About Visual Impairment

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There is no denying that a diagnosis of vision loss or visual impairment can present challenges that may feel insurmountable. It changes every aspect of life. However, it does not change who you are, what you believe or, what you want to accomplish. The first step towards an independent future is overcoming fear and uncertainty. The more you know about vision loss, the better you will be prepared to face it.

General Info

It is important to understand is that the person with vision impairment is no different than anyone else. They want to do all of the things that a sighted person might do, although they need to approach their day-to-day activities a little differently. Tasks are often completed by utilizing adaptive tools and techniques. Every persons vision impairment is different. Some people who are considered legally blind function very independently to the point where you may not be aware that they are visually impaired. Others may have more significant vision loss allowing them to only perceive shadows or light. And others may experience total blindness.

Causes of Vision Loss

This condition is caused by the breaking down, or degeneration, of the macula area of the retina of the eye.

Age-related macular degeneration (AMD) is a disease that affects an individual’s central vision. AMD is the most common cause of severe vision loss among people over 60. Because only the center of vision is affected, people rarely go blind from this disease. However, AMD can make it difficult of read, drive, or perform other daily activities that require fine, central vision.

Macular degeneration causes loss in the center of the field of vision.
Macular degeneration causes loss in the center of the field of vision.

AMD occurs when the macula, which is located in the center of the retina and provides us with sight in the center of our field of vision, begins to degenerate. With less of the macula working, central vision – which is necessary for driving, reading, recognizing faces, and performing close-up work – begins to deteriorate.

There are two primary types of Macular Degeneration:

Dry macular degeneration
This type of MD is the most common. While its cause is unknown, it occurs as the light-sensitive cells in the macula slowly deteriorate, generally occurring in one eye at a time.

Wet macular degeneration
This type of MD is less common but accounts for almost all severe vision loss caused by either type of MD. Wet MD occurs when new blood vessels behind the retina start to grow beneath the retina where they leak fluid and blood and can create a large blind spot in the center of the visual field. If this happens, there is a marked disturbance of vision in a short period of time

Symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors.
Symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors.

Diabetic retinopathy is the most common eye disease in persons with diabetes.

Diabetic retinopathy is the leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid, while in others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Diabetic retinopathy cannot be completely avoided, but the risk can be greatly reduced. Better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.
Anyone with diabetes is at risk for diabetic retinopathy. The longer a person has diabetes, the more likely it becomes that he or she will develop diabetic retinopathy. 

Although diabetic retinopathy cannot be prevented, the risk of developing it can be reduced by:

  • Having a dilated eye examination once a year
  • Strictly managing your diabetes
You slowly lose your peripheral (side) vision missing objects that you would normally see out of the corner of your eye - like looking through a tunnel.
You slowly lose your peripheral (side) vision missing objects that you would normally see out of the corner of your eye – like looking through a tunnel.

Glaucoma is a condition in which the normal fluid pressure inside the eyes slowly rises as a result of the fluid aqueous humor – which normally flows in and out of the eye – not being able to drain properly. Instead, the fluid collects and causes pressure damage to the optic nerve.

While physicians used to think that high intraocular pressure (also known as ocular hypertension) was the main cause of optic nerve damage in glaucoma, it is now known that even persons with normal intraocular pressure can experience vision loss from glaucoma. Thus, the causes are still unknown. 

What are the risk factors for glaucoma?
Although anyone can develop glaucoma, some people are at higher risk than others. The following are suggested as risk factors for glaucoma:

  • Race – Glaucoma is the leading cause of blindness for African Americans.
  • Age – Persons over age 60 are more at risk for developing glaucoma.
  • Family history – People with a family history of glaucoma are more likely to develop the disease.
  • High intraocular pressure – Persons with an elevated (greater than 21 mm Hg) intraocular pressure (IOP) are at an increased risk.
The main symptom is blurry vision. Having cataracts can be like looking through a cloudy window.
The main symptom is blurry vision. Having cataracts can be like looking through a cloudy window.

A cataract is a clouding or opaque area over the lens of the eye – an area that is normally transparent. As this thickening occurs, it prevents light rays from passing through the lens and focusing on the retina – the light-sensitive tissue lining located in the back of the eye. This clouding is caused when some of the protein which makes up the lens begins to clump together and interferes with vision.

In its early stages, a cataract may not cause a problem. The cloudiness may affect only a small part of the lens. However, the cataract may grow larger over time and affect more of the lens, making it harder to see. As less light reaches the retina, it becomes increasingly harder to see and vision may become dull and blurry. While cataracts cannot spread from one eye to another, many persons develop cataracts in both eyes. 

Possible risk factors for cataracts include:

  • Age – Probably the greatest risk factor for cataracts is age. And, although age-related cataracts may develop between 40 and 50 years old, vision is usually not affected greatly until after age 60.
  • Geographic location – Recent studies have shown that people who live in high altitudes are more at risk for developing a cataracts.
  • Excessive sun exposure – A person who spends more time in the sun may develop cataracts earlier than others. The American Academy of Ophthalmology now recommends wearing sunglasses and a wide-brimmed hat to lessen exposure to ultraviolet rays.

