tools helping visual impairment, low vision, and macular degeneration

Kevin Huff O.D.Viewfinder Low Vision Resource Center

www.ViewFinderLowVision.com

TOOLS AVAILABLE TO HELP GAIN INDEPENDENCE

INDEPENDENCE DESPITE VISUAL IMPAIRMENT

• When a person is diagnosed with visual impairment, the biggest fear that most people are forced to face is loss of independence.

• To face the challenges that come from visual impairment, patients must embrace the tools available

INDEPENDENCE DESPITE VISUAL IMPAIRMENT

• Decreased visual acuity does not have to lead to a loss of independence

• There are many tools available to help gain independence when facing visual impairment.

WHAT IS “LOW VISION”

•Any chronic uncorrectable visual impairment that limits daily functioning

• Vision cannot be corrected with medication, surgery, contact lenses or “regular eyeglasses”

•Better term for what we do is Vision Rehabilitation

DEFINITION OF LEGAL BLINDNESS

• The term “legally blind individual" means an individual whose

• (1) central visual acuity cannot read any letter on the 20/100 line in the better eye with best correction, or

• (2) that the widest diameter of the visual field subtends an angle no greater than 20 degrees.

• Don’t let the term legal blindness scare you into thinking you are blind

• “Tax” Term, not a functional definition

INDEPENDENCE= 20/20 VISION???

• Menu at McDonald’s requires 20/80 vision

• Microwave controls require approximately 20/100 vision

• Newsprint requires 20/50 vision

• Grooming requires 20/50 – 20/100 vision

• Independence is threatened when vision falls below 20/60

USE YOUR EYES!

• You cannot damage your vision by using your eyes

• Nor can you preserve your vision by not using your eyes.

TOOL #1

ENHANCE CONTRAST

ENHANCE CONTRAST• Most people with visual impairment see

better if objects are black and white.

ENHANCE CONTRAST

• Do not use heavily decorated plates as food becomes difficult to identify

• Do not use clear glasses or dishes as they become invisible

ENHANCE CONTRAST

ENHANCE CONTRAST• Set dishes on

contrasting placemats

• Utensils with contrasting handles

ENHANCE CONTRAST

TOOL #2

INCREASE ILLUMINATION


• A person in their 80’s requires nearly three times as much light as a 20 year old

• A person who is visually impaired will need even more lighting

• Use gooseneck lamps, flashlights and illuminated magnifiers

• Task lamps will provide the needed light without causing glare


• Sunlight or white light is preferred - enhances contrast of print

• Incandescent in gooseneck lamp• GE Reveal Bulbs

• Halogen – rarely used anymore


• Fluorescent• Standard fluorescent lighting is harsh and does not

increase contrast of text• Use Warm or Daylight Fluorescent

• Does not create shadows and is good for overall room illumination

• Does not create heat


• Top photo … 100 watt can flood lights 12 feet above counter top

• Bottom photo … same flood lights with 75 watt task lamp 12 inches from page

TOOL #3

CONTROL GLARE

CONTROL GLARE• Glare can further reduce vision and cause eye fatigue

• Decrease glare

• Lighting

• Windows

• Sun

CONTROL GLARE• Tinted Lenses

• Fitovers, Slip-ins, Clip-ons, or actual tinted lenses

• Transitions

• Anti-reflection coatings

CONTROL GLARE

• Hats, caps, visors

• Yellow acetate filters over shiny pages

• Lighting from behind

• Pin-hole contact lens for aniridia patients

CONTROL GLARE

CONTROL GLARE

http://www.cocoonseyewear.com/sunwear/

CONTROL GLARE

TOOL #4

Use Sound

SOUND• There are many products available that use

sound.

• Examples: Talking watches/clocks, talking scales, audio books, new CCTV’s with OCR technology

SOUND• Unfortunately, if your hearing is not good,

these products are not helpful.

• The old belief that when one sense goes away, the others take over is not usually true.

TOOL #5

Magnification

MAGNIFICATION

THREE TYPES OF MAGNIFICATION

• Relative Distance Magnification

• Relative Size Magnification

• Angular Magnification

RELATIVE DISTANCE MAGNIFICATION

• Get closer to objects.

• This magnifies by enlarging the angle that the object subtends on your retina


• Getting closer to the television will not hurt your eyes!


• This is why stronger glasses sometimes helps.

• When the prescription is stronger, the patient is required to hold things closer to their face to get the print in focus. This magnifies the object being read.

