Vision Loss Among Older People

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Vision Loss Among Older People

• The Vision Rehabilitation Service Delivery
  System
• What You Need to Know
• How to Refer

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Presented by

• Alberta L. Orr and
• Priscilla Rogers
• National Center on Vision Loss

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Vision Loss Among Older People

• Because of the growth in vision loss in the older
  population in the U.S., vision loss has become a
  public health issue.
• There is a national vision rehabilitation service
  delivery system in every state.
• As staff of the Aging and Disabilities Resource
  Centers, you need to become familiar with these
  services so that you can become an effective
  referral sources for this population to the
  vision rehabilitation service delivery system.

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The growing population

• There are already 6.5 million older people age 55
  and older who experience age-related vision loss.
  
• This number is expected to double as the
  remainder of the baby boom generation reaches its
  senior years in 2030.
• The first set reached age 65 on January 1, 2006.
  

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Leading Causes of Age-Related Vision Loss

• Most older people experience vision loss as a
  result of one of the following eye conditions
• Macular degeneration
• Glaucoma
• Diabetic Retinopathy
• Cataracts
• Hemianopia-vision loss due to stroke

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Impact of Each Eye Condition on Vision

• Macular Degeneration
• People with macular degeneration lose their
  central vision which makes it difficult to read,
  recognize faces, and do other close-up work.

• NEI

NEI
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Impact on Vision

• Glaucoma
• People with
• glaucoma lose the peripheral or side vision
  which makes mobility difficult. It can also make
  it difficult to find the next line of text.

NEI
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Impact on Vision

• People with cataracts experience overall
  blurring of their visual field, but cataract
  surgery has a 95 success rate.

NEI
9
Impact on Vision

• Diabetic Retinopathy
• People with diabetic retinopathy also
  experience overall blurring but with dark spots
  which block vision.

NEI
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Impact on Vision Loss

• Hemianopia
• This condition is a result of damage to the
  optic pathways in the brain, which can result
  from acquired brain injuries due to stroke, tumor
  or trauma. It can cause vision loss in half of
  the field. 

Right Homonymous Hemianopia Lighthouse
International
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Assessing Vision Loss

• Suggested Vision Component for Assessment
  Instrument
• 1. Has your vision become worse in the last 3
  months?
• ____Yes _____No _____Sometimes
• 2. Have you experienced any of the following
  problems?
• Sudden hazy or blurred vision
• Recurrent pain in or around the eyes
• Double vision
• Seeing flashes of light
• Seeing halos around lights
• Unusual sensitivity to light or glare
• Changes in the color of the iris
• Sudden development of persistent floaters in the
  eye

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Assessing Vision Loss

• 3. If so, have you seen an eye doctor?
• ____Yes _____ No _____Unsure
• 4. ______macular degeneration
• _____cataracts
• ______glaucoma
• ______diabetic retinopathy
• _____unsure
• 5. What is the severity of your visual
  impairment? (Select only one)
• ____ No Light Perception or LP only
• ____Other Legal Blindness
• ____Other Severe Visual Impairment
• ____ Declined to answer or doesnt know

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Assessing Vision Loss

• If you have not seen an eye doctor in the last
  few months or are experiencing problems with your
  vision, please complete the following
  questionnaire.
• The purpose of the questionnaire is to help
  identify people who may be experiencing a vision
  problem and who could benefit from seeing an eye
  care professional, either an optometrist or an
  ophthalmologist. People who use glasses or
  contact lenses should answer the questions in
  terms of how they see when wearing their glasses
  or contact lenses.
• (Note This does not include the use of
  magnifiers or any other special low vision
  devices.)
• (Source Arlene R. Gordon Research Institute,
  Lighthouse International).

