By Kendra Farrow
With nearly one in every ten seniors age 75 and older facing some level of reduced vision (Erickson, Lee, & Von Schrader, 2017), efforts should be made to incorporate good lighting, high contrast materials, and in general educate ourselves about ways to make activities and services more accessible for those with vision loss. Many of the modifications are simple and do not take a lot of time or energy. For instance, choosing white or light-colored paper for flyers and using black print increases contrast. Using simple fonts, like Arial, and bolding or enlarging the font size will increase the readability for those with reduced vision.
There are several common causes of age related vision loss and each of them results in different functional limitations. Macular Degeneration is the most common age-related eye condition. It effects the central, or most detailed, part of the vision. Functional limitations include reading, seeing faces, and watching TV. In general, persons with Macular Degeneration do not lose all their vision and navigate independently without serious difficulty in familiar environments. For individuals with Glaucoma, the central field remains intact until the later stages of the disease. However the peripheral, or side, vision deteriorates causing what is sometimes called tunnel vision. The functional limitations for Glaucoma are difficulty seeing in dimly lit areas and trouble moving around. In the later stages of Glaucoma the central vision will be effected causing difficulty with reading and completing tasks visually. Glaucoma can lead to total blindness, early detection and treatment are often effective in preventing the most advanced stages of vision loss. Diabetic retinopathy develops in persons with diabetes, although those who have good diabetic control are at lower risk. Functional limitations vary since diabetic retinopathy is not predictable and may cause blind spots in the center and/or periphery of the vision. Persons with diabetic retinopathy are faced with inconsistent vision, meaning some days they see better than others. Generally the condition is progressive and requires consistent monitoring and treatment. Cataracts are a clouding of the lens of the eye. Although they are the leading cause of vision loss in many parts of the world, surgery is successful in restoring vision for most individuals with cataracts in the United States. Before cataract surgery occurs, individuals may experience a hazy clouding of the vision, glare from some types of light, and an overall decrease in the acuity or sharpness of their vision. Left untreated cataracts will continue to worsen.
It is recommended for all individuals 65 and older to have a comprehensive dilated eye exam every one to two years (Prevent Blindness, 2019). Note that more frequent exams may be recommended for individuals who have already been diagnosed or are at risk for vision loss. Even when medical intervention is not going to correct vision, individuals should continue to have regular eye exams. New treatments may be available for the condition or additional conditions may be diagnosed and treated.
Once an individual has received medical intervention and the vision is not correctable, optimizing lighting is one of the most important factors to maximizing reduced vision. Unfortunately some persons require more light, while others require less. The person with vision loss will often be able to direct you as to the amount of light they prefer, so ask before making adjustments.
In general, facing a bright window is not as helpful as having the bright window behind the individual. If the individual is squinting, reduce the amount of light if it is possible. Task lamps are a good way to add extra light for an individual who needs more light for a specific task. Low vision professionals can assess an individual’s need for light, magnification, and techniques to enhance usable vision. Contrast is another factor that can improve functioning. Some examples include: place a dark placemat under a white dinner plate; pour coffee into a white mug; paint the door frames a contrasting color; install contrasting receptacle covers; etc.
When interacting with persons who have vision impairments, use specific words rather than gestures. For instance, you might say, “there is an open seat two feet to your right”. Also, introduce yourself. An individual with limited vision may not be able to distinguish your name tag or uniform to know who you are. In a group activity, have each person introduce themselves. This will help the person with impaired vision know who is in the room and may orient them to where that person is in relation to themselves.
Individuals with vision impairments may exhibit behaviors that can be mistaken for other age-related conditions. For instance, if the individual says something that is out of context to your purpose for being with them, it could be that they did not recognize you and assumed you were someone else. Assuming this is confusion can impact your opinion of the individual’s cognition. Introducing yourself and explaining briefly who you are, should help resolve this type of confusion.
Services for older individuals with vision loss are available in every state, although the actual services available may vary considerably. A list of programs that serve older individuals with vision loss can be found at www.oib-tac.org and click on “state agency contacts”. Additionally, searching local directories for low vision clinics or services may help identify services in a specific region. Some services provide adaptive devices at no charge, while other programs sell these helpful items. Support groups can also be a good resource for individuals with vision loss. One online resource is the Hadley Institute at www.hadley.edu . Hadley provides videos, online discussion groups, and courses at no charge for any individual with vision loss.
When interacting with individuals with reduced vision, make sure to ask how you can best help. Keep in mind that contrast and lighting are factors that can be adjusted to help them better complete tasks. Finally, research services and refer individuals with vision impairments to these services.
Don't miss Eye Friendly: Tips and Tricks for Interacting With Persons Who Have Vision Loss on April 17 during the 2019 Aging in America Conference in New Orleans.
Kendra Farrow, MA, CVRT, is Research & Training Associate at The National Research & Training Center on Blindness & Low Vision.
Erickson, W., Lee, C., & von Schrader, S. (2017). Disability statistics from the American community survey (ACS). Ithaca, NY: Cornell University Yang-Tan Institute (YTI). Retrieved from Cornell University Disability Statistics website: www.disabilitystatistics.org
Prevent Blindness, (2019). How often should I have an eye exam? Retrieved from: https://www.preventblindness.org/how-often-should-i-have-eye-exam
Community of Practice for working with older individuals with vision loss: www.oib-tac.org
Hadley Institute for the Blind and Visually Impaired: www.hadley.edu