February Is Low Vision Awareness Month

Help for People With Vision Loss

Here’s eye-opening news: Currently, 4.2 million Americans ages 40 and older are visually impaired. Of these, 3 million have low vision. By 2030, when the last baby boomers turn 65, the number of Americans who have visual impairments is projected to reach 7.2 million, with 5 million having low vision. For the millions of people who currently live or will live with low vision, the good news is there is help.

But first, what is low vision? Low vision is when even with regular glasses, contact lenses, medicine, or surgery, people have difficulty seeing, which makes everyday tasks difficult to do. Activities that used to be simple like reading the mail, shopping, cooking, and writing can become challenging.

Most people with low vision are age 65 or older. The leading causes of vision loss in older adults are age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma. Among younger people, vision loss is most often caused by inherited eye conditions, infectious and autoimmune eye diseases, or trauma. For people with low vision, maximizing their remaining sight is key to helping them continue to live safe, productive, and rewarding lives. The first step is to seek help.

“I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist,” advises Paul A. Sieving, MD, PhD, director of the National Eye Institute (NEI), one of the National Institutes of Health (NIH) and the federal government’s principal agency for vision research.

What is a low vision specialist? A low vision specialist is an ophthalmologist or optometrist who works with people who have low vision. A low vision specialist can develop a vision rehabilitation plan that identifies strategies and assistive devices appropriate for the person’s particular needs. “A vision rehabilitation plan helps people reach their true visual potential when nothing more can be done from a medical or surgical standpoint,” explains Mark Wilkinson, O.D., a low vision specialist at the University of Iowa Hospitals and Clinics and chair of the low vision subcommittee for the National Eye Health Education Program (NEHEP).

Vision rehabilitation can include the following:

Training to use magnifying and adaptive devices
Teaching new daily living skills to remain safe and live independently
Developing strategies to navigate around the home and in public
Providing resources and support

There are also many resources available to help people with low vision. NEI offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and companion DVD, featuring inspiring stories of people living with low vision. This booklet and DVD, among other resources, are available at
www.nei.nih.gov/lowvision.

With the aging of the population, eye diseases and vision loss have become major public health concerns in the United States. NEI is committed to finding new ways to improve the lives of people living with visual impairment. Aside from making information and resources readily available, NEI has dedicated more than $24 million to research projects on low vision, including learning how the brain adapts to vision loss; strategies to improve vision rehabilitation; and the development of new technologies that help people with low vision to read, shop, and find their way in unfamiliar places. Research like this will help people with low vision to make the most of their remaining vision and maintain their independence and quality of life.

2/17/15

The National Eye Health Education Program (NEHEP) of the National Eye Institute (NEI), a part of NIH, offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and a series of videos featuring patient stories about living with low vision. These and other resources are available at http://www.nei.nih.gov/lowvision.

The Best Nutrition for Older Adults

Our bodies change as we age. Our metabolism slows down and we lose lean body mass. Changes occur in the kidneys, lungs, and liver. Total body fat typically increases. The digestive system slows down and changes, producing less of the fluids it needs to process food, thereby making it harder for the body to absorb important nutrients. We lose bone density, which can cause osteoporosis, fractures, and vertebral compression. Many of us lose some sense of taste and smell and our medications interfere with many vitamins. Because of these changes, older adults have very different nutritional needs than those who are younger. What is the best nutrition for older adults?

The basic challenge when one gets older is to meet the same nutrient needs as when we were younger, but doing it while consuming fewer calories. Extra weight and health issues may be the result if we don’t. We can meet the challenge by eating a healthy diet that provides the necessary nutrients and variables for good digestion and absorption of nutrients. A nutrient-dense (meaning foods high in nutrients in relation to their calories), fiber-filled, colorful and varied diet is key.

First, let’s look at some of the important vitamins and nutrients we need to insure healthy bodies:

WATER – of all the nutrients, this the most important. Drinking enough water reduces stress on kidney function, which can decline with age. It also eases constipation. Be aware that the ability to detect thirst declines with age. Instead of waiting to feel thirsty, drink water and other healthy fluids throughout the day. The goal should be about 8 glasses of water per day.

