight uses a tiny telescope that is implanted inside the eye. The telescope implant was created to improve for people with end-stage age-related macular degeneration (AMD). The tiny telescope – about the size of a pea – is implanted inside one eye, behind the iris and is barely noticeable in your eye.
technology for vision
In end-stage AMD, the macula, where central vision occurs, is degenerated in both eyes without any healthy macular areas left for detailed central vision. There is no way for the individual to see around the central blind spot in their vision. It does not affect peripheral vision, which is blurry so you can’t use it to read, but you can use it to detect objects and movement.
technology for vision
Once implanted inside the eye, the tiny telescope works like a telephoto lens of a camera. It magnifies images onto the healthy areas of the retina to help improve central vision. Because the image is enlarged it reduces the effect the blind spot has on central vision. The surgical procedure is only performed on one eye because the peripheral (side) vision will be restricted in the eye with the telescope implant. This means the peripheral vision in the untreated eye will need to work in conjunction with the implanted eye. “A person uses the eye with the telescope implant for detailed central vision (such as reading “WALK” signs at a crosswalk). The other eye is used for peripheral vision (such as checking to see if cars are coming from the side).

Training with a CentraSight low vision specialist will be needed to develop the skills you need to use your new vision, such as how to switch your viewing back and forth between the eye with the telescope implant and the eye without the implant. You will still need to wear eye glasses and may need to use a hand-held magnifier with the telescope-implanted eye to read or see fine details clearly. However, in general, less magnification will be needed.

Ocumetics Bionic Lens

After eight years of research, a Canadian optometrist, Dr. Gareth Webb, has invented a tiny bionic lens that is able to enhance eyesight so that an individual can see three times better than the sharpness of 20/20 vision. The Ocumetics Bionic Lens is a button-shaped lens that can be injected into the eye in eight minutes in a procedure identical to cataract surgery.

As people get older, the lens inside the human eye becomes cloudy over time, causing blurred vision, known as cataracts. The Bionic Lens would be inserted, replacing the person’s clouded lens, similar to the intraocular lenses currently used in cataract surgery.

The Bionic Lens features a patented Ocumetics camera optics system, which is a tiny bio-mechanical camera that is able to shift focus from a close range object to optical infinity – as far as the eye can see – much faster than the human brain.

This device is still not available to the public, but Webb is hopeful that clinical trials will start soon. Depending on regulatory processes in each country, Webb hopes the Bionic Lens will be commercially available by 2017.


Susan DeRemerSusan DeRemer, CFRE
Vice President of Devlopment
Discovery Eye Foundation

The Importance of An Eye Exam

Why You Need An Eye Exam

The end of the year is fast approaching – when was the last time you had an eye exam? Was it a comprehensive eye exam?
eye exam
To keep your eyes healthy and maintain your vision, the American Optometric Association (AOA) recommends a comprehensive eye exam every two years for adults ages 18 to 60, and annual exams for people age 61 and older. However, if you have a family history of eye disease (glaucoma, macular degeneration, etc.), diabetes or high blood pressure, or have had an eye injury or surgery, you should have a comprehensive exam every year, unless otherwise indicated by your doctor.
Also, adults who wear contact lenses should have annual eye exams.

An important part of the comprehensive eye exam is the dilated eye exam to look inside your eye. Drops are placed in each eye to widen the pupil and allow more light to enter the eye. This gives your doctor a clear view of important tissues at the back of the eye, including the retina, the macula, and the optic nerve. This allows for early diagnosis of sight-threatening eye diseases like age-related macular degeneration, diabetic retinopathy, glaucoma, etc.

To better understand the importance of the dilated eye exam, here is a video from the National Eye Institute (NE) that explains what to expect.

At the end of your comprehensive eye exam your doctor should raise any concerns he has with you. But it is up to you to be prepared to react and ask questions for peace of mind and to help save your vision.

Questions To Ask After Your Eye Exam

It is always important to know if anything about your eyes have changed since your last visit. If the doctor says no, then the only thing you need to know is when they want to see you again.

If the doctor says the have been some minor changes, you need to know what questions to ask, such as:

  • Is my condition stable, or can I lose more sight?
  • What new symptoms should I watch out for?
  • Is there anything I can do to improve or help my vision?
  • When is the next time you want to see me?

