Low Vision and Vision Rehabilitation

1. California Eye SpecialistsA Medical Group, Inc. Low Vision and Vision Rehabilitation Making the Most of Remaining Vision

2. What is low vision? • Low vision is a loss of eyesight that cannot be corrected with glasses, medicine or surgery. • It makes everyday tasks such as reading, shopping, recognizing faces and even crossing the street difficult.

3. Dimensions of vision • Visual acuity • Contrast sensitivity • Depth perception • Area of vision (visual field) • Visual processing

4. Dimensions of vision • Visual acuity: The limit of eye’s ability to resolve detail.

5. Dimensions of vision • Contrast sensitivity: The ability to discriminate objects of similar tones; for example, black coffee in a black cup, milk in a white cup, or features on a face.

6. Dimensions of vision Depth perception • An estimate of the distance an object is from the observer. • Perfect when both eyes see equally well and are working together. • Vision loss in one eye will reduce depth perception; becomes less noticeable over time.

7. Dimensions of vision Area of vision (visual field) • Central field: area seen when looking directly at something (i.e. the print on a page you are reading). • Peripheral field: area seen around you (i.e. things seen out of the corner of your eye).

8. Dimensions of vision Visual processing • Light rays enter the eye through the cornea, pupil and lens. • These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye.

9. Dimensions of vision Visual processing • The retina converts light rays into impulses sent through the optic nerve to your brain, where they are recognized as images.

10. Patterns and causes of vision loss • Different conditions affect different parts of the eye in different ways.

11. Patterns and causes of vision loss Age-related macular degeneration (AMD) • AMD is caused by damage or breakdown of the macula—the small area of the retina responsible for detail vision.

12. Patterns and causes of vision loss Age-related macular degeneration (AMD) • Blurs center of vision (degrades detail of objects including print and faces). • Peripheral (side) vision remains intact, which can be used effectively. With AMD, dark areas may appear in your central vision

13. Patterns and causes of vision loss Glaucoma • Disease of the optic nerve—which carries the images we see to the brain; usually associated with elevated pressure in the eye.

14. Patterns and causes of vision loss Glaucoma • When damage to the optic nerve fibers occurs, blind spots develop; these usually go undetected until the optic nerve is significantly damaged.

15. Patterns and causes of vision loss Glaucoma • If vision is lost from glaucoma, your peripheral vision is affected first. Normal vision Vision as it might be affected by glaucoma

16. Patterns and causes of vision loss Glaucoma • Glaucoma is (usually) treated with eyedrops and/or surgery to relieve pressure in eye.

17. Patterns and causes of vision loss Diabetic retinopathy • Abnormal leakage and/or growth of blood vessels in the retina, affecting vision. • May occur in anyone who has diabetes. • Can affect detail vision, peripheral vision, or both.

18. Patterns and causes of vision loss Diabetic retinopathy • Sometimes treated with a laser (or other methods). • Keep blood sugar under tight control and have regular examinations by your ophthalmologist. Fluorescein angiography is used in diagnosing diabetic retinopathy

19. Patterns and causes of vision loss Stroke • Rupture or blockage of a blood vessel in brain, depriving parts of the brain of adequate blood supply. • Results in various symptoms depending on the site and extent of damage to the brain. • Affects the visual messages coming from both eyes.

20. Patterns and causes of vision loss Stroke • Usually eliminates right or left halves of the visual field. • Detail vision may not be reduced, yet reading may be difficult. • Training in scanning helps compensate for the missing area.

21. Patterns and causes of vision loss • There are many other causes of vision loss. • Important to find out the cause of vision loss; it may be treatable.

22. Patterns and causes of vision loss • If diagnosed with an eye disease, be sure to continue regular examinations by your ophthalmologist—even if there is no treatment— to prevent vision loss from other causes. Slit lamp exam

23. Patterns and causes of vision loss • The more you understand about your eye condition, the better able you will be to make the most of your remaining vision.

24. Making the most of your remaining vision • Move closer. • Sit close to the television; sit up front in an audience. • Make things bigger.

