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Keeping An Eye on Low Vision Issues

One of the health issues facing older adults that isn’t often talked about is vision loss. The National Eye Institute (NEI), reports the majority of people with serious vision issues are age 65 and older. While vision loss is fairly common as we age, it is also something that becomes difficult for seniors to adapt to. That’s because their other senses – hearing, taste, smell and even touch – become weaker as we age, too.

“Vision loss is very often a gradual process, so seniors may not be aware of how severe theirs is until something happens that forces them to confront it,” says Dr. Alexis Malkin, OD, FAOO, an optometrist with advanced training in low vision rehabilitation in Boston, MA. Dr. Malkin is Associate Professor of Clinical Optometry at the New England College of Optometry, Director of Low Vision Service at Boston Medical Center/BU Eye Associates, Attending Optometrist for the NECO Center for Eye Care and Fellow of the American Academy of Optometry.

“Getting eye exams regularly with an optometrist or ophthalmologist is essential for good eye health and to stay ahead of any low vision issues that could impair quality of life,” says Dr. Malkin.

What Is Low Vision?
Low vision is a little bit more than just “having bad eyesight.” It’s defined as having a visual acuity of less than 6/12 (or having less than 20/40 vision in your best eye). It’s most often caused by macular degeneration, diabetic retinopathy, cataracts, and glaucoma. Other factors can include stroke, cancer of the eye, albinism, brain injury, or inherited disorders of the eye including retinitis pigmentosa.

According to Dr. Malkin, low vision is usually a permanent condition and can’t necessarily be cured, but there are different treatments available to improve visual function, halt further deterioration and help seniors do the activities they love.

“Even though you may be living with vision impairment, it’s still possible to live an engaged and happy life,” Dr. Malkin Says. “The biggest keys to success are accepting your situation, keeping a positive attitude and being open to trying alternative methods.”

What Are the Warning Signs of Low Vision?
Symptoms of low vision can often include loss of peripheral or central vision, night blindness, blurred or hazy vision and increased difficulty recognizing faces, reading road signs, reading up close or identifying colors.

Seniors often start exhibiting signs of low vision issues subconsciously. For example, you may find yourself squinting or tilting your head when you’re trying to get a good look at something. Reading or writing may become too difficult to do on an everyday basis. Depth perception may be affected, such as being unable to gage where an item is when reaching for it, or being hesitant while walking.

One of the biggest dangers presented by low vision is auto accidents. Family members and seniors might not notice any huge issues until a loved one starts driving erratically or starts having accidents.

“Any signs that your loved one is having difficulty seeing should be evaluated,” says Dr. Malkin. “With all the technological advances in medicine and eye care these days, living a full and healthy life with low vision is completely possible.” Sometimes, she says, the issues can be halted or corrected if they’re noticed early on. But it’s important to be proactive and act quick in order to avoid any lasting, permanent damage.

Adapting Your Living and Working Spaces
It’s important for seniors with low vision to become educated about their situation and what to expect and prepare for as it progresses, says Dr. Malkin. “Being educated about your options, finding a transportation service you trust, discovering safe walking routes and other proactive measures will empower you to continue to live a full life for as long as possible,” she says. Here are some of her other top tips:

Use adequate lighting.
More light means that surroundings are easier to see. Be sure to have plenty of light, but also be aware of glare, which can cause vision trouble and confusion. If possible, cover reflective surfaces (like shiny tables) to reduce glare and increase contrast (which can help with vision and depth perception). If you’re doing an activity like reading, playing cards or doing a craft, find additional sources of light in order to illuminate what you’re doing. A clip-on craft light or a small gooseneck lamp can be found at just about any hardware or craft store. Remember, though, that large discrepancies in light can be disorienting, such as having one bright light in an otherwise dark room – make sure the entire room is well-lit instead of just one spot. An occupational therapist can be an important person in helping you appropriately set up the lighting in your home.

Watch for fall risks.
Falling is one of the biggest reasons seniors end up in the emergency room. Between mobility issues, poorer health and vision problems, it becomes fairly easy to trip and fall when our eyes start to betray us. Go on the offense and take steps to remove hazards and eliminate clutter from walkways. Avoid things like throw rugs, hard-to-see furniture or decorative elements that could be easy to stumble across in low light. You may also wish to install handrails in hallways that are traversed at night for an extra level of protection, or install lights at the floor level in order to keep the pitch black at bay.

