If you have been told you have low vision, you are not alone.  Fifteen million Americans (one in five people over age 65!) have some form of visual impairment.  Age related macular degeneration is the leading cause of low vision followed by glaucoma and diabetes.  Many other less common conditions can also impair vision.  While your vision loss may be irreversible, many adaptations are possible to help you function more fully.  This handout is designed to introduce you to various devices and resources that will help you to effectively use your remaining sight, maintain your independence and live your life with joy.

VISION AND ACTIVITIES OF DAILY LIVING

Much of the information necessary to complete daily activities is communicated through writing. Managing medications, reading recipes, shopping, dialing a phone, managing finances, paying bills, communicating, and reading can all be challenging when vision is impaired.  The following suggestions may make these tasks easier.

LIGHTING

Good lighting is important for best use of remaining vision.  The goal is to improve lighting while decreasing glare. You will need to try different tasks under various lighting conditions to decide what works best for you.  Suggestions to improve lighting include:

• Increase the amount of light on a task without letting the light shine directly into your eyes. A good reading/task light is one that has a hood or shade that directs light onto the surface of the reading matter or the work surface, has an adjustable/flexible arm and keeps extra light out of your eyes.

• Move the light closer, and position it so that it focuses on the task.  Place the light behind you so that it comes over your shoulder on the side of your best eye, or opposite the working hand.

• Position movable lamps to shine light in different directions throughout the room rather than depending only on overhead lighting.  Dimmer switches allow for greater adjustment of light intensity for various tasks.

• Increase light bulb wattage, but don’t use wattage higher than recommended for the lamp. If you increase the bulb wattage, remember that some bulbs (halogen and higher wattage incandescent bulbs) produce a lot of heat.  For task lighting, try a 45-65W indoor floodlight or chromalux bulb (full spectrum incandescent light) or a 50W halogen bulb in a gooseneck lamp.  LED desk and floor lamps or an OTT-Lite are other good choices but are more expensive.

• Minimize glare from a sunny window with a dark, open-weave drape, or adjustable blinds or shades.  Cover polished wood surfaces and shiny counters to reduce glare.

• Sunglasses may be helpful indoors, as well as outdoors for controlling the amount of light and glare. Specialty eyeglass tints for indoor use are available through vision specialists.  Yellow or plum clip-on of fitover glasses can be used indoors.  For outdoor use, try dark yellow, amber or plum glasses along with a visor to reduce stray sunlight.

Choices of Light Sources

People respond differently to different light sources. There is no one kind of lighting that is best for everyone. Try a variety of light sources to find out what works best for you.

• Natural sunlight – When possible, position seating (couch, chairs) so that the windows are behind you or to the side.  Avoid positioning the TV so that sunlight shines onto it.

• Incandescent bulbs – These bulbs may require high wattage to produce the same brightness as halogen lights of lower wattage. Coated, soft, reading light bulbs are easier for vision than the clear bulbs.  Intensities of 75 or 100 watts at distances of one to two feet from the reading material are generally needed.

• Fluorescent bulbs or tubes – These bulbs are brighter.  However, some older bulbs may produce a strobe effect that may be distracting or annoying.  This effect can be lessened by the use of multiple fluorescent instillations.  Warm-glow fluorescent bulbs can be easier for vision than the cool, white bulbs.

• Halogen bulbs – These bulbs tend to produce bright but diffuse light that reduce glare.  They can become uncomfortably hot for task lighting.

• Chromalux – These bulbs increase black-and-white contrast, improve readability, reduce eye stress, and closely simulate natural daylight.

• OTT-Lite – These provide full spectrum, true color, and non-glare light and are available as table lamps or goose neck floor lamps. They are available through office supply stores or craft catalogs.

• LED – These bulbs are currently more expensive than other lighting choices but use much less power and have a very long life-span.  The light output that is currently available is roughly equivalent to a 40 Watt incandescent light.  Unlike incandescent and halogen bulbs, they do not produce large amounts of heat and can be used for task lighting.  Many lighted hand-held magnifiers use LED lighting.  The light quality is perceived differently than natural daylight and red colors in particular can appear  to be distorted under LED lights.

