This issue of If Blindness Comes...is sponsored by a generous educational grant from
by Eileen Rivera Ley
Many people with diabetes experience some vision loss, and getting help can be confusing. For some, the loss comes from retinopathy; for others the culprit may be macular degeneration or glaucoma. While causes and severity vary, the solution may be the same—low vision services. There are excellent resources for people who are neither fully blind nor fully sighted, and I hope the following will answer your questions about them.
Q: What exactly is low vision?
A: You have low vision if your best corrected visual acuity is 20/70 or less. You are not “legally blind” until visual acuity drops to 20/200 or less. (Incidentally, someone who has no vision is also “legally blind.”) But those numbers don’t tell the whole story. Visual field loss and blind spots have profound effects on vision. For example, a blind spot obscuring your central field can make reading regular print nearly impossible, even if your visual acuity is 20/20. Specially trained low-vision optometrists will evaluate functional vision beyond visual acuity.
Q: Who uses low-vision services?
A: Anyone with deteriorating or permanently damaged vision. The typical patient is a senior with macular degeneration—the main cause of blindness. Since diabetes is the second-leading cause of blindness, however, low vision practitioners see many people with diabetes. They therefore know that diabetes self-management goals like measuring insulin and reading your meter are as important as reading your bills, price tags, or computer.
Q: Who provides low-vision services?
A: Optometrists. They spend four years learning about the eye, lenses and visual function, and some get extra training in low-vision services; they will know the most about prescribing specialized low-vision lenses and devices. Ophthalmologists are medical doctors who specialize in the health of the eye; they examine all parts of your eyes, prescribe medications, and do surgery. Many can test you for lenses and give you a prescription for glasses, but optometrists are the optical experts. You need to see both specialists: your optometrist to help you cope with your low vision and your ophthalmologist for your eye disease.
Q: What are the goals of low-vision services?
A: You and your practitioner will determine these together. What is most important to you? Checking a price tag in the store, studying a road map, reading the nutrition label, sorting mail, looking up a phone number, and viewing a theatrical performance are the types of things you might ask about. Finding the right low-vision tools will take time. Usually, the specialist will explore the optical alternatives first by assessing reading, writing, distance viewing, mobility, and lighting options.
Q: What is the Best Way to Work with My Low-Vision Specialist?
A: Ask questions, and make sure your specialist knows you want to hear all the options. Sometimes low vision specialists feel pressured to recommend only visual solutions because they know how much you want to see. Ask them to recommend anything they think will help you function best, whether their recommendation makes use of your eyes, your ears, or your sense of touch.
Q: How Difficult is Reading with Magnification?
A: You may need a variety of magnification devices to accomplish your goals, as they tend to be task-specific. In prescribing a reading device, the practitioner must balance the tradeoffs among magnification levels, fields-of-view, and working distance. The stronger magnifiers require you to be one inch from the lens, a less-than-comfortable position for sustained reading. Powerful magnifiers also tend to have a small field-of-view and can enlarge only a few characters at a time. These constraints may reduce reading speed.
A trained low vision specialist will systematically evaluate your reading by measuring speed and accuracy at different print sizes and documenting the print size of the last good reading. Then the specialist will select a magnification system that converts actual print size to the size you can see most clearly.
Endurance is perhaps the most important factor in determining an optimal reading system. Rarely will a low-vision device enable you to curl up comfortably with a book and read for hours. If the only way you can read unaided is by holding a book up to your nose, chances are that the reading system will become more cumbersome and inadequate as time progresses. This is true even when your visual condition is reported as stable.
Q: What are Low Vision Recommendations?
A: Low vision optometrists will provide you with a shopping list of choices, usually ranging in price and effectiveness, that they think will help you the most with your pre-determined goals. They should explain the pros and cons of specific systems and introduce non-visual options as needed. If you don’t understand, ask questions. If information is missing, ask questions. For example, you may be offered lighting advice for your home, but will need to ask about a plan for times when lighting is not in your control. The low vision optometrist should be realistic about the ease of use, practicality, and comfort level of a prescribed device.
