Low Vision

Low vision is the term used to describe significant visual impairment that can’t be corrected fully with glasses, contact lenses, medication or eye surgery.  Low vision causes a person to be unable to accomplish some daily tasks due to sight impairments. Low vision occurs when an individual struggles with any of the following common activities:

  • Reading
  • Everyday tasks like personal grooming
  • Viewing photos
  • Recognizing faces

Millions of Americans experience a normal loss of vision as they get older and the number of individuals who develop vision problems due to health conditions is projected to continue to rise.

There are many things that can cause low vision, including:

A few simple approaches can be:

  • Getting an eye exam
  • Update your reading glasses
  • Use bright light for reading

If these do not work for you, ask your eye care professional for help or ask for a referral to a low vision specialist.

Low Vision Technology 

Individuals with eye disease related to age, or vision compromised due to injury, may benefit from the usage of low vision devices.

There are two primary categories for low vision devices: Magnifiers for viewing things and objects that are close to you (magnifying lenses or machines), and magnifiers used for viewing objects and images at a distance (telescopic lenses). Many lighted magnifiers for close objects improve readability by increasing illumination.  With the advances in technology, many low vision devices are available to provide multiple function (near and distance) magnification and visual aid.

Technology is advancing to meet the growing needs of people with low vision impairment. There are a number of products that can help individuals with low vision. While considering the correct vision enhancer, keep in mind a few objectives:

  • What is the visual ability of the individual? Low vision aids are created with different options for specific low vision needs.
  • What tasks will the visual enhancer be used for? Find out what each product is best used for to decide if it will meet the needs of the individual.
  • Is the device easy to use? The right device should be easy for you to use.
  • How much does it cost? The cost of low vision aids can vary depending on a number of factors.

Popular products include:

Portable magnifiers and lighted magnifiers- offer magnified reading on the go. Perfect for menus, shopping lists, label reading, and more, portable magnifiers can fit in your pocket, purse, or be worn on the belt for quick, easy use.

 

Wearable magnifiers – wearable technology is the future for those with low vision who live an active lifestyle.  Wearable options make it possible to see and take part in everyday tasks, such as reading and recognizing faces.

 

Transportable magnification screens– are perfect for close up viewing as well as distance viewing. These great viewers offer great flexibility, from watching TV to using the mirror image feature for self-viewing. There are APPS for smart phones that can be used to magnify reading material.

  

Desktop devices for reading books, bills or letters – these have large, bright screens. A reading table offers visual aid for reading books, optional computer connectivity and more. This family of portable magnification units offers up to 75x magnification.

 

 

Consult a Low Vision Specialist–Consider making an appointment with a trained low vision specialist if you have specialized needs. They are available in larger cities or can be found by contacting The Braille Institute or by an internet search. Talk with your low vision specialist to find out which is right for you and where you can find them.

In addition to low vision devices and good lighting, inexpensive non-optical adaptive aids can assist with routine daily activities. These devices include:

  • Large-print cookbooks
  • Large-numbered playing cards, clocks, telephones and watches
  • Electronic “talking” clocks, kitchen timers, thermometers, blood pressure meters and even pill bottles
  • Large felt-tip pens and wide-lined paper for writing notes
  • Color-coded pill boxes
  • Signature guides help in writing your signature in the correct place

Many of these items can be found at your local drugstore, discount store or bookstore. Your low vision specialist can recommend retail sources for non-optical adaptive aids.

Vision loss can definitely be alarming but learning how to adapt, with the aid of low-vision specialists, can result in continued independence.  As low vision aids are tools focused on helping with the physical aspect, it is also important to seek the help of a counselor for psychological counseling if needed or join a support group, that may provide the help you need. Finally, maintaining a social network and asking for help will enrich your life, and help maintain your independence and quality of life.

Resources:
www.enhancedvision.com
www.allaboutvision.com
www.nei.nih.gov
www.brailleinstitute.org
www.visionaware.org
www.aao.org
www.amd.org
www.californiaphones.org
 

 

 

 

 

 

Ways to Reduce the Harmful Effects of Sun Glare

During the height of summer sunshine (and heat!), it’s helpful to discuss the importance of eye protection, including ways to reduce the harmful effects of sun glare.

Fundamentally, we need light to see. Approximately 80% of all information we take in is received through the sense of sight. However, too much light – and the wrong kind of light – can create glare, which can affect our ability to take in information, analyze it, and make sense of our surroundings.

