Low Vision and Smart Phones

Many of us just use the basics on our smart phone and never personalize them for our own needs. It is worth taking the time to adjust our phones to take advantage of the special services that may be available and unused. Making a phone call or sending a text message with a smart phone can be challenging, however, with simple modifications, keeping in touch with the world can become a snap. Getting comfortable with your smart phone will make staying in touch with your loved ones very easy.

If you’ve used a smartphone these past several years you already know that a great deal of voice command capabilities come built in to most current models, so you can verbally instruct your smartphone to “Call my wife,” or “Read my last text message.” The smart phone has been a wonderful addition to the world of technology; with built-in accessibility features these phones have provided individuals with visual impairments the ability to carry out several activities that have been difficult without the use of a magnifier or other assistive device.

One way to make it easier to see the names in your contact list is to magnify the text on the screen. After tapping the “SETTINGS” icon on your home screen, you will find “ACCESSIBILITY” features under General Settings or Personal Set-up. Accessibility features can be used to visually enhance the use of your smart phone. Adjusting the size of the text, under the “LARGER TEXT” selection can magnify the print in your contact list so that names are easier to see. Simply sliding the prompt on the larger text screen to the right will enlarge print throughout your smart phone: phone contacts, text messages and emails.

Despite enlarging text, you still may find it difficult to see contacts on your screen. That is where tools called “VOICE ASSISTANTS” or “TEXT-TO-SPEECH” can make it less stressful for you. After you have enabled the settings, you can engage them by speaking into your unit’s microphone. On most phones, this feature can be turned on by holding down the home button. Once you hear a beep, you say the name of a person or business. You can access your contact list by asking your voice assistant to call people from your contact list or by reciting the phone number you are trying to connect to.

Tips for a Better Low-Vision Phone Experience

Whether you use some or all of the low-vision phone features described in this article, there are still more things you can do to improve phone usability that don’t require a trip to Accessibility settings. Some involve choosing hardware and software, others are simple, and cost nothing.

  • Right-size your phone: How much magnification you need depends on your vision, of course, but also on the size of the phone you choose. If you need a high level of zoom, or larger text, you might want to pick a phone with a larger screen, which will allow more of the screen contents to remain visible when you zoom or crank up the font size. You’ll find Android and iOS phones with screens up to 5.7 inches. Tablets are bigger. The challenge of a large phone for some low-vision users is the need to hold the device close to your eyes to view it. Before you choose a phone, be sure to handle and use the model you’re planning to buy.

  • High-contrast wallpaper: You can change the background of your Home screen by turning any photo into wallpaper, or picking from wallpapers already available on the device. Using a solid color, rather than a busy photo that obscures your app icons and the text on the Home screen can make it much easier to locate text and icons. If a solid background seems boring, try a starry sky or snowy scene, for a dark or light look, respectively.

  • Apps with dark mode and/or font size options: Apps that focus on reading and navigation often have their own accessibility-enhancing options. Apple’s iBooks and Amazon’s Kindle app allow you to change font size, and even typeface, as well as changing the background or text color of what you’re reading. Seek out apps that compensate for what might be missing in your phone’s operating system, or that simply offer a better experience.

Get the Most from your Phone

The good news about smartphones is that they all provide features to support those with low-vision or whose eyesight has simply changed due to age. Your challenge is to try out as many of these features as possible, and decide which ones are right for you.

For tips and instruction on how to use smartphone (Iphone/Android) if you have low vision:

How a visually impaired person can use a smartphone

How To Set Up An Android Phone/Tablet For Low 

How I Use My iPhone 7 Plus | Life, Legally Blind 

Driving at Night – Tips on how to drive safe

Your night vision will naturally decline as you get older. While it may not always be a problem, it can make activities such as night driving more hazardous. Unfortunately, many people don’t take this fact as seriously as they should.

Night vision can be impaired not only by the darkness, but also by the sudden glare of lights from oncoming cars, traffic signals, etc. Our eyes are forced to constantly adjust, leaving brief periods of impaired vision between adjustments.