If the doctor sees a marked change in your vision or give you a diagnosis of eye disease, you would want to ask:

  • Are there treatments for my eye disease?
  • When should I start treatment and how long will it last?
  • What are the benefits of this treatment and how successful is it?
  • What are the risks and possible side effects associated with this treatment?
  • Are there any foods, medications, or activities I should avoid while I am undergoing this treatment?
  • If I need to take medication, what should I do if I miss a dose or have a reaction?
  • Are there any other treatments available?
  • Will I need more tests necessary later?
  • How often should I schedule follow-up visits? Should I be monitored on a regular basis?
  • Am I still safe to drive?

Your vision is a terrible thing to lose, but with proper diet, exercise and no smoking, along with regularly scheduled eye exams, you improve your chances of maintaining your sight.


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Diabetic Eye Diseases

November is National Diabetes Month. Diabetes is a controllable condition that is growing in the US. In adults 20 and older more than one in 10 people have diabetes, while in seniors (65 and older) that number increases to more than one in four.

Diabetic Eye Diseases

One of the eye diseases that can result from diabetes is diabetic retinopathy, which will affect approximately 11 million people by 2030. Check the infographic below to learn more about diabetic eye diseases.

diabetic eye diseases


NEI LogoCourtesy of the National Eye Institute (NEI), a part of NIH.

Increased Awareness for Saving Vision

The following is a survey done by Essilor (a French company that produces ophthalmic lenses along with ophthalmic optical equipment) and a large marketing research firm in the UK, YouGov. While the focus in on people living in the UK, the results would probably be similar to the US population. Even with increased access to the Internet, many people are still not aware of the risks associated with eye disease and what they can do to help retain their vision. Increased awareness of informational resources are important for saving vision.
saving vision
There are a number of websites with easy to understand information about taking care of your vision that I have listed under Resources to Help Save Vision at the bottom of this article. And while there are eye diseases that are hereditary, you can slow the onset and progression by making good lifestyle choices about smoking, diet and exercise. Your eye care specialist is also an excellent source of information about what you can to do reduce your risk of vision loss, at any age.

Increased Awareness for Saving Vision

A YouGov poll conducted with Essilor reveals that most Britons are unaware of damage to their eyes by surrounding objects, activities, and devices. This widespread lack of awareness means fewer people seeking methods of prevention and avoidance, and for those that are aware of risks, most are not informed of existing preventative measures.

The poll has shown* that many British people remain uninformed about the various ways in which eyes are damaged by common daily factors, despite evidence that eye health is affected by blue light, UV rays (reflected from common surfaces), diet, obesity, and smoking.
Of the 2,096 people polled, the percentage of respondents aware of the link between known factors affecting and eye health were:

  • Poor diet – 59%
  • Obesity – 35%
  • Smoking tobacco – 36%
  • UV light, not just direct from the sun but reflected off shiny surfaces – 54%
  • Blue light from low energy lightbulbs and electronic screens – 29%

More than one in ten people were completely unaware that any of these factors could affect your eyesight at all.
saving vision
72% of respondents own or wear prescription glasses but only 28% knew that there were lenses available (for both prescription and non-prescription glasses) to protect against some of these factors; specifically, blue light from electronic devices and low energy light bulbs, and UV light from direct sunlight and reflective surfaces.

76% admitted they haven’t heard of E-SPF ratings – the grade given to lenses to show the level of protection they offer against UV.

Just 13% have lenses with protection from direct and reflected UV light, and only 2% have protection from blue light (from screens, devices, and low energy bulbs).

Poll results showed that younger people were most aware of the dangers of UV and blue light, yet least aware of how smoking tobacco and obesity can affect your eye health. Within economic sectors, middle to high income people are more aware of the effects of smoking & obesity on eyesight than those with low income –

  • 39% of people with middle to high income compared to 33% of people with low income are aware of the impact of smoking tobacco.
  • 38% of people with middle to high income compared to 31% of people with low income are aware of the impact of obesity.