CALCIUM – Calcium’s most important role is for building and maintaining strong bones. Unfortunately, as we age, we tend to consume less in our diets. If you don’t get enough, your body will leach it out of your bones. If your diet includes dairy, three low-fat servings per day are recommended. But also consider plant alternatives such as collard greens, kale, and broccoli. In addition, tofu, almonds, sesame and chia seeds are other great non-dairy sources for calcium.

VITAMIN D – This vitamin helps the body absorb calcium, maintain bone density and prevent osteoporosis. Recent studies suggest it may also protect against some chronic diseases and vitamin D deficiency has been linked to an increased risk of falling in seniors. Vitamin D can be found in salmon, tuna, and eggs. You can also look for vitamin D fortified foods, including cereals, milk, some yogurts, and juices. Because aging skin becomes less efficient at producing the vitamin from sunlight, some experts believe seniors may need vitamin D supplements. You may want to discuss your vitamin D needs with your health care provider.

FIBER – Getting enough fiber in the diet will promote healthy digestion by moving foods though the digestive tract. It will also not interfere with the absorption of nutrients, which occurs with laxative use. Eating foods rich in fiber have additional benefits, including protecting against heart disease. So eat more whole grains, nuts, beans, fruits and vegetables.

POTASSIUM – Potassium is an essential mineral vital for cell function. It has been shown to reduce high blood pressure and the risk of kidney stones. It may also help keep bones strong. Older people can get the recommended daily amount by including fruits and/or vegetables in their diet at every meal. Banana, prunes, plums and potatoes with their skin are particularly potassium rich.

MAGNESIUM – Magnesium is important to many different physiological processes and keeps the immune system in good order. It also keeps the heart healthy and your bones strong. Absorption of magnesium decreases with age and some age-related medications, such as diuretics, may also reduce absorption levels. Eating as many unprocessed foods as possible, including fresh fruits, vegetables, nuts, seeds, grains, and beans will provide you a great source of magnesium.

VITAMIN B12 – Vitamin B12 is important in creating red blood cells and maintaining a healthy nerve function. Getting enough is the challenge for older people because of the decrease in absorption from food. The solution is to eat more food rich in B12 which includes fish, meat, poultry, eggs, and low-fat dairy. Also check with your health care provider about whether a supplement is in order.

FOLATE/FOLIC ACID – Anemia is the result of not enough of this essential B vitamin, which is related to B12 absorption and may improve hearing. Eat plenty of fruits and vegetables and/or make sure your breakfast cereals are fortified to ensure you are getting enough.

OMEGA-3 FATS – Primarily found in fish, these unsaturated fats have a wide range of benefits, including possibly reducing symptoms in rheumatoid arthritis and slowing the progression of age-related macular degeneration. They may also reduce the risk of Alzheimer’s disease and may even keep the brain sharper as we age. Strive toward at least two servings of fish a week and choose salmon, tuna, sardines, and mackerel which are especially high in omega-3. Plant sources of omega-3 include soybeans, walnuts, flaxseed, chia, hemp and sesame seeds, and cauliflower.

IRON – Iron intake sometimes appears to be low in many older adults. To improve absorption, include vitamin C-rich fruits and vegetables with iron-rich foods such as red meats, fish, and poultry.

ZINC – Along with vitamins C and E, lutein and zeaxanthin, it may help slow the progression of age-related macular degeneration. Eat lots of fruits and vegetables, especially those that are dark green, orange or yellow in color, such as kale, spinach, broccoli, peas, oranges, and cantaloupes.

VITAMIN E – This vitamin may have a potential role in the prevention of Alzheimer’s disease. Including whole grains, peanuts, nuts and seeds in your diet may help reduce the risk of this disease.

