This resource has two purposes: to give some information about the eye and conditions which result in low vision, also known as sight loss or visual impairment, and to provide some assistance with what is sometimes known as Assistive and Inclusive Technology (AIT) – products, devices and software which can be of great help in low vision households. This information was written by an academic occupational therapist, and should be useful to those diagnosed with vision loss and to the carers and families of those with vision issues.
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Sight loss or visual impairment brings many challenges in the household. These challenges include difficulty with reading (books, magazines, letters, bills, food or medication labels), seeing and using the TV or computer or smartphone screen, safety when moving around the home, preparing food and cooking it, and the ability to continue with hobbies and other loved activities. But there are solutions to most of these challenges. There is now a huge set of helpful products to access, both from mainstream product lines and from product ranges deliberately designed for those with visual impairments.
Equipment, products and software to help in households with visual impairment or low vision
We will look at the following categories of such aids for the home. Links to sources for such items or software are embedded with the descriptions.
Lighting
Good lighting in the home can enhance both the quality of life and ability to perform tasks for those with impaired vision. It is not generally known that “It is estimated that a typical 60-year-old only receives about one-third the retinal illuminance of a 20-year-old – i.e., they require 3-10 times as much light.” (See the research paper The Effect on Light on the Health of Older Adults with Low Vision). Good, bright light is needed in the areas of the home where most activities take place – the kitchen and the living areas; halls and passageways and steps need to be well illuminated to avoid falls; bedrooms and bathrooms need good illumination at night. Solutions can be as simple as stronger ceiling lamps, the addition of clamp, desk or floor lamps, installing some low-cost counter lights for the kitchen or motion sensing lighting in hallways. All of these are easily available and inexpensive. Lighting for low vision homes.
Magnification – traditional optical
Continuing to be able to read is essential for the quality of life of those with low vision, and magnification is one of the ways this can be achieved. Everyone knows about traditional magnifying glasses, but there are now many other options suitable for reading, hobbies and hands free use, as well as magnifying eyeglasses.
Magnification – dedicated electronic magnifiers
While a bit more expensive, high quality page size electronic magnifiers with no distortion can allow those with impaired vision to continue to take pleasure in books, magazines and newspapers.
Magnifiers for low vision homes
Computer use and screen readers
Continuing to be able use a computer for work or leisure is second only to being able to continue to drive as an indicator of self-respect and independence for many older people. Many devices which can help here are available, including monitor and laptop magnifiers and screen readers. A screen reader is a piece of software which will translate the text on a computer screen to speech. While designed for the blind, they are useful for low vision computer users also.
Kindle, ebooks and ebook readers
Through the use of a Kindle or other book-reading device, those who find reading tiring, difficult or impossible can still enjoy books in their audio format. Such devices allow access to audio books through headphone ports or through Bluetooth, and whole libraries of free and commercial titles with spoken text are available. The Amazon Audible subscription service is aimed the mass-market of busy people who like to listen to books while driving or doing other tasks, but has obvious benefits for the vision-impaired also.
iPhone and Android accessibility
Both the Apple and the Android operating systems pay special attention to accessibility issues, and have inbuilt screen readers, screen magnifiers, zoom functions and high contrast options. Voice control of the device through apps like Siri is now impressive and has great utility for the partially sighted. If you are helping a relative with low vision, take the time to explore and explain these assistive accessibility options, and try them out on your own device.
Kitchen and home aids
The trend in kitchen appliances towards small digital displays and controls on items like cookers, microwaves and dishwashers is nor helpful for those with low vision, and the only solution is when upgrading to carefully select the appliances which show some respect of accessibility principles. Otherwise, the use of tactile markers or color dots for important controls can be tried.
Large number and tactile timers, talking cooking thermometers and scales, safety cutters for low vision, high contrast cutting boards and item identification labellers are just a few of the other items which can help in the kitchen.
Talking clocks and watches are now easily available, and if there is any wariness of having a talking function on a watch operate in public, then tactile watches can also be used. The Apple watch has accessibility features as standard.
Everyone misplaces their keys and other often-used items around the home, so everyone also needs a key locator or a locator app which will make a sound when needed.
TV watching and remote control
Double lens television magnifier glasses, which help with focus, are available, as well as large button and simplified remote controls for television watching.
Reading and Writing
Large print calendars and address books are very useful for those with low vision, while bold-lined paper pads and shopping lists are also now available.
General tips
Technology is changing faster than ever, and it is hard to even keep up with all the wonderful innovations which can help those with low vision. Previously impossible accessibility resources like the TapTapSee phone app (available on Google Play and on the App Store), which uses the phone’s camera and online helpers to identify objects for the vision-impaired user, are now a reality. Orcam Glasses follow their user’s finger and can read any text to the user.
For those with a newly diagnosed visual impairment, it is highly recommended that you persevere with your computer and mobile device and their capabilities, as the benefits of being competent with technology and using its potential to support living your life to the full are growing by the year. Free software like the NVDA Screen Reader which is designed for vision-impaired people can have enormous benefits.
