The National Eye Institute of the National Institutes of Health reports that 4.2 million Americans age 40 and older are visually impaired, and by 2030, this number is projected to soar to 7.2 million — 5 million of these individuals will have low vision. Low vision is the eyesight condition when prescription eyeglasses, contact lenses, medication and surgery cannot correct one’s vision.
To help foster support, proper treatment and vision rehabilitation for people living with diminished eyesight, the National Eye Institute and the National Eye Health Education Program dedicate February as Low Vision Awareness Month.
Low vision occurs more readily as the eye ages. The Cleveland Clinic notes, “One in six adults over age 45 has low vision; one in four adults over age 75 has low vision.” Because of a number of eye disorders and injuries, anyone of any age can be affected by low vision, but older adults are at highest risk for impaired vision. The American Optometric Association lists common causes of low vision, including:
• Macular degeneration, the deterioration of the retina’s macula, which is responsible for sharp central vision. The retina is the back lining of the eye where images are focused. The AOA states that macular degeneration is the primary cause of blindness in people over age 50, and it is estimated that more than 1.6 million older Americans experience the age-related condition. Some people inherit a juvenile form of macular degeneration, while cigarette smoking and poor nutrition are suspect links to the age-related form of the incurable disease.
• Diabetic retinopathy, damage to blood vessels in the light-sensitive retina tissue because of complications from diabetes. Initially, diabetic retinopathy causes no symptoms or only mild vision changes, but can eventually cause blindness. Consistently monitoring blood sugar is the primary treatment for diabetic retinopathy, and laser and surgical treatments may slow progression.
• Glaucoma, increased internal pressure from blocked fluid in the eye that damages the optic nerve. If caught early, glaucoma can respond to drug treatment or surgery to minimize vision loss.
• Cataracts, a cloudy section of the eye lens that leads to murky or fuzzy vision and sensitivity to glare. Aging, injury, disease, inherited conditions and long-term exposure to ultraviolet light can cause a cataract. In an otherwise healthy eye, a cataract can be surgically removed and an intraocular lens implanted to help restore vision.
Other eye conditions that can cause low vision include retinal detachment, brain injury, eye cancer, albinism and inherited eye disorders such as retinitis pigmentosa. Individuals with low vision experience varying degrees of sight loss, from problems with glare to almost complete blindness. Types of low vision can affect the loss of central vision or peripheral (side) vision or leave a person with night blindness, the inability to see outside at night or in dimly lit areas. Partial sight can also present as blurred vision or hazy vision, which appears as a film or glare across the field of vision.
A person may show signs of low vision if they are wearing glasses or contact lenses and still find it difficult to:
• See clearly in well-lit areas. (Or, the person may feel that lights are dimmer than normal.)
• Identify the correct color of clothes or other objects.
• Read the print on signs (traffic, building, directions, etc.).
• Do close-up work such as reading, turning dials, sewing, fixing household items, etc.
• Go up and down stairs.
• Walk on bumpy or uneven surfaces.
• Pick up objects without over-reaching or under-reaching.
• Get food onto a fork or keep food on a plate.
• Pour liquids without spilling.
“Low vision makes everyday life a challenge,” said Gregg Balbera, president of Right at Home Nassau Suffolk. “It’s difficult to dress, read, write, cook, watch TV, and just function well around the home. Getting out to shop and socialize often requires careful planning and assistance. For anyone experiencing low vision, it is important to stay current with an eye care specialist and develop a coordinated support team of family and professional caregivers.”
The Vision Council, a global resource for vision care products and services, states that cataracts affect 20 million Americans, 2.07 million Americans have age-related macular degeneration, diabetic retinopathy affects 7.6 million individuals in the U.S., and glaucoma affects 3 million Americans. The Vision Council also reports that low vision disorders cost the country “$68 billion annually in direct health care costs, lost productivity and diminished quality of life.” In addition, The Vision Council says that the indirect costs of low vision conditions average more than $47,000 annually per caregiver.
The Vision Council notes that vision loss is the primary cause of age-related disability, and reports that 24,000 U.S. residents over age 65 succumbed to injuries from falls in 2012. The Vision Council relates that in a 2012 study, almost half of older adults with chronic eye disorders limited their activities, and that research has found that a third of elders with vision loss are clinically depressed, which is double the rate of the general population of seniors.
The promising news? The Vision Council shares that “up to 80 percent of cases dealing with visual impairment are considered preventable. Through annual comprehensive eye exams, an eye care provider can diagnose and treat many eye conditions early in the disease progression. In many cases, timely care can delay or prevent vision loss.”
Having a regular eye examination, annually for most people, is a crucial first step in eye care. Because some eye conditions are hereditary, family members may need regular monitoring by a general physician or eye care professional. If a low vision problem is detected, an eye care professional can refer the patient to a low vision specialist who is an expressly trained ophthalmologist or optometrist. The specialist will set up a vision rehabilitation plan for the patient. The goal is to maximize remaining eyesight when all measures medically and surgically are reached. Full vision cannot be restored to people with low vision, but their eyesight condition can be managed.
To assist people with limited vision, innovative assistive devices and technologies are continually improving and becoming smaller and more affordable. Many reduce light sensitivity, improve contrast or enlarge text size. A selection of vision tools and electronic aids features:
• Tinted eyewear.
• Telescopic eyewear, both handheld and mounted.
• Magnifiers that include handheld, hands-free and digital designs.
• Screen magnifier software.
• Reading systems (converts text to synthetic speech).
• Large-button telephones and computer keyboards.
• Audio products including clocks, watches, calculators, books, navigation tools and more.
A cohesive team of family members, friends and professional caregivers can help an older adult with vision challenges to maintain their condition as best as possible. One of the most essential ongoing supports is making sure the loved one keeps up with regular, comprehensive eye care exams and treatment. Low vision specialists design personalized solutions for patients such as mobility training and resources for vision aids.
Other tips designed to assist a senior with eyesight impairment include the following:
• Add non-glare lighting. Specialized lamps and bulbs reduce glare and improve contrast. A clip-on or small gooseneck lamp works well for direct tasks such as reading and crafting. Under-the-counter lighting is beneficial in kitchens and larger work areas. Add night lights in bedrooms, bathrooms and hallways to help prevent tripping and falling.
• Use large-print labels on medication bottles, pill dispensers and other frequently used objects.
• Simplify household organization. Place commonly used items in the same designated spot so the senior loved one can find them easily. Consider using a basket to store objects like electronics remotes, keys, etc.
• Juxtapose light and dark colors to see contrasts on household items easier. For example, use darker bath towels and washcloths to contrast with lighter tub/shower tiles and flooring. Or, add brightly colored tape to the edges of steps.
“It is not always obvious what a loved one with low vision needs, so regular, open communication with caregivers is essential,” Balbera explained. “As vision fades, verbal cues and directive speech become vital. Living with any form of visual impairment takes some time to accept and adapt to, so we encourage family members and our in-home caregivers to be patient in helping the love one maintain a positive outlook and remain as self-reliant as possible.”
For more information about low vision and Low Vision Awareness Month, visit the National Eye Institute at nei.nih.gov/nehep/lvam or call 301-496-5248. Or, contact a local ophthalmologist or optometrist.