Are You Seeing the Whole Picture? Understanding Low Vision

Summary

This CareLab episode explores low vision—what it is, who it affects, and how it impacts daily life. The hosts explain common causes like cataracts, glaucoma, macular degeneration, and diabetic retinopathy, while emphasizing that low vision affects function, not just eyesight. They highlight the importance of working with low vision specialists and occupational therapists, and share practical strategies—like improving lighting, using contrast, and leveraging technology—to help individuals maintain independence and safety.

 

Key Questions Answered

 

Transcript

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Welcome to Care Lab. Welcome to Care Lab, everybody. It's Friday. It's nice outside, actually. Yes, we are in Kansas City and it could be very cold on a February day, but it's nice out. Yeah, it's going to be like 70 degrees today. So I'm in a good mood. Are you in good mood, Bernie? Yeah. All right. Let's let's get started then. something that we have not talked about a lot, but really impacts people's function. Yeah, is low vision. Yes. And you've done a ton of work in this area, way more clinical work than I have.

So I wanted to kind of pick your brain today and ask you some questions about that and how people can think about it and how they can help make their lives better if it's an issue. Sounds good. Let's do it. So first, can you tell us what is low vision? Yeah, low vision sounds like two random words put together, but it actually is like a clinical definition that basically means that your vision at its best corrected state still is not serving you well, essentially.

And so that could be for a lot of reasons. It could be I have blurry vision. It could be I have tunnel vision and I'm not seeing peripheral. It could mean I'm missing some parts of my vision. So it's very generic term, but it basically means functionally my vision is not helping me as much as it should. Okay. So then if people have low vision, what kinds of problems might they have? Okay. So if you have low vision, then just think...

Vision is connected to literally everything you do every day. And so if you're not seeing things well, it makes everything harder. There are some key parts of your vision that can be affected when you have any number of low vision diseases. And that often turns out to be like inability to deal with light coming at you.

So that's like glare. So think about yourself driving down the highway when the sun is setting or rising and driving into the light. Yes, super dangerous. Like you can't see anything. You can't see anything. Yeah. Now you know you're on the highway. Maybe you got GPS and maybe it's just for a moment. So you flip your visor down. But if that was happening to you all the time, every time a light got flipped on or every time you went from inside to outside, that would severely impair your ability to function. So that's limited ability to deal with glare. Often we have trouble with contrast.

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So if something is brown and then also dark brown, not seeing the difference between those two things, it's not just about like your fashion choices, which is a problem. Like being able pick the right colors of clothes. also has to do with like your balance because if you're looking down the stairs and they're carpeted or whatever, they're all the same color, right? It's easy to not notice the difference between each step. And then you know their steps, you know kind of how much they should be, but you're unsteady with that.

Or even if you're going up the stairs and there's no difference between the actual step and the riser on the step, then you might not actually see that there are stairs there, right? could just run right into them, trip right over them. It happens a lot outside. We don't see the difference between the concrete sidewalk and the concrete road. And there's actually a curb there. And then we don't, that's just a little step. But if you don't step it right, you can break your ankle. In fact, that actually happens all the time. How many people do you think you've treated who have

broken their ankles stepping on the curb. That's like after falls, going to the bathroom, that's number two one, I would say. I would say, yeah, it's a lot. It's a lot, like a shocking amount. who is, like who's susceptible to low vision or who's at risk for low vision? That's maybe a better question. Everybody? Okay, so that's comforting.

We said it's a nice Friday. Here you go. Low vision is coming your way. We all are at risk for age-related disease. like a Debbie Downer, like that SNL skit, like wah, wah. Exactly. But there's a silver lining here. Sorry, continue. Is there a silver I mean, you will bring us a silver lining. Just keep watching and or listening. So you can be born with a vision loss, OK? There's lots of reasons why that might happen.

You could develop one over time from a neurological reason. But the biggest risk and the most incidence of having low vision actually comes from age-related vision changes. There's four big ones. You're going to know the first one, which is cataracts. This is the only low vision diagnosis that we actually have a solution for. You have surgery, have your cataracts removed. However, they don't remove your cataracts until they are ripe. That is not a great word. That is...

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I had not heard that before. That is a terrible, honey, those cataracts just are not ripe yet. We're just going to leave them there. them there. And that's exactly what happened. So, you know, they don't want to do more surgery than you do. Sure. But also at some point in there, you have pretty poor vision that hasn't gotten fixed yet. Yeah. So cataracts is one of them. Glaucoma is another. It's fairly high incidence of people getting glaucoma over time. There's lots of medical reasons for that, but that's one that limits our vision.

