2010-04-28-Two Kinds of Light-Friend and Foe
Seminars@Hadley
Two Kinds of Light: Friend and Foe
Presented by
Marshall Flax
Moderated by
Don Golembieski
April 28, 2010
Don Golembieski
Let me welcome today’s presenter, Mr. Marshall Flax,
F-L-A-X, who is a certified lower vision therapist and
he’s going to be talking to us today on Two Kinds of
Light – Friend and Foe. So I’d like to welcome Mr.
Flax and I’ll turn the microphone over to him at this
point.
Marshall Flax
Good afternoon everybody. This is the first webinar
I’ve done, so I’m sure I’ll be used to the format in a
few minutes, but it does take me a while to get used
to not having a live audience right there where I can
hear you breathing. So everybody breathe heavily
and maybe it’ll make its way up here to Wisconsin in
the U.S. where I am.
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Today I’m going to talk to you about light and as a
Low Vision Therapist I work with people and I tell
them all the time that if you have low vision light can
help you and light can hurt you and you have to learn
how to manipulate it. So my goal today is to help you
understand that light is a tool and that you will have to
learn how to work it if you’re going to make it work
well for you.
We all know that if there’s too little light, we usually
don’t see well – everybody understands that part. But
people forget that if there’s too much light or light from
the wrong direction, you probably won’t see too well
either.
As a Certified Low Vision Therapist, I spend a lot of
my time teaching people about how to get the most
useful lighting. And today of course I’ll be talking
about light and lighting from that perspective of a Low
Vision Therapist for people who have impaired vision.
But my suggestions and ideas will be necessarily
generic and I hope that you’ll understand that none of
what I say can be taken as a specific
recommendation for what you should do.
Everybody’s situation is unique and I recommend that
you consult with your own CLVT or your eye doctor if
you have specific questions about how lighting might
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affect your unique situation or if you have questions
about your own personal eye health.
So let’s talk first about indoor lighting. For a person
with low vision, we can divide it into two types of
indoor lighting – area and task or directed lighting.
And task is if you’re my age and you can’t hear that
sound very well, that’s T like in Tom, A, S like in Sam
and K like in kitten – task lighting. I use that word a
lot when I’m talking about this kind of lighting – task or
directed lighting.
So let’s say with area lighting, which is pretty much for
lighting up an area, its function is to help you locate
the walls, the doorframes and the furniture. For a
young person without a vision impairment, area
lighting is often enough light for reading. In fact, kids
seem to be able to read in a room where – to those of
us who are older – there’s simply not enough light at
all.
This is due partly to the changes in the eye
associated with normal aging. The older one gets,
the more light one needs. Children don’t require as
much light to do the same task as a 75-year-old.
Area lighting is usually a ceiling fixture or a table lamp
or a floor lamp. The lights will have a shade to diffuse
the light evenly over a broad area so that everything
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is more or less evenly lit. This is great for helping you
see the coffee table instead of smacking into it, but
usually this light isn’t very useful for reading.
There’s sort of an exception to that, however, so for
those of you with low vision or those of you who don’t
have low vision, how many times have you tried to get
more light on your page or the craft you were trying to
do by sliding all the way over to the edge of the couch
or sofa and leaning or stretching over to get the book
or paper as close to the light as possible?
Well, this works, and we’ll talk about why this works,
but it can be very physically tiring and uncomfortable
to do this for very long. So that’s where area lighting
sort of helps out but it’s not really a practical solution.
Task lighting on the other hand, does a terrible job
usually of illuminating the room, but it is the lighting of
choice for reading and for other near-vision activities.
A task light is usually a floor-standing or desk lamp
with an adjustable arm, often gooseneck that has a
shield or cone to direct the light at the visual target, a
low vision therapist term. If I’m referring to whatever it
is the person is looking at, whether it’s a book;
whether it’s a crossword; whether it’s stitchery, I may
often just refer to it as the visual target.
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Now to get this task light to really work for you, you’re
going to use the law and by that I mean the laws of
physics, specifically you’re going to use the inverse
square law. Now I’m not a physicist, but I learned
enough about the inverse square law to be able to
relay it to you and you’ll know how this works because
you’ve used it all your life.
The inverse square law says that if you move a light
so that it is twice as far away as it was when you
started, you’re going to need to increase the amount
of light by four times to get as much light on the object
as you had a minute ago before you moved it. So,
move it twice as far away, you’re going to need four
times as much light. Photographers use this kind of
thing all the time and figuring out when they move
their lights around how much light they’re going to put
on the person they’re taking a portrait of.
But the opposite is also true and it is much more
important for people with low vision. If you move a
light that’s four feet away and you move it into two
feet, common sense would say it’s twice as bright as
it was. In reality, it’s four times brighter when you
come from four feet to two feet because you’re going
to square that number.
Bring it in another foot – from four feet down to one
foot away and it’s 16 times brighter than it was at four
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feet. This is why you slide over to the edge of the
couch and hold your book as close to the light as you
can if you want to see it better. This is why when you
have something that’s hard to see, you move as close
to a light as you can if you’re able to see it at all
because the closer you are to the light, the brighter
it’s going to be.
One of the greatest things about this is it’s free;
doesn’t cost you a penny to move close to the light.
This is one way to really make light your friend. It’s
like a friend who likes to come over and shovel your
sidewalk or mow your grass for free.
The other part of task lighting is the shield, or cone or
the lamp should be shaped and positioned so that it
puts the light on the page and not in your eyes. The
area lamps that we talked about have a soft fabric
shade or a translucent diffuser so that the light is
spread evenly. This is not what you want in a task
light. You want the light directed at the target, so a
cone or a shield pointing down and protecting your
eyes from the direct light that will cause glare, which
we’ll also talk about in a little bit.
Finally, another equally important feature to look for in
a task light is the flexibility of the arm. I see many
lamps on the market that appear to be flexible and
adjustable. They will have what looks like a
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gooseneck, a plastic reticulated coil that seems like it
should adjust. Well, when I try to adjust them, I find
that they bend only a little bit and often they cannot
twist very much; they can barely bend up and down.
Personally I want a task lamp on a long piece of
gooseneck with a shield or a cone that can rotate so
that I can sit comfortable and bring the light down to
where I want it, not the other way around. So if you’re
a consumer, think of this; if you’re a practitioner in low
vision, think of this. Get comfortable; get how you
need to sit for the activity that you’re doing and then
find the lamp that will get to where it needs to be while
you’re comfortable.
So many times we do it the other way around where
we start with the lamp and we end up contorting
ourselves in a very uncomfortable way in order to get
close enough to make the lamp useful or to get to a
place where the lamp’s not shining in our eyes.
Before you buy a lamp you should position it for
reading. Try sitting in a chair the way you want to sit
and make sure that the lamp will bend and twist in a
position that works best for you. I happen to be a
very tall person and I have a long torso, so I get up a
lot higher in the chair than my wife, for example,
who’s much shorter than I am.
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If the same lamp doesn’t have enough bend in it, it’s
only going to work for one of us at best and probably
won’t work for both of us. Remember that the lamp
should be below the level of your eyes, the head of
the lamp where the light source is.
Older adults got taught, in fact I may be in that
category because I think I got taught the reading light
was supposed to come over a particular shoulder and
I have my patients in low vision who are in their 80s
and 90s – they can still remember being taught over
their right shoulder or their left shoulder, wherever it
was.
But for low vision it’s not over your shoulder. It’s
having that lamp out in front of you, below the level of
your eyes, about six to eight inches from the page or
the visual target. When I demonstrate the four
standing gooseneck clamp I use when I do low vision
evaluations, people are pretty impressed that I only
have a 60-watt household bulb in the lamp.
I do this very intentionally - keep a low wattage bulb in
there - because people generally think it’s gotta be a
fancy bulb that’s making this work so well. But I want
them to see, no, a plain old 60-watt bulb will do a
great job for you if you can position the lamp where
you want it. It’s not the wattage of the bulb that
makes the big difference.
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So to make light our good friend and our buddy when
we’re doing near-vision activities, remember you want
it close to the page or task or visual target; you want it
positioned so that it’s out of your eyes and you want it
to be adjustable, tiltable so that you direct any glare
that’s coming off the surface of what you’re looking at
– make that glare bounce away from your eyes so
that you can see.
Most of you probably have experience with reading a
magazine with shiny paper and how hard that can be
with that glare bounding back off the paper. But if you
have a lamp that’s adjustable, you should be able to
sit comfortably, tip that lamp so the glare spot – it’ll
still be there, but it can be off in some remote corner
of the page where it won’t be interfering with your
ability to read.
Keep in mind that the most important feature is the
fixture. I’m sorry. I forgot we’re going to talk about
light bulbs. This brings us to what kind of light bulb is
our friend and what kind of light bulb is our enemy.
But I wanted to go back and remind you that it’s the
fixture more than the bulb that’s important.
Everybody can understand that a zillion-watt light bulb
in the wrong place is not going to be your friend. So
basically, we have four or five choices for indoor
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directed lighting – incandescent; fluorescent; fullspectrum; halogen and I’ve added LED. They’ve all
got their good points and their not-so-good points.
But the one that works best for you will be – can I
have a little drum roll out there – the one that works
best for you will be the one you like the best. There is
no one task light bulb that is good for everyone, or
even for most people, at least in my experience.
Also I don’t know of any reliable way to pick your type
of light bulb based on your eye disease. I see a lot of
advertising that would like us to believe that if you
have macular degeneration, then you should use bulb
X or if you have glaucoma, bulb Z is the light for you.
But I don’t know where their proof is.
Now if you know of research in this area, I’m seriously
interested in finding it and I’d appreciate it if you
would send a citation or some kind of note to let me
know where I should be looking to find this.
Alright, let’s start with LED which is a relatively new
product. LED stands for light-emitting diode. It’s a
tiny little light, very bright, uses very little energy. It’s
relatively new on the market but based on what I’ve
found, there are only a limited number of products
available and because of that I’m going to skip it.
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They’re there but, boy, you just don’t get much
selection – that’s the problem. So rather than put a
lot of time into something that’s hard to find in what
you’re really going to need, we’re going to move on to
fluorescent.
Remember, we’re talking about task lighting now, not
area lighting. So generally fluorescent is used for
area lighting, like a big store or a school or a
warehouse. The big advantage is that it doesn’t put
out a lot of heat and it uses less energy. The big
disadvantage is that it puts out a lot of UV – ultraviolet
light – and there is some evidence that excess UV
light and blue light may be bad for our eyes.
Now there’s controversy about this and there’s
enough controversy and facts that this topic alone
would be a good Hadley webinar, but I’m not going to
go into it in great depth today. Let’s just say if you’re
going to use fluorescent light for reading, you should
probably consider wearing glasses with UV filters or
blue blockers just to be safe.
So here’s what Dr. Lilas Moke, a low-vision
ophthalmologist in the Detroit area, who has also
been a Hadley webinar participant, this is what Dr.
Moke says in her book on macular degeneration
about blue light.
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She says, “Can blue light rays cause macular
degeneration? Can you reduce your risk by
protecting your eyes from blue light? The answer is
maybe. Although the laboratory studies on animals
seem nearly unanimous, the real-world studies on
people have produced conflicting results. Some
studies positively link macular degeneration with any
kind of light exposure; other studies have found a
weak correlation between macular degeneration and
blue light exposure; and yet a third group of studies
has found no correlation at all between macular
degeneration and sunlight.”
So while these results, now that Dr. Moke has stated
absolutely that blue light contributes to the
development of macular degeneration, she believes
it’s certainly possible. With that in mind, I’m going to
err on the side of caution and just say since there may
be some connection out there, you probably want to
protect your eyes the best you can.
The blue light issue is also true for the full spectrum
lights or daylight simulating bulbs. There can be a lot
of UV and blue light which, as we just learned may be
harmful to your eyes. One of the most knowledgeable
people in this area of blue light and its possible effects
on the eye – and someone with a strong opinion
about it, is Dan Roberts of MD Support.
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So if you’re really interested in learning more, I’d send
you over to Dan’s website which is
www.mdsupport.org. M like in macular; D like in
degeneration, or M like Michael; D like David – that’s
easier – MD Support and read what Dan has to say
about blue light toxicity.
The next kind of lighting is halogen. Halogen is a
really bright white light. It was a real hot item a few
years ago before compact fluorescent bulbs because
it was bright but it doesn’t take as much energy as an
incandescent bulb for the same amount of brightness.
The problem with halogen is they get very hot and
there’s a concern for people either burning
themselves when they touch the lamp or something
coming in contact with the lamp and starting a fire.
And for those reasons I generally don’t recommend
halogen bulbs.
There were cases with the floor-standing halogen
torchiere lamps – that’s a lamp with a sort of a bowl at
the top and a halogen lamp and it would shoot a lot of
nice light up to the ceiling and it would bounce around
and light up a room very well or that corner of the
room.
But somebody’s drapes would blow in the wind and
suddenly it would land on the lamp and then it would
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set on fire and burn down the house, so a lot of those
lamps have gone out onto the curb now because of
that fire risk.
So this leaves us with my old buddy, my friend,
incandescent light. The reasons I like this type of light
have little to do with the quality of the light and
everything to do with its easy availability. As a CLVT
or a Certified Low-Vision Therapist, I work with a lot of
older adults with macular degeneration. I’m sure it’s
no surprise that many or most have difficulty with
transportation; many are on fixed incomes.
So I want to recommend a bulb that they can find and
that they can replace easily, say at the grocery store
or the hardware store or even the drug store and I
want one that doesn’t cost too much. I don’t object to
people getting fancier bulbs or other types of bulbs,
but I know that a lot of times somebody can’t get to
the store and so recommending a bulb that can only
be purchased through a lighting store is just not
practical, so I mainly go with incandescent.
And this takes me back to what I said when I started
talking about bulbs. You need to find what works best
for you. The best bulb for you will be the one that
makes you think that the page or hobby is easier to
see. It will also be the one you can afford and the one
you can find without too much trouble.
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So we know a little bit about our friends and enemies
indoors; let’s go outdoors. Outdoors most people with
vision impairment have one really big foe – the sun.
But the only way I can think of to turn off the sun is to
wait about 12 hours and arguably, it probably won’t be
there. Obviously it’s not terribly convenient.
So if you can’t turn off or turn down the sun, you
should do something about how much of its light is
getting in your eyes. There are two solutions to this
and you probably know both of them – sunglasses
and hats. So let’s start with sunglasses.
Sunglasses don’t just make it more comfortable to be
in bright light, they also block or filter out the harmful
UV rays of the sun and they should do this. So
consider, when you’ve got dark sunglasses on, your
eye thinks it’s dark and the iris will pull back,
expanding the size of the pupil to let more light in.
That’s a natural anatomic or physiologic reaction to
darkening in the area.
More light gets in, and if it’s UV light from the sun that’s what we just talked about not wanting to have
happen. So you want to make sure that your
sunglasses are blocking UV light. You can’t tell how
much UV protection a pair of sunglasses will provide
by their price, by their color or by the darkness of the
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lenses. The only way you can tell is to look for a label
that lists the types and the amount of protection to
make sure that they are coated and block both types
of UV radiation – UVA and UVB.
You should look for sunglasses that block at least
99% of ultraviolet rays. I just saw a comment, “Move
to where it’s cloudy.” Well that would be Wisconsin in
November most years. “Sleep all day and be up all
night.” That’s another idea for avoiding the sun.
The other feature you want to consider when looking
for sunglasses is the design of the frame. Will it block
out the light on the sides and from above? I worked
with a lady yesterday in low vision who is very
sensitive to light. And her preference was the little
clip-on glasses that barely covered the lenses of her
own glasses.
She did not like the fit-over glasses that probably
most of you, if not all of you, are aware of, but she
had these little fit-overs and despite the fact that she
understood and her daughter watching understood
that this was not blocking out of lot of light, she is
what she thought was most comfortable and what she
wanted to wear. So I’m all for consumer choice, but
I’m for informed consumer choice.
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So you know the kind of glasses I’m talking about.
These are big plastic fit-overs, or often they are, and
they don’t have to be the fit-overs, but they have a lip
along the top and seals along the side to block out the
light.
So when you are looking for sunglasses, keep in mind
that if you go to all the department stores and
drugstores and discount stores and gas stations and
every other retail outlet in your town or city, you are
probably only looking at sunglasses designed for
people with average vision and they are more
concerned about which movie star they look like than
how effective the lenses and frames are.
If you have low vision, your need for many products
are quite different than the larger group of consumers
that most of the designers and manufacturers are
thinking about. So I’m going to get on a little soapbox
here, if you’ll pardon me.
If you’re a consumer with low vision, as a Certified
Low Vision Therapist, I’ve seen many people who
have been to lots of stores looking for solutions to
their problems and I say good for you. You’re
persistent and you might call yourself stubborn, you’re
creative and you’re not giving up. But you need to
understand that your needs in the areas of your life
that are affected by low vision are unique and they’re
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generally outside the mainstream retail market. So
instead of doggedly looking for your solutions at
Target or Macy’s or Wal-Mart, find the vision
rehabilitation specialist in your area and ask them
where you can find the products you want.
You may need and evaluation by a professional in
order to figure out what’s best for you but this is no
different than fixing the problem of being hard of
hearing. You see the audiologist, not the clerk at the
counter in the department store. Hard of seeing is no
easier to work with, nor are its problems any easier to
remediate than hard of hearing. So you should
probably stop trying to find solutions in the big stores
that hope to meet everybody’s needs and find the
specialists that are trained to meet your needs.
Now I’m going to step down off my soapbox. Thanks
for listening to that. There are many types of special
sunglasses out there that filter 99% of the UV and
have shields on the top and sides to block the extra
light. They can be very light or very dark and they
come in many different colors or tints.
One brand that I have worked with for many years is
NoIR Medical Optics. NoIR is N-O-I-R – it literally
spells no infrared, no IR and IR stands for infrared, so
NoIR Medical Optics. Their lenses are all rated for
the percentage of the visual spectrum that is allowed
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to pass through the lens and the term that is used is
light transmission.
So these lenses are already blocking 99% of the UV
and all of the IR or infrared. You can get a 4% or
10% or 16% light transmission lens, for example, only
1% of UV and no IR is getting through, but just those
amounts of visible light and the visible light is the part
of the spectrum that we see. So a 4% light
transmission lens only allows 4% of the visible light to
pass through the lens.
They come in different tints or colors so you can
choose what seems to work best for you and your
situation. You can get the same tint or color in
different levels of light transmission and one of you
might like plum and the next person likes amber and
the next person likes green and so on, all wanting
about the same amount of light coming in.
Very important – make sure the lenses are dark
enough to keep your eyes comfortable, but not so
dark that they reduce your vision. This is very
important. Often people get one pair of sunglasses
and we’ll talk about that in a minute. But they don’t
wear them cause it’s too dark or they don’t wear them
cause it doesn’t work and they think because they
found that one pair that worked once in their life, that
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they’ve kind of exhausted all of the possibilities for
sunglasses.
No, there are specialty lenses that are made to help
people with low vision and you can get some that will
make you comfortable - hopefully you can get
something that makes you comfortable – and
something that will let you see well enough so you
know where you’re going.
For those of you who are extremely light-sensitive,
NoIR makes lenses that only allow 1% and 2% of the
visible light to pass through the lens. When a fullysighted person puts this on, they can’t see to walk – it
is just like night time all of a sudden. For a person
who’s extremely light-sensitive with different eye
conditions, it can spell relief and they are maybe even
able to go outside comfortably without their eyes
closed.
The frames can come in different sizes and most can
be for frames of these sunglasses and most can be
worn by themselves or over your prescription glasses.
So the advantage is you don’t have to buy
prescription sunglasses and if you don’t think these
look all that great fitting over your glasses, talk to your
optical dispensary, talk to your low-vision specialist or
your eye doctor about what your options are for
getting these lenses made into sunglasses. NoIR has
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come out with some really good options for doing that
for many of their lenses, but not all of them.
So there are other good brands and NoIR is just an
example that I’m familiar with. Check with your low
vision provider to find out if they know of other brands
that maybe they use and they’ve had good success
with and you can either try those or try those as well
as NoIR if you find the NoIRs.
If you get the chance to try sunglasses, try them in the
condition in which you are going to wear them. If you
need them for a sunny day, don’t try them indoors and
say, “Oh, they’re too dark or they’re too bright.” You
gotta wait and go check them out on a day when it’s
sunny, the day that you need the help with.
If you need them on a cloudy day or if you need them
in the shopping mall, that’s when you need to try them
and if it’s a matter if you have to buy them with the
promise that you can return them, then that’s what
you should do to make sure that they actually work
where you want them to work.
I encourage people to consider having more than one
pair of sunglasses or filters. As I mentioned before,
you know, there’s some people who are bothered by
bright sun, but they might also be bothered by the
kind of light you get on a bright cloudy day or a dull
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cloudy day. And some people are bothered quite a bit
when they go to some indoor environments.
You may need a special pair for the beach or for
when there’s snow on the ground or on a sunny day.
That’s about as bright as it gets up here in the
northern part of the U.S. - bright sun on a snowcovered day.
Here’s another little tip. When you’re entering a
building, try to leave your sunglasses on until you’re
well inside so that you don’t get to experience all that
bright light that you’ve been trying to stay away from.
It’ll be pretty bright by the door, but if your glasses
aren’t so dark that you can’t walk in, and then take
them off a few steps to the side and let other people
get in, take your glasses off, give yourself a few
seconds to adjust. You’ll probably, probably, be more
comfortable.
And when you go back outside, plan ahead. Think,
“Okay, I’m not going to wait till I’m at the door and
start fumbling for my glasses and now I’m moving
forward and I’m outside and it’s bright and I’ve got my
eyes closed,” have your glasses out, ready to go on.
Put them on as soon as you can and walk outside,
hopefully with your glasses already on, protecting you
from the sun and allowing you to see better.
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Finally, wear a hat or a visor to block the sun. A hat
with brim will reduce the amount of UV getting into
your eyes by 30%. It will also help reduce glare. And
if you really want to reduce glare – and we’ll talk
about glare in a minute – make sure that the
underside of the brim is dark, not light.
Ladies, I know that a hat might mess up your hair, but
there are visors that have been attached in the back
with Velcro so you don’t have to put it over your head,
you can sort of put it around your forehead and it
wouldn’t do as much damage to your hairstyle.
Gentlemen, if it messes up your hair, be thankful that
you have hair. And if you’re going to go outside for
any length of time, such as gardening, just give in a
wear a big floppy sunhat. Your dermatologist will love
you and your eyes will be happy and you’re potentially
going to see better. So all of this is how you’re going
to make light outdoors your friend and not your foe.
So let’s talk for a moment about a really unpleasant
form or light and that’s glare. And this is everybody’s
foe. Glare can generally be divided into two types discomfort glare and disability glare. Discomfort glare
is an instinctive desire to look away from a bright light
source. Disability glare renders the task impossible to
view, such as driving westward at sunset.
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When glare is so intense that the vision is completely
impaired it’s sometimes called dazzle. Whatever kind
of glare it is, nobody wants it; nobody likes it and it
knocks your vision down from whatever it is you’ve
got to work with.
The lenses that cut glare are polarized lenses. One
of the light definitions of glare is that it’s light coming
in from all different directions or all different angles.
Polarized lenses are like louvers or Levolor shades
where they’re horizontal and only lets light coming in
from one direction. And that cuts out all the other light
so the light you see is just all coming in in one straight
line, not in a zillion straight lines.
One manufacturer, Cocoon – C-O-C-O-O-N incorporates both polarizing filters and UV blocking
into their lenses, and they come in fit-over frames. So
there’s a nice combination of everything that I’m
talking about – UV blocking, polarization if you’re
glare-sensitive and on sunny days, especially near
water you will be – and a fit-over frame that will block
off the light on the side and along the top. I’m sure
there are other companies; Cocoon is just one that
I’m familiar with and I offer it as an example, not as a
comprehensive endorsement.
The last are I want to talk about is when there’s not
enough light outdoors to see what you want to see.
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Now many people can get enough light to walk safely
or locate objects with an over-the-counter flashlight.
Up until a few years ago, about the only way to get a
really bright light, portable for outdoor use, was to
have something that weighed about 10 pounds,
literally, that you needed to strap over your shoulder
or they wouldn’t stay charged up very long and so you
might get 30 minutes with it.
Since the introduction of LED lights into the
mainstream market, there are now many hand-held
flashlights that are very bright and not very heavy. In
addition to the low-vision specialty stores, there is
another group of people who use bright portable lights
outdoors. So here’s a case different from what I
talked about before. Here’s people who want the
same thing that people with low vision want and
you’re going to go to where they go.
That group is hunters and campers. So a trip to a
store that specializes in products for hunters,
campers, backpackers and that group, should give
you a number of choices. Some of these lights may
be head-mounted and can be very bright but require a
separate battery pack that is big and like a 9-volt
battery and clips to your belt and that might not be
what you want for walking around in some places.
