What Is Low Vision?

If you or your care receiver can't see very well . . . how do you know if it is "low vision" that regular glasses can't correct? There are many signs that signal vision loss. Blurred vision, trouble getting food to a fork, pouring liquid over the top of the cup, moving around the house slowly and cautiously or brushing against the wall while walking are just a few of the signals. Here are some questions to ask. Even with regular glasses, do you or the person for whom you are caring have difficulty:

• Recognizing faces of friends and relatives?
• Doing things that require seeing well up close, like reading, cooking, sewing, or fixing things around the house?
• Picking out and matching the color of clothes?
• Doing things at work or home because lights seem dimmer than they used to?
• Reading street and bus signs or the names of stores?

Vision changes like these could be early warning signs of eye disease. Usually, the earlier the problem is diagnosed, the better the chance of being treated successfully and keeping one?s remaining vision. Treatment options are continually improving. Regular dilated eye exams should be part of routine health care for you and the older person for whom you are providing care. Other suggestions for protecting vision throughout life include:

• Wear a wide-brimmed hat and sunglasses with 100% UV-A and UV-B protection outside, as ultraviolet rays are linked to cataracts and macular degeneration. People with fair skins and blue eyes may be most susceptible.

• Don't smoke. Cigarette smoking has been linked to eye conditions including cataracts and macular degeneration.

• Wear protective eye gear when working with tools.

• Eat a nutritious, low-fat diet rich in fruits, grains and vegetables, especially leafy greens. Check with a doctor before adding vitamin supplements, as too much of some vitamins can be harmful to a person's health while certain vitamin supplements are now recommended for people at high risk for macular degeneration.

• Exercise regularly and monitor blood pressure, as cardiovascular stress such as high blood pressure can damage parts of the visual system.

Older people need more light and more time to adjust to changes in light. Most people who are middle-aged or older use reading glasses or bifocals, trifocals, or no-line progressive lenses because the lens of the human eye loses elasticity, making it harder to focus up close. Changes like these are normal as we age.

Vision loss, however, is not a part of normal aging. The four most common causes of age-related vision loss are described below:

• Macular Degeneration occurs when there is damage to the macula, which is the central part of the retina, responsible for detail, color and daylight vision. There are two types: dry, which is most common, and wet, which affects about ten percent of those with macular degeneration. With the dry type, parts of letters may seem to be missing while reading and straight lines may look wavy. The wet variety suddenly causes a large dark spot in the center of vision, necessitating an immediate trip to an eye professional.

• Glaucoma, caused by damage to the optic nerve from abnormally high eye pressure or poor circulation, results in loss of contrast, difficulty driving at night, and loss of peripheral vision in late-stage glaucoma with no symptoms in early glaucoma. People with a family history of glaucoma are at higher risk, as are all older adults, African-Americans, and Hispanic-Americans. Treatment is evolving, but early detection through routine tests is important.

• Cataract is a clouding of the lens that reduces visual acuity, producing a haze and increased sensitivity to glare. Distinguishing colors and reading words even while wearing glasses may become very difficult. Cataract surgery to replace the affected lens with a plastic one has a high success rate.

• Diabetic Retinopathy, which can be a complication of advanced or long-term diabetes, causes hemorrhages in the retina, resulting in blurring or obstructions in the visual field. Monitoring glucose levels and visiting an eye doctor who specializes in treating this condition are recommended. Laser treatment of early stages of retinal bleeding can sustain vision levels.

Eye Disease Simulations (how the world looks to someone who has each of the eye diseases listed above)

Photographs of what the same scene may look like to persons with each type of vision loss may give you a better understanding of these conditions:

What should you do if you or your care receiver notice a change in vision?

• Make an appointment to see an eye care professional as soon as possible.
• If diagnosed with a condition that causes vision loss, seek information. Two Internet resources are the National Eye Institute at www.nei.nih.gov and Lighthouse International at www.lighthouse.org. These sites provide research information, publications such as fact sheets and booklets about eye conditions, eye problem simulations (how the world looks to someone who has macular degeneration, glaucoma, etc.), information about equipment to assist people with low vision, advocacy information, and more.
• Find a local resource that can provide services such as orientation and mobility training. In Pinellas County, the Watson Center, located in Largo, Florida, is a good place for someone with low vision or blindness to call and visit. Many people with low vision do not take advantage of vision rehabilitation services, which can greatly improve everyday functioning and help people deal with vision changes over time. Orientation and mobility training teaches the basic skills to get around in new and familiar surroundings. The goal is to help people with vision loss, regardless of age, develop and relearn the skills they need to remain independent and live full, productive lives.

• Rehabilitation services and classes offered at the Watson Center include:

• Techniques for daily living - cooking, cleaning, identifying money.

• Communication methods - talking books, writing guides, typing, and computers equipped with magnification and speech software.

• Individual case management - trained professionals assess each person's individual needs and help him or her link to a variety of resources.

• Employment Service - a model office provides an opportunity for training in the latest technology. On the job orientation and training is provided.

• Transportation - a taxi service at a special reduced cost is arranged for clients attending classes.

• The Sight Shoppe - for magnifiers, software and adaptive low vision devices for all ages.

The Division of Blind Services, a Florida state agency located in St. Petersburg, Florida, provides limited in-home mobility and orientation training and vocational rehabilitation for persons with severe visual impairments. Some clients are referred to the Watson Center for the in-depth services offered there.

To access the services or programs described in the Handbook, call: The Senior Helpline at 727-217-8111 in Pinellas, 1-800-861-8111 in other areas of Florida.