Recent developments in lighting technology and the production of much brighter and more efficient lighting units for the home means that those with low vision or eye conditions can easily benefit from more light in their home and more control of their lighting.
Why is lighting so important for those with low vision? Recent research has shown that the most effective single improvement in the quality of life and safety in the home for those with low vision can be achieved by increasing ambient light and making spot lighting for normal activities available when needed. Occupational therapists are now being encouraged by their research peers to consider all aspects of lighting when performing home visits and assessments, as improvements can have such dramatic and long-lasting benefits to their clients.
But there is no need to wait for such services. As a person with low vision, or as the relative or carer of someone with vision issues, improvements in day to day living and in safety can be made by obtaining improved lighting products, such as brighter bulbs, table, desk or floor lamps, kitchen lights, and battery powered and motion-sensitive lights for hallways and bathrooms.
But these improvements are not only relevant to those with vision loss or conditions like cataracts, macular degeneration, glaucoma or diabetic retinopathy. It is not generally known that ALL eyes, even in healthy adults, degrade in accommodation (the ability to focus) with age. After the age of 40 year hardening of the crystalline lens capsule of the eye, weakening of the ciliary muscles, and degradation of the clarity of the lens in the eye means that the light-gathering capability of the eye declines. [1,2] A typical 60-year old’s retinas receive only one third of the light that the eyes of a 20-year old receive, in the same setting: this is why more, brighter lighting in the home is such a benefit to older adults. Young therapists or health workers or relatives visiting a home may not realize their perception of a room’s light level is not the same as the older adult’s.
When considering improved lighting for a home, there is another important issue to consider. The visual effects of light are obvious to all, but research has established that light has profound non-visual effects as well.
The visual effects of light cover how well a task can be performed – cleaning, threading a needle, ironing clothes, engaging in a hobby. It is clear that good light is needed for those tasks. If lighting is poor, and valued activities are abandoned, depression and apathy can follow. Research has shown that older adults living in well-lit homes or rest homes rank their quality of life higher than those living in poorly-lit buildings . Increasing the light levels in a room can often mean that magnification for reading and other activities in the home is no longer even necessary. Even more critically, it has been found that the rate of falls can be reduced if lighting is improved in bathrooms, hallways and bedrooms because people can see and avoid obstacles, and retain their balance.
The non-visual effects of light are more subtle, but affect the body’s circadian rhythms and its production of melatonin, which influences our sleeping patterns. In addition, it is now known that bright daylight-like lighting can be used to treat Seasonal Affective Disorder (triggered by short winter days), which can lead to depression . Age-related vision loss is also implicated in depression, mood swings and frustration, and these can be ameliorated or avoided by improvements in home light levels.
Rates of insomnia are high for everyone over 65, and even higher for those with vision loss . How can lighting changes be of use here? Research carried out in a hospital has shown that the removal of all blue light (like daylight) for a few hours before going to bed and substituting it with yellow/amber light improved the ease of falling asleep, and improved sleeping duration. This research, with its implications for our circadian rhythms, has resulted in smartphone and tablet apps which allow the user to switch to yellower light in the evenings, in preparation for sleep. Color changing light bulbs are now available which can also be used in the bedroom or elsewhere.
Below we suggest some home lighting equipment which is easily obtainable and which can address the low vision issues we have discussed.
1. Boyce, P. R. (2003). Lighting for the elderly. Technology and Disability, 15, 165–180. doi:10.1201/b16707-17
2. Shikder, S., Price, A., & Mourshed, M. (2010). A systematic review on the therapeutic lighting design for the elderly. 18th CIB World Building Congress CIB W084 – Building Comfortable Environments for All, pp. 65-79.
3. Lahti, T., Helén, M., Vuorinen, O., & Väyrynen, E. (2008). AARP Book 3. Lighting Research Center.
4. Lam, RW. Beyond seasonal affective disorder: Light treatment for SAD and non-SAD disorders. Washington, D.C.: American Psychiatric Press, Inc; 1996.
5. Seixas, A., Ramos, A. R., Gordon-strachan, G. M., Aparecida, V., Fonseca, S., Zizi, F., & Jean-louis, G. (2015). Relationship between visual impairment, insomnia, anxiety/depressive Symptoms among Russian Immigrants. J Sleep Med Disorder, 1(2), 1–10.