Making Life Easier for Older Adults with Low Vision

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Many people would consider losing their sight one of the worst potential losses that they could encounter. While most of us will not suffer from complete blindness, millions currently suffer from some form of visual impairment, with numbers growing rapidly as we age.

According to the National Eye Institute (NEI), older adults represent the majority of the visually impaired population, with visual impairment included among the 10 most prevalent causes of disability in the U.S.

In a quest to discover methods of managing sight problems, I first contacted Pris Rogers, program manager of VisionAware.org.

VisionAware.org is the website for the American Foundation for the Blind (AFB). This website helps people who are new to sight impairment as well as their caregivers. According to Pris, caregivers are often just as confused and overwhelmed, not knowing where to turn or what to suggest.

"Even though many older adults have overcome an array of problems during their lives, when they receive a diagnosis of this loss, they may believe that there is no way that they can cope with this, since it affects almost all of daily life," Pris remarks. "Often, the doctor has given them a diagnosis but has had nothing to offer in terms of where the individual can turn for help to live with effective eyesight loss."

"But caregivers and persons with visual impairment need to know that there is indeed hope, and life, after vision loss," Pris says. "A wide range of services are available that can enable adults who are blind or have low eyesight to continue living independently. The term ‘vision rehabilitation' includes highly trained professionals and comprehensive services that can restore function after great impairment, just as physical therapy restores function after a stroke or other injury."

10 Tips for Low-Vision Living

  1. Good lighting is key: Keep rooms well lit. Use nightlights in bedrooms, hallways and the bath at night.
  2. Eliminate clutter: Return things to the same place. Try using a basket to store keys, TV remotes and other items.
  3. Remove hazards: Coffee tables, throw rugs or electrical cords can present a tripping hazard.
  4. Use contrasting colors in the house: This can make your doorways, stairs, and furniture easier to see.
  5. Use contrasting colors in the kitchen: For example, a white board for slicing red apples; a dark board for onions.
  6. Mark appliance controls: Use tactile dots or raised markings.
  7. Use contrasting colors in the bathroom: Towels, washcloths, and bath mats that contrast sharply with the tub and tiles.
  8. Identify medications accurately: Use large print, tactile labels or talking prescription bottles. Or check with your pharmacist to find out about talking medication devices that are available now in many drug stores.
  9. Make it easier to tell time: Find out about talking and large numeral clocks, watches, calculators, and other devices.
  10. Reinvent the reading process: Check into large print books, audio books, smart phone apps, and magnification devices such as video magnifiers in portable and desktop versions.

Pris also suggests that people go to Visionaware.org for more tips.

Insight from an Ophthalmologist

Charles P. Wilkinson, M.D., ophthalmologist and chair of EyeCare America, provides additional insight for low vision management from his medical perspective.

  • See your ophthalmologist. The American Academy of Ophthalmology recommends seniors age 65 and older get a dilated medical eye exam every one to two years, or as recommended by their ophthalmologist—a medical doctor specializing in the diagnosis, medical and surgical treatment of eye diseases and conditions. During an eye exam, your ophthalmologist does more than assess your eyesight. He or she also assesses the health of your eye and identifies any eye diseases and conditions. Additionally, new glasses may be able to help, even if there are other problems or conditions, such as cataracts.
  • Make things bigger. Sit closer to the television or to the stage at performances. Get large books, phone dials and playing cards. Carry magnifiers for help with menus, prescription bottles and price tags.
  • Make things brighter. Make sure areas are well-lit and cover shiny surfaces to reduce glare. Consider increasing color contrasts as well. For instance, drink coffee from a white mug and always use a felt-tipped pen with black ink.
  • Use technology. Many of today's newer technologies have applications that can help with low eyesight. For example, e-readers allow users to adjust the font size and contrast. Many smartphones and tablets can also be used to magnify print, identify cash bills and provide voice-navigated directions.
  • Organize and label. Designate spots for your keys, wallet and frequently used items in your refrigerator. Mark thermostats and dials with high contrast markers from a fabric store; label medications with markers or rubber bands; and safety-pin labels onto similarly colored clothing to tell them apart.
  • Participate. Do not isolate yourself. Keep your social group, volunteer job, or golf game. It might require lighting, large print cards, a magnifier, a ride or someone to watch your golf ball. Ask for the help you need.
  • Eat for your eyes. Try to consume a diet high in citrus fruits, dark green leafy vegetables, nuts, whole grains, vegetable oils and cold-water fish. These are packed with nutrients that support your eyes.
  • Exercise regularly. Even gentler exercise, such as walking, yoga or stretching can be effective in promoting good blood circulation and oxygen intake—two things our eyes need!
  • Quit smoking. Not only is it good for your body, it is also good for your eyes. This decision is one of the best investments you can make in your long-term health.
  • Wear your shades. Regardless of the season, wearing sunglasses with at least 99 percent UV protection helps protect your eyes from damage.
  • Consider low vision rehabilitation. If your eyesight is failing, you can greatly improve your quality of life through vision rehabilitation, which teaches you how to use your remaining sight more effectively. Talk with your ophthalmologist if low vision rehabilitation is right for you.

