Living Well with Vision Problems - PowerPoint Presentation

Slide1

Living Well with Vision Problems

Brenda Wendling,

MSW, LCSW

Director

of Adult

Services

St

. Louis Society for the Blind and Visually Impaired

Slide2

What Do We Know About Vision and Aging

There are

physical changes

to the eye as one gets older

Some

eye diseases and conditions

affect older people more than younger people

Some

environments and places

we regularly go are not always the best for seeing things easily

Slide3

Vision, the Eyes and Aging

In our 40’s

, it gets

harder to focus

for near (reading, sewing) and intermediate tasks (computer, reading recipes while cooking)

In our 40’s our

eyes also get drier

, especially while doing tasks for prolonged periods of time.

Many people are getting their first eye exam because of what they are experiencing.

Slide4

In Our 50’s

Medical conditions

such as hypertension and diabetes are developing at an increasing rate.

In our 50’s ,

eye dryness continues, especially with women

and with people taking more medications.

Annual routine eye exams are important as well as routine physicals

.

Slide5

In Our 60’s

Our health may continue to change and there is an

greater increase in risk for age-related eye diseases

and medical conditions.

One may notices that they are having

more difficulty while reading

with dimmer lighting ( in the evening, at a restaurant)

A healthy

60 year old retina requires 3 x’s as much light

as a healthy 20 year old retina

It may take

more time to adjust visually

when going from light to dark or vice versa

Routine eye exams and physicals

Task lighting

is very beneficial

Slide6

Common Problems

Blurred Vision

– Blurred vision makes this appear to be out of focus at distance and near even with best spectacle correction.

Generalized Haze

– This causes the sensation of film or glare that may extend over the entire field of vision.

Photophobia

– Extreme light sensitivity exists when standard levels of illumination creates discomfort and blur. It can produce a washed out image and/or glare.

Night Blindness

– The inability to see outside or inside at night when illumination is decreased slightly or significantly.

Slide7

Acuity Alone Is Not The Best Predictor

Visual acuity alone cannot be used as a good predictor

of the degree of problems a person may have.

Someone with relatively good acuity (20/40) can have difficulty functioning, while someone with worse acuity (20/200) might not have any major problems functioning.

Slide8

Main Eye Conditions Affecting Older Adults

Macular Degeneration

-macula

Glaucoma

-optic nerve

Cataracts

-lens

Diabetic retinopathy

-lens, retina, optic nerve, vitreous, macula, and blood vessels

Hypertensive Retinopathy

-blood vessels and optic nerve

Traumatic or Congenital

Eye Diseases

Slide9

Macular Degeneration

Macular degeneration- deterioration of the

macula

which allows us to see smaller details and centrally.

The

macula is what an eagle uses

to spot a small rodent from hundreds of feet away.

We use the macula

to read, write, see facial features, thread a needle, for cooking, driving, walking, dialing a phone, and etc.

Straight lines may appear wavy

and/or door frames may look crooked

Letters or numbers may be overlooked

or obscured

Faces can look distorted

or features may look blurry and missing

Slide10

What Does Someone with Macular Degeneration See

Slide11

Glaucoma

Glaucoma is a disease that

affects the optic nerve

.

It is one of the

leading causes of vision impairment when unt

reated.

It is

usually silent and painless

until it progresses to a more severe stage.

Glaucoma is usually manageable, but

is not curable

and vision loss cannot be regained.

Overall vision may be reduced,

things may look dimmer

One may

not notice things

that are in the periphery ( up, down, left, right)

Driving may not be an option anymore,

peripheral vision needed for driving

One

may bump into things

beside them or not notice what is out in the distance.

Slide12

What Does A Person with Glaucoma See

Slide13

Cataracts

Lens cloudiness creates blurriness, glare, and difficulty identifying similar colors.

The

cloudiness can be removed

when it interferes with vision to a certain level of vision.