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Backpacking and camping stores will have smaller
and brighter headlights. They may have a battery
pack, but they use the lithium ion batteries that last
longer and have more power than the old carbon
batteries with those lantern batteries and they might
even be so small that they’re all part of the elastic
band that goes on your head to hold the lamp on.
You can have nice bright light and your hands are
free. So these are folks – the backpackers and
campers and canoers who want small bright
headlamps and you can go to their stores to see what
is available in that market.
Finally there are some folks with low vision who have
night blindness as a part of their condition. In
particular, I’m thinking about people with retinitis
pigmentosa or RP. There is a special and
unfortunately expensive product called a night vision
scope. These are made primarily for defense and law
enforcement and in fact, the sales are restricted to
only to U.S. citizens and these devices cannot go
outside the United States.
The hand-held monocular scope is slightly bigger than
your fist and it intensifies the available light when
you’re looking through it. Now I’m fully sighted and
I’ve experimented with these and I can go into a pitch
dark room down in a basement, knowing there’s no
light getting in, turn this little thing on – there’s no light
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coming out of it – but it intensifies the available light to
the point where I can see the newspaper and read it.
It’s quite remarkable.
You’ve probably seen these in cop shows and shows
that are on TV, at least fictionalized and if you’ve
watched any footage from the military operations
overseas, you’ll see something with a green screen or
soldiers wearing some kind of weird looking robot
thing on their face. Very likely this is something to do
with night vision and a light intensifier.
A person with night blindness or RP can see an awful
lot better when they’re looking through one of these
but the price for new ones is around $3,000 to $4,000.
That’s a lot of money for a gadget that you might find
another way to get along without. But I can find the
link for you. I found a place that sells them and I’m
sorry I didn’t write it down, but if somebody is really
interested in the chat afterwards because I’m almost
done, I can go back and look that up for you.
I’d like to conclude by saying that if you’re interested
in a very good presentation on indoor lighting,
anytime day or night, I encourage you to go to AFB
Senior Site. AFB is American Foundation for the
Blind at their senior site, and search for lighting and
what will come up is lighting and glare and you’ll find
links to lots of information about this topic and some
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really good videos featuring my friend and colleague,
Brian Garrison.
And I’d like to extend my thanks to Brian for his great
work in this area because in reviewing the materials
to prepare for this, I sat down and watched his videos;
they were great and I said, “Oh, yeah, that’s what I tell
people too.” And it was nice to have it reinforced. But
they’re really, really good and he’s very, very
knowledgeable.
And I want to thank our moderator, Don Golembieski.
Nobody asks how to spell Don’s name; they ask how
to spell my name, but cowards, all of you. And I’d like
to thank Don for getting this organized and keeping it
running so smoothly. And I’d like to very much thank
the Hadley School for the Blind for providing this
opportunity. So I will stop there and I guess I click
stop or Don, you can probably…
Don Golembieski
Thank you, Marshall. That was wonderful and very
practical information. There were a couple of
questions that were posted by text message and I
wonder if you’d be willing to address them. One is the
question of the transition lenses that darken
automatically when exposed to light and lighten when
you enter a darker room – what are the benefits of
them?
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The other question would be if there’s anything in
particular that would be useful for glare control other
than what you’ve already mentioned for people who
have had cataract surgery. And I will jump off here
Marshall Flax
Thanks, Don. Well, let’s see – transition lenses.
Well, I’m kind of old school about – this is in the
category of photo-chromic lenses – lenses that
change from light to dark. Their advantage is they
change from light to dark; you don’t have to keep
track of two pair of sunglasses and you don’t have to
change glasses when you walk in and out.
My experience – years ago back when all you could
get was photo grey and you could only get that in
glass; transitions is in plastic. But my experience was
they didn’t get dark enough. I’m going to be saying
something not so great about a product here and it’s
nothing personal. They didn’t get dark enough for me
and for a lot of people I know, they don’t lighten up
enough.
If you’re the person who needs more light for reading
and you’re wearing a lens that’s already got that
residual light in it and maybe your transition lenses
aren’t so dark as I remember the old photo greys
being, but I hate to sacrifice any amount of available
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light for a person with low vision who needs light to try
and read.
And if you’re moderately needing of some light
filtering and you’re not so needing of extra light when
you read, then the transitions might work okay. But
basically they’re a convenience item and it’s very nice
and I think they’re great for people who can’t keep
track of two pair of glasses.
And then the question about glare - other things with
glare. I would say look for all the things I talked about
– polarized, UV filtering and seals on the sides and a
hat with a dark brim on the underside. I honestly
don’t know anything else that you can do that’s
practical beyond that.
Don Golembieski
Thank you, Marshall, and at this time, are there any
questions from anyone who is participating today for
Mr. Flax? There is a question about how beneficial
yellow polarized lenses might be on a sunny day and I
wonder if that could be addressed.
Marshall Flax
That falls in that category of if you like them, then
they’re beneficial and if you don’t like them, then
they’re not beneficial. I tell you, if I have three people
that I’m trying on doing lens evals with them, I get five
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different favorite lenses out of three people. Two low
vision consumers are three opinions. It’s just a matter
of personal preference when you get down to a
particular color and a particular condition, so there’s
no way from this side that I can tell you.
