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They told me nothing can be done…really?!

A 50 plus year old patient came to me once with very poor vision. She has Retinitis Pigmentosa (RP).

RP is a degenerative disease of the eye that results in loss of vision, even blindness. It involves the light receptors of the eye called the rods and cones. The rods are responsible for night and peripheral vision while the cones are responsible for central vision and color vision. In RP, the rods are affected first so that the most common symptom of the patient would be night blindness. Then there is loss of peripheral vision that eventually deteriorates further and ends up in tunnel vision. Patients with early signs of RP would be having difficulty at night, and would be bumping into things in the surroundings. In the later stage, they may have tunnel vision. Imagine looking through a keyhole, So on examination, the patient may be seeing 20/20 but actually is just seeing through a tunnel or keyhole. Some patients however progress to blindness. This is often hereditary although may be sporadic.

This patient that came was already Light perception. She could only see light, nothing else. She came in with her son who guides her when she walks. In a low vision exam, we concentrate on the patients function. So I ask the patient her history, what used to do before, when did she stop her job and if it was vision related, and what she would like to do for now. This patient came too late for low vision gadgets to work. She would need more audio devices.

She goes on to say that her doctors told her nothing can be done for RP. So as she was losing her sight, she had to look for ways to cope with it. She researched and she found Resources for the Blind, that taught her how to walk around with a white cane. She now tutors her children at home but her children have to read the assignments to her. So I asked how I could help her.

These were her simple requests. I was taught to walk with a cane indoors, but outdoors are a problem as there are many obstacles. Are there canes that vibrate so I would know when I have to avoid something instead of bumping into them? Next request was she wanted to know where she can learn massage therapy for the blind. Third request was to find a support group for Retinitis Pigmentosa. Three simple requests that would make her happy. Her complaint: If I only knew there were low vision specialists who could have helped me cope with my vision loss.

AND HERE LIES THE PROBLEM. Many doctors diagnose Retinitis Pigmentosa and tell the patients that there is no treatment and that they would go blind. Nothing more can be done for the eye. 

Here are some truths about people who are blind or almost blind:

Technology today has made accessibility better for the blind. 

There are audio books, smartphones that talk. There are free audiobooks in the App Store and in You tube.

There is a computer school for the blind and visually impaired called ATRIEV (Adaptive Technology for Rehabilitation, Integration, and Empowerment of the Visually impaired). The school helps the blind and low vision people learn how to use the computer and eventually find jobs that are computer related. (atriev.wordpress.com)

Resources for the blind has services for the blind and low vision. They have a school for blind children, and they have training for orientation and mobility with a white cane, and training for some job opportunities. (blind.org.ph)

There are new non visual devices in the market. The SmartCane is a device that is attached to the white cane which vibrates when there are objects above the level of the cane.  

The MIT Finger reader device is one device I found in YouTube that may help the blind to read. 

A newer technology which I am excited about is the BUZZCLIP which is a device that is clipped on to the shirt  or clothing and will vibrate when there is an object within 2 meters to avoid. It can be placed in different parts of the body where the visual impairment is worse. I will talk about this more when I receive the device.

 

There are many innovations now that help the blind incorporate into society. Accessibility is the key and accessibility is here.

So even if it may be true that nothing can be done for the eye, IT IS NOT TRUE THAT NOTHING CAN BE DONE FOR THE VISUALLY IMPAIRED PERSON.

Making print more readable

For visually impaired people reading is difficult because the contrast of the print is affected by reduced lighting. Also especially when their macula is involved, they cannot read small print.  Here are some guidelines to making print more accessible especially for students.

Using the highest contrast possible is best.  Use light letters on a dark background or dark letters on a light background. 

It is also preferable to use large print size, from about 16 point or 18 point at the least. 

The Font type should be recognizable characters,  using upper and lower case, avoiding italics, all caps, or slanted print.  Also do not use decorative fonts.  Recommended fonts are arial, verdana, and better if they can be bold.  

It is important to avoid glossy papers as they can cause glare. 

There must be adequate spacing between letters and words.  When the letters are too close to each other, they are especially difficult to read for persons with central field defects.  The recommended spacing between lines of text is 1.5 rather than single space, as recommended by the American Foundation for the Blind.  Also students may use a marker below the line to help them remain in the same line.  

An extra wide binding margin makes it easier to  the use low vision devices such as stand magnifiers and portable videomagnifiers, as it is better to read with these devices on a flat surface.  

