Category: Low Vision

Low Vision and Children

Guest Blogger, Melody Bettenhausen, Development Director with Ensight Skills Center.

Visual cues are central to most early childhood education systems. Consider the number of school lessons that revolve around students writing on the whiteboard or reading off of photocopied handouts or even tiny text in books! Every subject, from math to spelling and even geography, requires reading and writing.

That’s why whether visual impairments are moderate, severe or profound, they often interrupt a low vision student’s ability to participate in regular classroom activities.

What is low vision? Children and adults with low vision are not considered legally blind, they simply have reduced vision at or lower than 20/70. Students who are blind have vision that is at or lower than 20/200. Nonetheless, only 15% of students with visual impairments are considered to be completely blind, with no light or form perception ability. That means even legally blind children may have some useful vision.

Low vision in the classroom
In a school environment, visual impairments can cause difficulties when it comes to traditional reading and writing activities, reading at a distance, distinguishing colors, recognizing shapes and participating in physical education games which require acute vision, such as softball and kickball.

Children with visual impairments often start off learning to read and write with the assistance of low-tech solutions, such as high-intensity lamps and book stands. Sometimes screen magnification and computer typing and reading programs are used. In other cases, low vision students will learn to read using the Braille system over text, or a combination of the two.

Typically, children work within the school district using teachers for the Visually Impaired (TVI) who introduce tools and skills that will benefit them in the school environment. Outside of the schools, these students work with a low vision rehabilitation team to access tools and skills that will benefit them in their home and work environment.

There are many modifications and assistive technologies that can allow children who are visually impaired to thrive in their education and personal endeavors. If you have any questions about programs or resources, please contact the Ensight Skills Center at 970-407-9999 or email at info@ensightskills.org.

Why Should All Healthcare Providers Ask About Low Vision?

Blog post written by Krista Covell-Pierson, OTR/L, BCB-PMD & Owner of Covell Care & Rehabilitation, LLC.

As an occupational therapist, my job is to look at how functional things are for people. I don’t care so much if your shoulder lacks 24 degrees of range of motion as I do if you can wash your hair, reach into your cupboards and do your daily routine without hardship. I might measure your range of motion so I can track objective changes in your arm but I am primarily concerned with your quality of life. 

Because I focus on function, function, function I am often frustrated when healthcare providers of many different disciplines don’t take people’s vision into consideration for their interventions. Every single one of us from pharmacists, doctors, counselors, activity coordinators, etc need to understand different eye diseases and how they impact people we work with. An ophthalmologist or optometrist are not the only people that should ask about our eyes.  

For example, I worked with a client that told me she had seen a physical therapist months prior and was given a hand out of exercises. I said, “Perfect, let’s review those exercises.” The client referred me to her fridge where the sheet was hung up so she wouldn’t lose it. I handed her the paper asking her to show me some of the exercises. She responded, “Well, I haven’t done them in a while and I’ve forgotten a lot of them. And… I can’t see what’s on here. The pictures are too little and the writing is way too small.” 

Such a simple solution might have improved this client’s ability to maintain, or return to, her exercise program. If only the PT had enlarged the print and pictures and ensured the client could read the paper!

During my years working in a rehabilitation center I met countless residents and short-term patients with low vision and eye disease. Many times I would hear a nurse would report that a patient refused to go to meals and was isolating themselves in their room. I would often look into this with clients from an OT perspective. One particular client said, “I am so embarrassed by how I spill in the dining room. I knock things over, I can’t pour my water from the pitcher on the table and I don’t even know what I am eating until I take a bite. I can’t even tell who is sitting at the table with me because I can’t see their faces and I feel awful asking people when I should know who they are. I don’t want to ask for help because the staff is so busy already. I would rather just eat alone.” Simple modifications like contrasting plates with her place-mat and food, strategies to help her accurately pour water and see people with the remaining peripheral vision she had solved this issue. 

I could go on and on with examples of how vision impairments get overlooked and need to be a regular part of healthcare professionals’ assessments. When was the last time your doctor asked you about your eyesight? 