Tips on how to drive safe at night:

  • Make sure that you see your eye doctor regularly for eye exams. (At least once every two years, more often if you have certain eye conditions).
  • Ask your eye care professional to prescribe special eyeglasses that may help you see better on the road at night. Anti-reflective coatings can cut down on glare.
  • Minimize the risks of driving at night as you get older by planning your trips before you leave home. Drive only on streets you know, and avoid dark, unlighted roadways.
  • Wear good sunglasses on bright days and take them off as soon as the sun goes down. Prolonged exposure to glare from sunlight or headlights can temporarily affect your visibility at night. It can also lead to eyestrain and drowsiness.
  • Keep your windshield clean. Sometimes dust can accumulate on the inside of your windshield that you may not notice during the day. This dust can catch the light from oncoming cars’ headlights and make it difficult for you to see.
  • Dim the lights on your dash. Bright interior lights can hinder your visibility of things outside your vehicle.
  • Do not look at oncoming headlights while driving; it can leave you blind for as much as five full seconds.
  • If you are driving through wooded areas, use your peripheral vision to watch for deer on the sides of the road. Oftentimes, you won’t see the deer themselves, but their eyes reflecting the headlights of passing cars. If you have any passengers in your vehicle, ask them to keep watch so you can focus your attention on your driving.
  • If you are over the age of 60 it is important to continually evaluate your nighttime driving skills, so that you are not endangering yourself and others.

Walk In My Shoes

Walk In My ShoesDiscovery Eye Foundation is pleased to present the following excerpt from a just-released inspirational book called Walk in My Shoes. It is the result of two years of collaborative effort and is a unique collection of 27 powerful stories by individuals who are experiencing or witnessing the challenges of losing not one, but two senses: hearing and sight. The writers of Walk in My Shoes offer a glimpse into living with Usher syndrome, a progressive disease leading to blindness and deafness. Walk in My Shoes speaks to the more than 400,000 people worldwide dealing with Usher syndrome, to their families, to the professionals working with them, and to the rest of the world.

All proceeds from book sales will be donated to the Usher Syndrome Coalition to help fund scholarships to its annual conferences and to support research for a cure. The writers inspire hope for anyone dealing with difficult life challenges.


MY USHER’S LIFE LESSONS
By Mary Dignan

I remember how I wanted to die, or at least for the Earth to open up and swallow me forever, when I read that memo telling me how I’d been asking questions that had already been asked and answered, and how I’d said things that were irrelevant and inappropriate at our meeting earlier that day. I had always known that the hearing problem was more of an issue than the visual field loss associated with Usher syndrome. Now, this memo was the proof that I never should have tried being a lawyer, that I had no business in this profession, and should just go home.

Instead of going home, I got up to close the door to my office, sat back down at my desk, and picked up the memo from Tom to read it again. Tom was my supervising attorney, and we had both been looking forward to that meeting with a potential new client. The work would be on an issue that no one at the firm knew better than I and we were sure we’d close the meeting with the retainer agreement in hand.

But the meeting just didn’t go well. It started off well enough, but there were some odd pauses in the conversation, moments of uncertainty and careful courtesy, and I didn’t feel good about it when it was over even though we did, in fact, end up with the retainer agreement. I was still thinking about the meeting a couple hours later when Tom’s secretary came into my office and handed me an envelope, sealed and marked “confidential.”

It was a memo from Tom. “Mary, I need to make you aware of some things I observed during our meeting today.” He listed specific things I’d said and described how I’d asked questions that had just been discussed, and how I’d said things that were irrelevant to the actual conversation. He said he and the client both knew I wore hearing aids and assumed I simply hadn’t heard things accurately. He said that because I had an excellent reputation as a truly competent professional, and because he and the client knew how well I knew the issue, they made allowances for me, and we got the account. Still, Tom was concerned. “Mary, I’m wondering if you’re not hearing as well as you used to, and if there is anything we can do to help.”

My hands were trembling as I put the memo back down on my desk, and I felt a hot flush rise up from my toes to my face. God, what an incompetent idiot I must have sounded like. I was even more embarrassed by the courteous smiles and patient repetitions, the polite allowances they had made for the incompetent idiot. It would have been better if someone had just growled at me to go put in some fresh hearing aid batteries.