Awareness of the impacts of smoking and obesity on eye health is significantly higher in Scotland (47% & 49% respectively) than anywhere else in the UK (35% & 33% in England and 40% & 38% in Wales).
Essilor’s Professional Relations Manager, Andy Hepworth, has commented: “The lack of awareness about these common risks to people’s eyes is concerning. Not only would many more glasses wearers be better protected, but also many people who do not wear glasses would likely take precautions too, if made aware of the dangers and the existence of non-prescription protective lenses.”

To see the full results of the poll, please visit the Essilor website.

For more information on the protection offered from blue light and UV through specialist lens coatings, for both prescriptions and non-prescription glasses, please see here for UV & Blue Light Protection options.

*All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,096 adults. Fieldwork was undertaken between 21st and 24th August 2015. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

Resources To Help Save Vision
All About Vision
Macular Degeneration Partnership
National Eye Institute (NEI)
Prevent Blindness


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Vision Loss and Depression

On Tuesday, September 29, 2015, the National Eye Institute (NEI) hosted a Twitter chat on vision loss and depression. Here are some highlights of that discussion, along with some great resources to learn more about dealing with vision loss and depression.
vision loss and depression

  • Many studies show that people with vision loss or low vision are at risk for depression, although not everyone with vision loss gets depressed.

  • A person with low vision is defined as someone who finds it difficult to do daily tasks even with regular glasses, contacts, medications or surgery.

  • The number of Americans with low vision will increase over 70% by 2030. Broken down by ethnicity, African Americans with low vision will increase 93% and Hispanics with low vision will increase 190% during the same period. This is due to the rapidly aging Boomer population. 88% of Americans with low vision are age 65 and older.

  • Symptoms of depression include persistent feelings of sadness, anxiety, irritability and fatigue. It is a common and serious illness that interferes with daily life. Each year, about 6.7% of American adults experience major depressive disorder. Women and men experience depression differently, with women 70% more likely to experience depression than men.

  • People 65 and older are at particular risk for developing serious depression related to vision loss and yet it is often underdiagnosed and undertreated. Older adults may have other, less obvious symptoms of depression or they may not be willing to talk about their feelings. Many overlooked because sadness is not their main symptom. It is important to remember that while depression is a common problem among older adults, it is not a normal part of aging.

  • An estimated 29-58% of those who suffer significant vision loss have major depressive disorder one year later. People with vision loss are 2x more likely to be depressed than someone without vision loss. Depression can be very disabling and may reduce the effectiveness of low vision rehabilitation interventions.

  • A recent study confirmed age-related macular degeneration (AMD) is a big contributor to depression risk, as it accounts for about 45% of low vision cases.

  • Older adults w/ vision loss are also 3X more likely to report difficulty in 1) walking, 2) managing medications, and 3) preparing meals. In fact about 39% of people with severe vision loss experience activities of daily living ADL limitations, compared to 7% of those with better vision. ADLs include eating, bathing, dressing, toileting, walking and continence.

  • A link between depression and vision loss was also found in people as young as 20 according to a recent study. It looked at over 10,000 adults in the US and found they were approximately 2x more likely to be depressed.

  • A decline in vision can also be associated with lower emotional, physical, and social functioning. To help those with low vision avoid depression it is important that they remain active and engaged in the world around them. And while people may become depressed because of vision loss, other causes of depression may also be present.

  • An integrated approach to depression management in older adults with impaired vision may be the best course of action. Behavioral activation helps people recognize that loss of the activities they enjoyed that have led to depression and encourages them to find ways to re-engage with these activities. After 4 months, behavioral activation reduced the risk of depression by 50% compared to the control group. Behavioral activation can be used alone, or as part of psychotherapy called cognitive-behavioral therapy (CBT).

  • Cognitive behavioral therapy (CBT) helps people with depression restructure negative thought patterns and to correct distorted thinking that is often part of depression. But it is important to remember that the best approach to treating depression is to personalize it for each individual.

  • Often, the combination of pharmacotherapy and psychotherapy is a very effective option for depression treatment. Other time-limited psychotherapies, including interpersonal therapy (IPT) are effective in treating depression in people of all ages.

  • Collaboration between eye care and mental health professionals can help people with vision loss improve their quality of life.

Understanding depression

How to live with low vision

Living with Low vision – How you can help webinar

Update on depression and AMD

Association of vison loss and depression in those over 20

Sadness impairs color perception

Rehab helps prevent depression from age-related vision loss


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Primary Congenital Glaucoma

What is primary congenital glaucoma?

