Impact of Low Vision on
Clients’ Lives
March 25, 2017
Melinda Szilva, MTS, RP
Low Vision Rehabilitation
Counsellor
In This Session I Will…
• Talk about common issues that arise in the
counselling room at the Low Vision Clinic
• What techniques and strategies I find most
helpful
• Links to research
What Happens Behind That
Door?
Today I want to invite you in…
Before We Enter…
Confidentiality Please…
The First Thing You’ll
Experience in the
Counselling Room is…
The Therapeutic Alliance
The core conditions of a therapeutic counselling relationship. (Clark, 2010)
Top 5 Concerns
Shared In The Counselling
Room
#1. Feelings of Loss
• Perceived loss of Independence
• Loss of driver’s license
• Sometimes job loss/career change
• Changes…I can’t do things like I used to
• Death of a loved one
#2. The What If’s???
• What if my vision gets worse?
• What if I go totally blind?
• What if I have to move out of my home?
#3. Shhh!!! It’s a secret!
I don’t want to use assistive devices
because:
o I don’t want people to know I have vision loss
o I don’t want to look different
o I don’t want to be a target (white cane)
o I can’t even admit to myself that I
might just need to use them!
#4. Relationships Are
Complex• My spouse/children/parents don’t
understand my vision loss
• I can’t seem to meet anyone who is ok
dating someone with vision loss
• Abuse issues in families and couples
• Sexual concerns
#5. I’m Lonely…
• I am no longer working at my old job and I
miss the interaction & my colleagues
• With vision loss & other health challenges
I just don’t have the energy I used to have
• I moved & I don’t recognize faces so it’s
hard to get to know new people
• I’m depressed so I isolate
Counselling Strategies
Validate client perceptions and experience of
vision loss
Acknowledge losses and normalize feelings as
clients adjust to changes in vision, life style and
expectations
Assess for depression and/or anxiety that
could be affecting a client’s mood &
expectations
Use cognitive behavioural strategies
Dr. Don Meichenbaum a founder of
CBT says…
• We ask clients “Let me get this…what
happened? How did that make you feel?
And what did you do with those feelings?
How did that work? What was the cost?
• What have you tried before? What worked
or didn’t? If we worked together what
would success look like? Can you envision
anything that could get in our way?
Use Mindfulness Strategies
Use Solution Focused Therapy
Include family members in counselling
interventions when appropriate
Use Emotionally Focussed Therapy
Consider alternate paths to meet goals
Help clients access additional
community resources to help improve a
client's overall quality of life
Take An Interdisciplinary Approach
Low Vision clinician (optometrist), Low Vision Therapist, High Technology Assessment Specialist, Low Vision Rehabilitation
Counsellor, High Technology Assessment Specialists
Research Says…
Research on Loss and
Grieving…“Participants described their adaptation to
vision loss as being on a continuum with ups
and downs, rather than a linear experience
that culminated with adaptation.”
Kaminsky, T. A., Mitchell, P. H., Thompson, E. A., Dudgeon, B. J., & Powell, J. M. (2014).
Supports and barriers as experienced by individuals with vision loss from diabetes.
Disability and rehabilitation, 36(6), 487-496.
Research on Loss and
Grieving“Patients expressed great loss caused by
vision disease, emphasizing feelings of
sadness & vulnerability…these feelings also
appeared to be associated with challenges
during the adaptation process, such as how
to use assistive devices, especially the white
cane.”Senra, H., Oliveira, R. A., & Leal, I. (2011). From self-awareness to self-identification with
visual impairment: a qualitative study with working age adults at a rehabilitation setting.
Clinical rehabilitation, 25(12), 1140-1151.
Evidence for CBT
“How people think about chronic illness and
how they evaluate their ability to cope with it
are modifiable. Illness cognitions and
problem-focused CSE provide concrete
starting points for designing targeted
interventions to modify or neutralize unhelpful
cognitions.” Sturrock, B. A., Xie, J., Holloway, E. E., Hegel, M., Casten, R., Mellor, D., ... & Rees, G.
(2016). Illness Cognitions and Coping Self-Efficacy in Depression Among Persons With
Low Vision Illness Cognitions and Coping in Low Vision. Investigative ophthalmology &
visual science, 57(7), 3032-3038.