Macular degeneration is one of the strongest ones. It doesn't happen as often, but it has the biggest impact. Because eventually, because it continues to decline your vision, it can get to total blindness. And that's age-related, not a terrible amount of things you can do to prevent it. It is genetic in nature at some level. And then lastly is diabetic retinopathy. They stick it in there with the age-related diseases.

But mostly it comes from people having diabetes that's not well managed. And then we end up with little bitty blood vessels in the back of our eye, which we all have breaking because there's too much sugar floating around in your blood. And then actually blood spots and things floating behind your eye and you see those black spots. Diabetes is no bueno. No bueno. Lots of problems when you deal with You know what? We should do an episode sometime on diabetes. We should. And if y'all want to hear about that.

You should put it the comments. Yeah, please let us know. Or if there's other kind of concerns or disease processes that you want to know about, put it in the comments. Like we want to be responsive to that kind of thing. So basically anyone who plans on getting older. Cause the alternative is worse. Cause the alternative is definitely worse. Is at risk for developing low vision. And so this is something that maybe we don't think about, but we should probably be more thoughtful about.

as a society as a whole? Because how are people impacted, not just necessarily like in their day to day, but are there cultural or social impacts that go along with having low vision? Yeah, think yes, that's a really important point to bring up. And I also think that because it's something that could happen to any of us, we should be more mindful about what people might be experiencing behind their eyes because you can't see it, right?

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And I gave you four age-related diseases, but there's lots of other things that could be happening with the people around you, whether it's double vision, after a concussion. Vision can be a huge problem. Yeah. So there's lots of reasons our vision can't be impacted, but mostly you don't know about it. If I'm having a vision problem, you don't really know about it. Most people are not wearing an eye patch or something that demonstrates to you that they don't have the vision that they need.

And so that could show up in a lot of different ways in like your engagement with people, right? So I talk a lot to clinicians about how they can make their space, the place that they treat patients, more vision friendly. So you're handing papers to somebody. If they're asking you, where do I sign? They maybe can't see where to sign it. So one, be kind and help them figure that out. Or two, have bigger papers or have magnifiers around.

Or high contrast. Or high, yes, exactly. There's also the idea of like, if I walk up to you and we're talking with each other and you put your hand out to shake my hand, but you put it in a space where I can't see it and you feel bad because I just left you hanging. Right. And now you think a thing about me that I don't actually feel, right? Yeah. Uh-huh. So that those interactions can be really important. And so I think it's helpful to just like...

be mindful about the fact that somebody might not be singing quite as well as you are. Yeah. And maybe instead of like assuming that someone can't read or someone is, you know, blowing you off or whatever it is, maybe ask if there could be another reason. That's same thing with like, folks who are hard of hearing to totally write. So often there's an assumption that this person, maybe it, they actually have a memory impairment or that they're not paying attention or that they're being rude when in fact,

Maybe they just couldn't hear what was going on, right? So just asking like, hey, did you hear that? Okay. Did you see that? Okay. Is there something that I can do to make that easier? Like, is that all fair to say? Do you think I think it's totally fair? and you know, we could extrapolate that out to a whole lot of different things. course. the bottom line is just like, be more curious, than jumping to judgment because oftentimes things are happening because of something you don't know about. Yeah. Yeah. Ooh, gosh. Isn't that just good? Like,

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life advice overall. Just let's all maybe be more curious about each other. Okay. So what are like top three tips or pieces of advice or recommendations or things that you would want folks who either have low vision or maybe are caring for someone who has low vision to know? Yeah. I think I have, there's lots of things. Let me clarify this by saying.

Everybody's vision diagnosis or the way they see the world can be different and need to be moderated differently. Yeah And so none of these are like blanket states that anybody with low vision. I'm not even giving you a real diagnosis I'm just saying the low vision right? Yeah, could be cortical blindness. It be any number of things Yeah, the way that we might modify for macular degeneration is different than the way we might modify for a glaucoma or something like that. Yeah, I do think there's some there's three big

I guess I want to talk about three big things I want people to know about low vision and then maybe we could talk about three things that you can change in your home maybe to make it easier to manage low vision. Yeah. In everyday tasks. So the first thing I would say is that not all eye doctors are the same. And so you have an optometrist who will prescribe you glasses and that's who I would see to like update my glasses. You have an ophthalmologist.