Glaucoma in children includes a variety of disorders in which drainage system of the eye does not function adequately, leading to abnormally high pressure inside of the eye (the intraocular pressure, or IOP), and resulting in damage to many different structures of the child’s eye. If not treated promptly and successfully, pediatric glaucoma can lead to severe vision loss or even blindness in one or both eyes. In primary childhood glaucoma, the drainage system usually has not formed properly (often resulting from a genetic abnormality) while in secondary childhood glaucoma, the abnormal fluid outflow problem results from other problems with the eye(s), sometimes accompanied by other medical problems outside the eyes.

Primary congenital glaucoma is the most common of the primary childhood glaucoma types, although it is still rather rare. Let’s take a moment now to review the parts of the eye, and eye’s drainage system, sometimes also called the “aqueous outflow pathway”, since it drains the fluid within the eye (the aqueous humor), which is separate from the tears that flow on the outside of the eye’s surface and then into the nose or down a child’s cheeks.

The aqueous outflow pathway of the eye (comprising both the trabecular meshwork and Schlemm canal), situated at the junction (or “angle”) between the iris (the colored portion of the eye) and the sclera (the white part of the eye), has not formed correctly (Figure 1).

primary congenital glaucoma
Figure1. Schematic eye shows different structures of the ocular globe. Note that the Schlemm canal is part of the drainage system of the eye . Modified from National Eye Institute.

The aqueous humor therefore builds up within the front portion of the eye, causing abnormal elevation of the IOP.

In contrast to the eyes of adults and older children, the entire eye in infants and young children is distensible and the high IOP in primary congenital glaucoma often causes stretching and damage to several parts of the eye; this most often results in enlargement, clouding and scaring of the cornea (the front window of the eye) as well as severe nearsightedness, damage to the optic nerve, and resulting poor vision.

Primary congenital glaucoma (also called PCG) is almost always genetic, although usually there is no one else in the family with the condition. It is not related to anything that the parents did (or did not do) during the pregnancy or afterwards, and does not have any relationship to the baby’s sex or racial background. It occurs in about 1 every 10,000 to 20,000 births in western countries, but may be more common in certain populations of the world. Most babies with this disease are otherwise normal.

How is primary congenital glaucoma diagnosed?

Most cases present within six months of birth, with nearly 80% presenting before one year of age. In 70- 80 % of cases both eyes are affected. Most cases present for medical attention due to the size or cloudy appearance of the cornea in one or both eyes (Figure 2).

primary congenital glaucoma
Fig 2. Left eye of child with congenital glaucoma. The eye is enlarged and the front part of the eye is cloudy (corneal edema).

In cases where only one eye is affected, a difference in size can be seen between the two eyes and this sometimes brings the baby to the ophthalmologist (Figure 3).

primary congenital glaucoma
Fig 3. Different size of eyes in a child with congenital glaucoma. Note the increased size of the right eye. The brown area (iris) and the transparent part in front of the color part (cornea) are significantly larger in the right eye.

The diagnosis of PCG is based on clinical findings and there are three classic signs that the child can present with:

  • abnormal sensitivity or intolerance to light (photophobia)
  • excessive blinking or squinting of the eyelids (blepharospasm)
  • excessive tearing (epiphora)

The exam in clinic can be challenging for infants and young children and most require an exam under anesthesia, to allow detailed examination of the eye(s) that would not be possible in the clinic. Often the ophthalmologist will be able to follow the examination under anesthesia with the most appropriate surgery for the glaucoma, if surgery is indeed required.

How is primary congenital glaucoma treated?

PCG is almost always treated with surgery, although medications are often needed to help in addition to the surgery. Medications are very useful before initial surgery to help reduce the IOP and decrease the clouding of the cornea. In addition, medications may be recommended to keep the IOP to a safe level after surgery has been performed. If the IOP is not controlled successfully, or if damage has been substantial prior to diagnosis and treatment, PCG causes severe vision loss and can even cause blindness. Sometimes the damage from PCG is uneven between a child’s two eyes, leading to amblyopia (“lazy eye”) in the more severely affected size.