Now, how do we get these into our diet to ensure optimal nutrition? Strive to have your diet look like this:

Colorful and varied. Have three to five different colors of food on your plate at each meal. This will translate into getting the most variety of nutrients. Eat more veggies than fruit.
More natural and unprocessed. This will give you more fiber. Choose whole fruit over juice; whole grains over processed flours; include seeds, nuts, whole grains and beans in your salads and soups. Look at labels – choose foods with five or fewer ingredients you can pronounce.
The majority of your food should be complex carbohydrate foods – vegetables, fruits, grain products, seeds, legumes and nuts. Choose more vegetables to keep the calorie count down.
High-quality protein – eat less processed and high-fat choices and go for fish, lean meats, skinless poultry, low-fat dairy and plant-based protein sources.
Less sodium, sugar, and “bad” carbs (such as white flour, refined sugars, and white rice). Too much of these things can lead to many age-related health issues and diseases.
More steaming and sautéing and less battering and/or frying.
Use of good fats such as olive oil, avocados, salmon, walnuts, flaxseed, and other monounsaturated fats to protect your body against heart disease.
Try not to skip meals (it slows down your metabolism), eat smaller portions (we don’t need the extra calories), and exchange unhealthy snacks with healthier choices (raw veggies instead of potato chips, piece of fruit instead of a candy bar, etc).
Lastly, don’t forget to drink your water!

2/10/15

Michelle Moore, CHHC
Natural Style Health

Spotlight Text – A New Way to Read

For People With Low Vision There Is Spotlight Text – A New Way To Read

Spotlight Text is a new e-reading app specifically designed to address the needs of patients with eye disorders. Dr. Howard J. Kaplan, a retina surgeon in the Hudson Valley, started developing the app five years ago. Dr. Kaplan states, “When the first Amazon Kindle came out, a light bulb went off. If books are now digital, you can make the text of the book adapt to the reader instead of forcing the reader to adapt to the text. My patients were extremely frustrated with low vision devices such as desktop readers. Most found them very difficult to use and affordable.” Working with low vision experts at the Lighthouse Guild International, various text presentation methods were evaluated. “The app is based on real visual science and was built with the input of the top low vision specialists in the country, “ says Dr. Kaplan.

The greatest difficulty in creating the app proved to be getting access to e-books. Initially Dr. Kaplan approached the major e-content providers such as Amazon, Google, and Barnes & Noble. All of them considered the low vision market too small to address. During the 5 years, Bookshare, a Silicon Valley nonprofit, began to expand exponentially. Bookshare is dedicated to creating an accessible library for the print disabled.

How Spotlight Text Works, and What Makes it Different
The app is seamlessly tied into the e-book library of Bookshare. The library currently has 300,000+ titles including all current and recent NY Times bestsellers. It has a very extensive collection of textbooks for K-12 children. E-book downloads are free and unlimited for children, and Vets. There is a minimal joining/maintenance fee for adults. All patients that have any visual deficit that prevents them reading standard print are eligible to join. A physician, optometrist, therapist, or even librarian has to certify a patient by checking a single box on the form and signing their name. Bookshare then does the rest by contacting the patient and giving them an account. Bookshare functions due to an exception in US copyright law that allows the free distribution of copyrighted material in formats that are unique for patients with visual disabilities. The books are coded in DAISY, which is a sound file format. The App takes these files and renders them back to written text.

The user interface is designed such that an 80-year-old technophobe or a five-year-old child can easily use it (Apple-like minimalism). The app also synchronizes with Bluetooth Braille readers that convert the text to Braille. It can be connected to the HDMI port of any TV for unlimited screen size (hardwire or wireless through Apple TV). As you will see when you demo the app, text is now dynamic: in both teleprompter and marquee modes the text will move so that ocular movements are minimized. Marquee mode was specifically designed and tested to work for end-stage Retinitis Pigmentosa patients and any patient with only a remaining very narrow central visual field. Using VoiceOver all books are now audible books.

Social Entrepreneurship
Special iTunes links are created for vision nonprofits. If a patient clicks on those links and purchases the Spotlight Text App, 50% of sales profits are donated to the organization, including the Discovery Eye Foundation or the American Academy of Ophthalmology Foundation. Prior to being placed on the AAO’s website the app was evaluated by its Low Vision Rehabilitation Committee. It is the only app that the American Academy of Ophthalmology has ever endorsed.

The Future
Dr. Kaplan hopes to return to the major providers of e-content and persuade them that low vision and blind users are a viable market for them.

“I believe universal accessibility is achievable, but it will take a coordinated and combined effort. Reading is such a vital part of all our lives, with e-books, everyone should be able to enjoy a good book.”