But, when I read the memo yet again, I began to appreciate the inherent respect and sincere consideration Tom was showing me. Instead of confronting me with the painful truth, Tom could have just stopped working with me. He could have started whispering behind my back: ”Uh, best not give that assignment to Mary, she can’t handle it.” Or, “No, Mary’s not the best one to attend that meeting, she can’t handle it well.” And I would have slipped into miserable mediocrity.

He didn’t and, instead, he came to me and told me exactly how I wasn’t cutting it, and gave me the chance to find a way to measure up. I decided that before I handed in my resignation letter, I’d at least find out if there was a better hearing aid out there. I called my audiologist and told him what had happened. He told me I was already using the best and most powerful hearing aids available, but there might be one other thing I could do, “It’s time for you to get an FM system. Come on down this afternoon and we’ll get you set up.” This was an assistive hearing device that would enhance the use of hearing aids and therefore allow me to hear better.

I was in my early 40s then, down to less than 5 degrees of tunnel vision and wearing two high-power hearing aids. I still had good precision vision within my little tunnel. For the last 20 years of slow but steady vision and hearing losses, I had always figured out ways to work harder and smarter. It was the hearing losses that troubled me most. I’d been wearing the best high-power hearing aids for years, and was so good at reading lips and body language that it was easy to forget I had a hearing problem. But as my vision started to go and I could no longer read lips and body language well, we all began to comprehend just how deaf I really was. It didn’t matter so much that I was mowing down my colleagues in our office hallways, but responding inappropriately to clients and judges was a huge problem.

It took practice and patience to develop the skill to use my new FM system effectively, but the effort paid off. My FM system worked well because I made it work, and I made it comfortable for everyone around me to work with me.

There were several lessons, or rather reminders, for me out of that whole incident, including the fact that it’s just about impossible to die of humiliation, no matter how much you may want to. More importantly, I was reminded that everyone around me took their cues from me—if I was uncomfortable with the fact that I had to use an FM system to hear, everyone else would be uncomfortable with it too. So I not only learned to use the FM system well, I also learned to introduce myself and my tools with candor and humor.

”Hi, I’m Mary Dignan from Kronick, Moskovitz, Tiedemann and Girard, representing the State Water Contractors, and that’s my FM system in the middle of the table there. It helps me hear, and I would appreciate it if you would not touch the mike or the wires because it sends a lot of irritating static directly to my hearing aids.” I’d pull my aids slightly out from behind my ears to make them obvious and then I’d put them back, and go on. “The other thing you need to know about me is that I only see through a little keyhole,“ and here I would make a keyhole tunnel of my fist and peek through it, “which means I can see you.” Then I would point at someone else, “But I don’t see Tom sitting next to you,” and pointing at Tom I would continue, “This is a good thing because I don’t like looking at Tom anyway.”

That would generate a few chuckles. “This is my cane,” I would add, picking up my telescoping white cane from the table and opening it. “I use this to find the stuff that doesn’t show up in my keyhole when I’m walking around and it’s also highly useful for whacking people in the ankles and patooties.” More chuckles, and then we’d move on and get down to business.

I learned not to waste energy on trying to cover up my vision and hearing challenges. That meant I had more energy to focus on doing my job, and doing it well. I didn’t worry about attending conferences or night meetings, because I learned how to use my white cane to get around on my own safely and gracefully. I also learned to ask for and accept a helping arm with grace. I learned that if you are good at your work, and especially if you are a good team player, your colleagues will be willing to make any reasonable accommodations you need. Even before the Americans with Disabilities Act (ADA) and the term “reasonable accommodation” joined our vocabulary, I had no problem getting hearing-aid-compatible phones, lighting and other low-vision aids, adaptive computer technologies, and even cab rides when I had to stop driving.

I learned that when my colleagues knew I was putting my best effort into making things work, most of them were willing to put in a little extra effort themselves to help me out. Sometimes it was as simple as giving me an extra few seconds to get my FM system set up before they started the meeting, or steering me around pillars, potted plants and people that seem to always get in one’s way at a crowded conference, or giving me a ride home. Sometimes it was sending me a memo telling me honestly about some problems I needed to be aware of in order to figure out ways to solve them.

The FM system was a good solution for a few years. It turned out that, apart from the Usher Syndrome, one of the reasons I kept losing more of my hearing was an acoustic neuroma brain tumor that grew out of the cochlear nerve to my right ear. The surgery to remove the tumor saved my life but exacerbated my hearing and vision challenges so much that I had to give up my legal career.

