New York Times.
Monday, March 06, 2006.
By JANE E. BRODY.
Is low vision limiting your world?
This condition, which can result from a number of eye diseases, including age-related macular degeneration and diabetic retinopathy, often results in depression and social isolation.
But vision rehabilitation services, the use of low-vision aids and help from family members, friends and caretakers can bring back a productive, enjoyable and independent life for most people who are visually impaired.
Remarkable advances have been made through electronics, computerization and miniaturization to create devices that can help patients read, see and function well again. New and better gadgets are continually being developed at places like the Schepens Eye Research Institute.
But the devices are useful only if patients can afford them, know how to select those that are most likely to help, and receive training and practice in their use. All too often, people spend heavily on devices that are either not right for them, or they never learn to use them properly.
Knowing Where to Turn
The cost of low-vision aids is not yet covered by insurance. Before wasting money on products that may be less than useful, patients should consult an eye doctor who specializes in low vision. Even with professional help in selecting an appropriate vision aid, arranging a trial period to test the equipment may be wise.
A great place to start is Lighthouse International, a source of referrals to low-vision specialists around the world and educational and rehabilitation services for both old and new low-vision aids. This 100-year-old nonprofit organization, at 111 East 59 Street, New York, N.Y. 10022, can also be reached by phone (800-829-0500), e-mail (firstname.lastname@example.org) or through its Web site (lighthouse.org).
Also helpful is Prevent Blindness America at (800) 331-2020 (preventblindness.org), which, among other services, can help patients find support groups in their areas.
Low vision is not the same as blindness, but it can make normal life a tremendous challenge. As Dr. Eleanor E. Faye, a low-vision ophthalmologist in New York and longtime affiliate of Lighthouse, pointed out about people with low vision:
"Daily life becomes complicated when they are unable to read their mail, check price tags in stores, read nutritional information on food packages, drive, sew or travel alone. Social isolation often becomes the rule when they can no longer see facial details or enjoy simple activities such as playing cards or going to a movie. Even their health may be compromised when they cannot recognize medications or labels or when they lose interest in cooking because the microwave panel or stove dials are indiscernible."
There are both adaptive aids and optical aids. The former include large-type books and recorded books (available from the Library of Congress); talking clocks and calculators; boldface, Braille and talking watches; big button telephones; large-print cards and address books; easy needle threaders; bump dots to help with location (for example, on an oven dial, computer or telephone) and high-intensity lamps and lighting.
The variety of devices is endless. Magnifiers, for example, come in different strengths and styles. There are hand magnifiers, stand magnifiers, pocket magnifiers, magnifiers that look like tiny telescopes and others that look like glasses. Some are worn, others attach to lamps, and some have built-in lights.
Optical aids include simple and advanced electronics. They include closed-circuit television systems (even portable ones), special goggles onto which images from a video camera are projected and computer programs that enlarge text and switch it from black on white to white on black, reduce distracting color to black and white, and convert text to speech.
Computer accessibility aid is available for PC users through microsoft.com/enable and for Mac users through apple.com/accessibility. Before buying any device to make a computer more accessible, be sure it has adequate memory and the needed ports.
Training and practice in the use of optical aids is critical to success. Even learning to use a simple magnifier can require practice. For example, a hand magnifier should be held straight - tilting will distort the image - and on the paper, not lifted to the eyes.
But in focusing on devices, low-vision patients often neglect simple "housekeeping" aids. For example, the Low Vision Center in Bethesda, Md., suggests that hallways and staircases have good lighting that shines on the walls, floor, steps and railings. Mark the edges of steps with contrasting strips.
When working on a task or reading, good lighting should be provided throughout the room. Move lamps close to the work area and light it from both sides to eliminate shadows. Reduce glare by covering shiny surfaces with carpeting or clothes, placing shades on bare bulbs, using adjustable blinds and curtains on windows, and sitting where you don't look directly at a window.
Provide contrast wherever possible. Avoid clear drinking glasses. Rather, use a dark glass for a light-colored drink, and vice versa. Likewise, place foods on plates of contrasting colors. Use contrasting-colored drawer pulls and door handles throughout the home.
In the bathroom, use a toilet seat that contrasts with the wall and floor, and place contrasting-colored tape on the edge of the sink if it is the same color as the wall. Use different colored containers for shampoo and conditioner and use soap that is a color different from the wall. A lighted magnifying mirror is useful for shaving and applying makeup.
To keep track of medications, ask the pharmacist to provide a large-print label and information sheet. Color-code different medications or use bump dots.
Outdoors, the Low Vision Center suggests painting gates and doors in different colors from fences and walls to aid in their location.
Helping a Low-Vision Person
Family, friends and helpers can do much to aid the functioning and safety of people with low vision. Always ask first if help is wanted or needed. A person with limited vision may want to retain as much independence as possible.
When you approach a person with low vision be sure to identify yourself, and tell the person when you leave the room. In social situations, grasp the person's hand in greeting - your extended hand may not be seen. Try to avoid sudden changes in illumination, like having the person go from a brightly lit room to a dark one.
Night lights should always be used wherever there are dim areas and in bedrooms at night. Furniture should contrast with the walls and be positioned to avoid collisions day and night. Needless to say, trip hazards like shoes, clothing or books left on the floor are unacceptable.
In guiding a person with impaired vision, be precise. Say, for example, "There's a flight of steps going upstairs directly to your left," not just, "There are steps over there."
In serving food, identify what is on the plate using the clock - "the meat is at noon, the potatoes at 4, the string beans at 9."
End of article.
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