Howard J. Kaplan, MD
Retina Surgeon
Hudson Retina

1/15/15

Exercise And Physical Activity For A Healthy 2015

1/6/15

With the advent of the New Year, many people start making New Year’s resolutions which often include getting back in shape or losing weight. With that in mind, over the next few weeks we are going to be focusing on exercise and physical activity. Both are helpful in retaining good vision, regardless of your age.

Physical Activity and Exercise

What us the difference between exercise and physical activity? Exercise is generally a planned physical activity that is structured and repetitive such as yoga, Pilates, weight training, tai chi or Zumba classes. Physical activity are things you do throughout the day that involve movement such as gardening, walking the dog, grocery shopping, vacuuming or taking the stairs instead of the elevator. Both provide benefits, and a combination of the two can help improve health and help you lose weight.

Regular exercise and physical activity are important for your physical and mental health, and over long periods of time, can provide you with long-term health benefits. They can also help you reduce the risk of developing some disease and disabilities that can happen as you grow older as well as being an effective treatment for arthritis, heart disease, diabetes and even eye disease.

Exercise and physical activity can benefit you in many ways:

Help improve your physical strength and fitness
Help improve your balance
Help manage and prevent diseases like diabetes, heart disease, osteoporosis, etc.
Help reduce depression
Help improve cognitive function

Types of Exercise and Physical Activity

Endurance
This includes activities that increase your breathing and heart rate:

Brisk walking, hiking or jogging
Dancing
Swimming
Biking or spinning
Sports such as tennis, squash or basketball
Yard work such as mowing the grass or raking
Climbing stairs

Strength
This includes activities that help you in everyday life such as climbing stairs, carrying groceries, etc.:

Lifting weights
Resistance training such as using a resistance band or Pilates

Balance
These activities help prevent falls:

Standing on one foot
Heel-to-toe walking
Tai Chi

Flexibility
These activities help you stay flexible and limber, which means more freedom of movement and better posture:

Shoulder, upper arm and calf stretches
Yoga
Pilates

Making Your Goals For Success

Now that you understand the importance of keeping fit, it is time to make a written plan to help you achieve your goals. These goals need to be specific, realistic and important to you to increase your chances for success. They also need to be fun and interesting to keep you engaged. Think about both short-term and long-term (where you want to be in 6 months or a year) goals. Things to consider when making your plans include:

What kind of activity you want to do
Why you want to do it
When you are planning to do it
Where you will do it
Any financial considerations such as equipment, shoes and clothing, gym membership, etc.

Writing down your exercise and physical activity goals is important as it will help you follow through with your and help you track your progress. Put them where you can see them, and review them regularly. Some people also find involving another person, such as an exercise buddy or trainer, can help keep them motivated.

It is also wise to consult your doctor about any change in exercise and physical activity. This particularly true if you have had any previous injury, surgery, health issue or are older. While doctors will not tell you to be sedentary, they may have safety tips or suggestions that will help keep you healthy and increase your enjoyment and success with your plan. Things you might want to ask your doctor include:

Are there any exercises or activities you should avoid
Let them know about any unexplained symptoms you might have such as chest pain or pressure, joint pain or stiffness, dizziness or shortness of breath
If you have any ongoing health concerns, how can these affect your exercise of physical activity
Let them know what your activity plan is and the goals to assure they are reasonable

Finding A Personal Trainer

If you are not used to exercising, are trying a new type of exercise, or need the motivational help, you may want to work with a persona fitness trainer. One of the best ways is to get a referral from someone you know who likes and has had success with their trainer. But it is also important you learn more about the trainer as they will relate to you and your goals. Here are some questions you might want to ask them:

Do they have a certification from an accredited organization
How much training experience do they have, including training people your age or medical condition
Will they be able to develop an exercise program based you your goals and what should you expect from their sessions
Will the trainer give you a list of references you can check

When making your final assessment consider how well the trainer listened to you and answered your questions. Also, if they have a sense of humor and are a good match to your personality.

