1. Adapting to Visual Impairment: Learning to see through visually impaired eyes Kevin Huff O.D. Viewfinder Low Vision Resource Center www.viewfinderlowvision.com

2. Independence Despite Visual Impairment When someone is diagnosed with visual impairment, the biggest fear that most people are forced to face is loss of independence.Decreased visual acuity does not have to lead to a loss of independenceTo face the challenges that come from visual impairment, patients must embrace the tools available 3. Tools we use Contrast Illumination Glare Control Sound Magnification Using eyes more efficiently 4. Enhance Contrast Most people with visual impairment see better if objects are black and white. 5. Enhance Contrast 6. Enhance Contrast Setdishes on contrasting placemats 7. Enhance Contrast 8. Enhance Contrast 9. Enhance Contrast 10. Enhance Contrast 11. Increase Illumination A person in their 80s requires nearly three times as much light as a 20 year old A person who is visually impaired will need even more lighting Use gooseneck lamps, flashlights and illuminated magnifiers Task lamps will provide the needed light without causing glare 12. Increase Illumination Top photo 100 watt can flood lights 12 feet above counter topBottom photo same flood lights with 75 watt task lamp 12 inches from page 13. Increase Illumination 14. Increase Illumination 15. Control Glare Glare can further reduce vision and cause eye fatigueDecrease glare Lighting Windows Sun 16. Control Glare Tinted Lenses Fitovers, Slip-ins, Clip-ons, or actual tinted lensesTransitionsAnti-reflection coatings 17. Control Glare Hats, caps, visorsYellow acetate filters over shiny pagesLighting from behindPin-hole contact lens for aniridia patients 18. Control Glare 19. Sound 20. Sound Thereare many products available that use sound. Examples:Talking watches/clocks, talking scales, audio books, new CCTVs with OCR technology 21. Sound Unfortunately,if your hearing is not good, these products are not helpful. Theold belief that when one sense goes away, the others take over is not usually true. 22. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Practice and Patience Patients who have not read in a long time require practice to return to a functional level of reading For every week a person has not read, it will take 1 day of practice to learn to read with reasonable speed and accuracy 23. USE YOUR EYES AND TOOLS MORE EFFECTIVELY It is much easier to use low vision aids and continue to use them if you start using them when you dont need a lot of magnificationYou may not want to wait until your eyes are stable to start pursuing the tools you need for independence 24. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Conditions like Macular Degeneration affect the central vision Conditions like Glaucoma and Retinitis Pigmentosa affect the peripheral vision 25. USE YOUR EYES AND TOOLS MORE EFFECTIVELYPatients can be trained how to use parts of their vision that still remainEccentric Viewing Training 26. USE YOUR EYES AND TOOLS MORE EFFECTIVELY EccentricViewing A person with a normal healthy retina uses the macula, the very center of the retina, to view an object or print A healthy macula has the highest density of cone cells allowing clear vision and color perception A person with an unhealthy macula can learn to use a more peripheral part of the retina in order to see more clearly 27. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Eccentric Viewing Do not move your head when trying to find the clearest peripheral retinal loci Move eye only Identify the distorted or blind areas in the retina. An Amsler Grid may help 28. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Eccentric Viewing By using the Clock Technique identify the clearest part of the peripheral retina. Dont look at what you want to see! Look slightly above, below or to the side of the object that you wish to see in order to see it more clearly This area may differ for different tasks such as reading and watching TV 29. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Exercises that involve tracing and identification will help to learn to use this clearest part of the retinaDetail vision will not be fully regained by eccentric viewing training, but vision can be greatly improved when coupled with enlargement, enhanced contrast, and appropriate magnification devices 30. USE YOUR EYES AND TOOLS MORE EFFECTIVELY Visual Fields and Scotoma awareness: Humphrey 10-2: usually for Macular Problems Humphrey 30-2: usually for Glaucoma, Retinitis Pigmentosa, Strokes 31. USE YOUR EYES AND TOOLS MORE EFFECTIVELY 32. Three Types of Magnification Relative Distance MagnificationRelative Size MagnificationAngular Magnification 33. Relative Distance Magnification Getcloser to objects. Thismagnifies by enlarging the angle that the object subtends on your retina 34. Relative Distance Magnification This is why stronger glasses sometimes helps.When the prescription is stronger, the patient is required to hold things closer to their face to get the print in focus. This magnifies the object being read. 35. Relative size magnification Make things physically bigger, i.e. Large Print Items 36. Relative Size Magnification Bold print on white label attached to medicine bottle 37. Relative Size Magnification 38. Angular Magnification Object is not changed in position or size, but an optical system is placed between the object and the eye making the object appear larger Hand magnifier Telescope Electronic Magnification 39. Angular Magnification Hand magnifiers The stronger the magnifier, the smaller the lens Always use an illuminated magnifier LED Illumination 40. Angular Magnification StandMagnifiers The stronger the magnifier, the smaller the lens Good for patients with tremors 41. Angular Magnification Telemicroscope Better working distance Narrow field of view 42. Angular Magnification Telescopes Spectacle mounted: permanent mount or clip-on Hand held with either neck cord or finger ring Used for computer, music, TV distance or intermediate tasks 43. Angular Magnification BiopticTelescopes Steadier view than hand held Some are able to walk/drive with them 44. Angular Magnification VideoMagnificationCCTVs 45. Angular Magnification Advantages of video magnificationMagnification up to 72X Optical magnification up to 20X (80 diopters) Allows sufficient reading speed to make continuous text meaningful at high levels of magnification Image polarity can be reversed increasing contrast and decreasing glare Easily and instantly converts any material to large print Can be easily adjusted for fluctuation of vision 46. Angular Magnification Advantages of video magnification Increased Working Distance PC Compatible Portable Capture images Distance vision OCR technology 47. 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