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 Low Vision and the Elderly

Many elderly people have visual impairment, yet they are not blind.
Individuals with Low Vision have limitations that cannot be corrected
with standard eyeglasses or contact lenses. In the United States low
vision is commonly considered 20/70 or worse in the better eye with
best correction. Individuals with low vision may also have a decreased
visual field.

snellonchart This Snellen eye chart was originally created by Dutch
ophthalmologist Hermann Snellen, M.D., in 1862 to determine
visual acuity.

The first number refers to the distance a person
is standing from the chart. A person with normal
20/20 vision would be able to read line 8 while
standing 20 feet away. Someone who has 20/70
visual acuity would be able to see letters at least as large as
those on the third line with letters TOZ while standing 20 feet
away. People with normal vision could see that same line while
standing 70 feet away. This condition of decreased distance acuity
is called myopia or nearsightedness.
Acuity of 20/200-20/400 is considered a profound visual impairment.
Legal Blindness


is defined by a visual acuity of 20/200 or less
 in the better eye with best correction
or
 a visual field of 20 degrees or less in the better eye.
Meeting this criteria  determines eligibility for certain benefits.


            Normal Anatomical Changes in the Aging  Eye
 redeye         
The cornea becomes more likely to scatter light.The lens
becomes denser, more yellow and less elastic, accounting
for loss of accommodation.The pupil becomes smaller,
admitting less light. There is decreased capacity to adjust
to changing levels of illumination. The vitreous tends to
condense and collapse. Bits of  gel may appear as floaters. The
retina loses nerve cells and the visual cortex gradually reduces
over time. 

Who Has Low Vision?

visiontestIt is normal to have changes in the aging eye.  Between
the ages of 40 and 50 almost everybody has difficulty
focusing up close. Presbyopia is easily corrected with
reading glasses. There are also changes in color perception
 and contrast sensitivity so that it may be more difficult
to distinguish  blue from black or distinguish objects from a
background of similar color. 
This color contrast makes it easy to read                
                 
This color contrast makes
  it difficult to read                                                   
greenglassesOlder people need more light to see. But they are also more
sensitive to glare and very bright lights. Sunglasses and
glare shields can protect the eyes from bright light and glare. 

Common Diseases or Conditions
Impacting Vision in the Elderly
Age Related Macular Degeneration
ARMD results in loss of or impaired central vision.
Macular degeneration causes blurred, distorted or
dimmed vision and may cause a blind spot. 
Glaucoma
is a progressive condition involving pressure and build-up
of excess fluid in the eye. Glaucoma first impairs peripheral
vision so that the world appears to be viewed through a tunnel.             
Cataracts is a condition where one or both lenses which are
normally clear, becomes cloudy.The condition develops slowly
until vision becomes blurry and colors fade. Surgical removal
is a very common and effective treatment. 
Diabetic Retinopathy is a condition resulting from the damaging
effects of diabetes. Inadequate circulation to the retina leads to
changes in the tiny blood vessels and vision loss.Symptoms
include blurriness,increased sensitivity to light or glare,changes
in color vision and clouding of the vitreous.

Who Helps Elderly Individuals With Low Vision?

Eye Care Providers
eyechartOphthalmologists are physicians who specialize in the medical
and surgical care of the eyes and visual system and in the
prevention, diagnosis and treatment of eye disease and injury.

Optometrists are health care providers who are licensed to
examine the eyes to determine visual acuity and prescribe
spectacles, contact lenses and eye exercises. In some states
optometrists also manage and treat eye conditions and diseases. 

A clinical low vision specialist is an ophthalmologist or optometrist
who has additional training and expertise to assess, determine
treatment options,prescribe various optical and non optical devices
and provide follow-up services to individuals with low vision.

Rehabilitation Specialists
work with individuals interested in vocational training, employment
and independent living.

blindsymbolOrientation and Mobility Specialists
teach individuals how to use visual cues in conjunction
with the other senses to travel safely in both familiar and
unfamiliar environments. 



Occupational Therapists
focus on teaching individuals with low vision to use adaptations and
adaptive devices to maintain daily living skills and get around safely in
the home and community. They teach how to use Eccentric Viewing
techniques that utilize the unaffected peripheral vision.Occupational
therapists also help individuals with other impairments such as
decreased balance, arthritis or memory loss be more independent
in mobility and daily living skills.

magnifierOptical Devices include:
magnifiers, telescopes,
prisms, monoculars,
binoculars, microscopes,
computerscreen closed circuit televisions                    
and computers.                                                                                                                                		desklampNon-Optical Devices include:
illumination, sunglasses, visors, enlarged print, writing guides,


large button telephones, bold lined paper,
color contrast throughout  phonelitthe home and
tactile bumps on dials.
 
Note that most phones come with a bump on number five.                                                                          

Contact a low vision occupational therapist in the greater Boston area
at Visions of Independence.

Please visit Geriatric Resources for daily living skills information
helpful to to the elderly population and Vision Resources for
information relevant to elderly individuals with visual impairment
or blindness.

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 ©2008 Barbara Smith