Disability's in Eye of Beholder
With the right training and adaptive equipment, people with limited vision don't have to lead limited lives.
By Neil Osterweil
Reviewed By Michael Smith
As a volunteer at a visual rehabilitation center in Boston, Elaine knows that people with limited vision don't have to lead limited lives. Her life certainly hasn't been limited, despite the fact that she has severe loss of vision in both eyes -- one from a retinal detachment, and the other from macular degeneration.
Visual rehabilitation services and low-vision aids don't have the high-tech flash of laser eye surgery, and they can't offer hope of a cure for what ails a failing eye, but "they can do a great deal -- they did for me, and they do for many people. A lot of them are elderly, as I am, and it makes such a difference in their lives to realize that there's something else to do besides just sit," she says.
What Is 'Low Vision'?
The National Eye Institute defines low vision as "a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with activities of daily life."
Common causes of low vision include diabetic retinopathy, a common eye disease in people with advanced diabetes; glaucoma, where an increase in eye pressure causes damage to the nerves of the eye; and age-related macular degeneration, where the retina, the layer in the back of the eye that processes light, begins to deteriorate. According to the NEI, about 14 million Americans have low vision affecting their ability to cook, read, drive, and socialize. People at higher risk for loss of vision include blacks and Hispanics age 45 and older, and members of other ethnic groups over age 65.
Learning to Cope
Severe visual loss, whether sudden or gradual, can be devastating for many people, because it implies helplessness and a loss of independence.
"I refer many patients to therapists because of their need to cope more effectively with what they have and with trying to plan for the future," says Andrea Heinlein, MSW, a social worker at Boston's Massachusetts Eye and Ear Institute who helps patients with low vision find special services and resources that can help them function to their fullest.
An important but little-appreciated aspect of low-vision services is training in activities of daily living: teaching patients how to continue doing what they have always done -- cooking, cleaning, shopping, reading.
"If you live alone as I do, the kitchen and trying to cook is a problem, because you could get burned or you're going to have a mess," Cole says. "They were able to show me what to do just in everyday living. One of the technicians came and saw me at home, and saw how I lived. She showed me everyday stuff: how to pour hot water into a cup for coffee without getting burned, how to reach into an oven without getting burned, how not to spill -- small techniques that make life much easier for a person who has any vision problems."
Ann Marie Turo, OTR/L, an occupational therapist who works with low-vision patients at Massachusetts Eye and Ear, says patients with loss of vision in the central visual field, as occurs with macular degeneration, can use a technique known as decentered viewing, in which they are trained to use their peripheral rather than central vision to see images. Astronomers use a similar technique to pick up fine details in telescopic images of distant faint objects.
Putting Technology to Work
In addition to learning new ways of doing everyday chores, people with low vision often benefit from the use of adaptive techniques and technologies, ranging from simple but powerful handheld and stand-mounted magnifying glasses to prescription drug bottles that announce their contents when placed in a special reader.
"The most effective thing is the closed-circuit TV system for reading; it's a fantastic device, " says Eliezer Peli, OD, a senior scientist and specialist in low vision at the Schepens Eye Research Institute in Boston. Stationary or portable CCTV systems provide high-power magnification of even small-print items, allowing users to read their mail, newspapers, books, and other materials. A low-end system costs about $1,800.
In addition, computer users can choose from among a growing number of magnification programs, some of which incorporate speech recognition technology, allowing users to read documents on screen or surf the web.
For people with less severe visual loss, Peli has developed a special device using high-powered light-bending prisms mounted on eyeglasses that can help people with certain visual conditions drive a car safely. People who may benefit from the device include those with mild macular degeneration, as well as those with hemianopia, a condition resulting in loss of half of the visual field in each eye.
Thirty-six states also permit the use of specialized telescopes that allow people with low vision to drive, says Peli, associate professor of ophthalmology at Harvard Medical School.
Lack of Information
Among the biggest barriers to people with low vision is a lack of information about available resources, says Rosemary Janiszewski, director for the National Eye Health Education program of the National Eye Institute. She tells WebMD that organizations such as The Lighthouse International and the American Foundation for the Blind offer extensive information about local resources where people can go for services in their own community, including local low-vision clinics and visual rehabilitation services.
In addition, each state has a commission for the blind, and each runs a federally funded program, called "Independent Living Services for Older Individuals Who Are Blind," commonly known as Chapter 2. The program assesses the special needs of older people with low vision and provides recommendations and support for adaptations in the living environment and, if required, help with the use of special training and equipment.
"We need to let people know that they can remain in their homes and remain independent by using a these devices, and that the more expensive devices are not necessarily better," Janiszewski says.
The NEI provides on its web site (http://www.nei.nih.gov) a booklet on low-vision services, including a list of resources and questions that people with suspected or diagnosed low vision should ask their eye care professional and rehabilitation specialists, including:
For Elaine, support services have made all the difference.
"I have a pretty good time," she tells WebMD, "and when I realize that so many of my peers are dropping off, or in nursing homes, I just say 'thank you very much' to the good Lord that I'm as well as I am."
Originally published July 30, 2001.
Medically updated May 16, 2003.
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