An ophthalmologist will perform a cataract extraction and will insert an intraocular lens which has a particular power to focus one’s vision.

There are

several types of intraocular lenses

Many are designed to correct for distance vision

Some are designed as a bifocal

Some patients receive

monovision

correction-one eye focuses for distance vision and the other eye focuses for near vision.

Slide14

What Does A Person with Cataracts See

Slide15

Diabetic Retinopathy

Diabetes can

affect one’s heart, blood vessels, eyes

, kidneys, fingers and toes,

etc

Retina damage happens slowly

. This may or may not interfere with vision, so one may not be able to notice this change.

Blood can be in the retina and/or fill up in the vitreous of the eye and obstruct vision.

Sometimes the blood will clear out by itself.

Sometimes laser treatment

and/or surgery is needed.

Over time, the network of thin, delicate, weak vessels can form scar tissue and pull the retina from the back of the eye. This can

cause a retinal detachment.

This retinal detachment can cause

permanent partial or total vision loss

.

Slide16

What Does A Person with Diabetic Retinopathy See

Slide17

Strokes Can Affect Vision

Causing

Hemianopsia

Slide18

Charles Bonnet Syndrome

Charles Bonnet Syndrome is a common condition among people who have lost their vision. It causes people who have lost vision to see things that aren’t really there, known as visual hallucinations.

Two broad types of hallucinations:

Simple repeated patterns

Complex hallucinations of people, objects and/or landscapes.

No medical cure for CBS. Usually improves with time.

No proven drug available to stop it, but drugs for other problems have been successful in helping some people.

Slide19

Terms to know

:

Acuity

– the sharpness or clarity of vision. Acuity is typically measured in terms of what can be read standing 20 feet away from the eye chart.

Field

– is the width of the area seen without moving the eyes or turning the head. Normal vision is a field of 180

o

Legal blindness

– best corrected visual acuity is 20/200 in the better eye and/or if visual field is 20

o

or less.

Totally Blind

– unable to see anything out of either eye.

Low Vision

– with best correction, unable to read regular newspaper print.

Vision Impairment

– broad term used to refer to any degree of vision loss that affects a person’s ability to perform the usual activities of daily life and cannot be corrected with glasses or contact lenses.

Slide20

Driving

Most individuals report

giving up driving in the most difficult part of vision loss.

Not driving is a life altering change.

Many individuals do not know of the transportation resources

available.

Many individuals with vision loss are fearful of going out of the house alone.

Criteria for having a drivers license in Missouri:

Acuity:

For non-restricted - 20/40 with or without correction. If blind one eye, other eye must be 20/50.

Absolute minimum 20/160 – will have restrictions.

Field:

55

o

or better in each eye

85

o

in one eye only with restrictions.

Slide21

Vision Rehabilitation

Vision Rehabilitation is specialized training and services to help an individual learn new adaptive techniques to regain or maintain independence in daily living.

These services are provided by specially trained professionals.

The services include:

Low Vision Clinic

- evaluation by an Optometrist for devices that could enhancing reading and distance vision

Vision Rehabilitation Therapist/Occupational Therapy

– daily living tasks

Orientation and Mobility

– getting around safely

Assistive Technology

– using technology (computers, tablets, cell phones)

Social Work

– counseling, support groups, family education

Recreation

– leisure activities and socialization

Slide22

Tip # 1

Use T

ask Lighting for Better Light

Good Task Lighting Example

Slide23

Characteristics of a “Good” Task Light

Flexible arm or gooseneck

Many people now use “daylight” or LED bulbs & lights

CFL Bulb of 15 watt or incandescent bulb 60 watt or more

Light directs down on material

Shade does not block light

For general lighting, CFL bulb of 20 watt or more and incandescent bulb of 75 watt or more

Use of “light app” on smart phones

Slide24

Poor Lighting Example

Stationary light source

(overhead lights)