COLOR CONTRAST

The ability to see objects or print against a background is also known as the ability to see contrast. Use of light colors next to darker colors creates contrast and makes objects easier to see. Increasing color contrast can be as important as good lighting. When there is low color contrast it can cause difficulty with many daily tasks. Methods of improving color contrast include:
Lighting – Lighting is most important for developing contrast. Dim light decreases the ability to see (for example, trying to locate dark colored objects in a darkened closet). Bright, non-glare lighting improves contrast.  Task lighting (a table lamp or small lamp positioned for a specific purpose) works well for reading and writing.

Reducing Pattern – Avoid busy patterns on walls, furniture and dinnerware. Minimize clutter in the environment.  Black-on-white or black-on-white is best for maximum contrast. Dark colors next to light ones are also helpful.  For example:

• A black outlet plate will contrast with the white outlet and make it easier to see the electrical outlet.

• Place a dark place mat or cloth under light colored dinnerware, a light mat under dark dinnerware.

• Pour coffee into a light-colored cup, milk into a dark colored cup.

• Measure dark blue laundry detergent in a white or clear cup.

• Place dark colored non-slip material (or dampened cloth) underneath a clear plastic cutting board to make it easier to see light colored food like an onion.  Dark and light cutting boards are also available.

• Use a clear or light colored measuring cup with dark numbered measurements.

• Use color contrasting tape or paint to make objects easier to see:

-Mark the edges of light colored kitchen counters with dark tape.

-Mark appliance handles with a contrasting color.

-Outline doorframes with a color that contrasts with the walls.

-Mark the edges of steps with a contrasting color (each step, or just the top and bottom steps).

• Use a copy machine to copy and enlarge newsprint onto white paper. This improves contrast to make it easier to read articles or complete crossword puzzles.  A yellow acetate page filter (a clear yellow sheet) can be placed over a page of print to increase contrast.  These are available from an office supply store.

• Use dark colored furnishings to create contrast if wall colors are light. Use contrasting blankets or pillows.

• Use a felt tipped pen, such as the 20/20 pen, to increase contrast when writing.

• Dim the lights when watching television or using a computer to heighten contrast on the screen.

MAGNIFICATION

To make things bigger, move closer.  Sit closer to the TV and up front at performances.

Magnifiers, telescopes, and video magnifiers can be used for reading, writing, paying bills, and other tasks. Selecting the proper power and device along with training in its use is important for success. An ophthalmologist or low vision specialist is necessary for evaluation and prescription of optical devices, and can provide a referral for specialized training.

LOW VISION ADAPTATIONS

• Large print books – These are available from retail bookstores, catalogs and the internet, or can be borrowed from the local public library. The public library has large print books and audio books on tape. Also, there is a nationally supported library service for both large print material and audio books on tape.

• Use a reading stand or clipboard to reduce the fatigue caused by holding a book, thus making it easier to read longer.

• Use a reading guide. Cut an index card or piece of light cardboard as wide as a page, and mark the edge with a thick black line. Move the card down the page to follow the lines as you read.

• Use dark, bold pens to make your writing easier to see. Paper with widely spaced, dark lines can also make it easier to stay on the line.

• Use large print calendars, check registers, and address books. Many banks and credit unions offer large print checks, often with embossed or raised lines. Darkening the existing lines on checks can make it easier to see where to write (this doesn’t alter the acceptability of the checks as legal tender). Checks with plain backgrounds are easier to see than checks with many colors and pictures.  Plastic check writing guides are also available.

• Telephone use – Some telephone companies offer free directory assistance or operator assistance for people with low vision. Use a large button phone with bold print to make it easier to see and operate.

• Microsoft Windows has incorporated some features to ease computer use for persons with special needs.  These features can be found in the Control Panel.  High Contrast tells the computer to use colors and fonts designed for easy reading. Choices include white-on-black, black-on-white, and custom colors.  The screen can also be magnified up to 8X.  For more information, click on “Accessibility” in the Windows Help menu.  Screen-enlarging (up to 16X), text readers and voice recognition computer software can be purchased.

• Closed-circuit televisions (CCTVs) are devices that magnify objects by using a camera with a zoom lens.  The CCTV enlarges the image of an item and then projects it onto a monitor. It can be used for writing, reading (books, newspapers, bills, etc.), and to magnify photographs.