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Assessing Functional Vision

• Functional Vision Screening Questionnaireon ADRC
  websitehttp//www.adrc-tae.org/tiki-index.php?pag
  eEligibilityPublic
• Consists of a series of 15 questions to help you
  determine how the person is functioning
  visuallysuch as being able to read newspapers or
  books, being able to see faces, being able to see
  TV, to see prices when shopping, being able to
  get around home or neighborhood.
• Scoring and understanding the results Scores
  are indicated next to the answer for each item.
  After completing the questionnaire, total the
  number of 1s the older person provided. People
  who score 9 or above should be encouraged to seek
  an eye examination from an optometrist
  or ophthalmologist and possibly to obtain vision
  rehabilitation services.

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Vision Rehabilitation Services

• Independent living skills training in adaptive
  ways to carry out routine daily activities
• Communication skills such as reading writing
• Modification of the home environment to make it
  safe and functional
• Outdoor orientation and travel skills training

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Vision Rehabilitation Services

• Independent Living Functional Assessment
  Developed to Address IADLs Visual Impairments
  (PDF) or (Word)
• American Foundation for the Blind This tool
  includes major IADL items that generally affect
  persons with visual impairments. The American
  Foundation for the Blind developed the tool
  through its National Standardized Minimum Data
  Set project. It can be used as a pre/post
  instrument. http//www.adrc-tae.org/tiki-index.ph
  p?pageEligibilityPublic

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Vision Rehabilitation Professionals

• Orientation and Mobility Specialists teach
  orientation to the outdoor environment and how to
  travel using a long white cane. Some also teach
  electronic travel aids. They teach people how to
  get to bus routes and frequent destinations.

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Vision Rehabilitation Professionals

• Certified low vision therapists teach newly
  visually impaired older persons how to use
  magnification and telescopic optical devices for
  close up and distance vision.
• They work closely with a low vision specialist,
  either an ophthalmologist or optometrist with a
  specialization in low vision.

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Vision Rehabilitation Professionals

• Rehabilitation teachers teach adaptive techniques
  for carrying out routine daily activities, such
  as pouring liquids, safety tips for cooking, and
  methods for household management, such as
  cleaning and person management, such as grooming
  techniques

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Optical and Non-Optical Devices

• Optical devices such as magnifiers and telescopes
  mentioned above are designed to help an
  individual with low vision make the best use of
  his or her remaining vision.
• There are also many non-optical devices such as
  writing guides for signature, check writing and
  addressing envelops that can help make tasks
  easier.
• These devices can be found in specialty catalogs.
  

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Collaboration

• Get to know your colleagues in the vision
  rehabilitation field in your state and in your
  community. There is a Chapter 2 program in every
  state.
• This will help you know what services they
  provide and how the services are delivered so
  that you can be an informed referral source.
• Make sure they know what you do too!

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Resources

• http//www.afb.org
• The American Foundation for the Blind web site
  addresses the needs of family members, consumers
  and professionals.
• The site contains information about coping with
  age-related vision loss, how to find vision
  rehabilitation services in every state and
  location, and information about how to find
  specialized aids and equipment.

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AFBs Online Directory of Services

• http//www.afb.org/services.asp
• AFBs directory has information on more than
  1,500 organizations, agencies, and product
  manufacturers.
• It includes state and province listings of
  organizations in the U.S. and Canada.
• The online edition is fully searchable and
  includes a handy step-by-step how to guide,
  quick links to agency web sites.

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Resources

• http//www.nei.nih.gov/
• The National Eye Institute website has a wealth
  of information on eye diseases and the latest
  research. It contains vision simulations to help
  you understand how people with a variety of
  vision problems see.

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Resources

• http//www.visionconnection.org
• This web site, developed by Lighthouse
  International and sponsored by Pfizer
  Ophthalmics, contains valuable information for
  consumers and professionals about prevention,
  rehabilitation, research, and technology. Vision
  simulators are also available through this site.

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Resources

• The Talking book program--Through a national
  network of cooperating libraries, the National
  Library Service administers a free library
  program of braille and audio materials circulated
  to eligible borrowers in the United States by
  postage-free mail.
• Eligibility Any resident of the United States or
  American citizen living abroad who is unable to
  read or use standard print materials as a result
  of a temporary or permanent visual or physical
  limitation may receive service.
• Contact 1-888-NLS-READhttp//www.loc.gov/nls/in
  dex.html