All posts by reinventingvision

I am a doctor who started my practice as a general ophthalmologist a few years ago. Because of my experiences with visually impaired patients, I realized that patients who are visually impaired with no more treatment options but who still have vision, are left with no hope and have no idea that life can go on. So i subspecialized in Low vision and Vision rehabiliataion. I want to help them maximize their visual potential and improve the quality of their lives. I want to offer a glimmer of hope in their cloudy world.

Where’s the light?

good lighting: a neglected tool to improve your reading

If there is anything that is neglected or forgotten, but inexpensive and readily available for the visually challenged individual, it’s LIGHT!

Light however may be a problem being too much for some (light-sensitive people), or having light but not using it properly. For reading purposes, a desk lamp that has a gooseneck or adjustable pole would be the best option. It would be good to bring the light near the reading material. The closer the light, the more light it offers. Make sure there are no shadows on the page of the reading material. Make sure there is no glare.

Many people say they read by the window where there is a lot of sun, and others say their room is brightly lit. However sometimes the light by the sun, or by room lights, are not enough. There is nothing like a gooseneck lamp if you want to last longer reading. If you are using a magnifier that is not illuminated, then you hold the magnifier by the hand opposite where the light source is, to avoid shadows. So if the light source is on your left side, hold your magnifier with your right hand. There are also illuminated magnifiers, that have light so you can bring them anywhere without needing a bright light source.

For visually impaired individuals who have photophobia or are sensitive to light, there are filters or special sunglasses that help. They filter out ultraviolet and infrared light. The color amber enhances contrast, and comes in different shades, depending on your impairment. The filters also can usually be worn over your glasses.

So sometimes, with just large print material, your spectacles, and very good light, you can read as much as you can and longer than usual. And when you go out of the house and there is too much glare, then use amber-colored filters.

“I feel like I’m grade 1 all over again…”

Sometimes when patients start to learn to read with their magnifiers or whatever device they have, they get frustrated that they read like they are back in grade school.

The only real barrier to improvement is a resistance to learning something new.

When one is afflicted with a visual impairment, he suddenly cannot do some things he previously loved to do. So he may begin to feel useless or not worthy, and then depression sets in.

One way to conquer depression is to first acknowledge that you have the disease, and learn how to cope with it. You are not blind. You still have vision. It’s just a different way of seeing. You can read or be taught the techniques to use your vision, but if you are not motivated to relearn how to do things, then you will not be able to incorporate them in your lifestyle.

This is it. You have to first accept that you have the impairment. Then realize that you are not blind. So are you just going to sit and get depressed all day, or are you willing to relearn to get back into the lifestyle you want to have? This will happen only if you make it happen.

The book by Dr. Jill Taylor entitled “My stroke of insight: a brain scientist’s personal journey” reminded me of how the mind plays a big role in rehabilitation. Dr. Taylor is a brain scientist who got a stroke at the age of 37 and at the height of her career, and was able to recount her experience through the whole process until she recovered fully from the stroke. During her recovery period, she wrote ,” no one had the power to make me feel anything, except for me and my brain. Nothing external to me had the power to take away my peace of mind and heart. That was completely up to me. I may not be in total control of what happens to my life, but I certainly am in charge on how I choose to perceive my experience.”

90 years old and back to work!

Yesterday I saw my 90-year-old patient, (turning 91 this year), who is blind in one eye but has some vision in his other eye. He first came to me last year and asked if I could help him. All he wanted to do was read. He had retired already because of his vision but ever since his wife died, he got really depressed and his former job was willing to take him in as a consultant. He thought it was a good idea as he would forget his loneliness. So he wanted to know if there was a way he could read documents. He has macular degeneration in that better eye.

He was very happy with an illuminated stand magnifier, and so he went home excited to read with this device. A few days later he called to say that his magnifier got stolen when he was in a drugstore. But since he was able to read using it, he had to get another one.

Yesterday he came back and I asked him if he was able to go back to work. And yes he was back. He started as a consultant, but they later on made him corporate secretary, and just recently they added treasurer responsibilities.

He still misses his wife until today, but definitely going back to work has made him happier man.

Another ‘aha’ moment

This week, I met a woman with ocular albinism. She has had a visual impairment since childhood. She is now on her late 50s and she owns a famous bakeshop in the province where she lives. She was not part of the appointment list but she decided to stay and wait for her turn. It was about 7 in the evening when I saw her and so after some time of getting to know her, her history, and what her goals are, she summarized what she wanted from me in one sentence. “Doc, I just want to be able to read”. She especially wants to be able to read her bible.

So after the evaluation I showed her some illuminated hand and stand magnifiers with the proper magnification for her. And with that, she was able to read until the smallest print! With it she could even read print as small as the labels in the medicines! She was so happy she then said, doc, what about karaoke? I love to sing but I can’t see the words! Her friend with her laughed and said that singing was her first passion. So I offered a spectacle binocular for her and let her stand the approximate distance of her tv and then I made her read the print as big as the karaoke print she reads and she could read!

She was very happy and said that fate brought us together. She had no intentions of coming to see me but her friend told her that since they were there they should just wait since they live so far. She said she had lost all hope to read and was so ecstatic she could!!!!

Being able to help patients like her make it truly worthy to be in this subspecialty. It’s knowing that with just
making people aware that there may be hope, many people can be helped to improve their lives, or at least be happy with
the life they have now.

What is macular degeneration?