Ten years after the brain tumor surgery I received a cochlear implant, which greatly improved my hearing. I still have trouble with background noise, and I can only hear out of one ear, but I hear better than I ever could before. It is the one thing in my life that has gotten easier. I am 60 now, with almost no vision left except some high-contrast shapes in a world of murky shadows spiked with glare.

Those lessons I learned years ago still apply today and I have come to realize that this is because they are Life Lessons, not merely issues particular to Usher Syndrome or any other disability. I have also come to realize that part of learning and developing one’s abilities is as much a lesson of disability as it is ability. One such lesson came from my friend Brian, an extraordinarily competent computer wizard who was born blind.

Brian can listen the way I used to be able to read a thousand words a minute, and his orientation and mobility skills are awesome. We often talked about the differences between being totally blind from birth, and going blind later in life. Apart from the life adaptation and grieving issues, the main differences we noted involved the ways we perceived and comprehended the world around us. I told him about a totally blind guy who had a hard time wrapping his mind around the concept of transparency. He just couldn’t make out how a hard cold pane of glass that he could rap his knuckles on was something you could “see” through.

“Oh, I don’t have a problem with that concept,” Brian said. “My problem is pictures.”

“Pictures?” I questioned.

“Yeah, pictures,” Brian said. “How can you put a three-dimensional world onto a flat piece of paper?”

I remember my jaw dropping as I stared at him and began to comprehend how rich and real the world is to Brian. He can’t see any of it, but he knows it intimately. He moves in a world that he perceives physically and kinesthetically through all his other senses. He is always aware of how his surroundings feel, smell and sound. In a lot of ways, he is much more aware of and intimate with his world than most sighted people who superficially see their worlds from a distance and from a flat piece of paper.

Brian taught me that even though I am losing all my sight, I still have a rich world to perceive through touch, taste, sound, feeling, smell and experience. This, too, is a Life Lesson, not just an Usher thing, but it is a lesson sweeter because of Usher syndrome. It does not lessen the pain of losing my vision, and it doesn’t even necessarily make my life easier. But it does give me hope and joy. It is the reason I’m still doing my mosaics (with a little sighted help here and there), the reason I’m still in my kitchen baking from scratch and making up new recipes, the reason I can tell when I’m on the beach or in the redwood forest, or even just out on my patio enjoying the evening breeze and garden scents. And it is the reason I know I still have a good life to live.
 
 

ABOUT THE AUTHOR

Mary Dignan was diagnosed as mentally retarded before the moderate-severe deafness was diagnosed close to age five. She was then fitted with hearing aids and attended public schools. At the age of 20 she was diagnosed with Retinitis Pigmentosa and, years later, was told she had Usher syndrome, type 2.

Ms Dignan earned a B.A. in English/written communication from Santa Clara University in 1976. Her 21 year career in agriculture and water resources management issues includes work as a news reporter, legislative aide to the U.S. House of Representatives in Washington, D.C., and the California State Assembly Committee on Agriculture in Sacramento. She earned her juris doctorate with distinction from the University of Pacific-McGeorge School of Law in 1994 and practiced law until 1997. She now creates and teaches mosaic art and her work has been shown in several public venues including: Sacramento Society for the Blind and the Canadian Helen Keller Centre in Toronto, Canada. Her community service includes serving on the Sacramento Board of Supervisors’ Disability Advisory Committee, and on the Board of Directors of the FFB, Sacramento Chapter. She is a present member of the Sacramento Embarcadero Lions Club. Ms Dignan lives in Sacramento with her husband, Andy Rosten.

How to Lessen Computer Vision Syndrome

Your eyes are your window to the world – but your eyes get a lot of extra strain thanks to the advent of new technology. Especially at work, we’re looking at screens of all different sizes and types all the time. And what happens to our eyes can be more than just a case of tired muscles; in fact, it’s got a name – computer vision syndrome.

The cause of that is obvious – lots of screens, as we said, and often multiple screens. In addition to computer vision syndrome, sufferers can feel headaches and eye fatigue among other symptoms. Luckily there are steps you can take to reduce or mitigate the chance of eye strain. Setting up a work station properly can help, as can anti-glare screens or placement of technology in relationship to sources of natural light.