and there's lots of different specialists in the ophthalmology world for the different parts of the eye. And those are medical doctors. Medical doctors who can do surgery. so whether your problem is with your retina or your macula or a different part of the eye or it's happening in your brain, you get a different ophthalmologist for that. And then there's this class of eye doctors called low vision specialists. their function is to say, their function is to say like, how can I make your vision

as functional as possible for you, right? Like even though I cannot correct it, the glasses aren't working, surgery didn't work or we've done a much more camera surgery, how else can I make sure your vision is more functional? And so few people know that low vision doctors exist. And so if you have had long-term problems with your vision and your optometrist or ophthalmologist has not helped you get to the place where you wanna be, you still gotta live your life.

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Yeah, so alongside seeing occupational therapists who help you figure it out. We should also see a low vision eye doctor. What is the role of an, like why would someone see an occupational therapist along with their low vision doctor? Great question. What's the OT gonna do? The OT is gonna get into your life and help you figure out how to adjust it and adjust.

Hopefully not adjust your life so much, but adjust the things around you so that you can do the life that you wanna do. Whereas the low vision doctor is going to maybe prescribe you a special kind of glasses that the optometrist can't do, or a special kind of scope that goes on a pair of eyeglasses, or decide exactly what kind of magnifier you should have in order to best maximize your vision. So they're also using tools to help improve your vision.

And also sometimes eye exercises that they might pass along to occupational therapists to help you fulfill that afterwards. Okay. So they definitely work hand in hand. Yeah. So it's it's a team, like most things in healthcare, actually it's, it's a team effort and things probably go better when we have all the players on the team. A hundred percent. Yeah. Yeah. Like you wouldn't show up to a baseball field and only field four or five players, right? Yeah. You're going to lose that game. Yeah. You show up, you have your full team and then guess what?

You're gonna you get to win you're gonna be a lot more successful. Okay, so you're talking about three. Yep. Okay three things I want you to know about low vision. Yes care. Yeah. So number one see a low vision eye doctor Number I should say number zero is work with an occupational therapist. I feel like in our show we say that a lot That's true. So I feel like you already know that guy. Yeah. Yeah, like see you know, T You can't say we don't have a point of view Exactly.

So that's the baseline. Then also have a low vision doctor. The other really big misconception is if my vision is poor, I need a magnifier and the bigger I can get the better. Okay, bigger view, bigger lens. However, it doesn't work like that. So the physics of glass is that the stronger the magnification, the smaller the field of view, the smaller your magnifier is. So if you see somebody pull out a magnifier that's only this big,

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it's likely that they have a really bad vision problem. And now they have to read things letter by letter. Everybody wants a page magnifier so that the whole page is bigger. But those don't work. And not for everyone, at least. Not for most people. Oh, OK. Because the bigger it is, the less magnification we're getting. And in that space, the magnification is still in the center. Yeah. And so if you just need one or two X magnification,

then sure, you can have a page magnifier and look right in the center. But other than that, you need something better. And so if you see a really big difference in prices, there's a reason for that. I'm mostly my person for like find the cheaper option and work with it. But in this case, if you have low vision and you really need a quality magnifier in order to, it's your eyes. It's something that you're gonna use all day, all the time. And you kind of have to invest in something that's gonna work well for you. Yeah, and you wouldn't want to have something that

is subpar in that case because that could maybe actually increase your eye problems like eye strain, which can decrease your ability to keep your eye focused on something or keep your visual attention on something. So you don't want to buy something that's going to cause you more problems. The whole goal is to make it easier. Yeah. You might as well buy nothing if you're going to get something that doesn't actually fully help you. Okay. Yeah. All right. So that you don't have those bad effects like you were just saying. Okay.

Number three? Number three. Yes. We're for number three. Thank you

I a little worried I was gonna lose track honestly. You're on par. Number three is actually a good one. Because of the perifalation of technology, everybody has a pretty high quality magnifier in their pocket. Almost everybody. Yeah. And so the thing is, I don't think people use their devices to their best capability. 100%.

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when they have vision changes. And this will help us transition to things that you can change in order to help you. And so if you have a screen of any kind, TV, laptop, computer, phone, it has some level of accessibility settings in it. And you can change things so that you can see them better. yes, you can change the size of the text to be bigger. You can also change it so that there's less light coming at your eyes.