• E-readers have become increasingly popular over the last several years.  No commercially available e-reader has been designed specifically with low vision patients in mind.  However, they generally all have software built in to allow adjustment in text size as well.  Most also allow for conversion of written text into an audio format.  Various screen sizes are available as well.  When shopping for one of these items, make sure that the device controls are easy to understand and manipulate.  Often, the print on the controls is small in size and of poor contrast.  The number of books, newspapers and magazines that can be accessed with these devices continues to grow.  Make sure that the materials you have interest in can be viewed on the device you choose.  Popular e-readers include Amazon’s Kindle, Barnes and Noble’s Nook, Sony’s eReader, and Apple’s iPad.

PHYSICAL ENVIRONMENT

Environment plays a major role in being able to perform day-to-day tasks.  Evaluating the home and/or workplace for factors that impair independence or safety is important.  An organized, stable, and clutter-free environment is best.

• Keep the hallways and floors clear and free of obstacles. Keep the largest pieces of furniture against walls and out of the walkways. Make sure that no low-to-ground or hanging objects (like hanging plants) create obstacles.

• Be aware if furniture has sharp edges and corners.

• Do not use throw rugs. Be sure that carpets or area rugs have non-skid backs or are tacked to the floor, especially carpeting on stairs.  Use color contrasting rugs so they are easy to see against the floor.

• Mark stair treads with a contrasting color to assist with locating the first and last steps.

• Carry a portable telephone from room to room to prevent the need to rush to answer the telephone.

• Leave furniture and personal items in the same place once they are safely and conveniently positioned. Tell family members, friends, and others in the house not to move furniture or personal items without approval.

• Keep flashlights or penlights in every room so they are within easy reach for lighting dim areas.

• Keep all doors either completely open or completely closed, as doors can be a major hazard when left ajar. Close cupboard doors and drawers after use.

• Organize the cupboards, refrigerator and drawers to reduce clutter. Group items so that they are easy to access and find.

MODIFICATIONS

Reducing the number of steps necessary to complete a task can allow for activities to be completed with less vision. Some ideas include:

• Use convenience foods, such as grated cheese, chopped fresh vegetables, frozen foods, or cake mixes to simplify food preparation.

• Use a microwave or a toaster oven to simplify cooking.

ADAPTIVE EQUIPMENT

Using adaptive equipment to substitute for vision can improve independence and safety while performing daily activities.  There are many non-optical devices that are available to assist people in using their vision more effectively. Most of these are available in specialty stores or through specialty catalogs. There are too many devices available to list them all, but the following are some examples:

Organization: Sectioned large-print medication boxes or jars, slotted coin purses, large-print address books, large-print/color contrast measuring devices, key holders, book rests and book holders.

Contrast: Bold markers and pens, bold-lined paper, labelers, writing and signature guides; clear yellow overlays for written materials to reduce glare and enhance contrast; set of dark and light-colored plates, bowls and cups; black and white cutting boards.

Enlargement: Magnifiers; high-magnification makeup mirrors; large-print telephone books, address books, recipes, games, clocks and watches; large-button telephones and television remotes; enlarging software for computers and larger computer monitors; and CCTVs. Large, flat screen TVs for general viewing are ideal and some electronic aides like CCTVs can be hooked to them as well.

OTHER SENSES

Touch – Permanent raised markings can be placed on objects by using products such as puff paints and Hi-Marks. They can be of a contrasting color and can be used to mark the controls of most household appliances, including oven and burner dials, microwave controls, timers, irons, thermostats, televisions, remote controls, telephones, and stereos. This allows the appliance to be felt with your fingers in addition to using vision.

Hearing – The sense of hearing is also helpful in completing many day-to-day tasks. Devices such as talking watches, clocks, calculators and timers can allow you to use your hearing rather than your vision.  Computers can have both voice input and output. Books are available on tape. Audiotape can be used to keep a record of frequently used addresses, telephone numbers, or recipes.

Smell – Your sense of smell can be used to identify personal care, and hygiene products. Do not attempt to smell household cleaners to identify them due to potential dangerous fumes.

LOW VISION RESOURCES

For a list of external resources, click here: Low Vision Resources