If you’re focused on the health of your eyes, this graphic is an absolute must-read.

How to Protect Your Eyes in the Digital Age

thumbnail_eugene
Eugene Feygin
Program Manager at Quill.com

Planning a Vacation With Vision Loss

When you think of a vacation, you think of having fun, relaxing and trying new experiences. This is not so easy if your are visually impaired, especially if it is a new vacation location. It can become stressful, scary and a big ordeal, even if you have someone who is sighted going with you. What follows are a few tips and strategies for planning a vacation with vision loss. Hopefully they will help you enjoy your trip.

Planning a Vacation With Vision Loss

Susan DeRemerSusan DeRemer, CFRE

Discovery Eye Foundation

7 Tips for Living With Glaucoma

living with glaucoma
Did you know January is Glaucoma Awareness Month?  Although no cure exists, the eye disease may be treated with medication and surgery.  If left undiagnosed and untreated, however, glaucoma can cause permanent damage to vision.  According to the National Eye Institute, glaucoma affects more than three million people in the United States. The population that is at highest risk is adults over the age of 60. Glaucoma affects vision by damaging the optic nerve and typical vision loss occurs in the peripheral visual field. This type of loss can create difficulty performing everyday tasks. To mark the importance of Glaucoma Awareness Month, Low Vision Focus @ Hadley offers these tips to improve independence and safety for people with glaucoma-related vision impairments.

Tips for Living With Glaucoma

  1. Loss of peripheral vision makes it difficult to see steps and stairways.  Marking treads and handrails with contrasting colored paint or tape can improve navigation and reduce the risk of falling.
  2. Persons with glaucoma often experience difficulty adjusting to darkness or darkened rooms. Increase illumination in dark closets or hallways by installing additional lighting fixtures. When outdoors at night, carry a strong flashlight.
  3. Area rugs can pose a hazard for persons with visual field loss.  It’s best to keep home pathways and work areas free of extra floor coverings.
  4. In all locations where you might be a frequent visitor, ask someone to give you a tour.  It goes without saying you need to know where the bathroom is located, as well as how to exit the building from a variety of locations.
  5. Some persons with glaucoma prefer to use a human guide when traveling in unfamiliar places.  To use a human guide effectively, grasp the guide’s arm firmly just above the elbow and walk a half a step behind. This positioning gives the most protection from potential obstacles and allows both people to function as a team.
  6. Get in the habit of consistently closing kitchen and bathroom cabinets, especially those above countertops.  Make sure doors are either all the way open or shut.  Practicing both of these safety techniques can greatly reduce the risk of head injury.
  7. Before reaching down to pick up dropped objects, place your hand, palm out, about 12 inches in front your face.  This way, you’ll make sure you don’t hit the edges of tables or countertops with your forehead.

Remember, although glaucoma cannot be cured, it can be treated.  Regular eye exams, especially for adults over 60, are critical to control the spread of the disease.  For those who are affected by vision loss, it’s important to remember that the acquisition of some simple adaptive skills and techniques can help maintain safety and independence.  Low Vision Focus@Hadley is dedicated to assisting persons with low vision to live life to the fullest all year long. For more information on how Low Vision Focus@Hadley can help you or someone you know, please visit our website www.lowvisionfocus.org, or call (855) 830-5355 to find out about our free programs and materials.

1/12/16

Ed Haines - living with glaucomaEd Haines
The Hadley School for the Blind
Low Vision Focus @ Hadley

5 Elements of Accessible Web Design

A common misconception is that all you need to have a successful blog or website is good content. While content people want to read is important, if you can’t see it, or it is difficult to read, very few people are going to take the time to try. There is lots of good content to choose from.

Making your content easy to scan and read and using great graphics that can tell a story are just as important. Especially if you want to reach the millions of potential readers that are blind or visually impaired.

While a person with low vision (due to age-related macular degeneration, cataracts,glaucoma or other eye diseases that are related to aging) can increase font size or graphics by enlarging them with a pinch of the fingers or scroll of the mouse, the result is often blurry and still difficult to see.

