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
• 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
• Training in disability and aging
• Ability to address physical, psychological,
cognitive and social needs of clients
• Safety assessments
Identifying the Challenges and
Medicine Management and Health
Money Management
Home Management
Home Safety
Food Preparation
Personal care and hygiene
• Clients need to be educated
–The eye disease they have
–The outlook for their future
–The expectations of vision
Rehabilitation Strategies
• Adapting the Environment
–Color and Contrast
–Eliminate Clutter
• 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
• 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
• Incandescent bulbs are cheaper to
buy, but use more electricity and are
• 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
Contrast and Color
• High contrast
makes it easier
to locate objects
• Use of bright
colors against
white or black
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
• 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
• Use larger print – enlarge on
Xerox, buy large print books, write
• Bring things closer
• Use magnifiers
–Hand held
• 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
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
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
Eccentric Viewing Training
• Using PRL to see single letters or short
• 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
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
Prodigy Voice
Prodigy Auto Code
Advocate Redi-Code
Drawing up Insulin
Safe Shot
Syringe Support
Insulin Pens
Safe Shot
• Safe Shot (#80010)
– Can use any syringe
– Needs a sighted person to set it at the correct
– 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
• Cumbersome to do large doses of insulin
Resources for adaptive