Get organized.
Muscle memory can play a huge role in helping seniors with low vision find the things they need and live well. For example, use a basket and designate a spot for things like keys, remote controls, eyeglasses and other little things that can be easily misplaced. Color-coded labels are another option, as is a tactile system to help those with very poor vision differentiate objects by touch (putting felt dots, sandpaper shapes or rubber bands around items to help users know what they do or where they need to go).

Use contrast whenever possible.
Contrasting colors, especially light and dark colors, make activities much easier for people whose vision is failing. For example, using a white cutting board to cut up carrots or apples can assist in safety. Dark bathroom mats against a light-colored floor can help seniors know where to put their feet when getting in and out of the bathtub.

Use magnification.
Making things bigger is a simple way to help some people with low vision see things more clearly. There are many large-format items on the market these days to help people perform everyday tasks – calculators with large buttons, big remote controls, clocks, large-print books and the like. You can also go old-school and get a magnifying glass or a clip-on magnifier to help while doing delicate tasks. Technology is coming into play in the marketplace, too – electronic magnification units can take photos of objects and project the digital image onto a large screen.

Look for a low vision doctor.
Having a general ophthalmologist is a good first step if a senior has vision issues, but visiting a provider with advanced training in low vision may be able to provide solutions personalized for you or a loved one’s specific issues. These providers can help with vision rehabilitation as well as provide tips on how to organize the house in order to keep your loved one as independent as possible. They can also provide appropriate referrals to other members of the care team including occupational therapists, vision rehabilitation teachers, certified low vision therapists and orientation and mobility instructors. They will also help you get connected with the Massachusetts Commission for the Blind if you are eligible for their services.

Boston Resources From A Resident Living With Low Vision
Dr. Ginger Chappell is a Waterstone at the Circle resident who is living – and thriving – with low vision. Ginger is very active in the community and a huge advocate for using available resources and living well with low vision. “I’m big on enjoying life,” says Ginger. Here are her recommendations for resources in the Boston area, as well as some of her favorite sites that help her live well.

The Carroll Center for the Blind in Newton hosts courses that teach people with low vision how to navigate their environments safely and use electronic aids. Ginger says their store is stocked with great vision aids such as item locators, talking watches and clocks, mobility aids, sunglasses and more. “They’re an outstanding organization,” says Ginger. “They’re incredibly helpful and such advocates for those with low vision issues.” (This is also an organization where Dr. Malkin is on staff.)

The Massachusetts Commission for the Blind in Boston is another organization that Ginger can’t praise enough. “Their assistants will escort you to doctors’ offices, help you navigate the building, and also help you with running errands and other daily tasks,” says Ginger. “I was impressed on my first visit when my case worker spent three hours with me, assessing my needs and helping me find solutions.” The organization also has certified low vision therapists, mobility instructors, technology advisors and other specialists on staff.

The Massachusetts Association for the Blind and Visually Impaired in Brookline is an excellent resource for those who wish to receive assistance and recommendations from the comfort of their own home. “Their occupational therapists will make house calls and provide recommendations on how to best adapt your home to fit your needs,” says Ginger. The organization also provides mobility training with walking aids, and can also provide volunteer companions who are able to assist seniors with chores, be sighted guides or even simply be companions.

The Perkins School for the Blind Library in Watertown has helped Ginger and so many others stay on top of what their favorite authors are writing. They can mail audio books back and forth from your home to the library, and will also send special equipment that will enable you to listen to audiobook CDs at home.

Ginger also recommends Audm.com and LSSProducts.com as two sites that can help improve the quality of life for those with low vision. Audum is an $8/month subscription service that will read online articles to you, allowing you to stay on top of current events and other special interests. The app works with top publications such as The Atlantic, The New Yorker, Wired, ProPublica and more. LSSPRoducts has just about any accessibility product you could want or need, including lighted magnifiers, specialized telephones and tablets that will read emails and texts to you thanks to accessibility features.

Finally, Ginger urges seniors to remember their best resource: other people! “Don’t underestimate the kindness of strangers,” she says. Ask a fellow grocery shopper to read a label for you or point you to the correct shelf, for example. People are usually quite happy and eager to help!”

Shedding Light on Low Vision: An Eye-Opening Series
Dr. Alexis Malkin, OD, FAOO will be holding an educational series at Waterstone at the Circle. A low vision rehabilitation specialist, Dr. Malkin will share insight into treatment options and provide expert advice for maintaining a fulfilling, independent life with low vision.

Tuesday, October 22 | 3 p.m. -- Adapting Living- & Workspaces
Tuesday, November 12 | 3 p.m. -- Community Resources at Your Fingertips

Contact us at 617.431.1880 to register.


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