These suggestions should get you started for a healthy 2015. Next Tuesday we will explore more ways to help you succeed.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Hadley’s Online Education for the Blind and Visually Impaired

12/4/14

The Hadley School for the Blind (www.hadley.edu) is the world’s largest educator of people who are blind or visually impaired as well as the world’s largest Braille educator. The school’s curriculum has always been delivered completely through online education, meaning students can study from anywhere at any time. Hadley serves nearly 10,000 students in all 50 states and approximately 100 countries. Hadley serves adult students, age 14 and over. Our mission is to promote independent living through lifelong, distance education programs for individuals who are blind or visually impaired, their families and blindness service providers.

Hadley courses are tuition-free for people who are blind or visually impaired and their family members; there is modest tuition for professionals. Students study at their own pace and receive personalized, one-on-one instruction from their instructor by phone, email, virtual “office hours” or mail.

Students can take courses in four formats: large print, Braille, audio or online. Since we began offering courses in an online format in 2002 as part of our eHadley initiative, more than 13,000 students have completed one or more online courses. 89 of our approximately 100 courses are offered in an online format, and 20 new online courses were introduced in 2014. Most of our online courses also are now accessible on mobile devices, so that students can literally study on the go if they choose.

If you’re not familiar with blindness, you may be asking yourself how a blind person can take courses online. The answer is through adaptive technology, such as screen magnifiers or screen readers. A screen reader is a software application that converts text on a screen to speech. One of the most popular is called JAWS. If a student doesn’t know how to use a screen reader, Hadley has a series of courses to teach them how to use this technology!

While many students come to us to learn to read and write Braille, we offer much more than just Braille education. In addition to Braille, some of our most popular areas of study include access technology, independent living skills, employment skills and recreation. These courses fall within Hadley’s Adult Continuing Education Program, which represents the largest number of students at Hadley. Some examples of ACE courses include:

Independent Living Series: This series of two-lesson courses focuses on a variety of topics central to the tasks of daily living. When individuals lose their sight, it can be overwhelming. They must relearn key daily living skills, such as cooking, dressing themselves and getting around. These courses give our students the tools they need to retain their independence and lead productive lives. The individual course topics include: orientation and mobility basics; clothing care and dressing confidently; socializing and dining; and cooking.

Self-Esteem and Adjusting with Blindness: Whether a student was born visually impaired or lost vision later in life, this course will help them understand the adjustment to life’s demands. Maintaining self-esteem with the changes and adaptations that come with blindness are discussed in-depth and illustrated with quotes from many blind persons.

Human Eye 1 and 2: These courses explain the parts of the human eye, how it works and how corrective lenses work. They enable the student to describe the basic anatomy, routine examination procedures and some common conditions of the human eye. Hadley also offers courses on some of the specific conditions that can lead to vision impairment, including: macular degeneration, diabetes and glaucoma. These courses are designed to help students living with these conditions to better understand them and how to manage them.

Developing Your Technology Toolkit: Technology plays a significant role in how people interact with each other, and most will likely encounter some aspect of technology in their everyday life. This course presents a variety of prominent desktop and mobile solutions. It also discusses how adaptive technology solutions provide access to mainstream hardware and software. In addition, it focuses on proprietary, adaptive technology products designed to be used specifically by persons who are visually impaired.

Enjoying Bird Songs: Listening to birdsongs helps people reduce stress, improve cognition and memory, interact with nature and even have spiritual experiences. This course guides students through the many bird songs presented in Hadley student John Neville’s audio CD set Beginner’s Guide to Bird Songs of North America. This course helps students become able to appreciate nature and birdsongs, as well as reflect on their experiences with birdsong.

Also part of the ACE program is the Forsythe Center for Employment and Entrepreneurship (FCE), designed to address the 70 – 80% un- and underemployment rate among people who are blind or visually impaired. The FCE is not an academic, college-level business program, but instead was designed to provide the requisite computer training; relevant social security, tax, accounting, legal, marketing, management and communications information; and content specific to the needs and concerns of visually impaired individuals who want to launch and grown their own businesses. All FCE courses are online, and many are just one-lesson modules, which makes learning quick and easy. Some examples of modules include: The Marketing Plan, The Business Plan, Forms of Ownership and Networking Skills.