We talked about glare as a problem for people with cataracts and glaucoma. You get glare from your screens. If you are reading your phone and it's a white background with black letters, that's extra light coming to your eyes and that can be washing out things. You can actually flip that so that you have a black background and white letters so there's less light coming to your eyes. I actually, I already have that for mine because it's more comfortable to read. My eyes don't get as tired.

Because your eyes aren't working as hard to filter out all the light that's coming to your eyes and then think about what is it that I actually need to see. Right? It's like double work. So you can change that aspect. You can use it as a tool, as a magnification tool. So you could put a little magnifier window on your phone or computer so that as you move your mouse, get, instead of blowing everything up, which sometimes can be disorienting, you can just have a magnifier on the screen.

You can make the device itself be a magnifier, even just with your basic camera app. You you could take a picture of a document, you can zoom it up and you can go, oh, I can see this and I can read, right? There's even apps that you can download for free, like Be My Eyes, that will help you in the world. So you can open the Be My Eyes app and it will tell you what it sees through the camera of your phone and say that to you verbally. So you can figure out, is this a can of beans?

Or is this a can of corn, right? It even has AI built into it now so that it can figure out documents and a whole bunch of other things. And you can even connect with a person who will just like tag in. And then they'll be like, they'll verbally talk to you about what they see. like, you're like, well, what's happening over to my left? on your left, there's a door over there and they'll explain it all to you. technology has helped us come a long way to help with low vision. And it doesn't have to cost a whole lot.

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That's really cool. mean, because like you said, a lot of this is just, it's already in our pockets. And most of the time we just don't even know that those options are there. But yeah, so cool. love the way that technology can democratize access. That's my favorite thing about it, I think. And that's why I feel so sad about people who are just having a wall up to dealing with technology. I do understand that it's moving very fast.

But you don't gotta do everything. Just engage with it at the level that helps your life. So yeah. Okay. Well, that was a pretty darn good overview, I think, of low vision and what people can, how people can think about it. Maybe some options for getting help with those things. Anything you want to add before we wrap up? Yes. I have a few things actually. Oh, okay. So number one, all those things I just said about messing with your phone.

You could do with your grandkid or somebody like that, if you feel like you don't know how to find it, you also could find an occupational therapist to help you figure that out. Because every setting is not for every set of eyes. And so that's just another plug for why an OT would be helpful. There's also a few little tricks that I like to share about things you might change in your house to make things a little bit easier. OK. Should we do three?

Yeah, we should definitely do three. Okay, good. Three is a nice number. It's not a bad number, but it's a good number. It's a great number. People love things that come in threes. I do too. Myself included. Yes. Okay. Okay. these days, okay, let me back up. A lot of times when you're having trouble with your vision, you need to rely on your other senses to help you. Especially since the touch. And so if we think back to our old school phones that had individual buttons, you could feel the buttons and understand like one, two, three, four, five, six, seven, eight, nine, right?

And then you could from there not have to look at it to know. Now we have touch screens, flat screens that have buttons. And that makes it a lot harder. No input. Yeah, you don't get no physical input to know that like I've switched from number one to number two. And so one of my favorite things to offer people is bump dots, which is essentially little pieces of foam or Velcro that have stickers on that bag that you put on top of things that orient you by feel.

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This is awesome for the stove and for microwaves. Yeah, because often your microwave is up high you have these buttons It's flat so you can wipe it clean I get it but then the numbers are like gray you can't really see them So if you put one of these little stickers on the five now you're oriented because then you're like, okay I feel the five and instead of straining to try to see where the one two and three are I now know where they are because I know what the five is

This works great for the oven too, because if you need to, if your controls are in the back, you can't really reach across a hot stove and use your magnifier and try to see where's 350 on the oven if it's not up close to you. And so you can put those colored dots and then you can see the color. And now I know that this dot is at 350. So I'm going to turn my knob to that or whatever. So bump outs have such good impacts in all kinds of places. You can put them everywhere and they're cheap.

Yeah, it's like five dollars for a hundred. Yeah, it's like such a low tech simple solution. Yep. Yeah. Yep. So bumped office is number one. Okay. Number two is consider your lighting. We've talked about this, I think, around like falls, getting up at night, but it also is really important for low vision. So one of the things that we like to do is set up a specific place for people to read. So if you're a person who needs to read their bills, look at their recipes, read the newspaper.

check the mail, instead of just sitting down and reading wherever and then straining our eyes, if you have a spot that has good overall lighting and also task lighting that goes down on the thing you're looking at. Not up into your eyes. Not up into your eyes. on the thing. So like if you're by a window, don't face the window. The window's sending you light from the daylight into your eyes. I can wash things out. Sit in front of the window so have this window behind you.

so that that light's coming down over onto what you're looking at. And that lighting change can make all the difference with how much contrast is being seen. And then if you need a magnifier, you can have that sitting right there. Or if you need to block out some of the text with another piece of paper so that you can follow the line better, you can do that easily at a table. So is it more restrictive than just plopping down on the couch and reading a book? Yes. But do you want to be able to read the book? Yes. Yes. Yeah. Exactly. And also, then you're not...

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going around hunting down all the tools and stuff that you might need in order to do that activity. have, like everything has a home. You can make it comfortable for yourself. And then to me, that would reduce the amount of like stress and frustration that I was having during that time. Cause I wouldn't feel like I was wasting time trying to hunt down all my stuff. 100%. Yeah. Okay. Next one. more. One more. Okay. Last one is... I counted again.

You can count all the up to three. All the way three with my graduate education. Good job. Number three. Number three is I said add lighting. Now I'm going to say every light is not the same. OK. So the color temperature of your light can really impact how well you can see. So if you've ever walked into a space and seen a more yellow light versus a more white or bluish light, those colors

can be used to accommodate. Okay. So you might want some warm light if it's, it makes us look really nice in the mirror. Sure does. Yes. Nice, soft me some warm light. I'm blanched. I'll throw a hanky over that. It makes you look nice and rosy. It's also good for the side of the bed because maybe you want to turn on a light to go to the bathroom, but you don't want to be fully awake. There's a good purpose for those lights. Sure. They're not great for reading though. No. Cause that yellowness does not help you have high contrast.

And so things that maybe should be standing out from the page or not and everything's kind of getting washed around and Instead if you get a daylight light bulb You will have much the best light I should back up the same the light that's closest to the sunlight that we can produce as humans and That gives you the most crisp and clear version if you've ever taken photos outside on a nice day They show up so much differently than taking pictures inside the house. Yeah, right sure for sure you get that light

And so you get that crisp clear image every all the colors are kind of bright and popping out and you can create that in your reading space You have a daylight bulb. Okay. I have a question for you about that. Yes says that I would imagine that that crispness and Clarity also translates beyond just reading though into the greater space. yeah large So if you are someone who has low vision and just seeing so seeing in your environment is a challenge then maybe having that like

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close to daylight light is probably gonna make it easier for you to see contrast and have clarity within just your living space as well, right? 100%. Okay. It's great to put it like in the kitchen. Uh-huh. Where you gotta use your eyes a lot more. Um, and in the living room where there might be things you might trip over. But yes, you can change all of your light bulbs to be daylight bulbs so you can see more clearly. You might even want it in the bathroom so that you can see and put your makeup on better. Oh, I definitely want it in the bathroom. Yes. Because listen,

When you don't have that good lighting in the bathroom, you think you look great. And then you go and maybe then you see yourself in the car rear view and you're like, what is happening right now? That is, I am not, no, this needs to be dealt with here. Exactly. Yeah. Your light matters. That's right. So daylight is the thing you're looking for. However, the light bulb manufacturers, because we live in a capitalist society, have figured out that people are looking for these.

And there is no qualification from anybody about who can use daylight on their packaging or not. Okay. So the thing I want you to do is pick up a box that says daylight bulbs and then turn it over. And on the back, it has something that looks exactly like nutrition facts on our food, but it's called lighting facts. And if you look at that, you'll be able to see what the color temperature is. And it goes by Kelvin. So it'll be a number with a K at the end of it. You want the biggest number, the bigger the number.

The bigger the number, the closer to daylight. Yes. Okay. Five or 6,000 Kelvin is what you're looking for. I did not know that. That's actually really, really helpful. Yeah. I mean, all of this was really, really helpful, but like, I did not know that. Yeah. That's how you can figure it out. And they don't cost any more than other bulbs. Yeah. But you got to know what you're looking for. You got to know what you're looking for. Yeah. Okay. This has been, I think, a really awesome, wonderful episode. Thanks for sharing all of problem. Glad to. All right.

If you got to the end of this episode and you enjoyed it, then please make sure that you are liking, subscribing, following, please share. And most importantly, leave us a comment, leave us a review. This is the best way for us to help reach new listeners and a wider audience so that we can spread helpful information to people who need it. So thanks so much for listening. Thanks so much for watching. And we'll see you right back here next time on CareLab. Bye, everybody. Bye.

 

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