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Macular Degeneration: Low-Vision Support Tools and Rehabilitation

Eyes, Age related illnesses | July 17, 2014 | Author: The Super Pharmacist

macular degeneration, age related

Macular Degeneration: Low-Vision Support Tools and Rehabilitation

Coping with macular degeneration often entails learning how to adjust to the vision loss that has occurred, or may be gradually developing. Low vision rehabilitation is an effective approach that involves the use of specialised support tools and enlists the services of highly-trained ophthalmologists and optometrists and sometimes an occupational therapist, rehabilitation teacher, or a technology specialist.

Refractive Correction

One of the first approaches that are utilised is called refractive correction, which entails providing supportive equipment such as corrective glasses and contact lens. Refractive correction reduces vision problems that are associated with macular degeneration such as presbyopia, which is the inability to focus up close (e.g. to read letters in a book or newspaper).

Magnification and Computer AssistanceWhen this condition is diagnosed in the early stage, corrective eyeglasses and contact lenses can help individuals regain their ability to read, write, do housework, recognise faces, and see images at a distance.

In some cases, this approach also corrects vision for people with the intermediate form of the disease.

Doctors also recommend that individuals with this disease wear sunglasses that block 98%-100% of ultraviolet light as this protects the retina from further damage. 

Magnification and Computer Assistance

The degree of low vision often varies with each individual so there are a number of different options that are available. These include:

  • Reading glasses that have high-powered lenses
  • Video magnifiers for watching television and movies
  • Handheld magnifiers
  • Computers that have speech-output software and large print
  • Clocks, watches, and even calculators with speech-output
  • Reading material with large print

Computer aids are especially helpful. Software that can read aloud and even write spoken words can be installed on most computers and laptops. In addition, there are programs that automatically increase the size of text in order to improve readability.

Scan-to-read devices are especially useful for individuals with the intermediate stage of macular degeneration who have significant vision loss or partial blindness due to the late stage. These handheld tools take pictures of documents or images and convert printed words into audio output. Moreover, these types of vision aids help individuals, who were becoming dependent upon others to read for them, regain their independence.

Occupation Therapy and Household Optimisation

A specialist such as an occupational therapist, rehabilitation teacher, or a technology specialist may also come into the home to demonstrate how to use low-vision devices and equipment (e.g. magnifiers and specialised computers). 

Some suggestions they may make include:

  • Improving the lighting or illumination in the home by recommending the installation of overhead lights or task lights that direct the light to where it is needed most. Installing under-cabinet lighting and additional lighting on the stairwell as well as night lights and the use of dimmer switches that can control the amount of light in a room.
  • Controlling glare through the use of blinds and curtains.
  • The installation of handrails on both sides of the stairs, outlining the edges of steps with bright, colored tape that is neon or glows in the dark, and painting the steps in contrasting colours.
  • The installation of grab bars in the bathroom and bathtub as well as the application of contrast tape around the edge of the bathtub.
  • Using brightly colored, non-slip mats and purchasing faucet labels that clearly indicate which one is hot and which is cold.
  • The removal of certain doors and replacing them with a bright curtain or installing magnetic door stops may also be recommended.
  • The labeling of electrical outlets, light switches, and thermostats with bright, coloured tape.
  • Tacking down rugs, ensuring that rugs which are chosen are skid-proof, and replacing broken or worn tiles.
  • Arranging furniture in a manner that does not hinder movement, especially in the hallways.

Peripheral Vision Techniques

A therapist may also help an individual with macular degeneration learn how to better use their peripheral vision.
When vision loss increases or blurry grey areas become enlarged, individuals with this disease may start to turn their entire body or tilt toward objects, which may cause poor posture, bodily pain, and discomfort over time. In addition, they may begin to limit their level of activity in the home and in the community altogether due to a fear of having an accident and becoming injured. Learning how to use the peripheral vision involves finding a spot in the peripheral view that is less blurry than the rest of the visual field.

A trained therapist can guide an individual through this process and with consistant practice, the use of the peripheral vision eventually becomes habitual. Furthermore, research has shown that some individuals with macular degeneration are able to successfully adapt to their environment and gradually improve poor posture as their ability to utilise peripheral vision increases.

Effects on mood due to low-vision

Individuals who have significant vision loss or partial blindness due to macular degeneration may experience feelings such as helplessness, anger, shock, and depression. They may also struggle to learn how to cope with the disease or make lifestyle adjustments as the condition progresses.

Once macular degeneration has been diagnosed, understanding the types of services and options that are available can improve an individual’s ability to live with this condition.

It is most important for an individual to regain a sense of control and independence when low-vision becomes an issue.

 

Summary

Low vision rehabilitation, which offers the provision of vision aids and other support services, has demonstrated the ability to correct visual errors with the use of prescription eyeglasses, contact lens, and enhanced technology. This approach also improves reading ability and sometimes even increases reading speed in persons with macular degeneration. In many cases, this approach allows people to regain their quality of life while continuing to discuss treatment options with their doctors and is therefore, an effective way to cope with this condition.

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References

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Gill K, Mao A, Powell AM, Sheidow T. (2013). Digital reader vs print media: the role of digital technology in reading accuracy in age-related macular degeneration.Eye (Lond), 27(5):639-643.

McKeague C, Margrain TH, Bailey C, Binns AM. (2014). Low-level night-time light therapy for age-related macular degeneration (ALight): study protocol for a randomized controlled trial. Trials, 15(1):246.

Mainster MA. (2006).Violet and blue light blocking intraocular lenses: photoprotection versus photoreception. Br J Opthalmol, 90(6):784-792.

Nguyen NX, Weismann M, Trauzettel-Klosinski S. (2009). Improvement of reading speed after providing of low vision aids in patients with age-related macular degeneration. Acta Ophthalmol, 87(8):849-53.

Virgili G, Acosta R. (2006). Reading aids for adults with low vision. Cochrane Database Syst Rev, 18;(4):CD003303.

National Eye Institute (2009). Age-related macular degeneration: What you should know. The National Eye Institute's Office of Science Communications: Bethesda, MD. Retrieved from http://www.eyeresearch.org/pdf/nei_wysk_amd.pdf

Tarita-Nistor L, González EG, Markowitz SN, Lillakas L, Steinbach MJ. (2008). Increased role of peripheral vision in self-induced motion in patients with age-related macular degeneration.Invest Ophthalmol Vis Sci, 49(7):3253-3258.

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