RELATIVE SIZE MAGNIFICATION

• Make things physically bigger, i.e. Large Print Items


• Bold paper

• Felt tip pen


• Bold print on white label attached to medicine bottle


• Computer• Use a larger monitor• Both Windows and Apple operating systems have

settings for people with decreased vision• Windows Mouse with magnifier


• Computer• Large Print (LP) Software with or without speech

output• LP Software with scrolling of text• Braille - hard copy and refreshable• Optical Character Recognition

ANGULAR MAGNIFICATION

• Object is not changed in position or size, but an optical system is placed between the object and the eye making the object appear larger

• Hand magnifier

• Telescope

• Electronic Magnification


• Hand magnifiers• The stronger the magnifier,

the smaller the lens

• Always use an illuminated magnifier

• LED Illumination

• Stand Magnifiers• The stronger the

magnifier, the smaller the lens

• Good for patients with tremors


• Telemicroscope• Better working distance

• Narrow field of view


ANGULAR MAGNIFICATION• Telescopes

• Spectacle mounted: permanent mount or clip-on

• Hand held with either neck cord or finger ring

• Used for computer, music, TV - distance or intermediate tasks


• Bioptic Telescopes• Steadier view than hand

held

• Some are able to walk/drive with them

• Video Magnification- CCTV’s


http://www.enhancedvision.com/low-vision-products/merlin-family-of-products.html


• Advantages of video magnification• Magnification up to 72X

• Optical magnification up to 20X (80 diopters)

• Allows sufficient reading speed to make continuous text meaningful at high levels of magnification

• Image polarity can be reversed increasing contrast and decreasing glare

• Easily and instantly converts any material to large print

• Can be easily adjusted for fluctuation of vision


• Advantages of video magnificationIncreased Working Distance

PC Compatible

• Portable

• Capture images

• Distance vision


• Disadvantages• Cost: Many options available to help with this

• Portability: Not a problem anymore

• Hard to use: this is a myth


• Types of Electronic Devices• New HD and Text-to-speech (OCR) CCTV

• Desktop

• Portable

• New Type I call the Acrobat Class

• Merlin elite is a high performance desktop video magnifier (CCTV).

• HD provides a beautiful crystal clear picture and vibrant color.

• Text-to-speech

• Experience the joy of reading with the push of a button.

• Sony HD auto focus camera – work on hobbies and see small details.

• 24” High resolution HD LCD.

• 28 viewing modes allows you to personalize Merlin elite-perfect for reading newspapers, magazines and doing crossword puzzles.

• Screen easily pivots horizontally and vertically-providing the most comfortable viewing position.

MERLIN LCD & HD

Desktop CCTVCombines large magnification range with large

field of viewEnhances ContrasTray allows for smooth reading even at higher

magnification levelsControls are very easy to use

• Excellent option for near tasks• Reading

• Writing

• Looking at photos

• Long lasting LED lighting for truer picture and color

• 19”, 22” and 24” Monitors

• Magnification 2.4x to 85x varies with monitor size

• You can personalize with 7 viewing modes

• 3 year warranty

• When the Acrobat LCD was introduced, it created the standard for a new class of CCTV• The portable desktop CCTV• Ideal for patients who travel for extended periods of time,

i.e. winter visitors in Arizona• No longer have to purchase two desktop CCTVs

• Moving camera head allows patient to use this device for multiple tasks• Reading

• Writing

• Working with hands

• Moving camera head allows patient to use this device for multiple tasks• See their own face, i.e. makeup, shaving etc.

• See others faces, i.e. grandchildren

• Distance vision

• Auto focus 3-in-1 camera

• Detachable camera for use at multiple work stations

• 19”, 22”, & 24” provide up to 82x adjustable magnification (varies with LCD size)

• 28 available viewing modes to optimize contrast and brightness

• Line markers, object locator, remote control and more…

• Two Year Warranty

Features

• DaVinci is a high performance desktop video magnifier (CCTV).

• Has taken the next step in the “Acrobat” class

• Featuring HD, text-to-speech and

a 3-in-1 camera.

• HD provides a beautiful crystal clear picture and vibrant color.

• Experience the joy of reading with the push of a button.

• Sony HD auto focus 3 in 1 camera – see near, far and everything in between.

• Read any printed text with the push of a button.

• 24” High resolution HD LCD.

• 28 viewing modes allows you to personalize DaVinci - perfect for reading newspapers, magazines and doing crossword puzzles.

• Slide mechanism provides flexibility for various camera arm positions.

• Similar Advantages to Acrobat LCD with a few extras• Even more portable

• Able to capture images

• Excellent option for students or people who attend presentations/ conferences often

• Weighs less than three pounds• 2.4x to 30x magnification (based on17” screen)• Camera rotates 330 degrees reading, distance & self

viewing modes• Connects to laptop, desktop computer or monitor.

