Impact of Low Vision on

Clients’ Lives

March 25, 2017

Melinda Szilva, MTS, RP

Low Vision Rehabilitation

Counsellor

mmszilva@uwaterloo.ca

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

mmszilva@uwaterloo.ca

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.