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.

KindleVoyage - E-Readers for Low Vision

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.

NookNooik - E-Readers for Low Vision

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 DeRemerSusan 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.

Optelec ClearView low vision magnifiers
Optelec ClearView Magnifier

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 DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Diabetes Awareness Month & Diabetic Eye Disease

11/11/14

Even though people with diabetes are at a greater risk of developing blinding eye diseases, a recent study of Medicare beneficiaries show that very few of the people at risk have a preventative yearly eye exam.

Facts About Diabetes

In the US there are 29.1 million that have diabetes, 21 million have been diagnosed and 8.1 million are undiagnosed. Unfortunately, if left undiagnosed or untreated, diabetes can lead to serious health problems such as high blood pressure, increased LDL cholesterol, heart disease, stroke, kidney disease and blindness.

Although African-Americans and Hispanics are more likely to have diabetes, less than a third are aware of diabetic eye disease. And for those that have been diagnosed with diabetes, where a yearly eye exam is considered essential, ¾ of them have not had an eye exam in five years.

Diabetic Eye Disease – 3 Ways Diabetes Affects Vision

diabetic eye disease
Courtesy of National Eye Institute, National Institutes of Health
Diabetic retinopathy affects 28.5% of people 40 and older that have been diagnosed with diabetes. It happens when the blood vessels in the retina are damaged by leaking or blocking blood flow to the retina (the source of your central vision for reading, driving, recognizing faces, etc.) and if untreated, it can lead to complete blindness. In the very early stages there are no symptoms. And while there are some treatments that may help slow the progression of the macular edema, there is no way to regain sight that is lost.

Cataracts occur when there is a clouding of the eye’s lens, making your vision blurry or cloudy. While it is a normal for this to happen as a person ages, someone with diabetes is more likely to develop them at an earlier age. While beginning cataracts can be treated with glasses, when they become more advanced, cataract surgery will be needed to replace the cloudy lens with an artificial lens.

glauccoma diabetic eye disease
Courtesy of National Eye Institute, National Institutes of Health
A person with diabetes is nearly twice as likely to get glaucoma as other adults. Glaucoma is an eye disease that damages the optic nerve. The damage occurs when the pressure in the eye increases, squeezing the optic nerve and restricting its visual transmissions to the brain. Like diabetic retinopathy, you rarely notice any changes in your vision in the early stages, but as it progresses you begin to lose your peripheral vision. It can be treated with eye drops or surgery, but left untreated it can result in blindness.

Controlling Diabetes

Diabetes can be controlled, and some cases prevented, with careful attention to diet, watching your weight and exercise. Also learn your family medical history. You are at a higher risk of diabetes if a mother, father, brother or sister has the disease. If you are diagnosed with diabetes, make sure you have a yearly comprehensive eye exam to avoid vision loss. To learn more about diabetes go to www.ndep.nih.gov.

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

Night Blindness

10/28/14

As the number of daylight hours decrease and daylight savings time is about to end, many of us feel that the days are getting much shorter. If you suffer from night blindness, your days are shorter, because getting around or driving at night, are sometimes impossible.

Night blindness is a condition that makes it difficult for a person to see in low-light situations or at night. Some types are treatable, while others are not. You will need to consult your eye doctor to determine the underlying cause of your night blindness to determine what can or cannot be done.

night blindness
Courtesy of wikipedia
There are several things that could cause night blindness:
•Cataracts
•Genetic eye disease
•Vitamin A deficiency
•Diabetes
•Aging eye
•Sunlight exposure

Here is a brief look at each.
Cataracts – This is when the lens of the eye becomes gradually becomes clouded, reducing vision. Besides reducing vision at night you may also experience halos around lights. This is a treatable condition requiring cataract surgery and replacing your clouded lens with a clear artificial lens. Your vision should improve considerably.

Genetic Eye Disease – Both retinitis pigmentosa or Usher syndrome are progressive genetic eye diseases where the rods that regulate light, and cones that control color perception and detail die. Progressive night blindness is one of the first visual symptoms of these two diseases. Currently there is no treatment for them as there is no way to treat or replace the dying rods.

Vitamin A Deficiency – While rare in the US, it can be a result of other diseases or conditions such as Crohn’s disease, celiac disease, cystic fibrosis or problems with the pancreas. Options to help with the deficiency include vitamin supplements suggested by your doctor, or increasing your intake of orange, yellow or green leafy vegetables.

Diabetes – People with diabetes are at higher risk for night vision problems because of the damage to the blood vessels and nerves in the resulting in diabetic retinopathy. Not only can it cause poor night vision, it may also take longer to see normally after coming indoors from bright light outside. There is no cure, but controlling blood sugar levels with medicine and diet can help prevent developing retinopathy or help slow the progression.

