LESSON FOUR: LIVING WITH VISUAL IMPAIRMENTS FOCUS: Students should gain a basic understanding of what the primary causes of visual impairment and disability are late in life. Further, by donning impairment glasses, students will get an insight into what it is like to live with compromised vision. Students will also learn activities they may undertake to assist a person with vision problems. Common Eye Disorders To better understand the nature of the visual impairments in Activity 4A, Seeing Straight, a brief description of common eye disorders follows: CATARACTS a clouding of the lenses of the eyes (usually formed in the back layers of the lenses) that blocks or changes the amount of light that is needed for clear vision. Cataract development is related to increasing age, diabetes, ultraviolet radiation, and chemical changes within the lens. The hazy effect of cataracts varies depending upon the location of the clouded area. When in bright light, people with cataracts may experience a worsening of the haziness or may complain of a glare or blurred vision. Some may experience a constant haziness even in average or dim light or may say that it is like looking through dirty windows. Others may experience double vision or see spots. Caregivers may note milky or yellowish spots in the pupil and can advise the elder friend to have more light on their work and less light near the eyes ; Cataracts are the third leading cause of blindness among the elderly. They are very common and account for 40 percent of all eye surgery. Removal of cataracts is successful in most of the cases. Nearly all patients become more interested in personal grooming, cleaning, socializing, reading, and can find their way without the assistance of others. Cataract removal and intraocular lens implants are recommended if the visual difficulty caused by the cataract interferes with everyday activities. Note: Without cataracts, normal lenses are clear. This results in a red reflex when a flash photograph is taken, hence the red eyes seen on many photo graphs. The red reflex is the light of the flash reflecting off of the retina. When cataracts are present, the light is blocked and never makes it to the retina and thus, there is not a red reflex. GLAUCOMA is an abnormal condition of elevated pressure within the eye (intraocular pressure) because of an obstruction of the outflow of aqueous humor. Ophthalmologists detect the disease with eye pressure measurements using a tonometer, examination of the optic nerve, and measurements of the central field of vision. Pressure may be between the iris and the lens, or against the optic nerve from the aqueous humor (causing nerve to atrophy); chronic glaucoma develops slowly. Sometimes is called the silent disease because it has indefinite symptoms. Glaucoma may produce no symptoms except for gradual loss of peripheral vision over a period of years. Sometimes headaches, blurred vision, and dull eye pain may be present; Halos or 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -1
rainbow-colored rings around lights and central blindness are late manifestations of the disease. People with glaucoma may bump into things or lose words on the printed page. Patients may have extreme difficulty adjusting to a darkened room (such as a theater). Glaucoma is usually controlled with eye drops designed to reduce the flow of aqueous humor and lower intraocular pressure. MACULAR DEGENERATION is a progressive deterioration of the macula of the retina and choroid of the eye. A common eye disease, it is a leading cause of blindness in persons over the age of 80. The macula lutea is a small area in the retina, about 1/1 inch in diameter, that is the area for central vision (or daylight vision). It is the area for seeing great distances, reading fine print, sewing fine stitches, perceiving color, and identifying people s features at a distance. Central vision is reduced to 20/70 in moderate cases, and can be 20/200 or less in advanced cases. Side vision is usually maintained; persons can get around and take care of themselves, but do have difficulty recognizing friends and family members, and frequently must give up reading, writing, and handicrafts. DIABETIC RETINOPATHY disorder of retinal blood vessels characterized by capillary microaneurysms, hemorrhages, exudates, and the formation of new vessels and connective tissue. The disorder occurs most frequently in patients with long-standing, poorly controlled diabetes. Repeated hemorrhages may cause permanent opacity of the vitreous humor, and blindness results. The retinopathy starts with the forming of a small dilation of a capillary (microaneurysm) which results in blood seeping out of the capillaries; the hemorrhaging may become so severe that the vitreous cavity becomes completely filled and vision is totally blocked. Diabetic retinopathy is treated with an argon laser beam used to obliterate the bleeding retinal blood vessels or coagulate damaged vessels. A reminder: it is strongly recommended that all persons with diabetes have their eyes checked by an ophthalmologist once a year. Treating the retinopathy with laser therapy preserves sight. HEMIANOPSIA vision loss in half of the visual field. Hemianopsias are usually caused by a cerebro-vascular accident (stroke) creating a defect in the optic pathways between the eye and the brain; may occur in the right or left field, lower or upper field, in one or both eyes. A hemianopsia may cause reading impairment (caregivers can help a victim with left hemianopsia in their reading by simply marking a dark black line down the left-hand edge of the print of each page). 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -2
ACTIVITY 4A: SEEING STRAIGHT Donning a Visual Impairment What is it like for persons who have vision impairments? To gain a better understanding of the impact that some vision problems have on the elderly, have the students wear impairment glasses and then perform simple, everyday tasks. You may construct your own impairment glasses or order simulation products from Chronic Care Challenges, Inc. Chronic Care Challenges, Inc. of Wichita, Kansas P.O. Box 781535 Wichita, Kansas 7278-1535 Telephone: 31-34-845, FAX: 31-34-1554 www.chroniccare.com Simulation Glasses $25.00 per set. Set includes: Diabetic Retinopathy Glasses, Macular Degeneration, Glaucoma, Cataract, Hemianopsia, and Detached Retina Glasses Have the students wear the glasses while performing daily activities such as filling out forms, reading, measuring, mixing ingredients, writing, walking, reading a newspaper or prescription label. Use alone or combine with other sensory or mobility compromises (such as noseplugs to simulate olfactory loss, ear plugs to simulate