The initial surgical procedure of choice is usually aimed at opening the trabecular meshwork and Schlemm canal (the aqueous outflow pathway) of the affected eye(s). This so-called “angle surgery” can be performed either from inside of the eye (goniotomy) or externally (trabeculotomy), and may need to be repeated more than once in some cases.

If angle surgery fails, other procedures are available to allow the aqueous humor fluid to exit the eye (glaucoma drainage device or filtration surgery), or even to decrease the amount of fluid the eye makes (cycloablation procedures). For these more difficult procedures, the child is usually referred to an ophthalmic surgeon with expertise in treating childhood glaucoma.

What is the prognosis for children with primary congenital glaucoma?

While vision loss can be severe, prompt diagnosis and effective treatment and follow-up for children with PCG usually allows affected children to have best-corrected vision of at least 20/50 vision in their better-seeing eye. Children with PCG require continued careful follow-up and treatment their lifetime, and may require more than one surgery, eye drops, and spectacles.

Successful care for children with PCG takes a dedicated team including the family, ophthalmologist, teacher and community support, and the child him/herself.


primary congenital glaucomaElena Bitrian, MD
Assistant Professor of Ophthalmology, Division of Glaucoma
Mayo Clinic



primary congenital glaucomaSharon F Freedman, MD
Professor of Ophthalmology and Pediatrics
Chief of Pediatric Ophthalmology
Duke Eye Center, Duke University

Vision Rehabilitation Services

The term “vision rehabilitation” covers a wide range of services that can help you learn how to remain active with vision loss while maintaining your independence and quality of life.
sorting meds - vision rehabilitation

Vision Rehabilitation Services

The following are different vision rehabilitation services you can access in addition to the information and help you will receive from your ophthalmologist or optometrist.

  • Communication skills: These help you with reading, writing and assistive computer technology. In some cases you may even want to learn braille.
  • Counseling: This can be beneficial, not only to you, but and family and/or friends that want to better understand or help you with your vision loss.
  • Independent living skills: These skills can be a simple as learning how to cook safely, take care of your personal appearance, manage your finances, keep exercising, or enjoy hobbies. The people that come to your home to help you keep your independent may also suggest home modifications to make life easier and help ensure your safety.
  • Independent movement and travel skills: These skills are important not only to help with your independence, but also to keep you from isolating yourself. Isolation is a common problem with vision loss as you may not want people to know you are losing your vision, or you are afraid of falling or embarrassing yourself. However, isolation can lead to depression.
  • Low vision evaluations and training: There are a variety of hand-held and desktop magnifiers, special reading glasses, lighting sources and other devices that help you make the most of your remaining vision.
  • Vocational rehabilitation: Loss of vision does not necessarily mean you can no longer work. Vocational evaluation and training, along with job modification and restructuring, can keep you enjoying the work you have enjoyed and depend on.

laptop help - vision rehabilitation

Vision Rehabilitation Service Providers

When looking for vision rehabilitation services, what should you know? You are best looking for a specially trained person including low vision therapists, vision rehabilitation therapists, and orientation and mobility specialists. They each have completed a standardized certification process that will let them help guide you as you work toward your vision goals.

  • Certified Low Vision Therapists (CLVTs): These therapists work with you to use your remaining vision with various devices and assistive technology. They also help you determine what modification you might need at home or work to remain independent and safe.
  • Certified Vision Rehabilitation Therapists (CVRTs): These therapists teach special adaptive skills that will allow you to confidently carry out a range of daily activities.
  • Certified Orientation and Mobility Specialists (COMS or O&Ms): These specialists teach skills that help you navigate safely and confidently when you are home, in the community or traveling far from home. This can include the use of a cane, GPS devices or public transportation. They also include guide dog instructors, but this training is more intense and takes place at a guide dog facility for several days.

To remain active and independent may require learning new skills, but it is important to find the right person to help you learn those skills. By finding the best person to suit your needs, the process can be a fun and positive experience.