Since the 1930s, The Hadley School for the Blind also has offered a nationally-recognized, accredited High School Program, available to students with visual impairments age 14 and up who live in the United States. Students may transfer credits from courses taken at Hadley to their high school to graduate locally. Students may also earn their high school diploma directly through Hadley. Frustration with local schools not offering quality vision services or accessible formats, difficulties passing the state-required exit exam for graduation or inability to travel long distances have prevented many of our students from earning their diploma in the past, so the Hadley High School Program is a much-needed “second chance.”

Courses are supplemented by Seminars@Hadley, free 60 to 90-minute webinars that are available to the public. These seminars are designed to bring together our blind and visually impaired students from around the world to discuss various topics in a virtual conference room with a panel, moderator and guest speakers. Participants listen to the seminar from their computer and post questions electronically. They also ask questions and/or make comments using a microphone. Seminar topics are timely, practical and determined by what our students tell us they need. Some of our most popular seminars include: Learning to Put the “You” in YouTube, Simplifying Internet Searching and Crafting with Vision Loss. Some seminars are approved for Continuing Education Credits (CEUs).

Hadley also offer a series of instructional videos on YouTube called iFocus (www.youtube.com/hadleyschool). These videos explain how to use the vision accessibility features on iDevices (Apple products such as the iPhone and iPad). Each video focuses on a specific task on iDevices, such as sending a text message or creating a calendar event . There are now 25 videos in the series, and they have been viewed nearly 10,000 times!

For more information about Hadley or to enroll, visit our website at www.hadley.edu, call our Student Services Department at 800-526-9909 or send an email to student_services@hadley.edu.

Kate Streit
Media and Marketing Specialist
The Hadley School for the Blind

Drugs to Treat Dry AMD and Inflammation

12/2/14

Below is an article from the monthly Macular Degeneration Partnership E-Update on potential drugs to treat dry AMD and inflamation. To learn more about dry AMD, including stem cell treatments, go to AMD.org. You can also subscribe and have the monthly newsletter delivered to your inbox.

There are many causes of age-related macular degeneration and any of them may prove a good target for treatment for dry AMD. A long list of these was discussed at the recent Academy of Ophthalmology meeting. They were divided into the types of drugs being studied. We’ll look first at inflammation and the complement factor system, which is part of the immune system.

Inflammation is known to be associated with macular degeneration. The target may be the inflammation itself, or the cause of the inflammation.

Lampalizumab (or anti-Factor D) is a drug that is injected into the eye. In earlier Phase II trials, it was shown to reduce the area of the geographic atrophy by 20%. A Phase III clinical trial is now underway for individuals with geographic atrophy from dry AMD. Several research sites are actively recruiting now and many others will start recruiting in the near future. For more information and a list of participating centers, visit Clinical Trials.

LFG316 is also an antibody and an injection. This Phase 2 study is a randomized clinical trial of a drug that targets the C5 complement pathway (part of our immune system). It is designed to test the safety and efficacy of different doses of LFG316. There are three arms in the study: one group receiving a higher dose of the drug; one group receiving a lower dose of the drug; one group receiving a sham injection (no drug). These are successive monthly injections for people with geographic atrophy (GA). It is taking place in multiple locations throughout the U.S. and is sponsored by Novartis. For more information and a list of participating centers, visit Clinical Trials.

Oracea is a pill for dry macular degeneration, now in Phase II/III clinical trials around the U.S.. The pill contains doxycyline, which suppresses inflammation. Participants will be randomly assigned to either receive the drug or a placebo. More information at Clinical Trials.

Zimura by Ophthotech has been tested as a drug for wet AMD, but also seems to affect the drusen of dry AMD. Zimura targets the complement pathway plays a significant role in dry AMD. A Phase 2/3 clinical trial investigating ZimuraTM for treatment of geographic atrophy, is in the planning stages.

Eculizumab was also presented. This intravenous treatment for dry AMD did not show the desired effect in clinical trial, so no further development is planned at this time.

POT-4 is another drug that targets the complement factor system involved in inflammation. It is delivered through injection into the eye. The Phase I trial is completed and a Phase II clinical will be announced soon.

Iluvien is a drug delivery system that has been used in patients with diabetic retinopathy. A Phase II clinical trial for dry AMD is underway, though it is no longer recruiting patients. This is an implant inside the eye that releases fluocinolone acetonide. For more information, see Clinical Trials.