Higher Depression, Anxiety
But Also Social Support “We conclude that vision loss has a negative
impact on ADLs, symptoms of depression and
feelings of anxiety in older people. However, social
support was highest in the low-vision sample.
Professionals working at vision rehabilitation
services may improve their quality of care as they
take such information into account in their
intervention work.” Kempen, G. I., & Zijlstra, G. R. (2014). Clinically relevant symptoms of anxiety and
depression in low-vision community-living older adults. The American Journal of Geriatric
Psychiatry, 22(3), 309-313.
Why Counselling is Part of
the Interdisciplinary Team…“Maladaptive coping, particularly avoidant
coping, has been found to reduce vision-
related quality of life over time, while
adaptive coping, specifically instrumental
coping, social support, and use of assistive
aids predicts better adjustment to vision
impairment.”
Thanks for Visiting!
Melinda Szilva, MTS, RP
Low Vision Rehabilitation Counsellor
Tel: 519-888-4567 ext. 36763
Centre for Sight Enhancement
School of Optometry & Vision Science
University of Waterloo
200 University Avenue West, Waterloo, OTN N2L 3G1
Fax: 519-746-2337
To Contact Me
References• Sturrock, B. A., Xie, J., Holloway, E. E., Hegel, M., Casten, R., Mellor, D., ... & Rees, G. (2016). Illness
Cognitions and Coping Self-Efficacy in Depression Among Persons With Low Vision Illness Cognitions and Coping in Low Vision. Investigative ophthalmology & visual science, 57(7), 3032-3038.
• Kaminsky, T. A., Mitchell, P. H., Thompson, E. A., Dudgeon, B. J., & Powell, J. M. (2014). Supports and barriers as experienced by individuals with vision loss from diabetes. Disability and rehabilitation, 36(6), 487-496.
• Tabrett, D. R., & Latham, K. (2012). Adjustment to Vision Loss in a Mixed Sample of Adults with Established Visual ImpairmentAdjustment to Vision Loss in Adults with Visual Impairment. Investigative ophthalmology & visual science, 53(11), 7227-7234.
• Kempen, G. I., & Zijlstra, G. R. (2014). Clinically relevant symptoms of anxiety and depression in low-vision community-living older adults. The American Journal of Geriatric Psychiatry, 22(3), 309-313.
• Senra, H., Oliveira, R. A., & Leal, I. (2011). From self-awareness to self-identification with visual impairment: a qualitative study with working age adults at a rehabilitation setting. Clinical rehabilitation, 25(12), 1140-1151.
• Kempen, G. I., Ballemans, J., Ranchor, A. V., van Rens, G. H., & Zijlstra, G. R. (2012). The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services. Quality of life research, 21(8), 1405-1411.
• van der Aa, H. P., Krijnen-de Bruin, E., van Rens, G. H., Twisk, J. W., & van Nispen, R. M. (2015). Watchful waiting for subthreshold depression and anxiety in visually impaired older adults. Quality of Life Research, 24(12), 2885-2893.
References Continued• Alexopoulos GS, Raue PJ, Kiosses DN, Mackin RS, Kanellopoulos D, McCulloch C, Areán PA.
Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry. 2011 Jan;68 (1):33-41.
• Glover-Graf , N., Millington, M. (2012) Psychosocial aspects of disability: Insider perspectives and counseling strategies. New York, NY: Springer Publishing Company.
• Livneh, H and Antonak, R “Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors,” Journal of Counseling and Development 83 (2005): 12—13. lbid., 14.
• Psarraa, E & Kleftaras, G. Adaptation to Physical Disabilities: The Role of Meaning in Life and Depression. The European Journal of Counselling Psychology, 2013, Vol. 2(1), 79–99.
• Rovner BW, Casten RJ, Tasman WS. Effect of depression on vision function in age-related macular degeneration. Arch Ophthalmol. 2002 Aug;120(8):1041-4.
• Tuttle, Dean. W. & Tuttle, Naomi. R. (2004). Self-esteem & Adjusting With Blindness: The process of Responding to Life’s Demands. Springfield, Illinois: Charles C Thomas Publishing.
• Rees G1, Fenwick EK, Keeffe JE, Mellor D, Lamoureux EL. Detection of depression in patients with low vision. Optom Vis Sci. 2009 Dec;86(12):1328-36.