Aging Eye – As we age several things happen to our eyes. Our iris, which regulates the amount of light going into the eye, gets weaker and less responsive. This can make adapting from light to dark more difficult and slower. Our pupils shrink slightly allowing less light into the eye. The lens of the eye becomes cloudier, as explained above in cataracts, limiting the amount of light into the eye. We also have fewer rods for light perception. Aside from cataract surgery there is no treatment for age-related night blindness. However, eating a diet rich in fruits and vegetables and low in saturated fat is the best way to slow the progression. Here is more information on how the aging eye is affected.

Sunlight Exposure – If your night vision seems temporarily worse after a trip to the beach or a day on the ski slopes, it probably is. Sustained bright sunlight can impair your vision, especially if you fail to wear sunglasses or goggles.

Night blindness due to genetic conditions or aging cannot be prevented. However if you protect your eyes from extreme sunlight, eat a healthy diet, and monitor blood sugar levels if needed, you can reduce your chances for night blindness.

As we head into the holiday season, you should know that some great sources of vitamin A include sweet potatoes, butternut squash and … pumpkins!

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development

20 Tips For Cooking With Low Vision

10/21/14

People cook for different reasons. Some just so they can eat, others enjoy the creativity and find it relaxing and for some it is a activity they have fun doing with others. But cooking can become difficult and dangerous as you lose your vision. Here are some useful tips to help keep you safe and give you confidence to enjoy cooking with low vision.

Cooking with low vision
1. To avoid burns, place a pot or pan on the burner before turning it on and, turn the burner off before removing the pot or pan.

2. Turn pan handles inward from the stove or counter to avoid spills and burns.

3. Mark common or often used settings on appliances with bright nail polish, bright colored tape, or raised dots.

4. Purchase a microwave with a sensor reheat feature to automatically reheat food to the proper temperature.

5. Use long oven mitts to protect your hands and arms from hot surfaces.

6. Turn on the oven light while using it to remind you the oven is on.

7. Use a double spatula to help avoid spills when turning food.

8. Use a special measuring cup that enhances contrast.

9. Use a knife with an adjustable slicing guide.

10. Have light and dark cutting boards to be able to provide the most contrast depending on what you are slicing or chopping – such as black for slicing onions and white for chopping kale.

11. Use a large print, low-vision kitchen timer.

12. Use an automated coffee maker that makes a single cup of coffee or tea to eliminate the need to pour boiling liquids and risk burns.

13. Attach low-glare fluorescent lighting to the underside of cabinets to make it easier to see.

14. Outline the end of countertops with colored duct tape, or paint in a color that contrasts with the work surface. Also choose kitchenware that contrast with the countertop.

15. Organize shelves in a logical way, possibly alphabetically, with most use items easily accessible. Be sure to return items to where they were originally.

16. Use a color for the interior of cupboards that contrasts with your dishes to make them easier to see. Do not use clear glasses or dishes as they appear invisible.

17. If you have glaucoma and experience tunnel vision, remove cabinet doors or replace with sliding doors.

18. Place rubber bands around the milk carton to distinguish it from the orange juice carton. This also works well with distinguishing a can of chicken noodle soup from tomato, etc.

19. Avoid overflows by hooking a “liquid Level” indicator to your glass or cup that will play a tune when you are ¾” from the top.

20. For cold drinks you can also use your finger by placing the tip of it over the edge of the glass and stop pouring when you feel the liquid.

Once you have prepared your food, eating can also be a challenge, so here are five bonus tips.

1. Use dinner plates with a raised lip to avoid spills or pushing the food off while eating.

2. Avoid patterns on dinnerware.

3. Make sure your dishes contrast with the table or table linens.

4. Have a system for putting food on your plate such as meat at 6:00, vegetables at 3:00 and starches at 9:00.

5. Use a gooseneck lamp directly over you plate.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development

15 Things Doctors Might Like Us To Know

10/16/14

The Doctor Patient Relationship

Doctors are human. Professional decorum may not let them speak their minds and for that reason, I have gathered comments heard from eye doctors with whom I have been privileged to associate as a so-called “expert patient”. These may not speak for all, but I do think they represent the majority. Here are 15 of the most important, which we might benefit from hearing.15 - doctor patient relationship

1. Your eyes are growing older, and I can’t turn back the years in an aging retina. I can, however, help you try to maintain your current vision for as long as possible.

2. Your appreciation means a lot. Don’t hesitate to compliment me if I have earned it.

3. I have quite a few patients who need my help and don’t want to be kept waiting. So I don’t have to keep repeating myself, please take notes, or bring someone with you who can refresh your memory later.