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Vision, the eye and visual impairment
When we start to read and learn about vision, it can be helpful to divide the various conditions into the places where you could expect to find them. These places are
- the front of the eye
- the back of the eye
- the optic chiasm
- the rest of the brain
- the occipital lobe.
In terms of the professional health experts you may meet, optometrists deal with conditions that go as far as the back of the eye; ophthalmologists tend not to look beyond the optic chiasm; while the whole brain and visual system is implicated in low vision. It is helpful to have a very basic working knowledge of the various elements of visual impairment that someone is likely to encounter in daily practice.
So, what does it mean when someone is diagnosed with cataracts, glaucoma, macular degeneration, or any other visual impairment?
Cataracts are an example of a condition that affect the front of the eye, caused by clouding of the eye’s natural lens. This is the most common cause of vision loss in people over the age of 40. To understand what it is like put a piece of Scotch tape over your glasses and try to make out the hazy outlines.
Glaucoma is an example of a condition that affects the back of the eye resulting in damage to the optic nerve. To understand glaucoma, make a tunnel of your fist and look through it and you can see how peripheral vision is reduced dramatically. The onset of glaucoma tends to be slow and insidious, and for this reason it is sometimes called ‘the silent thief’. You will sometimes notice this condition when someone in the family starts to walk into branches, or the sides of doors.
Macular degeneration affects the back of the eye, but this time the damage is done at the tiny spot known as the macula (about 5.5mm in diameter). To understand the effects of macular degeneration, put a fist in front of your face and there will be a blind spot (scotoma) in the centre of your visual field. This blind spot gradually increases as the condition progresses, but it is possible to learn to see using just peripheral vision.
Given that the brain devotes about 30-50% of its capacity to serve the need for vision, it is not so surprising that various forms of acquired brain injury also carry a substantial burden in terms of visual impairment. The most common categories of neuro- related vision dysfunction tend to be vision field deficits, ocular motor dysfunction and unilateral neglect. However, in children (where the condition is covered by the term ‘cerebral visual impairment’) it can affect colour and contrast sensitivity, facial recognition, search capacity, visual attention problems and problems with seeing more than one object at a time.
We are a visual society and 90% of sensory input comes in the form of vision. It is the first system to alert us to both danger and pleasure. With vision we reach out into the environment further than with any of our other senses. It is hardly surprising that loss of vision is the disability that people are most afraid of.
There is therefore much more to vision loss than meets the eye. Changes can come at structural level because of a condition like cataracts. This can lead to functional changes like a loss of visual acuity. This in turn can lead to the loss of treasured skills and abilities like reading, sports or hobbies. Finally, all of this can lead to devastating social and economic consequences, like the loss of job and income.
We aim to do different things to help at each of these stages of vision loss. We have different levels of control for each of these and in this site, lowvisionhealth.com, we hope to point you towards the devices and ways in which you can help yourself, while also reminding you of the medical treatments that are available.
Here are the levels of help you can utilize.
Prevention: For example, we can try to prevent the condition from happening in the first instance. We might wear sunglasses, if we are living in countries with intense sunlight. We will be particularly aware of wearing sunglasses as a preventive measure if we have a hereditary predisposition to macular degeneration. However, we also know that maximum cataract damage is done before the age of 25, so we would ideally encourage children also to protect their eyes.
Medical treatment: The next level of help usually comes from medical interventions. We are dependent on having a good healthcare system, and/or good health insurance. This will allow us to pay for our cataracts to be done if needed. There are some visual conditions which can be also delayed in terms of their effects, like wet macular degeneration with the use of the drug Avastin / Bevacizumab.
Self help and rehabilitation: This is the most important stage where someone can help themselves. It is possible to get the correct spectacles, for example. There are many different forms of lighting and magnification, as discussed above, that can help people to improve their capacity to read and engage in myriad activities at home and beyond. There are also ways of working to improve visual impairments, like visual fields, by doing eye exercises and improving awareness of the loss in various ways. Increasing contrast between objects and their backgrounds is a simple and effective way to improve visual function, such as using different coloured chopping boards. Filters can be used for glare control, contrast enhancement, retinal adaptation and eye protection, and these are provided in the form of ‘sunglasses’ in a variety of colours and levels of light filtration. There are a number of different skills that can be taught, such as eccentric viewing, visual tracking and visual scanning. Other techniques include sensory substitution, which can help people learn to use their remaining vision more effectively, for example by putting bump dots onto appliances. Neurological and cerebral visual impairment can be helped using a range of simple interventions including lenses and prisms, occlusion (generally done in consultation with an eye care professional), attention training and scanning.
Social integration: Finally, it is possible to stay engaged in work and social activities through drawing on all one’s individual capabilities. These include psychological and physical makeup, intelligence and one’s general capacity for resilience. What we know is that people with the same limitations have very different levels of adaptation. It is this final level that we work on by using tools that strengthening our mental health and capacity for personal development.