50+: Live Better, Longer

Disability's in Eye of Beholder

As a volunteer at a visual rehabilitation center in Boston, Elaine knows that people with limited vision don't have to lead limited lives. Her life certainly hasn't been limited, despite the fact that she has severe loss of vision in both eyes -- one from a retinal detachment, and the other from macular degeneration.

Visual rehabilitation services and low-vision aids don't have the high-tech flash of laser eye surgery, and they can't offer hope of a cure for what ails a failing eye, but "they can do a great deal -- they did for me, and they do for many people. A lot of them are elderly, as I am, and it makes such a difference in their lives to realize that there's something else to do besides just sit," she says.

What Is 'Low Vision'?

The National Eye Institute defines low vision as "a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with activities of daily life."

Common causes of low vision include diabetic retinopathy, a common eye disease in people with advanced diabetes; glaucoma, where an increase in eye pressure causes damage to the nerves of the eye; and age-related macular degeneration, where the retina, the layer in the back of the eye that processes light, begins to deteriorate. According to the NEI, about 14 million Americans have low vision affecting their ability to cook, read, drive, and socialize. People at higher risk for loss of vision include blacks and Hispanics age 45 and older, and members of other ethnic groups over age 65.

Learning to Cope

Severe visual loss, whether sudden or gradual, can be devastating for many people, because it implies helplessness and a loss of independence.

"I refer many patients to therapists because of their need to cope more effectively with what they have and with trying to plan for the future," says Andrea Heinlein, MSW, a social worker at Boston's Massachusetts Eye and Ear Institute who helps patients with low vision find special services and resources that can help them function to their fullest.

An important but little-appreciated aspect of low-vision services is training in activities of daily living: teaching patients how to continue doing what they have always done -- cooking, cleaning, shopping, reading.

"If you live alone as I do, the kitchen and trying to cook is a problem, because you could get burned or you're going to have a mess," Cole says. "They were able to show me what to do just in everyday living. One of the technicians came and saw me at home, and saw how I lived. She showed me everyday stuff: how to pour hot water into a cup for coffee without getting burned, how to reach into an oven without getting burned, how not to spill -- small techniques that make life much easier for a person who has any vision problems."

Ann Marie Turo, OTR/L, an occupational therapist who works with low-vision patients at Massachusetts Eye and Ear, says patients with loss of vision in the central visual field, as occurs with macular degeneration, can use a technique known as decentered viewing, in which they are trained to use their peripheral rather than central vision to see images. Astronomers use a similar technique to pick up fine details in telescopic images of distant faint objects.