25. Making the most of your remaining vision Enlarge • Use large size checks from your bank. • Use large-print books, magazines, playing cards, bingo cards, crossword puzzles, calendars. • Use large number telephones, TV remotes, computer keyboards, watches, and thermostats.

26. Making the most of your remaining vision Magnify • Standard magnifiers come in powers from two to twelve times magnification. • Not all magnifiers work for all people or for all purposes.

27. Hand magnifiers • Portable, easy to use. • Good for price tags, menus and other items.

28. Magnifying spectacles • Stronger than ordinary glasses. • Hands remain free to read or perform tasks. • Requires holding reading material and other objects closer than usual for focus.

29. Illuminated stand magnifiers • Rests directly on the reading material. • Useful if you have a tremor or arthritis.

30. Video magnifiers • Also called closed-circuit televisions (CCTVs). • Most have a camera and a screen that magnify up to sixty times.

31. Video magnifiers • Provides a large viewing area and good contrast. • Some cameras plug into a standard TV so that it becomes a magnified reading screen.

32. Telescopes and binoculars • Magnify things at a distance.

33. Make things brighter • Lighting is key for anyone with any level of vision loss. • For detail tasks, sit with back to window with natural light on your work. Sit with your back to a window so things look brighter

34. Make things brighter • Use directed light of a gooseneck lamp. • Use 45 to 65 watt indoor floodlight bulb or a full spectrum bulb.

35. Make things brighter • A penlight is portable and helpful for price tags, menus and other items. • Don’t forget to add more light to dark areas of your home.

36. Reduce glare • Cover shiny surfaces: place table cloths on polished wood tables, towels on shiny kitchen counters. • For indoor glare, try wearing yellow or plum tinted sunglasses or clip-on shades. • For outdoors, wear dark yellow, amber or plum glasses, and a visor.

37. Increase contrast • Use black ink, gel, or felt tip pen instead of ballpoint. • Pour coffee into a white cup; put a colored soap dish on a white sink. • Use plain tablecloths so items won’t disappear in a pattern. • Keep contrast enhancement in mind all the time.

38. Other ways to make everyday activities easier • Talking books. • Talking watches, timers and blood sugar machines. • Signing guides for writing checks. Signing guide for writing checks

39. Making the most of your remaining vision What vision rehabilitation can teach you: • New strategies to complete daily activities. • Ways to master new techniques and use low vision devices to regain confidence and live independently.

40. Making the most of your remaining vision Amount of rehabilitation needed depends on your degree of vision loss and your personal goals.

41. Vision rehabilitation services When assessing low vision rehabilitation services in your area, ask: • Is the low vision evaluation by an ophthalmologist or optometrist? • Are assistive devices prescribed?

42. Vision rehabilitation services When assessing low vision rehabilitation services in your area, ask: • Is device training available for desired tasks? • Are devices loaned on a trial basis before purchase? If not, are they returnable?

43. Vision rehabilitation services If rehabilitation training is available, does it include instruction for: • Finding and using a clearer, off-center area of vision? • Reading and writing?

44. Vision rehabilitation services • Shopping and cooking? • Achieving optimal lighting and managing glare? If rehabilitation training is available, does it include instruction for:

45. Vision rehabilitation services Do vision rehabilitation services include: • Assessment in your home? • Information about resources and support groups? • If services are not free, what is the charge and is it billed to Medicare or other insurance?

46. Experiencing vision loss • It is normal to be shocked, angry and frustrated to learn that your vision loss is irreversible and possibly progressive. • Acknowledge the emotions of new vision loss and don’t hesitate to seek help to work through these feelings.

47. Experiencing vision loss • Recognize signs of depression (fatigue, lack of interest in doing things you once enjoyed)—and seek treatment and counseling if needed. • It is worth the time and energy it takes to make the most of the vision you have.

48. Experiencing vision loss • Make the changes you need to in order to keep doing your daily activities.

49. Experiencing vision loss “By using techniques, training, and new devices, and communicating with others who share this experience, almost everyone with any level of vision loss can be greatly helped towards a life of fulfillment and – yes, joy.” - Yale Solomon, MD, an ophthalmologist who has lost vision from AMD.