Facts about Sunlight

Every type of light has advantages and disadvantages, and sunlight is no exception:

Advantages:

• Sunlight is the best, most natural light for most daily living needs.
• Sunlight is continuous and full-spectrum: the sun’s energy at all wavelengths is equal and it contains all wavelengths of light (explained below).

Disadvantages:

• It is difficult to control the brightness and intensity of sunlight.
• Sunlight can create glare, which can be problematic for many people who have low vision.
• Sunlight is not always consistent or reliable, such as on cloudy or overcast days.

Visible Light and Light Rays

An important factor to consider is the measurement of visible light and light rays, beginning with the definition of a nanometer:

• A nanometer (nm) is the measurement of a wavelength of light.
• A wavelength is the distance between two successive wave crests or troughs:

Wavelength - glare

• A nanometer = 1/1,000,000,000 of a meter, or one-billionth of a meter. It’s very small!

The human visual system is not uniformly sensitive to all light rays. Visible light rays range from 400 nm (shorter, higher-energy wavelengths) ? 700 nm (longer, lower-energy wavelengths).
Visible Light Spectrum - glare
The visible light spectrum occupies just one portion of the electromagnetic spectrum, however:

• Below blue-violet (400 nm and below), is ultraviolet (UV) light.
• Above red (700 nm and above), is infrared (IR) light.
• Neither UV nor IR light is visible to the human eye.

Ultraviolet Light and Blue Light

Ultraviolet (UV) light has several components:

• Ultraviolet A, or UVA (320 nm to 400 nm): UVA rays age us.
• Ultraviolet B, or UVB (290 nm to 320 nm): UVB rays burn us.
• Ultraviolet C, or UVC (100 nm to 290 nm): UVC rays are filtered by the atmosphere before they reach us.

Blue light rays (400 nm to 470 nm) are adjacent to the invisible band of UV light rays:

• There is increasing evidence that blue light is harmful to the eye and can amplify damage to retinal cells.
• You can read more about the effects of blue light at Artificial Lighting and the Blue Light Hazard at Prevent Blindness.

A new study from the National Eye Institute confirms that sunlight can increase the risk of cataracts and establishes a link between ultraviolet (UV) rays and oxidative stress, the harmful chemical reactions that occur when cells consume oxygen and other fuels to produce energy.

Sunlight and Glare

Glare is light that does not help to create a clear image on the retina; instead, it has an adverse effect on visual comfort and clarity. Glare is sunlight that hinders instead of helps. There are two primary types of glare.

Disability glare

• Disability (or veiling) glare is sunlight that interferes with the clarity of a visual image and reduces contrast.
• Sources of disability glare include reflective surfaces (chrome fixtures, computer monitors, highly polished floors) and windows that are not covered with curtains or shades.

Discomfort glare

• Discomfort glare is sunlight that causes headaches and eye pain. It does not interfere with the clarity of a visual image.
• Sources of disability glare include the morning and evening positions of the sun; snow and ice; and large bodies of water, (including swimming pools).

Controlling Glare

You can protect your eyes from harmful sunlight and minimize the effects of glare by using a brimmed hat or visor in combination with absorptive lenses.

• Absorptive lenses are sunglasses that filter out ultraviolet and infrared light, reduce glare, and increase contrast. They are recommended for people who have low vision and are also helpful for people with regular vision.
• Lens colors include yellow, pink, plum, amber, green, gray, and brown. Ultra-dark lenses are not the only choice for sun protection.
• Lens tints in yellow or amber are recommended for controlling blue light.
• NoIR Medical Technologies: NoIR (No Infra-Red) filters absorb UVA/UVB radiation and also offer IR light protection.
• Solar Shields: Solar Shields absorb UVA/UVB radiation and are available in prescription lenses.
• You can find absorptive lenses at a specialty products store, an “aids and appliances store” at an agency for the visually impaired, or a low vision practice in your area. Before you purchase, it’s always best to try on several different tints and styles to determine what works best for you.

More Recommendations

• Always wear sunglasses outside, and make sure they conform to current UVA/UVB standards.
• Be aware that UV and blue light are still present even when it is cloudy or overcast.
• Make sure that children and older family members are always protected with UVA/UVB-blocking sunglasses and brimmed hats or visors.