4. It is important that you comply with my instructions and show up for appointments if you want the best results.

5. My specialty is eye care. I will, however, try to provide you with resources for other ailments you may have.

6. Please be concise with your questions and stay on topic, so I’ll have time to treat other deserving patients.

7. Don’t believe everything you see in the media unless the source is reliable. If the information isn’t based on good evidence, my response to you may be disappointingly negative.

8. My services may seem expensive, but I have so many expenses and debts resulting from my profession that my bottom line may not be much different than yours.

9. An ethical physician will not choose a particular drug or treatment by how much of a profit he can make prescribing it.

10. I might not agree with everything you say, but rest assured that I will never let it affect the level of care I will provide.

11. Don’t expect me to keep all eye research in my head. I do know where to look it up, so allow me some time to get back to you on some questions.

12. Conferences I attend are sometimes in exotic places, but most of the time is spent going from one event to another, so it is really not a vacation.

13. Even if there is no current effective treatment for your eye disease, I still need to see you regularly to monitor your condition. Regular check-ups are important to your health and preventative care and treatment options are changing all the time.

14. I may not remember you personally, especially in the beginning or if I see you only see you once or twice a year, but your records contain everything I need to know to care for your vision.

15. I may not agree with your decision to try an alternative treatment, but I respect your right to do so. All I ask is that you seriously consider my opinion, and if you decide to go ahead with the treatment on your own, please keep me in the loop so I can monitor your condition.

We should try to understand that doctors are human beings who truly care about our welfare. Doing so could turn a top-down doctor-patient relationship into one of mutual respect and understanding. We might even get a few extra minutes of precious time in the chair, just because we’re a pleasure to have around.

dan robertsDan Roberts
“Expert Patient”

Our Thanks to Guest Bloggers Continues

10/7/14

More Amazing Guest Bloggers

Last week I took the opportunity to thank our very first guest bloggers for helping us launch the Discovery Eye Foundation Blog. We are pleased that so many people appreciate the wide range of eye-related information from eye care professionals, as well as the stories from people that live with eye disease on a daily basis.
Thank you part 2
Here is a round-up of guest bloggers since June 2014 that shared their time, experience and/or expertise to provide you with the best eye-related information.

Sumit “Sam“ Garg, MD – what you should know about cataracts

Randall V. Wong, MD – floaters, causes and treatments

Roy Kennedy – his personal experiences with the miniature telescope implant

Sandra Young, OD – the importance of getting vitamins and minerals from your food and not just supplements

Jeanette Hasseman – living with keratoconus

Greg Shane – theater for the blind

Caitlin Hernandez – blind actress and playwright

Jullia A. Rosdahl, MD, PhD – lasers for glaucoma and genetics and glaucoma

Maureen A. Duffy, CVRT – ways to reduce harmful effects of sun glare

Kooshay Malek – what is it like to lose your vision and being a blind therapist

Jeffrey J. Walline, OD PhD – children and contact lenses

Robert Mahoney – choosing a home care agency

Robert W. Lingua, MD – nystagmus in children

Buddy Russell, FCLSA, COMT – common pediatric eye diseases, treatment options for children and pediatric contact lenses

NIH (National Institute of Health) – telemedicine for ROP diagnosis

Harriet A. Hall, MD – evaluating online treatment claims

Patty Gadjewski – the life-changing effects of a telescopic implant

Michael A. Ward, MMSc, FAAO – proper contact lens care and wearing contacts and using cosmetics

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

Coffee and Glaucoma: “1-2 cups of coffee is probably fine, but…”

10/2/14

The Relationship Of Coffee And Glaucoma

Research shows that drinking caffeinated beverages, especially coffee, causes eye pressure to go up, even just one cup of coffee. The effect is highest in glaucoma patients and people at risk for glaucoma. However, eye pressure goes up only a small amount, so it is probably not a significant risk.
Coffee and glacoma
In some people, though, too much coffee may be causing damage. In people at risk for exfoliation glaucoma (a type of open angle glaucoma where some flake-like deposits are seen on the lens of the eye), drinking three or more cups of caffeinated coffee was associated with an increased risk of developing exfoliation glaucoma. The effect was strongest in women with a family history of glaucoma. This study doesn’t show that coffee causes glaucoma, but does suggest that drinking three or more cups of caffeinated coffee might not be good for your eyes.

One group of scientists applied caffeine eye drops directly on to healthy eyes, and they did not see any increase in eye pressure. This suggests that caffeine doesn’t appear to have a direct effect.