Lamps with heavy,

ornate shades

Slide25

Tip # 2

Contrast is an Eyes Best Friend

Color Contrast helps highlight and makes some tasks easier to do

Black on White typically best, some reverse of white on black also can help

Colors that are similar make things more difficult, such as black letters on blue background

Can be incorporated into everyday living

Pour coffee into white lined mug, or milk into black lined mug

Use of placemat for dinner plate, with placemat opposite color of plate/dishes

Rug (or tape) at foot of stairs/outside step and before 1

st

step down, contrast color to floor/carpet

Bathroom towels contrast with wall color

Dark trash can with white liner

Reversible cutting board (white onion on black, hamburger on white)

Slide26

Adding Contrast to Everyday Living

Slide27

Tip #3

Use Quality Magnification Tools

Hand Held Magnifiers, Non-Lighted

Lighted Hand Held Magnifiers

Stand Magnifiers

Hands Free Magnification

Distance Magnification

Electronic Magnification Tools

Slide28

Hand Held Magnifiers

Pros

Portability & most common style

Low cost

Cons

Needs additional lighting

Scratches easily

Slide29

Lighted Hand Held Magnifiers

Pros

portable with light

medium price range

Cons

replacement of batteries

may not be enough light

Slide30

Stand Magnifiers

Pros

Holds right focal distance

Holds page flat

If lighted, has own source

Cons

Not able to write under

Reflection from light if not a

lighted magnifier

Higher cost

Slide31

Hands Free Magnification

Pros

Hands are free

Easier to use when writing

Cons

Close focal distance when increasing magnification

Slide32

Distance Magnification

Pros

See things at a distance without moving closer

Cons

Small visual field

Hard to hold steady or heavy if mounted on glasses

Slide33

Electronic Magnification Devices

CCTV’S

Pros

Easy to use

Lighting not an issue

Various magnifications

New hand held units

Cons

Cost

Space needed

Slide34

Computer Screen Magnification

Pros

Software options to enlarge text

Increase font size

Contrast options

Cons

Larger size print makes harder to see

entire screen

Slide35

New and Emerging Technologies

Smart Phone Based Applications

Picture to voice, Extra Lighting, Money & Other Identifying

Head Mounted Magnification

Devices worn on the head and magnifies to screen on device

“Star Wars” type look

Expensive as most are over $5,000

Eyeglass Camera to Voice Devices, Not Magnification Based

Use of “Artificial Intelligence” to make “Artificial Vision”

Takes Picture of Printed Material and converts to speech

Programmable for facial recognition and other objects

Price range from $2,500 - $4,500

Slide36

New and Emerging Technologies

Magnification & “Artificial Vision”

Iris Vision

OrCam

Slide37

Tip #4

Use Non-Optical Aids

Writing guides

Large number phone, clock, TV remote, thermostat

Talking clock or watch

Posture Board or Lap Desk

Bold line paper

Dark felt tip pen

Magnifying mirror

Large print or size pill box

Slide38

Tip # 5

Keep Your Home Safe

Reduce Clutter: be organized

Arrange furniture for clear paths

Put handrails by stairs, both sides if possible

Use good lighting by stairs

Remove or tape down throw rugs

Use contrast

Put yellow tape or paint on steps

Use different colored plates on electrical outlets

Use plates and cups that contrast to tablecloths or placemats

Slide39

Tip # 6

Set Up An Ideal Working Area

Comfortable and adjustable chair

Desk or table, free of clutter

Posture board or lap desk

Good task lighting

Magnification device(s)

Appropriate writing device

Appropriate writing tablet

and guides

Slide40

Tip # 7

Slow Down and Pace Yourself

Most falls happen when someone is rushing

Using magnification requires practice and learning a new way of doing things

Read for shorter periods of time

Slide41

TIP # 8

Obtain Large Print Materials

Books, checks, menus, playing cards, magazines, utility bills, religious materials or address books are in large print.

Inquire at libraries, book store, restaurants or place of subscriptions.