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

Unleash the Power of Age

5/29/14

Employment Challenges Faced by Older Persons with Visual Impairments


Growth in Number of Older Persons with Vision Loss
May is designated as “Older Americans Month” and last year’s theme “Unleash the Power of Age” seemed an appropriate title for this article with the number of baby boomers who are coming down the pike. In fact, according to the U. S. Bureau of Labor Statistics, the annual growth rate of “boomers” (those 55 and older) is projected to be 4.1 percent, 4 times the rate of growth of the overall labor force. Indeed, the Governmental Accountability Office estimates that by 2015 (just next year!!), older workers will comprise one-fifth of the nation’s workforce.
man at computer
At the same time, the number of older persons with vision loss are growing dramatically due to age-related eye conditions such as macular degeneration . The 2011 National Health Interview Survey (NHIS) Preliminary Report indicated that an estimated 21.2 million adult Americans (or more than 10% of all adult Americans) reported they either “have trouble” seeing, even when wearing glasses or contact lenses, or that they are blind or unable to see at all. The survey also indicated that 12.2% of Americans 65 to 74 years of age and 15.2% of Americans 75 years of age report having loss of vision. These estimates only include the non-institutionalized civilian population.

Economic Burden of Vision Loss and Aging
According to Prevent Blindness, disorders of the eye and resulting vision loss result in a major economic burden to society, for all ages, but most dramatically with people 65 years of age and older: 77.27 billion of direct and indirect costs . Loss of productivity is estimated to be almost $25 billion for the 65 plus population.

Older People Want to Continue to Work
The loss of productivity costs are of particular concern given the fact that older people, including those with vision loss, want to continue to work. In fact, older persons are staying in the labor market beyond the usual retirement age. This is due to many reasons: people are living longer and often are in good health; because of the downturn in the economy, some need to work beyond the usual retirement age to meet to supplement diminished retirement funds; and some are looking for social engagement through the workplace.

Assets Versus Perceptions
Experienced workers who are older offer many assets to employers such as: an understanding of the expectations of employers; respect for co-workers and supervisors; loyalty; and skills and knowledge based on prior work experience. However, a major dichotomy is occurring in our society regarding older workers: “…companies are struggling with the large numbers of older workers who are retiring, and that the brain drain is a matter of concern to many…While the loss of experienced staff is a challenge that all companies must address, technology has improved the workplace and the work environment by enabling workers of all ages to complete work from other locations…Evidence shows that ageism, stereotypes, and misinformation about mature persons continue to be issues across all segments of society, including the workplace. … studies revealed that the positive perceptions characteristic of older workers held by managers include their experience, knowledge, work habits, attitudes, commitment to quality, loyalty, punctuality, even-temperedness, and respect for authority. These same studies also reveal some negative perceptions held by managers about the mature worker: inflexibility, unwillingness or inability to adapt to new technology, lack of aggression, resistance to change, complacency….. While the results of these findings may appear confusing or contradictory, they clearly focus on the precise and delicate balance between positive and negative perceptions that, depending on the industry or work environment, may affect a manager’s decision to hire, retain or advance an older worker.”

Kathy Martinez, Assistant Secretary of the Office of Disability Employment Policy at the Department of Labor, feels that this dichotomy, as it relates to people with disabilities, will not really change until disability becomes more of an environmental issue than a personal issue and that workplace flexibility is critical in terms of time, place, and task. (“Public Policy and Disability: A Conversation about Impact”, Disability Management Employment Coalition conference, April 1, 2014).

Challenges of Obtaining and Retaining a Job for Older Persons with Vision Loss
In addition to the negative perceptions noted above, older persons who experience vision loss, have additional challenges: learning to live with vision loss, dealing with the workplace to retain or obtain a job, working with a disability including having to learn new skills such as speech access for a computer, getting transportation to and from work (if they keep or land a job), dealing with co-workers and even managers who often don’t know what to say or do. Those persons with low vision or no vision whose medical condition is stabilized and with appropriate reasonable accommodations as assured by the Americans with Disability Act (ADA), can continue to be productive members of the workforce thereby contributing to the profitability of the business and to their quality of life.

An informal review of the latest available data submitted by public vocational rehabilitation agencies indicates the following: In 2011, there were 9609 blind and visually impaired individuals who obtained jobs through the vocational rehabilitation agencies; of these 505 (or 5%), were 65 years of age and older. We truly need to “unleash” the power of age in this country!