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Using Andragogy to Help People with AMD

Adults and children do not learn in the same way. The concept of “andragogy” was widely introduced to the world of educational theory by Malcolm Knowles, PhD, in the latter part of the 20th century. He contrasted “pedagogy,” which is generally used to describe the method or practice of teaching — and comes from the Greek for “child learning” — with the practice of “andragogy,” which applies specifically to adult learning. While Knowles did not invent the term, he advanced the argument that andragogy should be very different from pedagogy.
Andragogy to Help People with AMD
Maureen Duffy, CVRT, LVT, an editor for Journal of Visual Impairment & Blindness, a writer and blog editor for VisionAware, and author of Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, relies heavily on andragogy in her work with vision-impaired adults. Loved ones — especially adult children of older people — have a tendency to push care and “help” on grown-ups as if they were children, she says. Not surprisingly, this method seldom works.

Using Andragogy to Help People with AMD

From her work as a certified vision-rehabilitation therapist (CVRT) and low-vision therapist (LVT), Duffy calls out three concepts of andragogy to keep in mind when trying to help an adult who is coping with vision loss:

1. Adults have life experience.
Children don’t have a lot of life experience. And while adults have an incredible amount of life experience, we don’t always treat them as if they do. They already know how to problem-solve. If they have been cooking for their entire lives, they don’t need to learn to learn how to cook all over again; they just need to make adaptations.

“We treat adults as if they have to forget everything they’ve learned, and try to teach them something new,” Duffy says. “That doesn’t usually work. I say, ‘Show me how you’ve always done this. There’s probably just a little adaptation you need to make, and you can keep doing things the way you’ve always done them.’ You can’t just go in, and tell someone you’re going to change everything they do. Just figure out an adaptation.”

2. Adults are reactive learners.
Children are ready to learn when they are told they are ready to learn: We send them to school, and they know it’s time to learn. Adults are ready to learn when they decide they need to know or do something to improve their daily lives — not before. You cannot make an adult learn until they are ready to learn. That’s a big difference.

“Adults tend not to say, ‘I’m going to learn this now because I might need it later.’ They say, ‘I have this problem right now; I need to learn this thing right now,’” Duffy says. “It’s common for family members to tell a person with macular degeneration, ‘You need to learn braille in preparation for when you go blind in the future.’ That’s not true. They can read larger and larger print for as long as they are able to do so. It creates additional anxiety to tell an adult they have to start now to prepare for when they can’t see. You can’t prepare for that. It’s a process, and you make changes as you go.”

Andragogy to Help People with AMD
3. Adults are self-directed.
Adults want to be independent and determine, for themselves, what it is they need to learn. And that won’t necessarily match what family members think or want.

“Adults will decide what they want to learn, usually based on a hierarchy of needs and what they really need to know now,” Duffy says. “That hierarchy starts with survival needs: making food, getting food, reading medications, etc. And the only way to know what an adult wants and needs to learn is to ask them.”

At the heart of andragogy, it seems, is respect for the fact that an adult is an adult — and should be treated as such. “Andragogy is more focused on teaching problem-solving skills, which can be used over and over again by the adult in a variety of situations,” Duffy says.

Another difference between the way children and adults learn is the need for adults to maintain a sense of autonomy, points out Judi Delgado, director of the Macular Degeneration Partnership (MDP). “People with AMD may need to adjust the way they do some things, but they can still do them,” she says. “It doesn’t help them if others try to take over or do things for them. It’s important to understand that the person is already losing so much; if loved ones try to take over their lives, it just adds to the loss of independence.”



Maureen Duffy, CVRTMaureen A. Duffy, CVRT, LVT
Social Media Specialist,
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

3 Tips for Caregivers Helping People With Low Vision

Receiving a diagnosis of age-related macular degeneration (AMD), diabetic retinopathy or glaucoma can be a shock. Loved ones naturally want to help, but they don’t always know what to do or how to do it. Here are 3 tips for caregivers helping people with low vision.

We asked vision-rehabilitation expert Maureen Duffy, CVRT, for advice. She suggests turning to local low-vision agencies, trained low-vision professionals and online resources, such as the Macular Degeneration Partnership and the VisionAware services guide. Perhaps most importantly, she says, look for a support group.
3 tips for caregivers
“I have found that most adults with whom I’ve worked turn to their peers, and they get the most guidance and help in vision-loss support groups,” says Duffy, an editor for Journal of Visual Impairment & Blindness, a writer and blog editor for VisionAware, and author of Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss.