Retinitis pigmentosa (RP) refers to a group of inherited diseases causing retinal degeneration. The cell-rich retina lines the back inside wall of the eye. It is responsible for capturing images from the visual field. People with RP experience a gradual decline in their vision because photoreceptor cells (rods and cones) die.

Symptoms depend on whether rods or cones are initially involved. In most forms of RP, rods are affected first. Because rods are concentrated in the outer portions of the retina and are triggered by dim light, their degeneration affects peripheral and night vision. When the more centrally located cones – responsible for color and sharp central vision – become involved, the loss is in color perception and central vision. Night blindness is one of the earliest and most frequent symptoms of RP.

How is RP diagnosed?
RP is typically diagnosed in adolescents and young adults. It is a progressive disorder. The rate of progression and degree of visual loss varies from person to person. Most people with RP are legally blind by age 40, with a central visual field of less than 20 degrees in diameter. It is a genetic disorder and, therefore, is almost always inherited.

How is RP inherited?
An estimated 100,000 people in the U.S. have RP, mainly caused by mutated genes inherited from one or both parents. If a family member is diagnosed with RP, it is strongly advised that other members of the family also have an eye exam by a physician who is specially trained to detect and treat retinal degenerative disorders.

Adjusting to Vision Loss

We understand that each person’s vision impairment affects them differently.  For most, people may experience an actual grieving process. This is normal, and with support, we can help those experiencing vision loss move past this challenge.

Below are some common feelings that someone may be experiencing. The process does not necessarily move in a straight line and some may find that they deal with specific components more than once. It is not uncommon for family members to also experience some of these feelings as well.

Shock and Denial
Following a significant loss, there’s a feeling of disbelief.  This is different for everyone.

Emotional Expression
Once we begin to feel the full impact of the loss, we may express our emotions with tears, sadness or anger.

Depression and Isolation
The feeling of being alone or that no one understands what you’re going through. You may find that you’re no longer participating in activities that you once loved or spending time with friends and family.

Panic
A feeling of inadequacy can lead to panic, as simple tasks are now frustrating and more difficult to accomplish. Don’t give up, consider a new approach.

Guilt, Regrets or Shame
Some people may feel a sense of guilt.  “Why didn’t I go to see a doctor sooner”; “Why didn’t I get a second opinion”. These normal feelings are often attempts to understand why the loss has occurred.

Anger
As we begin to move out of depression, we often have more energy and can express feelings of anger we didn’t know we had. Anger helps us begin to direct the grief outward, allowing us to move beyond the feeling that “life is not fair”.

Resistance to normal activities
We may resist returning to normal activities, and attempts to do so can be frustrating and stressful. This is particularly true if we need to make significant life changes.

Hope
We now begin to experience periods of hope. Knowing that there’s help and hope for a promising future by learning new skills and returning to some sense of normalcy in our daily living activities.

Rebuilding
We realize we can live in the world again, contribute to our households and communities.  We’ve adjusted to our vision loss and don’t allow it to define who we are. The grieving process and its components are different for everyone.

If you find yourself experiencing deep depression due to vision loss, speak with someone. It’s important to understand that each person’s experience is their own. What works for one may not work for another.

HERE ARE SOME SUGGESTIONS THAT MAY BE HELPFUL.

  • Acknowledge and accept your feelings about your vision loss.
  • Recognize and identify the successful coping skills you’ve used previously in your life when faced with a challenging situation.
  • Recognize that you are the same person you were before your vision loss.
  • Learn from and share with others who’ve experienced vision loss.
  • Find out about resources and services in your community. Just knowing about them can calm your fears about what might happen in the future if your vision decreases.
  • Understand that you may need to educate family and friends with regard to your vision loss. Let them know if and how they can help.    

Living with Visual Impairment

There is no denying that a diagnosis of vision loss or visual impairment can present obstacles to every aspect of life that can have a damaging effect on a person’s psyche. However, it’s important to realize that it does not change who you are, what you believe or, what you want to accomplish. The first step towards an independent future is overcoming fear and ignorance. The more you know about vision loss, the better you will be prepared to face it.

Resources

If you or someone you care about is experiencing vision loss, there is likely a sense of frustration in performing everyday tasks.  Most people want to remain in their own home and remain as independent as possible.  Others may choose to seek alternate living arrangements.

We’ve put together some simple tips that you can begin using immediately help maximize your independence and safety along with make performing daily living tasks a little easier.

You can do nearly everything you did with sight, you’re just going to do it a little differently now.