If a healthcare provider finds that a client struggles with vision, or lives with eye disease, not only should the client be referred to an ophthalmologist but also to an OT for an evaluation. At our practice, we provide mobile, outpatient services and can see clients in their homes rather than making them come to our office for an assessment. This is huge when it comes to low vision training! If a provider can’t find a mobile provider (and they are hard to find), a referral to a traditional outpatient clinic may suffice. Some eye doctors have OT’s on their staff which is always refreshing and supportive to comprehensive care for patients. 

For the best outcomes, therapists and patients should work together beyond the evaluation and focus on the recommendations. Leaving clients to figure out devices or integrate new ideas into routines greatly reduces the likelihood of positive carry-over. Using magnifiers, learning how to use their preferred retinal locus (PRL), problem-solving with new strategies requires SUPPORT. If you are a patient and feel like you aren’t doing well with recommendations, go back to your therapist or find a new one that will take the time to help you master your new skills. 

In order to get folks thinking about things that can help with low vision I put together a simple list of things I have used many times with clients. This is just the tip of the iceberg!

  1. Lighting: Try different light bulbs–both style and wattage. Different light affects the eyes differently. I keep a box of various light bulbs in my low vision kit. Remember that what works in the kitchen may not work in the bathroom. (And it’s ok to keep the lights on during the day if it’s helpful!) 
  2. Contrast: An onion on a white cutting board is difficult to see for someone with low vision. Buy a cutting board with a dark color on one side and a light color on the other. Cutting the onion? Use the dark contrasting color! Cutting open an avocado? Use the white side! 
  3. Establish tactile cues to help with matching clothes: For example, take tiny safety pins and pin one on the tag of all the black shirts, pants and skirts. Then take two tiny safety pins and put them on everything that is navy blue. Work together with someone to set up the system that works and then be confident that you are wearing the colors you want to! If you know you like to wear certain outfit combinations put them together on a hanger so you aren’t searching or wondering if you have the right clothing items.  
  4. Reduce strain and stress by converting to large print calendars, playing cards, books and magazines. 
  5. Buy a talking watch or clock. 
  6. Reduce glare. Bright lights can reflect off of granite counter tops or shiny floors and cause distorted or irritated vision. Older adults can tolerate 2.5 times less glare than a young adult. 
  7. Use a 20/20 pen to write in large, black ink that is less likely to leak through your paper than a Sharpie. 
  8. Integrate a large print and/or high contrast keyboard to the computer. 
  9. Use a goose-neck lamp with built-in magnifier and spotlight in order to read, see medications, and keep up with hobbies. 
  10. Paint or put high-contrast tape on the edge of steps in and out of the garage to help with depth perception.
  11. Sign up for you state’s Talking Book Library. In Colorado, people receive an electronic device and books on tape to play. It makes it really easy to navigate the buttons on the device and hear what you enjoy. Plus, it’s all free!  
  12. Add high contrast to light switches to make them easier to locate. 
  13. Keep things in the same place so people with low vision know where they are. Don’t move furniture around! 
  14. Check out different scanners that can read labels, price tags, medication bottles and differentiate between denominations of dollar bills.

Share your low-vision tips, equipment, ideas with me! We will take all of the tips and share them together before the end of the month! You can message me at krista@covellcare.com

Glaucoma & the value of Occupational Therapy

Glaucoma is a common eye disorder and there are more than 3 million cases per year in the United States alone. What is it? Pressure build up in the eye that can result in a functional visual impairment, impacting a person’s daily life.

Occupational therapists are in the business of function and purpose. They support people in most everything involved in a person’s day: bathing, driving, toileting, paying bills, working, home safety….the list goes on. The overall goal is to keep people involved and engaged in their environment, at home or in the community.

For people living with glaucoma, occupational therapy can offer modifications (i.e. equipment, lighting) for their home environment to make them safe, new techniques like visual scanning and tracking and training on low vision tools. But most off all OT’s look at things in a holistic approach to ensure people are able to participate in the things they want and need to do.

To learn more about occupational therapy and low vision support contact Covell Care at (970) 204-4331. We would love to share how we are impacting our clients’ lives.