Judith Delgado
Executive Director
Macular Degeneration Partnership
A Program of the Discovery Eye Foundation

E-Readers for Low Vision

11/18/14

While the devices mentioned in the November 13th post will help you read a hardcover or paperback book, what about an e-reader?

E-Readers for Low Vision

These lightweight portable devices come with a variety of options for people with limited vision, at a more moderate cost. The two we will look at are the Kindle and the Nook.

Kindle

There are two options here, an e-ink reader (the Paperwhite or the new Voyage), the closest to reading a paper page, or a full-color tablet. The only accessibility options for the e-ink readers are the ability to select a font you find easy to read and the ability to increase the font size. The increase in font size is a big help, but remember, that as you increase the size you will be “turning the page” more often – the screen size is 6” diagonally. The Voyage has a whiter background than the Paperwhite allowing for more contrast. Both include a built-in screen light that can be adjusted to your needs. One thing to note is that while it does have a screen light, it is not a backlit display as you will find in the Fire HDX. This might mean less eye strain.

The Fire HDX is a full-color tablet with quite a few more accessibility options and the screen sizes range from 6” to 8.9”. Since it is a full functioning tablet you can access email, play games, watch videos and a variety of other things. It has more large-font options (that can even be used for your emails), a screen magnifier that is easily activated with a triple tap on the screen and you can pinch to adjust the zoom and the backlit display provides high contrast. There are other options for people that are blind including a screen reader to describe actions taken on your screen, five accessibility shortcut gestures to help you navigate and even Braille support with a free app from the Amazon App Store. Because it is a backlit display you may experience eye strain if you don’t occasionally take reading breaks.

Kindle also has a free accessibility plugin that is downloadable for your Windows PC. It provides the following features: text-to-speech reading, voice-guided menu navigation, large font sizes, high contrast reading mode, keyboard navigation and accessible shortcuts. It is compatible with JAWS, NVDA and Microsoft Narrator.

Nook

Nook, like Kindle, has two options. An e-reader called the Nook GlowLight and a full-color tablet called the Samsung Galaxy Tab 4 Nook in 7’ and 10.1” sizes. As with the Kindle e-ink reader, the only accessibility options are the font and font size. There is also a built-in light to make the page brighter.

The new full-color tablets now made by Samsung, provide you with the access of a full functioning tablet such as email, playing games, watching videos, etc. The vision accessibility options include screen magnification for the text and pictures, TalkBack which reads aloud menus and on-screen options for navigating the device, negative colors to invert the color of the screen (text that usually appears black on white will be shown white on black), color adjustment if you are color-blind, and a text-to-speech option that will allow you adjust the rate at which text is spoken and your preferred text-to-speech program. Once again, these tablets have backlit screens that may tire your eyes after an extended period of reading, so take breaks.

E-Book Formats

The Kindle and Nook each have their own proprietary book formats, meaning that you can only read a book purchased for the Kindle on a Kindle or a Nook book on a Nook, however EPUB and CBZ formats can be easily transferred to the Nook. This is more important when it comes to borrowing e-books from a library. The EPUB format is more common when e-books are offered; and while some libraries now offer Kindle books, there are more EPUB titles. If you are comfortable with technology, you can use Calibre to convert most formats into whatever format you need.

Choosing between a Kindle and a Nook is based on personal preference. You can try out both devices before you buy them at Best Buy or Staples for the Kindle and at Barnes & Noble stores for the Nook. If you already own an iPad or Android tablet, remember you can also download the free Kindle and Nook apps from the App Store or Google Play.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

For Book Lovers – Low Vision Magnifiers

11/13/14

The first of this month was Book Lover’s Day, and as an avid reader, I am willing to celebrate any day that is about reading. However, if you suffer from low vision due to age-related macular degeneration, cataracts, retinitis pigmentosa or other sight-threatening eye diseases, you may not be able enjoy reading as much as you used to.

There are several options to help you enjoy books again, including low vision magnifiers, e-books and tablets. We will provide you with a quick primer to help you select the best option for your lifestyle and budget. Today we will look at magnifiers and Tuesday we will explore e-readers and tablets.