Duffy shared the three most important things to ask a loved one after they find out they have AMD:

1. What do you understand about what the doctor said and about what’s going on with your vision? What don’t you understand? What do we need to clear up?
If they don’t understand completely, ask if you can go to doctor with them to be a note-taker and information-gatherer. Ask the doctor for explanations. Be clear and concrete about the information you need — and ask the doctor for next steps.

The Macular Degeneration Partnership website has a downloadable list of questions to take along, as well as suggestions on how to be an advocate during a visit to the doctor on its “Be an Advocate” page.

2. What is the one thing you are most afraid of RIGHT NOW?
At first, their biggest fear is of going totally blind: “I won’t be able to do anything; I’ll be all alone; I’ll be totally helpless.” With AMD, they won’t go totally blind, and they can learn to make the most of their peripheral vision. There are services that can help, but it’s tough in the beginning: Go slowly.

Vision-rehabilitation services can help teach them to function safely and independently in critical day-today activities, such as:

• Independent movement and travel:

  • getting around indoors
  • walking with a guide
  • using a long white cane
  • crossing streets
  • using public transportation
  • using electronic travel devices

• Independent living and personal management:

  • preparing meals
  • managing money
  • labeling medications
  • making home repairs
  • enjoying crafts and hobbies
  • shopping

• Communication and technology:

  • telling time with an adapted clock or watch
  • signing their name
  • using tablets and smartphones
  • using computers with speech or screen magnification
  • learning braille

3. What is the ONE thing you are most afraid you can’t do?
Don’t start talking about everything that may need to go on; it’s just too much and is overwhelming. Start with the one thing. “I can’t aim for the toilet”; “I can’t keep food on the fork”; “I can’t make my coffee in the morning.” Help them find solutions for simple things. Figure out alternatives. That little bit of accomplishment encourages self-analysis.

“Many people have difficulty telling currency bills apart,” Duffy says. She shares a simple, effective way to do this by folding each bill differently:

  • Keep the $1 bill flat and unfolded.
  • Fold the $5 bill in half crosswise (with the short ends together).
  • Fold the $10 bill in half lengthwise (with the long sides together).
  • Fold the $20 bill like a $10 bill lengthwise, and then in half again crosswise, like the $5 bill.

It’s important to remember that no matter how much you may want to help, your loved one may not be ready to accept assistance. Pushing too much too soon isn’t helpful. Once you ascertain that your loved one is ready to be receptive, offer your help gently, slowly and with empathy.


Maureen Duffy, CVRTMaureen A. Duffy, CVRT
Social Media Specialist,
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

Which Eye Care Specialist Do You Need?

It’s time to get your eyes checked – do you go to an ophthalmologist, optometrist or optician? Your optometrist sees the beginnings of age-related macular degeneration, but is sending you to see and ophthalmologist, why?
eye care specialist
One of the most confusing things about taking care of your eyes can be differentiating between an ophthalmologist, optometrist and optician. Each eye care specialist has a very important part to play in the health of your eyes and here is a quick synopsis of what each does so you can choose the best one for your vision issues and treatment.

These specialists are fully trained medical doctors that have completed the eight years of training beyond a bachelor’s degree. Their training has included a full spectrum of eye care, from prescribing glasses and contact lenses and giving eye injections, to carrying out intricate eye surgeries. Many doctors may also be involved eye research to better understand vision, improve eye disease treatments or potentially find a cure. They are easily identified by the MD following their name.

These medical professionals have completed a four-year program at an accredited school of optometry. They have been trained to prescribe and fit glasses and contact lenses, as well as diagnose and treat various eye diseases. They provide treatments through topical therapeutic agents and oral drugs, and are licensed to perform certain types of laser surgery, such as Lasik. They are easily identified by the OD following their name.

These eye care professionals are not licensed to perform eye exams, medical tests or treat patients. Their purpose is to take the prescription from the ophthalmologist or optometrist and work with you to determine which glasses or contact lenses work best for you. If you suffer from an eye disease like keratoconus, these specialists can make the difference between a relatively normal life, or one that is dictated short periods of vision because of contact lens pain. These eye care professionals may hold and associate optician degree or have apprenticed fore required number of hours.

While each one of these eye specialists has their own area of expertise, they can form a team whose only concerns are your eye health and the ability to see as clearly as possible.


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation