“Indentifying Functional Indicators of
Vision Problems in Older Adults”
Presented by
Northeastern Association of the Blind at Albany (NABA)
301 Washington Avenue
Albany, NY 12206
(518) 463-1211
www.naba-vision.org
Lighthouse International
111 E 59th St New York, NY 10022
95 Church Street, White Plains NY 10601
(800) 829-0500
www.lighthouse.org
Presenters: Cheryl Lawyer, NABA Outreach & Community Education Coordinator
Janet Weinstein, Lighthouse International, Director of Outreach
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Who are we?
• Work closely with the NYS Commission for the Blind and
Visually Handicapped (CBVH)
• NABA
– 100+ year old non-profit serving blind/visually impaired of all ages to
achieve & maintain independence
– Based in Capital Region serving 15 county area
• Lighthouse International
– Founded 1905, pioneer in low vision, vision rehabilitation
– Based in NYC, serving NYC, lower, mid-Hudson Valley
– Fight vision loss through prevention, treatment and empowerment
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Who are we?
Mid Hudson Valley Low Vision Network
– Founded in 2009, is a donation-funded, non-profit
organization comprised of collaborating vision
organizations, community partners and health care
providers. The mission of The Network is to facilitate
knowledge of and access to low vision and vision
rehabilitation services through education, advocacy and
outreach in an eight-county area of the Mid Hudson Valley.
– http://midhudsonvalleylowvisionnetwork.blogspot.com/p/s
ervices.html
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Purpose Today
• Functional Vision Screening Questionnaire
– Identifying early signs of vision problems in
seniors
• Four leading causes of vision loss in older
Americans today
• How can Vision Rehabilitation services help?
• Resources
Definitions
Low Vision
– vision that cannot be corrected to “normal” with
medication, surgery or the use of conventional
glasses/contacts
– interferes with the performance of daily activities,
such as reading or driving
Vision Rehabilitation
– helps people maintain independent lifestyles by
teaching adaptive techniques and utilizing adaptive
vision aids such as magnifiers, large print & talking
devices, and adaptive devices
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Definition of Legal Blindness
• Acuity – is 20/200 or less in the best eye
with best correction
• Field of vision – restricted to 20 degrees of
total field of vision in best eye with best
correction
– Can have 20/20 vision within the 20 degrees
field of vision
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The Eye
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Four Leading Causes
of Vision Loss
– Age-Related Macular Degeneration
(ARMD)
– Glaucoma
– Diabetic Retinopathy
– Cataracts as a complication of other
eye condition(s)
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Age-Related Macular
Degeneration (ARMD)
• Loss of central vision due to degeneration of the
macula
– 2+ million Americans 40 and older
– Projected to double in the next 20 years
– Does not cause total blindness
• Therapies include injections and laser
treatments to prevent further vision loss
• Nutrients and anti-oxidants showing some
promise in research
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Age-Related Macular
Degeneration (ARMD)
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Amsler Grid
Glaucoma
• Damage to the optic nerve, often resulting
from increase of fluid pressure in the eye
due to lack of drainage
– 2.5 million Americans 40 and older
– The “sneak thief of sight”
– Hispanics and African Americans at greatest
risk
• Therapies include eye drops, surgery and
laser
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Glaucoma
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Diabetic Retinopathy
•The leading cause of new cases of
legal blindness in American adults.
• Prolonged periods of high blood sugar
levels cause damage to the small blood
vessels in the retina at the back of the
eye.
• Therapies include laser and vitrectomy
to prevent further vision loss.
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Diabetic Retinopathy
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Cataracts
• Caused by a buildup of waste protein in the
lens that makes vision cloudy/fuzzy/hazy/smoky
• Leading cause of blindness in the world
• More than half of Americans over 65
• 90% report improved vision with outpatient
surgery
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Cataracts
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Early Signs of Vision Loss
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Headaches
Flashes of light
Bumping into objects, tripping, falling
Reaching out for objects in an uncertain manner
Requesting additional lighting
Sensitivity to light
Difficulty recognizing familiar people or objects
Squinting or tilting head to the side
Reporting traffic ‘incidents’ ie missed stop signs, fender benders
Having an unkempt appearance
Uncertain or hesitant near stairs
Discontinuing favorite activities, such as reading, TV watching,
crafts
• Spilling liquids when pouring
• Dropping food or utensils when eating
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Lighthouse International’s
Functional Vision Screening
Questionnaire (FVSQ)
• Goals: Early identification of vision
problems and Referral for comprehensive
clinical evaluations
• Functional, not a medical diagnosis:
how the vision problem impacts daily life
• Relevant to vision rehabilitation services:
restoration of function
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FVSQ History/Background
• Developed by Lighthouse International
Research department in early 1990s
• Tested on older adults at senior centers
and in home care
• Self-report of vision impairment rises with
age: ages 45+: 1 in 6; ages 75+: 1 in 4
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Use in Planning Services
FVSQ helped to :
• Project great need to address growing
incidence of vision impairment among
elders
• Adjust focus of vision rehabilitation
agencies toward needs of older adults in
programming
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How to use the FVSQ
• Audience: groups of seniors
• Completed as a group or individually
• Can be completed to individual or staff
member
• Tabulation: score of 9+ indicates possible
vision problem
• Follow-up and referral
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Functional difficulties due to
vision loss
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Reading & writing
Identifying medications
Moving around safely (falling)
Household activities
Getting or keeping a job
Feelings of sadness
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FVSQ questions
1.
2.
3.
4.
5.
Do you ever feel that problems with your vision make it
difficult for you to do the things you would like to do?
1. Yes 0. No
Can you see the large print headlines in the newspaper?
0. Yes 1. No
Can you see the regular print in newspapers, magazines or
books?
0. Yes 1. No
Can you see the numbers and names in a telephone
directory?
0. Yes 1. No
When you are walking in the street, can you see the "walk"
sign and street name signs?
0. Yes 1. No
•
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FVSQ questions cont.
6.
7.
8.
9.
10.
When crossing the street, do cars seem to appear very
suddenly?
1. Yes 0. No
Does trouble with your vision make it difficult for you to
watch TV, play cards, do sewing, or any similar type of activity?
1. Yes 0. No
Does trouble with your vision make it difficult for you to see
labels on medicine bottles?
1. Yes 0. No
Does trouble with your vision make it difficult for you to read prices
when you shop?
1. Yes 0. No
Does trouble with your vision make it difficult for you to read your
own mail?
1. Yes 0. No
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FVSQ questions cont.
11.
12.
13.
14.
15.
Does trouble with your vision make it difficult for you to
read your own handwriting?
1. Yes 0. No
Can you recognize the faces of family or friends when they are
across an average size room?
0. Yes 1. No
Do you have any particular difficulty seeing in dim light?
1. Yes 0. No
Do you tend to sit very close to the television?
1. Yes 0. No
Has a doctor ever told you that nothing more can be done for your
vision?
1. Yes 0. No
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Examples
• 2007/2008 Early Action Saves Sight
Project: focused on macular degeneration
• 2009-2011: East Harlem Early Action
Saves Sight Program: focused on
diabetes in targeted geographic area
• FVSQ adapted in abbreviated version for
other general use
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Vision Rehabilitation &
Low Vision Adaptive Aids
Courtesy Guide for the Sighted
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Always ask first if you may be of assistance.
Identify yourself each time you meet.
Speak in a normal voice.
Speak directly to the person rather than
through a companion.
It is perfectly fine to use the words “look” and “see”.
When dining out, read the menu.
Use a clock face reference system to describe
the positions of things on the table.
Give clear and concise directions.
If you must leave the room, find a wall or
piece of furniture for the person to stand
next to.
Avoid unnecessary touching.
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Sighted Guide Technique
Preferred and safe method
for escorting the visually
impaired
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Senior Adaptive Living Program
• NYS sponsored services to help older adults
“age in place” while adjusting to vision loss
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Low vision adaptive aids
Vision rehabilitation
Orientation & Mobility
Counseling
• Qualifiers
– Over 55, Legally blind, Not working, Living
independently
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Conclusion
• Helpful resources
– NABA www.naba-vision.org
– Lighthouse International
www.lighthouse.org
– NYS Commission for the Blind and Visually Handicapped
www.ocfs.state.ny.us/main/cbvh/
– NYS Talking Book Library ttp://www.nysl.nysed.gov/tbbl/
– National Eye Institute www.nei.nih.gov/
– American Foundation for the Blind, Senior Site
www.afb.org/seniorsitehome.asp
– Low Vision Adaptive Aids –
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www.naba-vision.org
www.independentliving.com
www.maxiaids.com
www.shop.lighthouse.orrg
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