Low Vision Magnifiers

There are several general classifications for magnifiers –

• Hand-held magnifiers – These are smaller and more portable, allowing you to read thins such as menus, price tags, prescription bottles and ingredients in addition to books. Some also come with built-in lighting that can help you see in low light situations. They can be as simple as a single glass lens to more advanced digital devices that can auto-focus, change text color and magnification or even let you snap a picture of what you are reading if steady hands are an issue. However, because of these are small enough to make them portable, the field of vision is small and reading books for any length of time might become tedious.

• Stand magnifiers – These are really better for reading books, magazines and newspapers as the field of vision is larger, your hands will not get tired holding the device and the distance between the page and the magnifier will remain more constant, making reading easier. This is especially important if you have tremors. However, these require sitting at a desk or table to be used.

• Magnifiers mounted on reading glasses – These are great for being “hands-free,” but they also limit your ability to see at varying distances, and are generally used for seeing things less than a foot from your nose.

• Video magnifiers – These devices use a video camera (similar to the portable digital device listed above) that focuses on the page and then magnifies it for viewing on a screen or monitor. Text color/background, brightness, contrast and levels of magnification can be adjusted as needed. As with the stand magnifiers, the ones able to scan an entire page of a book need to be used at a desk or table. However, now there are some machines that will even read out loud to you!

To get an idea of the range of devices available, along with the wide range of prices, here are three websites to get you started – Enhanced Vision, Optelec and Humanware.

Because each person has a different vision issue, not one magnifier works for everyone. A person with central vision loss from age-related macular degeneration will have different needs from a person with peripheral vision loss from glaucoma. That is why we suggest that you consult with a low vision specialist to help guide you in selecting the correct device for your specific needs.

Check back on Tuesday, or subscribe to the DEF blog, to learn about e-reader and tablet options for people with low vision.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Living With Dry Age-Related Macular Degeneration

11/6/14

Donna Cole gives new meaning to the term lifelong learner. “I love school. I love learning,” says 79-year-old Cole, who still regularly attends classes at the Osher Lifelong Learning Institute at California State University, Long Beach. “It seems like I’ve gone to school all my life. I just love it.”

While she did not earn her college degree until she was 65, Cole excelled at jobs ranging from assistant vice president of a savings and loan association, to president of the Long Beach Committee for the 1984 Olympic Games, to assistant athletic director for Cal State Long Beach — where, incidentally, she helped raise $300,000 in a month to save the football team in the 1980s — to vice president of communications and PR for the Grand Prix Association.

It was while working as a senior systems analyst at Boeing that she earned her BA degree, and when the company laid her off in 2003, Cole convinced them to pay for her to go back to school to earn her teaching credential. “It was the only thing I could come up with to do at my age,” she says. She earned the credential at age 70 and was a substitute teacher until her retirement in 2008.

When her doctor diagnosed her with dry age-related macular degeneration (AMD) in 2010, she picked up a card in his office that advertised The Discovery Eye Foundation’s Vision Symposium at UC Irvine. She attended the half-day event, and she’s been “obsessed with DEF ever since. There were great speakers, and it gave me the opportunity to mingle with people at all stages of AMD,” she says, adding that she regularly attends events through DEF and the Macular Degeneration Partnership (MDP), relying on the MDP website as her primary source of AMD information.

Cole says she has yet to experience any real effects of AMD: “I’m too young for that!” she insists. “My doctor just checked me and said the same thing he says every year: ‘See you in a year’; he told me I only need to come in sooner if I notice a change in my eyesight.”

Thanks to MDP, Cole believes she is better prepared to deal with the effects of AMD when they do happen. “Knowing that support is there makes it OK,” she says. “No matter what happens, I know DEF and the Macular Degeneration Partnership are there for me.”

The California native takes an eye vitamin and mineral supplement, and she added salmon and tuna to her vegetarian diet because of their eye-healthy properties. “To me, it’s just a matter of being healthy,” Cole says. “I’m very healthy. I don’t like taking drugs — not even aspirin — but I do make sure to eat chocolate at both lunch and dinner.”

Additionally, she tries to go walking at least two or three times a week, though, recently, she laments, “I accidentally signed up for three days of classes every week this quarter, which is interfering with my walking.”

Donna Cole
Age-Related Macular Degeneration Advocate

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