If a person is blind and using a screen reader, what they hear may not match what is written or displayed. A picture without underlying descriptive text is worthless. And when a blind person is using a screen reader to read a web site, they will often tab from link to link to scan your article, skipping over your text, to get a sense of what the options are. “Click here” says doesn’t tell the reader anything.

Here are 5 essential elements of accessible web design.

5 elements of accessible web design

12/15/15

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

6 Tips to Help With Holiday Stress

We all know that the holidays can be stressful with the many demands of shopping, baking, parties and the expectation that you should be filled with cheer and goodwill. This is all daunting under the best circumstances, but if you are also losing your vision to eye diseases such as glaucoma, age-related macular degeneration or diabetic retinopathy, the depression can increase.

6 Tips to Help With Holiday Stress

holiday stress
Being realistic, planning ahead and asking for help will let you deal with the stress and depression that may come with the holidays. Here are six tips that will help you deal with the pressures of the holidays, with additional tips for those with vision loss.

  1. Begin by realizing you don’t have to be happy just because the holidays are here. You may have experienced a loss of someone close to you that makes celebrating the holidays hard.
     
    With vision loss: You may miss seeing or putting up decorations; baking for friends and family; or seeing the joy and smiles of loved ones. You can’t force yourself to be cheerful because of the time of year.
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  3. While the common reaction to depression is stay home and isolate yourself, don’t, it will only make you feel worse and dwell on things you cannot change. Join friends when they ask you out, find community events to attend or volunteer. Sharing time with others can provide a welcome distraction and lift your spirits.
     
    With vision loss: It is common to be uncomfortable with asking friends and family for a ride, but if they are attending the same party of community event, ask them if you can get a ride. They won’t mind a will be glad you are there. Worst case, call a taxi or use Uber.
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  5. Don’t expect perfection. You need to define for yourself what would make a great holiday and not let the media and retail stores tell you what the holidays should be. Also remember that your traditions will change as your family changes and grows. Look at this as an opportunity to be creative and start new traditions.
     
    With vision loss: Scale your holiday to what is comfortable to you. If fewer decorations make it safer and easier for you to navigate around your home, then reduce the number of things that go up to a few larger items you can enjoy more easily – you can even “decorate” with holiday music.

    Even traditions may need to change. Allow someone else to host the family or neighborhood celebrations. It is nice to pass the honor on and you won’t be so stressed and tired you can’t enjoy the festivities.

  6. Plan ahead so you don’t feel the pressure. This refers to budgeting both time and money.
         • Plan extra time for decorating, shopping, baking, wrapping presents, or any other activity you want to include. Rarely do things run smoothly, especially at holiday time.
        • Decide how much money you can spend, and stick to it. To make money go further, give homemade gifts, start a gift exchange instead of shopping for everyone in your family or office, or make a donation to a charity in someone’s name.

    With vision loss: The same concepts apply – you need to budget your time and money.

  7. Don’t over extend yourself and learn to say no. If you don’t you may become resentful and overwhelmed. Friends and family will understand if you can’t do everything. If your guilt gets the better of you, ask the person making the request to help with the tasks. They will gain a new appreciation of what you do.
     
    With vision loss: Don’t be afraid to let people know that you may not be able to do things as easily as you could in the past. No one, except you, know the limitations you have with your vision. It can be very uncomfortable for others if they think they are asking too much of you, and you could become resentful for being asked to do something beyond your capabilities.
  8.  

  9. Stay healthy. The best way to do this is to watch what you eat and drink, get plenty of sleep, continue any exercise routine you have and take time to relax.
         • You will be tempted with lots of sweets and snacks. Try eating something healthy like cut veggies before you go to the party to curb your appetite. Remember to limit your alcohol because of the calories and the fact that it is a depressant.
         • Sleep will keep you alert and better able to focus what you want to get done and will help keep you more positive.
         • Exercise is a great way to help relieve the stress you feel, give you an extra burst of energy and help you clear your head.
         • Taking 15-20 minutes to just listen to music, take a bath, go for a walk or read book can help you think more clearly and relax. You will actually get more done when you can “re-charge” yourself.

    With vision loss: Everything listed above is good for good eye health. A good diet of brightly colored fruits and vegetables and exercise are very important. Being tired can affect how well you see, and stress has been known to have an adverse effect on a person’s vision.

