Adaptations for Low Vision

Improving quality of life and targeting challenges.

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Improving quality of life and targeting challenges. Cheryl Guttman Krader reports. Magnification aids are what most ophthalmologists think about when discussing compensatory measures with patients suffering from low vision. However, the industry should not overlook the need for adaptations to address environmental challenges created by visual function deficits. Ophthalmologists have a valuable role in referring these individuals to other professionals who can provide advice on simple strategies that help low vision patients live safely and independently. “I think that as ophthalmologists we can have our greatest success helping patients with low vision by becoming part of a vision rehabilitation team,” said low vision specialist Donald C Fletcher MD. “Our role is not to teach patients the tools and skills they can use to confront environmental challenges, but we should identify how the multiple parameters of their visual function are impacted, talk with them about the difficulties they can encounter because of their deficits, and use that discussion as a springboard to introduce team members such as occupational therapists or orientation and mobility specialists who can help them with recommendations on adaptations.” Dr Fletcher provided examples of how decreased visual acuity, visual field loss, and reduced contrast sensitivity interact with the environment to create hazards and difficulties with localisation and navigation. In addition to talking to patients about where they might encounter these issues, Dr Fletcher said he educates family members about the challenges using simple tools. For example, he has them look through empty cardboard tubes from toilet tissue, paper towels, and wrapping paper, simulating differing degrees of visual field constriction. ASK PATIENTS WHAT MATTERS Occupational therapist Michele Vandendooren provided specific examples of how to help low vision patients overcome environmental challenges encountered in the home. The adaptations consider comorbidities, such as problems with balance, tremors, and cognition. The first step, however, is understanding the patient’s goals, including whether the individual actually wants to stay in the home. “Occupational therapists ask, what matters to you, not what is the matter with you,” Ms Vandendooren said. Offering examples for increasing contrast to improve safety and accessibility, she discussed selecting items that contrast with the surroundings, such as furniture that contrasts with the walls and floor or towels that contrast with the bathroom walls. Marking the edges of stairs, thresholds between rooms, and the leading edge of a bathtub or shower entry are other ways to increase contrast. Installing grab bars in the bathroom or a tub chair serve as helpful aids for patients with comorbid balance issues. Contrasting colour choices or markings that provide contrast are also needed to increase visibility. Placing tactile labels on appliances and the dials on the stove fashioned of a contrasting colour and with lettering in large print enables functioning and safety in the kitchen. Other useful kitchen adaptations include talking thermometers that alert individuals when their food is properly cooked. Choosing dishes solid in colour and contrast with the table is another recommendation. “Patterns or designs on dishes may look like food to someone with low vision and make it hard for them to locate food on the plate,” Ms Vandendooren explained. As a simple measure to increase safety in the kitchen, lowvision patients should be advised to pour hot beverages after first placing the cup or bowl in the sink. Two-toned cutting boards that are black on one side and white on the other are useful for assisting with safe preparation of light- and dark-coloured foods, respectively. Rugs that contrast with the floor colour or tablecloths chosen to contrast with the floor can be helpful for persons with low vision by providing a reference point for orientation. With safety in mind, all rugs should have a nonslip backing. Adequate lighting, including in closets, and the need for good task lighting should also be assessed. Keeping a flashlight handy will also help patients find what they need. Increasing illumination, however, may create problems with glare reflecting off walls and floors. Not all patients experience issues with glare, but Ms Vandendooren said she often gives patients glare control filters so they can see if they are helpful. Locating computer monitors and televisions away from windows is also recommended to reduce problems with glare. Strategies focusing on improving organisation can also make life easier for the low-vision patient. These include labelling food containers, creating a filing system using large print tabs, or simply pinning socks together. Magnification, including handheld magnifiers and magnifying mirrors, can also be recommended along with home technology devices—e.g., Amazon Echo or Google Home—that can help individuals with a variety of tasks. This information was presented during the AAO21 conference in New Orleans, Louisiana, USA. Donald C Fletcher MD is a retinal specialist and low vision specialist at Retina Consultants of Southwest Florida, Fort Myers, USA. floridafletch@msn.com Michele A Vandendooren is the founder of Low Vision Works, Sarasota, Florida, USA, a company specialising in low vision rehabilitation. michele@lowvisionworks.com