How can you best protect your eyes? Consider going decaffeinated or limit your caffeine consumption. If you are at higher risk for glaucoma or have been diagnosed, be sure to have regular comprehensive dilated eye exams, use medications as directed and see your eye care provider as scheduled.
For more information about glaucoma, visit www.nei.nih.gov/glaucoma.

References
The effect of caffeine on intraocular pressure: a systemic review and meta-analysis. Li M, Wang M, Guo W, Wang J, Sun X. Graefes Arch Clin Exp Ophthalmol 2011. 249(3):435-42.

Effect of caffeine on the intraocular pressure in patients with primary open angle glaucoma. Chandra P, Gaur A, Varma S. Clin Ophthalmol 2011. 5:1623-9.

The relationship between caffeine and coffee consumption and exfoliation glaucoma or glaucoma suspect: a prospective study in two cohorts. Pasquale LR, Wiggs JL, Willett WC, Kang JH. Invest Ophthalmol Vis Sci 2012. 53(10):6427-33.

Effects of caffeinated coffee consumption on intraocular pressure, ocular perfusion pressure, and ocular pulse amplitude: a randomized controlled trial. Jiwani AZ, Rhee DJ, Brauner SC, et al. Eye 2012 26(8):1122-30.

Julia Rosdahl - coffee and glaucomaJullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

Our First Three Months Of Eye Care

9/30/14

Discovery Eye Foundation Blog’s First Three Months

It is hard to believe, but this blog has been providing information and insights into eye disease, treatment options, personal experiences of living with vision loss, and other eye-related information for seven months.

All of this would not have been possible without the expertise of remarkable eye care professionals who took time out of their busy schedules to share information to help you cope with vision loss through a better understanding of your eye condition and practical tips. Since so much information was shared in the seven months, here is a look at the first three months, with the additional four months to be reviewed next Tuesday.
Thank You - first three months
I am very thankful to these caring eye professionals and those with vision loss who were willing to share their stories:

Marjan Farid, MD – corneal transplants and new hope for corneal scarring

Bill Takeshita, OD, FAAO, FCOVD – proper lighting to get the most out of your vision and reduce eyestrain

Maureen A. Duffy, CVRT – low vision resources

M. Cristina Kenney, MD, PhD – the differences in the immune system of a person with age-related macular degeneration

Bezalel Schendowich, OD – blinking and dealing with eyestrain

Jason Marsack, PhD – using wavefront technology with custom contact lenses

S. Barry Eiden, OD, FAAO – contact lens fitting for keratoconus

Arthur B. Epstein, OD, FAAO – dry eye and tear dysfunction

Jeffrey Sonsino, OD, FAAO – using OCT to evaluate contact lenses

Lylas G. Mogk, MD – Charles Bonnet Syndrome

Dean Lloyd, Esq – living with the Argus II

Gil Johnson – employment for seniors with aging eyes

We would like to extend our thanks to these eye care professionals, and to you, the reader, for helping to make this blog a success. Please subscribe to the blog and share it with your family, friends and doctors.

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

Genetics and Glaucoma: Why don’t we have a genetic test for glaucoma?

9/25/14

We have known for a long time that there is a genetic component to glaucoma, since having a family history of glaucoma is one of the most important risk factors for developing the disease. Glaucoma is actually a group of diseases, including some starting at birth or in childhood, as well as the more common types that happen in adults, such as primary open angle glaucoma.dna strand - genetics and glaucoma

In some of the glaucomas of childhood, scientists can trace the cause to a single gene. For example, mutations in the gene for myocillin can cause juvenile-onset open angle glaucoma. And there are genetic tests available for some of these genes. These genetic tests, however, are helpful only for a subset of glaucoma patients. For most glaucoma patients, these tests don’t give us the answers we need.

In the types of glaucoma that happen in adults, both environmental factors and genetic factors contribute to whether or not someone develops the disease. This complex interplay of factors makes testing only one gene or a handful of genes not as helpful. For diseases like adult-onset open angle glaucoma, instead of having just one gene that is mutated and causing the disease, there are many genes involved. All these genes contain tiny differences, some potentially helpful and some potentially harmful. It is an individual’s mix of genes combined with the lifetime of complex environmental exposures, that determines whether he or she will get the disease. In the future, genetic tests that incorporate this group of genes will help doctors, patients, and families better understand their susceptibilities, and hopefully lead to prevention of vision loss from glaucoma.

Genetic testing has the potential to offer a lot of benefits, but is not without risk and unintended consequences. Genetic counselors are trained to help patients, families, and doctors navigate these areas.

For more information about glaucoma, visit www.nei.nih.gov/glaucoma.

References:
Genetics of primary glaucoma. AO Khan. Current Opinion in Ophthalmology. 2011. 22(5):347-55

Julia Rosdahl - genetics and glaucomaJullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University