Because of the busy holiday season, this month we will only be publishing once a week, on Tuesdays.

12/8/15

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

Low Vision Aging Adults at Higher Risk for Falls

Low vision in aging adults varies as do the occupational therapy techniques that might help older adults in becoming more independent. Mr. P has glaucoma resulting in a narrowed field of view. He is light sensitive, and keeps his blinds closed, darkening the house. He is responsible for doing his laundry, yet his washer and dryer are in the basement, causing a safety concern. Mrs. K has macular degeneration with 20/400 visual acuity. She has severely reduced contrast sensitivity, and can no longer drive or recognize faces easily. She no longer gets to the senior center for regular exercise sessions, which is concerning to her and her OT. Ms. T was diagnosed with diabetic retinopathy. She has struggled for years to accurately see her glucometer and insulin. She has recently developed peripheral neuropathy, leading to wheelchair dependency. Each of these patients is likely to leave their home less often because of their low vision, eventually leading to a decline in lower extremity weakness, balance, endurance and confidence. The fear of falling leads to more isolation, which can cause even more lower extremity weakness, problems with balance, decreased endurance, and even depression. The irony is that this cycle, which began with caution and a fear of falling, lends itself to exactly that. . .a fall.

Why are low-vision aging adults at higher risk for falls?

According to the CDC, “Each year, millions of older people-those 65 and older-fall. In fact, one out of three older people fall each year, but less than half tell their doctor. Falling once doubles your chances of falling again.” The typical aging adult with low vision faces challenges that others do not. Difficulty seeing details combined with reduced contrast sensitivity leads to a decline in mobility and socialization.
risk for falls
risk for falls
So how do we help older adults with low vision lower their risk for falling? When considering safety within the home, persons with low vision must make it a priority to add lighting & contrast whenever possible. Consider all rooms of the house, including entrances, hallways and stairways.

  • Placement of night lights in hallways, stairway, etc.
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  • Keep flashlights in accessible places throughout the home where night lights are not possible.
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  • Instead of closing blinds, keep them open & wear appropriate colored filters to manage glare/light sensitivity.
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  • Small battery operated stick-on lights or rope lighting is inexpensive, and easy to place on steps to light up a stairwell.
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  • Line edge of steps, or stairway railing with brightly colored duct tape to increase visibility.
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  • Make sure grab bars, tub benches, shower chair are high contrast, to be most visible.
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  • Remove throw rugs, with the exception of those providing function, such as the one at the entrance and bathtub. Their purpose is for providing dry shoes and feet, but they should have a non-skid back and a high contrast color to “stand out.”
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  • Reduce clutter in rooms to increase safety by removing items from floors, walkways and stairwells.
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  • Consider investing in a Medical Alert System to provide added piece of mind, confidence, especially when living alone.

Persons with low vision can decrease their frequency of falls by staying social and walking in the community. Unfortunately, many low vision adults become more house bound when they can no longer drive. Locating sources of alternative transportation may be helpful. Seeing faces is difficult, making socializing a challenge, which can lead to depression. The following recommendations take into consideration the challenges of not seeing details or across the visual field normally, while improving lower body strength, endurance, coordination, confidence, and hopefully reducing the risk of a fall.

  • Encourage regular trips to the grocery stores and the mall to keep physically fit. Malls are safe environments to walk around because of wide, straight hallways. Use magnifiers to see price tag/label details, or take advantage of personal shoppers who assist with locating items.
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  • Participate in regularly scheduled exercise sessions (videos, groups, etc). Sit/stand in the front row, ask instructor to provide clear verbal instruction, instead of only demonstration. Consider hiring a personal trainer in order to get 1:1 instructions for how to use exercise equipment. If watching a video, move closer to your largest TV screen. Home exercise equipment can be labeled with high contrast markings to increase visibility of its details.
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  • Consider joining a senior center in the community. Some have low vision support groups.
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  • Access driving alternatives, such as the Smart Bus, Senior Centers, Local Volunteer or Church groups. Consider using money previously spent for a car and its expenses to hire a private driver.
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  • Use appropriate colored filters in bright outside conditions or darker inside environments (i.e. Amber outside in the sun; Yellow inside a dark restaurant or outside with overcast weather).
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  • Consider using a walker or support cane when walking longer distances in the community or neighborhood. Many individuals decline using an assistive device, not realizing how active and fit it can make them. Rolling walkers are even available with seats, allowing for rest breaks wherever necessary.