Sometimes, all it takes to make life easier in school for students with visual impairment is to make print legible for them.  Simple adjustments can make a difference in a person’s life.

 

 

Don’t forget the 3Bs

Bigger, Bolder and Brighter are the 3 Bs that every person with eye problems should never forget. These are the three most important concepts in maximizing your vision.

Magnify: Bigger

Increase contrast: Bolder

Improve lighting: Brighter

Today I will talk about magnification. Patients afflicted with a central scotoma or a central blind spot benefit well from magnifying. By magnifying, more of the image is projected in the part of the retina that can see. Examples of diseases with a central scotoma or a maculopathy are macular degeneration, macular dystrophies , and macular scars.

There are many kinds of magnifiers. The most common ones are the hand held magnifiers, which could be lighted. Your low vision specialist or ophthalmologist will know what power you need. The thing with hand held magnifiers is that it could be tiring to use for prolonged reading as a certain distance has to be maintained. Also the bigger the magnification (in the second picture 5x), the smaller the field of vision (smaller lens). The smaller the magnification (3x rectangular), the bigger the field allowing you to read more letters without having to move the magnifier. However, for this hand held magnifiers, you have to maintain a certain distance and this could be tiring to use for prolonged reading, especially if the person has tremors.

The same goes with stand magnifiers. The disadvantages of stand magnifiers are they are bulky and heavier but these are placed on the reading material without having to adjust the distance. With the lower 2 pictures, a lower magnification stand magnifier 4x sees more words while the higher magnification at 6x shows bigger letters but less words to view. However, stand magnifiers are heavier than handheld magnifiers.

The best quality magnifiers are the digital magnifiers

With digital magnifiers, the magnification, contrast and brightness can be modified. There is no distortion. This magnifiers can also be used to write.

There was this 92 year old male who was brought to me by his daughter for a low vision consult. He has had age related macular degeneration in both eyes for quite some time. Everything had been done, from injections to lasers and surgery, and nothing more could be done for him. He was very depressed. He could not read and that was the only thing he enjoyed doing.

When I showed him the Videomagnifier, he read the smallest print, which is smaller than newspaper print. He was not so interested as he did not want to learn to use the device. I told him that he can read, but he has to learn how to read with this device. His daughter got the device for him anyway. After a few months of having the device, he began to read and hasn’t stopped since then. He spends his time reading and he is not as depressed as he used to be.

To see more features of this device, go to you tube and look for smartlux digital videomagnifier or go to

https://youtu.be/5a3yYXXZpdw

There is always hope for the visually impaired.

Looking through the eyes…

When visual impairment develops from birth, more often than not, the parents are the ones that need counseling. They get depressed because they want the best for their
child. They want their child to see the world as they see the world. The child
on the other hand, sees the world as it is. He doesn’t know any better. He was
born this way. The child learns how to see with his impaired vision, he
develops visual clues in order to adapt to the vision he was given.

I recently had a patient, a young handsome man, on his late 20s who has
a rod cone dystrophy. What is rod-cone dystrophy? This is an inherited disease
that affects the rods and cones of the eye. There are two kinds of cells in the back
of the eye or the retina called rods and cones. The cones gather information
about details and color. They work best in bright light. They are located in the
center of the back of the eye. The rods are all around the rest of the back of the
eye. They gather information about things that move and things that are on
the sides, above and below the person. They work best in dim light. People
who have rod-cone dystrophy lose the use of the rods and cones. Aside from the dystrophy, he is also very nearsighted and wears very thick glasses. Despite the impairment, up until employment, he was leading a normal life. He went through elementary and high school with no problems. He continued to college and finished hotel and restaurant management. I asked him what his goal was. He wants to work in a hotel, but he keeps being rejected due to his vision or the fact that he wears very thick glasses. He has been trying to get a job in a hotel as a bellboy or at the housekeeping department. He always faced rejection. The reason? His vision!

This man is very independent. He can commute on his own, he does everything by himself, and he can even drive. While jobless, he continues to educate himself and look for opportunities where he can work through the internet. He is very driven and motivated. He said, actually doctor there is nothing wrong with him as far as functioning with my daily activities. The problem lies with people who can’t accept me for my thick glasses. It’s so difficult for visually impaired people to get a job, even if they are as capable. They have rights and it’s all in republic act no 7277 known as the magna carta for disabled persons. This is a law passed since 1991 but sadly has not been enforced.