If you have progressive retinopathy you may find low-vision services frustrating, because prescribed devices may quickly become ineffective as your condition gets worse. In such cases, you should evaluate whether your time and resources might be better spent in refining non-visual skills such as typing, Braille, and cane travel.
Q: How Can I Be a Wise Consumer of Low Vision Services?
A: Think about your needs, and insist on getting help. The fact that vision enhancement is technically feasible doesn’t automatically make it a good idea. Ask yourself if a low-vision optical system will meet your needs at home and at work. Consider the ergonomics (working conditions) of a device. Will using the device give you a headache, back pain, or eye strain? Understand the field-of-view limitations and necessary lighting conditions. Consider portability. Will you need training to use the device? Ask about the usefulness of the device as vision fluctuates, a common complaint of people with diabetes. Selecting low-vision devices is highly individual. During your comprehensive low vision evaluation, ask your provider to lend you a device to test at home (this may not always be feasible).
Also consider economics. For example, telescopic lenses are a big-ticket low-vision device and they definitely work. Many people with low vision keep a telescope handy for occasional spotting tasks, but they are expensive. Is the investment warranted? How much benefit will you gain from the device compared to the cost? Are there community resources that might assist with the cost? Sometimes state vocational rehabilitation services and groups like the Lions Clubs can help.
Keep in mind that visual goals change as technology changes, so plan to return to the low-vision center every few years to see what’s new. You may be pleasantly surprised, as I was when I first saw the hand-held CCTV (electronic magnification) products.
Part of being a satisfied consumer is to understand your own needs and limitations, as well as the available options. Keep traditional low-vision solutions in perspective; many low-vision people never learn to make the most of their other senses, so they cling to their visual solutions, reducing overall efficiency. If you are significantly visually impaired or are legally blind, consider non-visual techniques for reading, such as audio books. Even if non-visual strategies are your second choice today, familiarity with them will serve as an excellent resource in later years. Having a full range of alternative techniques is always your best bet.
You can learn more about your options and meet others with diabetes and low vision by contacting the Affiliate Action Office of the National Federation of the Blind, at (410) 659-9314.
The NFB Diabetes Action Network (NFB DAN) will hold its annual meeting July 2, 2007, in Atlanta, Georgia. The NFB DAN, which publishes Voice of the Diabetic, is a peer support and action group for diabetics experiencing complications of their illness. The annual meeting will be held in conjunction with the annual convention of the National Federation of the Blind.
The NFB DAN meeting promises to be exciting and informative. This year’s
theme is “Lose to Gain.” “We all know that we should lose
weight, but most people don’t know that taking off just a few pounds can
really improve your diabetes management,” noted NFB DAN president Lois
Williams. Glenda Somerville, a Certified Diabetes Educator, will be the featured
speaker, providing practical advice about losing weight and managing diabetes.
In addition, the Voice of the Diabetic team will discuss recent changes in the magazine and their plans for even more improvement over the coming year. Voice Director of Publishing Eileen Rivera Ley encourages all readers to attend: “We love hearing from our readers! Help us make the Voice great. There’s lots of fun to be had. It’s wonderful to see other diabetics who are thriving, despite complications, with the support and encouragement of fellow travelers. I hope to meet you there!”
The NFB DAN Meeting will be held in Atlanta, Georgia, on Monday, July 2, 2007, at the Marriott Marquis Hotel, 265 Peachtree Center Avenue. For registration information, contact the NFB DAN at (410) 659-9314 or on the web at www.nfb.org/voice. For reservations at the Marriott Marquis, call (888) 218-5399.
Electronic Magnifiers (CCTVs)
Computer magnification software
Bold line paper
Felt tip markers
Jumbo-print playing cards
Adapted board games
Large checkbook and registers
Talking and Braille watches
Talking blood glucose meters
Books on Tape
Self threading needles
Talking calculators and clocks
Computer screen readers
Long white canes