And I see Doug O’Mannon asking me a question and
Doug, if it’s sort of a specific question, obviously I
can’t answer it. If it’s a general question, I don’t know
of anybody who’s come out and said, “Oh, the one
thing we can say is those yellow lenses are really
good in these conditions.”
The people who aren’t vision-impaired who wear
yellow lenses in high light conditions are the downhill
skiers who are looking at white-on-white moguls,
bumps in the ski hill. They’re very low contrast; they
need to see distinct shadows.
And people who shoot trap shooting or skeet shooting
there’s clay pigeons that are shot up – they wear
yellow lenses a lot because it makes the foreground
stand out more sharply against the background. But
that’s them and it may not be Joe or Susie low vision.
Don Golembieski
We have another question on halogen light and
whether it emits UV radiation.
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Marshall Flax
That’s a really good question and I don’t know. I can
answer that pretty quickly with an “I don’t know.” I
should go look that up. I got a feeling that there’s
probably UV in just about everything and the question
may come down to does it emit so much that it’s a
concern or is it just this background stuff? But I don’t
know.
And I see the next question in chat – “Should all low
vision evaluations include sunglass recommendations
or does it have to be requested specifically?” Well,
when I do a low vision evaluation and I’m taking the
history, the most important question I ask is, “What
kinds of things are giving you the most trouble? Let’s
make 10 of a shopping list here of problems in your
life that we’re going to try and solve.”
I often need to prompt people about that and I have a
lot of colleagues and I’d agree that a sunglasses eval
or darkened lens eval should be a part of every low
vision evaluation. And I’ll tell you, it’s a simple,
painless procedure and often it can be the greatest
thing that as a practitioner that we do for the
consumer.
We may not make them read as well as they want, or
the style they want – they’re not entirely happy with
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the solutions we have to offer or whatever – but oh
my gosh, are they happy about the relief that they’re
getting now with these sunglasses because the old
ones they were wearing were just awful or didn’t do
much. So I’m going back to looking at your questions,
so yes, they should all include sunglasses
recommendations but the consumer should mention
this if you’re bothered by the sunglasses that you
have.
Don Golembieski
There was another question from someone regarding
a 5-month-old with severe vision loss and whether
that person should be protected from excessive
sunlight as well. And I wonder if you’d be willing to
address that one.
Marshall Flax
Sure and you really should ask that child’s pediatric
ophthalmologist because I really can’t go there at all.
That’s a very good question but it’s very person to
that individual, to that 5-month-old. So see what he or
she says.
And I guess, Don, I’ll just jump in. I see at the end of
the chat - “What category do the Reveal brand light
bulbs fall into?” So far as I know – I know the ones
you mean – I think they’re just plain old
incandescence. They’ve got the filament in them and
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I don’t know what makes them different. It must be
the coating on the inside.
My experience has been there’s been little difference
for the individual’s low vision, little difference between
those and a plain old frosted incandescent bulb
except for price and they’re more. But I think they’re
nicer for a fully sighted person to use. They seem to
feel that they do more. I confess a lot of ignorance for
a variety of popular incandescent bulbs on the
market.
Don Golembieski
It appears that people are trying to get the
microphone but for some reason they’re not able to,
so at this point we have to ask if you would post a text
question and we will try to answer it. I’d also be
willing to get questions sent to me –
Don@Hadley.edu – and forward those questions to
our presenter, Marshall Flax, if you’re unable to use
your microphone today.
Caller
I have a question. The brand of sunglasses you
recommended – where would you find that brand at?
Marshall Flax
The NoIR sunglasses – to recommend a specific
place that I know where they are is at the LSS Group
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– www.LSSGroup.com. L like in Larry; S like in
Susan; S like in Susan. I know that they carry them. I
know they also carry the Cocoons. I’m not sure if
Shop Low Vision carries NoIR or Cocoons. And then
another big brand is the Solar Fields. But those are
two big low vision retailers who carry these kind of
glasses.
It would be really nice for you as a consumer if you
could find a place to try them on in person, as I
mentioned before, under the conditions that you want
to use them. So that may be finding your local
agency for the blind, low vision provider, eye doctor
who does low vision evals, the best resource you
think you’ve got in your area.
And I see someone just posted that NoIRs are also on
www.amazon.com. NoIR has a website. I don’t know
if NoIR sells to individuals or if they only sell
corporately, but I only know them from that end so we
order them to dispense to people seen in the low
vision program.
Don Golembieski
Are there any further questions for Marshall today?
Karen, it looked like you were trying to use the
microphone but for some reason we’re having a
technical difficulty with some individuals. I apologize.
If you can either post a text question or send me an
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email with the question to Don@hadley.edu, I can try
to get that answered for you.
Marshall Flax
Don, I see there’s a question from Theresa about is
there a good type of light for just regular light and
household use. Well, if you mean for lighting up the
area, most people are just going with the
incandescent or the compact fluorescents which I
know everybody doesn’t like them unless you’re a
tree-hugger like me. They take a little while to warm
up and brighten up.