Resources
These resources listed can help older individuals with vision loss, employers, and professionals working with individuals with vision loss. The American Foundation for the Blind (AFB) hosts a family of web sites with information that can help older persons with adjusting to and living with vision loss, information on how to find and apply for jobs, adaptations to the work environment and assistive technology and workplace accommodations, and mentors who are blind or visually impaired and are willing to assist others with career choices. These sites can help individuals interested in working or retaining employment as well as employers seeking to know what to do. AFB has a directory of services for each state, which includes state vocational rehabilitation agencies charged with helping people with vision loss with the adjustment and career needs.

AFB Links
Information related to living with vision loss:
Visionaware.org/gettingstarted
Information about working:
Visionaware.org/work
AFB.org/careerconnect
Data base on how to find public and private agencies:
AFB.org/directory
Online courses including “Employment of Older Persons”, technology, etc. (for professionals):
Elearn.afb.org

Other Resources
Department of Labor funded Job Accommodations Network
http://askjan.org/
JAN provides consultation to employers and job seekers about the wide range of accommodations which can help to select the appropriate technology and job restructuring accommodations.
Department of Labor Office of Disability Policy
http://www.dol.gov/odep/topics/OlderWorkers.htm
Section on research and reports on employment of older workers.

Gil JohnsonGil Johnson
Contributing author to VisionAware ™
American Foundation for the Blind

Low Vision Resources

What to do when “There’s nothing more that can be done.”

“I’m sorry, but there’s nothing more that can be done. There is no cure for your eye condition.”

In your work as healthcare professionals and health educators, it’s likely you’ve encountered a significant number of adults and older adults who have been on the receiving end of this devastating news.

When an eye care provider says, “There’s nothing more that can be done,” what he or she likely means is, “There’s nothing more I can do for you surgically.” But instead of saying, “There’s nothing more that I can do,” the discouraging message delivered to the patient is, “There’s nothing more that can be done.”

Thus, in many cases, the discussion ends there. Patients will either exhaust their resources searching for an elusive cure or become resigned to a life that is restricted and defined by incurable vision loss.

When receiving a diagnosis of vision loss, many adults who have managed to overcome a host of obstacles in their lives may now believe they are facing an obstacle with no viable solution. A natural, and understandable, initial reaction is to focus instead on the devastating losses that are seen as an inevitable accompaniment to blindness and low vision such as:

  • Loss of independence: “How will I prepare meals, clean my home, or shop? Will I become a burden to my family and friends?” 
  • Loss of confidence and self-worth: “All my life I’ve been physically active and self-reliant. Has my life as an independent person come to an end?” 
  • Loss of privacy: “I won’t be able to handle my finances independently. Will I have to surrender control of my life to someone else?” 
  • Loss of employment: “I’ll have to quit my job. How will I earn a living?” 

It’s important to let your clients and patients know that there is indeed hope—and life—after vision loss. A wide range of vision rehabilitation services enable adults who are blind or have low vision to continue living independently. The term “vision rehabilitation” includes highly trained professionals and comprehensive services that can restore function after vision loss, just as physical therapy restores function after a stroke or other injury.

Patient working with a low vision therapist
Patient working with a low vision therapist

Vision rehabilitation professionals include:

Additional vision rehabilitation services can include:

  • Peer support and counseling: talking with peers, sharing common concerns and frustrations, and finding solutions to vision-related problems. 
  • Vocational rehabilitation: vocational evaluation and training, job training, job modification and restructuring, and job placement. 
  • Veterans’ services: vision rehabilitation and related support services for blinded veterans of all ages. 

There are many resources available to help your patients and clients locate vision rehabilitation services. For example, the VisionAware Directory of Services allows you to browse by state and type of service, including counseling resources, support groups, low vision services, independent living skills, and orientation and mobility. The VisionAware “Getting Started” Kit provides tip sheets on specialized services and products that can assist with everyday life after vision loss.

The National Eye Institute’s National Eye Health Education Program (NEHEP) also has low vision education resources. The video, Living with Low Vision: Stories of Hope and Independence, explains how, as a health professional, you can help your patients make the most of their remaining vision and improve their quality of life by referring them for vision rehabilitation services. Share it with your colleagues, too. You can find additional resources and ideas for promoting vision rehabilitation on the NEHEP Low Vision Program page.

 

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