reduced auditory function, wrap fingers, wrists, or hands with foam, splints, or tape to mimic arthritic impairments or surgical alterations). Common visual impairments affecting older persons include cataracts, glaucoma, macular degeneration, retinopathy, hemianopsia (left side, right side, inferior, superior, or combinations), and detached retina. There may also be problems with dry eyes that occur when tear glands do not produce enough tears, the eyes itch or burn and vision may be reduced. Artificial tears may correct the problem. Conversely there may be excessive tears which can be a symptom of increased sensitivity to light, wind, or temperature changes, or which may indicate serious problems such as eye infections or blocked tear ducts. While it may seem this activity focuses too heavily on the negative aspects of aging, it is most assuredly a way to increase sensitivity to the special needs of the elderly and to understand some of the odd behaviors youngsters may perceive in the older persons. ACTIVITY 4B: PROCESSING OUT SEEING STRAIGHT Following their experience with Seeing Straight, students should take time to reflect on the feelings and sensations that have occurred. Conduct a brief class discussion then allow enough time for students to thoughtfully complete the PROCESSING OUT ACTIVITY 4 WORKSHEET. Compare the students answers to number 5 with the suggestions given on the handout HELPFUL THINGS A CAREGIVER CAN DO FOR THE VISUALLY IMPAIRED. How did they do? 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -3
MAKE YOUR OWN IMPAIRMENT GLASSES To construct your own impairment glasses, use safety glasses, recycled frames, swimming goggles, or cardboard cutouts. Design lens coverings for each impairment as described below: cataracts cover lenses with wax paper; scrape or rough up the surface of the glasses with steel wool; or cover the lens with Vaseline. glaucoma paint over each lens (or cover with tape or felt) leaving only a small central area open to see through (approximately 1/2 circular opening) and shield the sides of the glasses, so peripheral vision is impossible. macular degeneration glue or stick label dots in the centers of each lens or paint a blackened area in center of each lens, leaving peripheral area clear. diabetic retinopathy paint over each lens (or cover with tape or felt) leaving only the sides of the glasses, so peripheral vision is impossible: hemianopsia paint over half of each lens (or cover with tape or felt) for example, occlude the left side of each lens, leaving the right side open to see through, this would represent left side homonymous hemianopsia; occlude the top half of each lens, leaving the bottom half open to see through to represent superior homonymous hemianopsia or the reverse to represent inferior homonymous hemianopsia. detached retina early phase paint several small floating spots on one of the lenses (or stick several small map dots onto lenses); in this phase the victim may see spots or flashes of light; this phase passes in a few days, but the disease process continues. late phase paint a darkened area along the outside edges and just under the center of one lens; then cover the center portion with Vaseline or scratch through the center with wavy lines. advanced phase completely darken or paint over one lens (or cover with tape or felt) and shield the sides of the glasses so peripheral vision is also impossible. reduced color vision provide colored lenses, then look at pictures containing a variety of color, see which lenses confuse color detection; or lay a colored plastic sheet over a magazine page, notice which colors become indistinguishable. Diagrams of six impairment glasses are illustrated on pages -30 and -31 (cataracts, glaucoma, macular degeneration, detached retina, diabetic retinopathy, and hemianopsia). These diagrams may be photocopied onto heavy stock paper and cut out for use in the classroom. The patterns may be attached to the glasses of children or made into masks. Materials: 1. Impairment Glasses either homemade or obtained from Chronic Care Challenges, Inc. 2. Processing out worksheet SEEING STRAIGHT 3. Line drawing for processing out SEEING STRAIGHT 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -4
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HELPFUL THINGS A CAREGIVER CAN DO FOR THE VISUALLY IMPAIRED 1. Provide enlarged telephone dial and/or one that lights up in the dark. 2. Provide sufficient light over the work diffused with a shade (not a bare bulb). 3. Advise rest periods and a change in positions (especially true for those who still do fine needlework). 4. Label all glasses with name, have cord attached to glasses or make sure she/ he has pockets to put glasses. 5. Make sure eyeglasses are clean.. Avoid bright glare, such as from highly polished floors, enamel walls, and windows without curtains. 7. There should be a soft light on at night (especially in the bathroom, kitchen, or other frequently visited areas). 8. Provide large-print books, newspapers, calendars, and magazines or page size lenses. 9. Provide talking books. 10. Provide playing cards with enlarged numbers. 11. Face individual when speaking (if s/he is a lip reader, consider wearing bright red lipstick, don t cover your mouth, keep moustache or beard neatly trimmed so your lips are easier to see). 12. Provide large clocks and large calendars. 13. Make sure there is a clear line of demarcation between items (for example, use colored plates on a white tablecloth, dark switch covers on white walls, dark strips on edge of light colored steps). 14. Don t move furniture or other belongs around without explaining what you are doing and why. Adapted from Nursing and the Aged, Irene Burnside, McGraw Hill, 1988 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -7
PROCESSING OUT ACTIVITY 4 Seeing Straight Donning a Visual Impairment In each blank, write in the name of the visual impairment you experienced. Then answer each question in complete sentences. 1. How did interfere with your abilities and activities? 2. What was most bothersome about? 3. What things did you have to do to overcome the difficulties you experienced with? 4. Look at a picture. With a black color, cover over the parts you would NOT be able to see if you really had. With a yellow color, shade the areas that would be difficult to see (blurred, hazy, discolored, etc.) if you had. 5. Now that you have had some experience with, name at least three things you could do out of consideration to someone with this disorder or to show them that you empathize with the daily problems they encounter. 2001 UTHSCSA "Positively Aging " a trade mark of the University of Texas Health Science Center at San Antonio -8