I can give you a good example – my wife and I –
we’re both fully sighted; we both have very different
opinions about what’s good lighting and what’s not
good lighting. Maybe that’s a husband and wife thing;
maybe that’s a man and woman thing. I don’t know
but Theresa, it just gets back to when you find light
that you like, figure out what it is.
Let me throw in one little quick piece here.
Fluorescent lighting doesn’t have to be that sickly
yellow color or whatever color you got. It depends on
the Kelvin temperature – K-E-L-V-I-N – and you get
hotter or colder as they describe it when they’re
talking Kelvin and you can get some really white,
blue-white kind of clinical looking lights and some very
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warm – this is all fluorescent – very warm looking
lights.
But that’s where you have to start going to a specialty
lighting store often to be able to see those side-byside and see the difference. And then you’d be able
to say, “Oh, man, does that kind of make my kitchen
look better,” or something like that.
And I see the question, “What is your opinion of a
better vision lamp?” I don’t know that specific lamp.
Sorry. You know, it’s the bulbs and we go back to if
the bulb type is good for you, and you can get the
fixture down to where you need it, probably a good
lamp for you with all the caveats about UV and all that
stuff that I talked about earlier.
Don Golembieski
We’re just about out of time today but if there’s one
more question, if Marshall has time for that, we’d be
willing to entertain it. Otherwise, we want to thank
you and thank you, Marshall. There’s one person.
Caller
I’m asking about children-sized fit-over glasses. Do
you know anything about children-sized fit-overs?
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Marshall Flax
Yeah, the children-sized fit-over glasses, I’m pretty
sure they’re available through NoIR. NoIR makes a
whole line of children’s glasses and again, I keep
saying this. I hope everybody understands. I don’t
want to make it sound like I’m up here under
commercial contract with anyone. First, I’m under
commercial contracts with no one. But I’m just citing
the places that are the companies I’ve worked with.
Sometimes – I’ll go on another 30 seconds –
sometimes for children’s stuff you can ask your
pediatric ophthalmologist or your children’s
optometrist and they don’t know because often they
may not see enough kids like your kid to have this
wealth of information.
But generally if you talk to a teacher of the visually
impaired or a low vision therapist, if they don’t know,
they’ll know who should know because we’re the
group that’s dealing with this really small market, if
you will, people with low vision. And we’ll probably
tend to have more of that information available or
know who should have it.
And that’s why if you were here and asked me,
“Where can I get these for my daughter,” I know who
in Wisconsin I would call next to find out what they
know about it. I know two or three people right off,
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even if I don’t have the full answer. So think about it
that way. Eye care may not know everything they
need to know that you want them to know, but
education or rehabilitation who deal with people who
are visually impaired, they will tend to know.
Don Golembieski
I noticed one more question and then we’ll wrap this
up today, but the question is about varying light
conditions outdoors such as walking in and out of
bright sunlight and into a shadowy area. I wonder if
you could answer that one.
Marshall Flax
That’s a good question and it’s a tough problem to
solve. I guess you’d have to look at where am I
spending most of my time – in the sun or in the
shade, sun or shadow and correct for that. The
solutions aren’t elegant – that’s the problem. There
are solutions – have a few pair of sunglasses. Every
time you change conditions, you change sunglasses.
Honestly, nobody wants to do that, but that’s a
functional solution, but not necessarily a practical
solution.
I would say if you’re anticipating entering a shadowy
condition, then scan ahead, figure out, “Okay, I’ve got
30 feet of shadow under this tree I’m going to go
through but I can tell there’s nothing there cause I can
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see if from this distance or not,” if you’re able to do it
and tell.
These are all work-arounds that don’t really get to the
heart of your question, I know, which is, is there an
optical kind of gadget that would, or something I’d
wear on my face that would fix this. Use a cane and
pull it out when it’s too light or too dark to see.
Don Golembieski
Okay, I think we’re going to wrap it up today. I really
appreciate all the practical and very helpful
information on Lighting – Your Friend and Foe and I
think we had a great turnout today of participants
learning all about lighting and how to control it and
use it to your benefit.
Again, this webinar will be archived in approximately
one week on our website and again, it’s free and
available 24/7. Additionally, we have applied for
continuing education unit credits through the
ACDREP for professionals out there who are in low
vision orientation and mobility or vision rehabilitation
therapy and you know if you are. So we will be
hearing back their decision very shortly I believe.
So, again, thank you, Marshall, for your wonderful
comments today. It was really, really helpful very
practical information that people can use and start
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implementing in their daily lives right away. So thank
you and I appreciate all your time on this.
Lenore
Hey, Don. This is Lenore. I have an answer to your
question – how many low vision therapists does it
take to screw in a light bulb? Two – one to actually
screw the light bulb in, but one to go to the Lions Club
to get it.
Don Golembieski
Lenore, that’s great. I’m going to be having a session
with the Lions in a real short time and I may have to
use that one and I’m also a member of our local Lions
Club. Thank you, Lenore, it’s good to hear from you
again.
Thank you everybody again for joining today and we
appreciate your time and keep watching our website
for future seminars. We will be posting a resource list
with most of the resources that Marshall mentioned so
that will be posted as well on our website. Thank you
all for joining us today and I wish you all well.
[End of Audio – 0:58:03]
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