Macular degeneration refers to a group of diseases that affect the macula causing loss of central vision. The macula is the portion of the eye that is responsible for central vision. And, any disease that affects central vision can give rise to difficulty in doing tasks that require your central vision like reading, writing, sewing, and the like.

You will not get blind with age related macular degeneration. You lose your central vision which is you sharp vision, but the peripheral vision remains unchanged. However, when you lose your central vision, you lose your reading ability. It will be difficult to pass a driving test exam and to recognize faces.

Even if blindness is not something they should worry about, (it would be a relief to know this), the disease is still disabling because most of what you do requires using your central vision. IT’s no wonder why people affected with this disease gets depressed.

To detect the onset of the disease, one of the easiest and earliest sign is distortion of your vision. Here, lines, or the center of images may be crooked or bent or faded.

Although treatment for macular degeneration is constantly changing, from laser to intravitreal injections, there are solutions for affected people to go on with their lives. Visual solutions include magnifiers and eccentric viewing training techniques. With these solutions, even while being treated and waiting for their vision to improve, they will be able to maintain their jobs, or even just continue reading.

New gadget to help with reading, from Eschenbach!!!

I recently added to my diagnostic tools, a handheld magnifier by eschenbach. It is actually a videomagnifier that looks like a hand-held magnifier. Its super light and portable. Unbelievable. Magnification is 3x and 6x, and with flexible viewing angles of up to 170 degrees. It has a 2.0 megapixel camera having the ability to freeze and capture images. The contrast is very good and the images are very sharp. This device is very easy to use, and it can be used outdoors or in the sunlight. the images are colored, black and white or white on black. This device can be used for people with macular degeneration too.

The easiest technique to deal with vision loss: get closer!

When we cut the distance in half, this doubles what you see. If you can’t see something, then first try to move closer to it. When the object gets nearer the eye, it seems to be larger. This is true for all. When one cannot see what is written in the blackboard, then the first step is to go nearer the blackboard to read what is written in it.

However, sometimes, when you move closer, the eyes do not focus well at that distance. One may be able to see the object better, but not necessarily sharper. If you have a visual impairment, it is important first to accept that they will not be able to see things as sharp as others,but they can learn to use this technique to maximize whatever vision they have left.

So don’t forget to get closer. It’s a simple and easy technique that is sometimes forgotten and neglected!

Why didn’t I know about low vision solutions earlier?

I recently had a patient who had his visual impairment from childhood. He went to many doctors and was told that nothing could be done for him. He tried to go to school, and ended up having difficulty coping. He passed elementary but during high school, he was not able to cope and was asked to enroll in the school for the blind. After graduating, he was able to find work in a place who accepts visually impaired people.

When he came to me, he was able to read with just plain LED hand and stand magnifiers, but when he tried out the videomagnifier, he claimed, “why was I not told earlier that there are solutions like these? I could have done better in School, I could have gone to college!!!

If your relatives are visually impaired and were told that nothing can be done for them, don’t forget to ask your doctor about low vision and vision rehabilitation. Indeed there is hope for the visually challenged individuals.

What can give rise to low vision?

illuminated hand-held device of different powers

There are certain diseases of the eye that can give rise to a visual impairment and can affect the daily activities of the individual.

We will start with the disease affecting the macula, or MACULOPATHIES. The macula in the part of the retina that is responsible for the central vision. So any change in the macula will noticeably affect activities that we do daily since they affect the central vision.

Diseases that affect the macula are the following:

Age related macular degeneration which is a degenerative disease that affects the macula which happens to some people as they age. This destroys the central sharp vision, and fine details will be affected. Most of our daily tasks use our central vision so this becomes a problem for reading, driving, etc. If you were diagnosed with this disease, you might have been given vitamins, or you may have been injected with anti-vegf drugs like lucentis, or avastin or macugen. These drugs slow down the progress of the disease but do not restore vision to normal.

The good news is that with the advent of these new treatments, the visual solution is not relying on training for eccentric vision. There are devices that can make you read again, and hopefully get back to work, or doing the things you love to do.

Most of the time, glasses cannot correct the vision because of the macular disease, but there are several devices that can help.

First is the hand magnifier. They come in different powers, and the power will depend on your vision and your needs.  They have a flexible working distance.  With this device however, you should have steady hands or this could be tiring for prolonged reading.

How to use them:

Turn on the light switch.  Hold on the magnifier flat on the page, and slowly raise the magnifier but don’t tilt the magnifier. Lift it until the page is magnified and clear.  then move it sideways to read.

You can use this for spot reading, or reading material for a short time only.  It’s very handy and you can carry it around with you.

Its not that you can’t see, its just a different way of seeing

What is Low Vision?

Low vision is poor or bad vision that cannot be corrected or improved with glasses, contact lenses, laser, medicines, or surgery.

What happens when you have low vision?

If you have low vision your everyday activities are affected like reading, writing, watching television, driving, and cooking. Because of this, independence is curtailed.

What can cause low vision?

Certain diseases can cause low vision. The most common ones that affect the central vision are:
Age related macular degeneration
Diabetic retinopathy with macular edema
Central retinal vein occlusion with macular edema
Other maculopathies or diseases affecting the macula
corneal opacities or scars

The ones that affect peripheral vision are:
Retinitis Pigmentosa

When these diseases reach their end stage, you are left with vision that affects your function in daily life. And sometimes, nothing more can be done to treat the disease. However, LIFE DOES NOT END HERE. Remember, you are not blind. You are just seeing in a different way.