Good things happen to people that patiently yearn

I saw a young lady a few months ago who had to stop school after she finished high school. It was just too difficult for her to handle the school work because of her vision. She has a condition that affects the nerves of the eye (optic nerve), which she developed as a child. As she grew up, her vision began to slowly deteriorate. For this impairment affecting the optic nerve, she was told that there was no medical or surgical treatment option for her. She came for low vision consultation, and when I asked her what she wanted to do, she said she wanted to go back to school. We tried several devices. She was happiest  with the bioptic telescope. With it, she was able to see 20/20 and although she knew there was a learning curve on how to use it properly, she was determined to learn and use the device. “I can see! I can see!. Dad, I want this telescope!”. Unfortunately, the telescope is very expensive. But she wanted it. She said it will be very useful for her because with it, she will be able to see the blackboard, and see her computer too. I saw the sad face of her father. His expression said it all. (She wants it so much and I want to give it to her, but I can’t). So they told me they would think about it and get back to me if they were going to order it.  Months passed and I would be checking on her but she kept postponing her return. She finally came back and said she wanted the bioptic telescope and she was ready to order. She even enrolled for the next school term. So she tried the device again and was really happy. Her parents were smiling now and they said they can get it for her now. I thought she had given up.  Then she told her story. She would go everyday to church and pray that she would be able to get the device so she can go back to school. Then one day, one of the church members donated an amount to her. Much to her surprise, she donated the whole amount needed!

 I was touched with her story. Her desire to go back to school and to learn was very inspiring. This is one student who will not rejoice when classes are suspended!  She is very eager to go to school. This girl wished, and she wished harder.  Her impairment was not an obstacle. Instead, her motivation and enthusiasm made her want and dream.  I know that her dreams will become a reality.

Bioptic telescope by Ocutech

 It is a telescope mounted into eyeglasses that are very light and portable. They are convenient to use as they leave your hands free! It improves your distance vision (watching tv, recognizing faces), and has an adjustable knob for intermediate vision like for computer work, playing cards, painting, and the like.

White cane week? Everyday miracles unnoticed…

In case you are not aware, this week is White Cane Week. White cane activities are centered on the capabilities of the disabled and visually impaired. This year, one day is dedicated to the visually impaired. This is on August 5 Friday from 8 am to 5 pm at the Legislative Building Quezon city hall. This event is organized by My Refuge Low Vision Support Group. They call this a KA Vision Fest and entitled it a Journey Behind Low vision.

The my refuge support group has been around for quite some time and this is their time to shine. Everyone is welcome, especially visually impaired individuals, and their families. If you want to understand what low vision is about, and if you want to see that indeed, life goes on with visually challenged individuals, this is the place to be. Success stories will be shared; and an understanding of low vision and the diseases leading to it will be discussed. Furthermore, assistive devices will be demonstrated. There will also be a movie showing about dealing and coping with visual impairments. No one should miss this very touching and interesting movie. There will also be a show of talents. It will be a day filled with information, awareness, and entertainment.

There is no one more excited than myself to be part of this event. I get my inspiration and desire to work from my visually challenged patients. They teach me that with perseverance and the right attitude, you can do anything you want to do.

when opposites attract

the yellow tape helped enhance the change in level of the steps

One of the most basic principles of enhancing vision is contrast;Our vision is improved when we enhance our contrast.  When there is good contrast, things stand out more clearly.  For example, if you eat white rice on a white plate its more likely that a visually challenged person would have difficulty seeing it.  So if you use a blue plate or a dark-colored plate, then the white rice stands out.  When there are steps to go to a different room, if the person is not familiar with the place, and the elevated step is the same color as the floor, then there is a higher chance that one can trip over or miss this step.  To remedy this, if the floor is grey, then you put a bright-colored  tape that contrasts with grey (neon yellow, white, etc) at the edge of the step so that it would be easy to detect that there is a change in the level of the floor. These are easy tips of how to enhance contrast at home.

One way to enhance contrast for visually challenged people is to wear filters.  There are yellow, or amber lenses and different shades of amber.  These can be sunglasses, or fit-overs (they fit over your glasses).  When worn, they improve one’s vision almost always. When used for outdoors, they darken dark colors, but they don’t darken the light colors.  When used for reading, it can darken the print on the page. It can also improve watching television.

Enhancing contrast is another easy way to maximize your visual potential.

the black coffee on a transparent cup is easier to see than water on a transparent cup

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.”