Some of the most important things to remember when living with vision loss are:

  • Contrast and Visibility
  • Lighting
  • Home Environment Organization

TIPS & THINGS TO CONSIDER
CONTRAST: In most cases either black on white or white on black is effective in maximizing visibility. This is an individual preference and should be considered when considering options.

  • If possible, paint walls and trim in contrasting colors to better identify doorways. Avoid glossy finishes, they can cause additional glare.
  • In the kitchen consider getting cutting boards in various colors: use the dark-colored one for cutting potatoes and onions and the light-colored one for cutting tomatoes and carrots.
  • Some manufacturers are making pots and pans with white interiors, this can help increase contrast when cooking.
  • If you can, purchase solid color plates and bowls, preferably black or white.
  • Use with contrasting placemats or table coverings. This can make it easier to see the food on the plate.
  • Use this same process for glassware, pour light-colored liquids in a dark glass or mug and vice-versa.
  • In the bathroom, use towels, washcloths and bath mats that contrast with the tub, tile, wall and floor.
  • Throw a brightly colored sponge in the bath so you better distinguish the height of the water more easily.

LIGHTING: There are times when additional lighting can be beneficial and other instances where it can increase glare and cause more difficulty in seeing.

  • Make sure that stairways are well lit and have hand railings that are secured to the wall.
  • Use blinds or sheer curtains on windows to help control natural light.
  • Try to avoid shiny surfaces on walls, floors, tables and counter tops.
  • Be cautious when placing mirrors in any room. The reflection may cause additional glare.
  • Provide adequate lighting for the activity you’re trying to do.

ORGANIZATION: Making a private or public environment comfortable and functional for individuals who are blind or visually impaired should be part of universal design that will benefit all users of a facility, whether it is a workplace or a home.   

  • Organize your belongings into logical groupings.
  • Store equipment and supplies near the activity you’ll use them for.
  • Always return things to the same place.
  • Eliminate clutter wherever possible by disposing of unnecessary items and finding a place for everything else.
  • Use a large print calendar with large enough squares to track your appointments.
  • Develop a filing system by using color-coded folders and large print labels for keeping important documents.
  • Use labels and markers to identify items around the home. This can be especially helpful when trying to differentiate canned and boxed food items and medications.

Making a home safe for persons who are blind or visually impaired doesn’t have to take a lot of time, energy, or money.

  • Throw rugs can be a tripping hazard but can also be beneficial in identifying landmarks within the home. If you use throw rugs, make sure they are slide resistant and buy them in contrasting colors to the flooring underneath.
  • Discard old or expired prescription and nonprescription medications.
  • Close cabinet doors and drawers immediately after use.

Your parent has driven a car safely for 40, maybe 50, years. He/she prides him/herself on their driving skill and values the independence it affords. But as the birthdays pile on, your concern for their safety behind the wheel grows. There hasn’t been an accident yet, but you have reason to suspect that their eyes aren’t what they used to be.

When is the Right Time to have that Conversation?
According to The Hartford, the best answer is now, before their driving skills begin to noticeably decline – when safety becomes a life-or-death issue and emotions are running high. So yes, the sooner you have that talk, the better, but don’t broach the subject unprepared.

Here are some questions you’ll need to think about first:
Who should do the talking?
A Hartford/MIT survey found that 50% of married drivers prefer to hear about driving concerns from their spouses. Doctors are a close second, followed by adult children.  Most older drivers living alone prefer to hear first from their doctors, followed by adult children, close friends, or other supportive helpers. Preference for adult children breaking the ice increases when drivers are over 70.

What should I know before initiating the conversation?
Know the warning signs of potential driving problems. Is your relative easily distracted while driving? Has parking become erratic? Is the driver less confident or do they fail to notice traffic activity to the right or left? Are there signs of scraping on the car, fence, or mailbox? These are just a few of the signs. Try to observe the driver over time to see if troublesome patterns emerge.

Should I consult my relative’s doctor beforehand?
It’s advisable to consult a physician to determine what information you need to provide, given the person’s specific vision issues.

What about conversation starters? Are there especially appropriate times to break the ice?
While it’s best not to wait for a serious accident, obviously, 50 percent of older drivers surveyed reported being more open to a discussion about driving safety after a bad accident. Minor scrapes and near-misses are also opportunities to broach the subject. You could also express concern over a new medicine your parent may be taking and how that might affect driving. You may have even noticed that the driver has taken steps on his or her own, such as stopping night driving, for instance. Use this: “Dad, I’m glad you’ve decided to cut back on night driving.”

What do I do if the person reacts badly?
It’s very possible that your older relative agrees with your assessment that driving is no longer safe and will have to stop. That won’t necessarily make the idea easier to hear or deal with. Nearly a quarter of older adults report feeling depressed by this conversation; 10% said they felt anger. Remember, though, that the cause for these feelings is the message, not the messenger. The important thing is to remain calm and respectful, and be prepared to have several conversations before achieving your goal. Whatever strategy you ultimately choose, don’t let fear or guilt prevent you from following through.