Vision Rehabilitation
Throughout the Lifespan
Working with Older Adults with
Low Vision
Chris Nelms, OTR/L, MLVR
May 7, 2011
The Goals of Independent Living
Skills Training with the Older Adult
• Help them remain in their home safely and
independently
• Develop ways to use their remaining vision
• Help then know how and when to use
devices and strategies in addition or
instead of their vision to do independent
living skills
• Safety
OCCUPATIONAL
THERAPIST
PERFECT FIT FOR LOW
VISION
OCCUPATIONAL THERAPY
• Training in disability and aging
• Ability to address physical, psychological,
cognitive and social needs of clients
• Safety assessments
Identifying the Challenges and
Goals
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Reading
Medicine Management and Health
Money Management
Home Management
Communications
Home Safety
Food Preparation
Personal care and hygiene
Education
• Clients need to be educated
about
–The eye disease they have
–The outlook for their future
–The expectations of vision
rehabilitation
Rehabilitation Strategies
• Adapting the Environment
–Lighting
–Color and Contrast
–Eliminate Clutter
–Organize
–Labeling
–Magnification
Lighting
• Appropriate lighting can make all
of the difference to a person with
Low Vision
• Lighting is preferential you need
to look at the glare and quality of
light to see what works best for
the client
Lighting
• The closer the light is to the
object the more intense and
brighter it appears
• Light should be directed towards
what you are trying to see
Lighting
Lighting
• Incandescent bulbs are cheaper to
buy, but use more electricity and are
hotter
• Fluorescent bulbs use less electricity
and are cooler to use
• Halogen bulbs use less electricity but
are very hot
• LED bulbs are the most efficient in
their use of electricity and last the
longest
Contrast and Color
• High contrast
makes it easier
to locate objects
• Use of bright
colors against
white or black
background
Color and Contrast
• Pouring coffee into a white cup and milk
into a dark cup or glass
• Cutting meat on a white
board and chicken on a black
cutting board
• Using a towel of contrasting color on a
light surface to find things
Eliminate Clutter
Organize
Labeling
• Use tactile labeling
–Bump dots, Braille, puff paint
–Rubber bands, safety pins
• Use large print labels
• Use auditory labels
RNIB PenFriend
ID Mate Summit Bar Code Reader
Magnification
• Use larger print – enlarge on
Xerox, buy large print books, write
larger
• Bring things closer
• Use magnifiers
–Hand held
–Stand
–Video
Magnification
• The higher the magnification the
smaller the field of view - Stronger
isn’t always better
• Each magnifier has its own length
of focus and it is important to
keep the magnifier that distance
from what you are reading.
Resources for adaptive
equipment
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Maxiaids.com
Shoplowvision.com
Independentliving.com
LSSproducts.com
Maximizing Vision through
Eccentric Viewing/ PRL
• What is a PRL?
• Preferred Retinal Locus
• That area of the retina that the best visual
acuity can be located on.
• Learning to use another part of the retina
to see takes training
Vision is more than 20/20 sight
• 20/20 sight only describes whether a
person can read a letter 3/8 of an inch in
height from 20 feet
• It does not tell anything about color vision,
peripheral vision, depth perception or other
visual skills that we use daily
Vision is Understanding
Eccentric Viewing
• Is training the client to point their eye in a
different direction to see better
• Is training the brain to understand what it
is seeing with a different part of the retina
Maximizing Vision through
Eccentric Viewing/ PRL
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Determining near acuity
Evaluation of the PRL
Eccentric Viewing Training
Improving Reading Ability
Using it in ILS
Determine near acuity
• Single Letter Acuity
• Continuous Text Acuity
Evaluation of the PRL
• Use of the Clock Method
• Use of the Playing Card Method
CAT
Eccentric Viewing Training
• Using PRL to see single letters or short
words
• Using PRL to see ILS items
• Using PRL to see Faces
• Using PRL with Optical devices
Improving Reading Ability
• Retraining the brain to understand what it
is seeing and how to look with the PRL
• Starting with short words and good
spacing and progressing
• Starting at an appropriate size type and
working towards their goal
Using PRL in Daily Living
• Using PRL to see markings better rather
than feeling for them.
• Practicing using the PRL for watching
television or when looking at friends or
family
Medications
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Large letter labeling
Organization strategies
Pill boxes
Auto refill through the pharmacy
Diabetic Education
• Research shows that keeping the blood
glucose at a stable level, will help reduce
the diverse secondary effects of Diabetes
Talking Meters
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Prodigy Voice
Prodigy Auto Code
Advocate
Advocate Redi-Code
Drawing up Insulin
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Safe Shot
Count-A-Dose
Syringe Support
Insulin Pens
Safe Shot
• Safe Shot (#80010)
– Can use any syringe
– Needs a sighted person to set it at the correct
setting
– Good for large doses of insulin
Prodigy Count-A-Dose
• Count-A-Dose (#50166)
– Used with 50 unit ½ cc syringes
– Counts in 1 unit increments
– Can be used with 2 bottles of insulin
– Cumbersome to do large doses of insulin
Syringe Support
• Syringe Support (#50113)
– Used with 100 Unit 1cc syringes
– Each rotation in 2 units of measure
– Cumbersome to do large doses of insulin
Insulin Pens
• Available by prescription only
• Not available in all types of insulin
• More expensive than regular insulin and
syringes
• Cumbersome to do large doses of insulin
Resources for adaptive
equipment
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Maxiaids.com
Shoplowvision.com
Independentliving.com
LSSproducts.com
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Low Vision and Aging