Religious resources

Slide42

Tip # 9

Use Your Resources

Access services from state or local agencies

State Library, Minds Eye, Phone Service

Missouri TAP program

Personal shopper or customer service

Order groceries by phone or internet

Large print bills, bank services

Public Transportation

Family and Friends

Slide43

Tip # 10

Don’t Be Afraid to Ask for Help or Let People Know

Some try to hide their vision problems, which can make matters worse

If vision loss gets too severe it is not uncommon to get feelings of depression

Many sources of help and/or aids are inexpensive or free

Some use a white cane to let others know they have a vision problem, especially when walking or crossing intersections

Social impact of not recognizing faces and not letting a person know

Slide44

The Drews Low Vison Clinic

at

Society for the Blind and Visually Impaired

Who Can Be Helped

Individuals with Vision Problems that Interfere with Daily Life

What Does the Drews Low Vison Clinic Do

Assist a Person to Best Use Their Remaining Vision

Identify Magnification and Devices Most Helpful

Over 250 Different Aids & Devices

Transportation Provided to Clinic if Needed

What Does it Cost

 

Appointment Covered by Medicare and Most Insurance Plans

Aids & Devices begin as low as $10

 

Slide45

Tips for staff caring for a person with

vision impairment

Communication

:

Introduce yourself and address the patient by name, so they know you are talking to them.

Introduce the patient to others in the room.

Say good bye and tell the patient when leaving the room.

Always explain to the patient what you are about to do.

Ask what the patient is able to see. Few patients are totally blind.

Describe things in detail – food, gift items, rooms, situations.

Slide46

Orienting the Patient to the Room and or Facility

When orienting a patient to a new area or room, walk with them rather than giving verbal directions only. This helps them learn distances and sensory cues.

Don’t assume you know what the patient needs. The person uses their hands more for “seeing” and will explore specific orientation to objects accordingly, such as feeling the chair, sink or other fixtures.

Ask if the patient would like to take your arm for guiding purposes. If so, use

sighted guide method

, let them hold your arm above the elbow with their thumb to the front.

Keep pathways and corridors clear of obstacles.

Inform patients of any changes to environments.

Slide47

Patients in Bed

Put an “identifier sign” above the patient’s bed/or door station.

Consider adjustable extra lighting for patients with some useful residual vision.

Don’t move patient’s belongings. If must be moved , notify patients of such.

Orient the patient to controls for bed, TV, radio, and call button. Use tactile markings on these items, if needed.

Patient may prefer a corner bed close to door for easier orientation to room.

Knowing the time can help with daily routines. Offer some method for telling time for patient. (talking clock or watch)

Slide48

Mealtimes

Read aloud menus and have patients choose their meal.

Tell patients when trays or meals arrive, and the placement of food on plate using clock method. (Chicken at 6 o’clock, peas at 10 o’clock)

Ask patient if they would like assistance with meal or packaging.

Color contrast can be very helpful for patients with some vision. A light colored plate on dark tray is helpful. Clear drinking glasses may be difficult to find on a tray.

Provide hot drinks in non-spill containers and tell the patient where they are placed.

Slide49

Mealtimes

Read aloud menus and have patients choose their meal.

Tell patients when trays or meals arrive, and the placement of food on plate using clock method. (Chicken at 6 o’clock, peas at 10 o’clock)

Ask patient if they would like assistance with meal or packaging.

Color contrast can be very helpful for patients with some vision. A light colored plate on dark tray is helpful. Clear drinking glasses may be difficult to find on a tray.

Provide hot drinks in non-spill containers and tell the patient where they are placed.

Slide50

Help is as Easy as a Phone Call or E-mail

For More Information, Assistance or

to

Make a Referral

Brenda Wendling, Director of Adult Services

314-968-9000 or 314-301-7374

bwendling@slsbvi.org

Or Visit us on the Web at

:

www.slsbvi.org

Referrals

can be made from the website.