• 28 custom color select modes

• Battery operated - up to 4 hours

• Built in LED lighting

• Auto install software/ plug & play

• 2 year warranty

• Large portable CCTV• Extremely large field of view for portable CCTV• Screen tilts up and down to allow for comfortable use• Can be connected to TV Monitor for even larger field

of view• Able to freeze images and adjust contrast and size

• Crisp, high-definition image

• Lightweight and portable

• 3.5x to 14x magnification

• Large 6.5” anti-glare LCD screen

• 6 viewing modes to optimize contrast and brightness

• 2 year warranty

• Lightweight Portable CCTV• Ideal size for patient to carry with them

• Can be used for reading and many near spotting tasks• Reading menus

• Shopping- seeing price tags and labels

• Seeing household items like stove dials and thermostats

• Signing documents such as checks and receipts

• Adjustable magnification 2x to 10x

• 3.0”, 3.5” or 4.3” high resolution LCD

• Large viewing area in a small package

• Adjustable brightness

• 28 available viewing modes

• Foldable handle with comfort grip 3.5” and 4.3”

• Freeze image feature with capability to magnify and change mode.

• 2 year warranty

TOOL # 6

LEARN TO USE YOUR EYES AND YOUR TOOLS

MORE EFFECTIVELY

USE YOUR EYES AND TOOLS MORE EFFECTIVELY

• Practice and Patience• Patients who have not read in a long time require

practice to return to a functional level of reading

• For every week a person has not read, it will take 1 day of practice to learn to read with reasonable speed and accuracy


• It is much easier to use low vision aids and continue to use them if you start using them when you don’t need a lot of magnification

• You may not want to wait until your eyes are “stable“ to start pursuing the tools you need for independence


• Conditions like Macular Degeneration affect the central vision

• Conditions like Glaucoma and Retinitis Pigmentosa affect the peripheral vision


•Patients can be trained how to use parts of their vision that still remain

•Eccentric Viewing Training


• Eccentric Viewing• A person with a normal healthy retina uses the macula, the very

center of the retina, to view an object or print

• A healthy macula has the highest density of cone cells allowing clear vision and color perception

• A person with an unhealthy macula can learn to use a more peripheral part of the retina in order to see more clearly


• Eccentric Viewing• Do not move your head when trying to find the clearest

peripheral retinal loci• Move eye only

• Identify the distorted or blind areas in the retina. • An Amsler Grid may help


• Eccentric Viewing• By using the “Clock Technique” identify the clearest

part of the peripheral retina.• Don’t look at what you want to see!

• Look slightly above, below or to the side of the object that you wish to see in order to see it more clearly

• This area may differ for different tasks such as reading and watching TV


• Exercises that involve tracing and identification will help to learn to use this clearest part of the retina

• Detail vision will not be fully regained by eccentric viewing training, but vision can be greatly improved when coupled with enlargement, enhanced contrast, and appropriate magnification devices


• Visual Fields and Scotoma awareness:

• Humphrey 10-2: usually for Macular Problems

• Humphrey 30-2: usually for Glaucoma, Retinitis Pigmentosa, Strokes

TOOL #7

Become Familiar with Community Resources

BECOME FAMILIAR WITH COMMUNITY RESOURCES

• You are not alone• Support Groups

• Counseling

• Transportation services

• Aging services


• Community resources • Talking book program

• Large print books

• Various agencies that service the blind and visually impaired

• DES Independent Living Services and Vocational Rehabilitation

• Free telephone directory services

• Descriptive video services


• Your family can be very helpful in helping you to adjust to your vision loss • Don’t fall into this trap of becoming dependent on family members

• Becoming dependent on others can be more disabling than the disease itself

• You need to learn to use low vision aids and learn to do things differently in order to become independent

• Your family needs to support your independence


• If you view your vision problem as a challenge and are willing to be flexible and learn new ways to do your daily living tasks, you will live productively and independently

• The only significant barrier to your independence is YOUR resistance to change and learning something new

• By using the tools that we discussed today everyone with a visual impairment will be able to accomplish more than they thought they could

FOR MORE INFORMATION

Visit: www.enhancedvision.com

Call: 888-811-3161

http://www.enhancedvision.com/

tools helping visual impairment, low vision, and macular degeneration

Health & Medicine

relative distancemagnification

increase illumination

vision independence

control glare glare

relative sizemagnification

vision newsprint

vision grooming

vision rehabilitation