While the fear of falling is great amongst all seniors, those with low vision need to consider adding strategies that specifically benefit them. Making changes within the home may be as simple as improving lighting and contrast. Remaining physically fit outside of the home may be done with shopping or exercise equipment, but either way staying active will improve confidence, the fear of falling, and hopefully decrease the chance of a fall. If you are unsure of what approach is best for you, consult with your ophthalmologist about scheduling a low vision eye exam and occupational therapy.

Reference:
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control-CDC 24/7: Saving Lives, Protecting People

12/3/15

Annette Babinski's headshot thumbnailAnnette M. Babinski, OTR/L CLVT
Henry Ford Health System
Vision Rehabilitation Center
 
 
 
 
 

Michelle Buck's headshot thumbnailMichelle Buck, MS, OTR/L CLVT
Henry Ford Health System
Vision Rehabilitation Center

Business Opportunity for Blind Adults

Food for Thought – Business Opportunity for Blind Adults

For those not in the know, the acronym sounds like a popular sandwich. However, for Louisville, KY resident, George Bouquet, The Hadley School for the Blind’s and the National Association of Blind Merchants’ joint“BEPLT” program (Business Enterprise Program Licensee Training) is more like a dream come true.

George Bouquet - Business Opportunity for Blind
George Bouquet

Hadley is the largest provider of distance education for people who are blind and visually impaired worldwide and the BEPLT program is part of the school’s Forsythe Center for Employment (FCE) and Entrepreneurship. Under the Randolph-Sheppard Act, legally blind adults are given first right of refusal on operating state and federal government vending facilities including cafeterias, snack bars, convenience stores, micro markets, and vending machines and rest stop vending areas nationwide. In February 2014, Hadley’s FCE partnered with the National Association of Blind Merchants (NABM) and the National Federation of the Blind Entrepreneurs’ Initiative (NFBEI) to bring the academic portion of training to would-be blind vendors. Individual state Business Enterprise Programs provide the hands-on component of the blind vendor training. Bouquet is Hadley’s first graduate from the school’s new BEPLT program.

Born with both Pierre Robin Syndrome, which often results in a smaller-than-normal lower jaw, a cleft palate, a tongue that falls back in the throat, and difficulty breathing, as well as Stickler Syndrome, which causes hearing loss, eye abnormalities and joint problems, Bouquet has struggled with health issues throughout his 54 years. Although he was born without eye lenses, he was not born blind. Rather, his vision worsened over time. Bouquet worked in several food service positions since high school and had wanted to become a Randolph-Sheppard vendor even before he would have qualified as legally blind!

There are only so many blind vendor licensee training slots available and many more people compete for them than such programs can accommodate. The first time Bouquet applied to receive the training was in February 2014. Unfortunately, he was not accepted into a program. However, he was fortunate to gain some blind vendor experience by working under friends who already held the license. In early 2015, Bouquet’s counselor told him of another opportunity to apply for vendor training. This time he was accepted and Bouquet began Hadley’s BEPLT program in April 2015. Bouquet was so motivated to graduate from the program that he completed approximately two modules (one-lesson online courses) per week. Hadley’s BEPLT students complete a 10-module program and then take their state’s physical training component. After passing both elements, graduates are eligible to bid for the opportunity to become a blind vendor in their community.
George Bouquet - Business Opportunity for Blind
“The [Hadley BEPLT] program offers a lot of useful information. It will really help anyone wanting to undertake vending,” he said. Bouquet then acknowledged that the material about food borne illnesses helped him to realize the tremendous responsibility he would be accepting by running a government food service area. “As a manager, you need to decide what you are willing to delegate to other people,” he added.

For Bouquet, becoming a blind vendor allows him to hire and train his 25 year-old unemployed son, who inherited most of his visual and hearing problems. This training is Bouquet’s first step toward creating a legacy of financial independence.

10/13/15

Sheryl BassSheryl Bass, MA, MSW
The Hadley School for the Blind