Educating Patients Living with Vision Impairment—from lifestyle changes to low vision device options at home and on-the-go.

Low vision is defined as a decreased visual acuity in an eye that is not correctable through surgery, pharmaceuticals or glasses. A patient with low vision is not blind but has compromised vision that may prevent the patient from performing daily activities to a satisfactory level. For instance, the person may have difficulty recognizing faces or people at a distance, difficulty reading or driving, differentiating between colors that have a similar hue, and problems crossing the street and seeing traffic. Low vision can impact any age group but is primarily seen in older individuals. Some of the most common causes of low vision are:

•Age-Related Macular Degeneration
•Diabetic Retinopathy

To determine the cause of the low vision, the patient should undergo a very thorough functional vision exam to investigate how the patient uses their eyes and how the decreased vision affects the patient”™s visual needs in daily life. This assessment can help the doctor determine if using low vision devices will help to maximize the patient”™s remaining vision, assist the patient in having a more independent lifestyle and maintain their quality of life.

The optometric assistant not only helps perform the tests required for the clinical and functional vision evaluation but also can be an integral part of educating the patient in the use of different optical and non-optical devices. In addition, the technician can be involved in suggesting social and environmental changes to improve and maximize the patient”™s current vision. To ensure that the patient is in compliance, the optometric team should provide instruction whenever required because training is key for the successful use of low vision devices.

Low vision treatment usually focuses on the use of devices or changes in the home environment that can help the patient perform everyday tasks more easily and with less frustration. These options include good lighting, better contrast, spectacles, magnifiers and closed circuit TV (CCTV).

The optometric technician can discuss ways to enhance the patient”™s remaining vision by using home management techniques, such as keeping their home environment organized and free of obstacles that can trip them.

Patients with low vision have increased difficulty reading, so the type and amount of lighting in the home can also help. Changing the lamp shades from dark to white, as well as adding a three-way switch to a lamp, will brighten a room. Adding more lamps with brighter bulbs and placing them near stairs, hallways and closets will improve safety. The patient should also be advised to use halogen or LED lights which will provide the best light and decrease shadows. Another suggestion is that when reading, the patient should place a chair near the window with the natural sunlight falling on the reading material. The optometric assistant can help the patient determine the type of lighting needed and location.

Contrast loss is a common problem for patients with low vision. Difficulty distinguishing objects of similar color or hue can be extremely frustrating to these patients. First, there should be discussion of the current living conditions, issues and problems that the patient currently experiences, then suggest some low tech adjustments, such as:

•When eating, use a dark table cloth and contrasting white dishes instead of table and dishes that are the same color.
•Use brightly colored utensils and writing implements which will stand out.
•Color-code pill boxes to make it easier to distinguish different medications.
•Read large print books.
•Switch to large numbered clocks, telephones and watches.

Standard eyeglass prescriptions are not usually sufficient to improve the patient”™s visual acuity for different daily activities. Patients may require several pairs of glasses to satisfy their visual needs. For instance, they may require spectacle correction for distance, near and intermediate vision. During careful examination, refraction and documenting the patient”™s history, the optometric team can determine which power spectacles are needed to improve acuity and help with the variety of everyday tasks. In addition, the patient may be advised to get glasses with absorptive filters that are designed to improve contrast and reduce glare.

The patient may be advised to obtain magnifying reading glasses that allow them to read more comfortably for longer periods of time. These glasses enlarge words as well as objects and can also be useful when reading on the computer or doing hand work such as sewing. The patient should also be educated as to what is the proper distance that they should hold reading materials. (The glasses are strong, so they will have to hold things very close to the face in order to see clearer.) Also consider that when holding things very close to the face the patient will have to have a very steady hand. Shaky hands make it more difficult to see words. Patients experiencing this problem may not be able to read for long periods of time.

Freedom Scientific”™s Topaz PHD allows for reading comfort
with a reasonable field of view.

If the patient reads for long periods of time, a stand magnifier may be suggested. To use this low vision device, the patient should be instructed to place the reading material on a table or desk then place the stand magnifier over the reading material. This device can also be used in combination with reading glasses. Patients should also be warned that they may see shadows or reflections on the page when using a stand magnifier, making it more difficult to read.

For reading menus or prices while shopping, a portable handheld magnifier is recommended. These magnifiers are small, portable, can be carried in a pocket or handbag, and may be purchased with a built-in light. This type of magnifier is relatively easy to use, but the patient should be instructed on the proper distance to hold the device. If the device does not have a built-in light, the patient should be warned about shadows and reflections that might appear on the page and make it more difficult to read. Also, because the field of view of the magnifier is small, the patient will only be able to read a few words at a time.

A stand-mounted video camera projects a magnified image of the reading material onto a video monitor or television when using a CCTV. The camera is equipped with a zoom lens that allows the patient to increase the magnification in order to read. The device also allows for contrast and color adjustment. Be sure to advise the patient that when increasing the zoom of the lens the field of view will decrease. OO

Janet Hunter, COMT, president of Eye Source, LLC, specializes in ophthalmic technician training.


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