How caregivers can help

Losing eyesight is often so subtle, it may not be apparent to those whose vision is getting worse. This is where caregivers can come in.

  • Squinting or tilting the head when trying to focus,
  • Knocking objects over,
  • Discontinuing everyday activities such as reading or writing,
  • Missing objects when reaching for them,
  • Falling or stepping hesitantly, or
  • An increase in "dings" on the car.

Encourage open and honest communication. Some people with low vision experience hallucinations known as Charles Bonnet Syndrome. This is often confused with dementia, but is very different and is harmless. Let your loved ones know they can talk to you if something seems to be amiss.

Help identify useful resources. Often older Americans are worried that sight impairments will affect their ability to live independently; so put your loved one at ease by suggesting resources that allow them to maintain independence.

Go to eye exams with them. Write down questions for their ophthalmologist in advance and help them get the answers they need. Be aware and be an involved advocate for your loved one.

I would like to thank both Pris Rogers and Dr. Wilkinson for their insight and tips. Glaucoma and macular degeneration are two common causes of low vision in aging adults. See an ophthalmologist regularly to maintain eye health, and for help coping with impairment from these diseases and others, should a problem occur.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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18 Comments

Carol, thank you for all the great ideas. Both my parents have macular degeneration and how I wish they would turn some lights on in their home... it's like walking into a cave. Plus several years ago my Dad went and changed all the old fashioned light bulbs to the new twisty florescent which I feel doesn't give the correct amount of lighting for them to see. And the shades are always drawn so very little outside light coming in.... Mom doesn't want to fade the rug or furniture :P

Mary, many elderly have some type of macular degeneration to which there is very little that any Ophthalmologist or Retina specialist can do to correct that, at this point in time.... there is research going on for stem cell to help reverse the degeneration but that is years away. Hopefully the next generation can be helped.
Invisible, there are many different shades of sunglasses designed to reduce glare, my mom chose a very light amber tint in a wrap around frame that she could wear over her prescription glasses. On very bright days or when going places with florescent light she wore them inside, she had a dark amber pair for outdoors in sunny weather.
There are also so many magnifiers available with built in lights, ranging from inexpensive drugstore varieties to high power 14X magnification (usually prescribed after a low vision assessment). It has been a few years since I've checked, but I imagine the tech side of low vision aids has improved exponentially in the last few years too.
This is so good, one of the best articles I have seen on AgingCare. I can verify that all of the above are definitely helpful, if not a must! I first noticed I was "losing things" too much, then, I noticed a pattern. The things that "disappeared" were dark objects, because I couldn't see them contrasted against a dark background. A "tip" for anyone might be to avoid dark colored stuff. Unfortunately, the tech industry makes everything black! A workaround would be using stickers, bright cases, labels, or even bright duct tape. If your floor is very dark, consider brightening the room (if you can) with lighter floor coloring, but not a bright red rug. Rugs also present problems if they buckle. Also, make a habit of carrying a reliable pocket flashlight. Have spares and hang these around the house in handy places.

Losing pills is a problem if pets are around. A person who has trouble seeing may hear a pill hit the floor, but will have a lot of trouble retrieving it. Locate the pill by first shining the flashlight onto the floor. If that fails, try the "broom method." The lost pill is bound to show up among the dust bunnies.

As far as using a computer, I'd suggest color reversal, which is available with most browsers as an extension. In Google Chrome, try one called Deluminate. There are others, too. Firefox has several. I find for font enlargement, Firefox tends to do a better job since Chrome is more likely to overlap the print. I'm not sure about other browsers. Adobe Reader will reverse colors as will most Word-type applications (even Scrivener).

I am pre-senior, but my vision has decreased so much that most would feel limited at this level. However, I am very lucky because I gave up driving decades ago. I am still able to do most of what I need to do, including reading and writing, which are such important skills to retain to connect to the world if one tends to be verbal. I also enjoy distance running, usually on a treadmill but I can still run outside if I want. Don't ask me to read street signs! And much of the time, I can't recognize people faces, either. (Don't worry, I still love you all, though....)