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Photograph by Paul Myers
Patricia Steuerwald does a low-vision exercise at Dr. Curtis W. Keswick's office in San Jose.
Low vision can cost sufferer the pleasures of everyday life
By Rita Baum
It seems that age-related low vision has been with us for thousands of years. The Book of Genesis describes Isaac's vision dilemma: "Now it came about, when Isaac was old and his eyes were too dim to see, that he called his elder son, Esau that he might give him a blessing." Unfortunately, Isaac's vision was so impaired that he could not distinguish by sight which son was the older and which the younger. As a result he blessed the wrong son--the younger Jacob. Most elders affected by low vision may not encounter a predicament as dramatic as Isaac's, but the condition can profoundly affect quality and enjoyment of life if appropriate steps are not taken. Low vision is a condition that persists after glasses, contact lenses, medicine or surgery have not been able to restore enough vision to make ordinary tasks possible.
One of the most overlooked and misunderstood groups of disabled people suffers from vision impairment or low vision, but not total blindness--generally vision of 20/200 or worse. Low vision is not just a part of getting older, as many believe. Most age-related vision changes can be remedied and usually don't lead to low vision. However, there are approximately 5.5 million elderly Americans who are visually impaired. According to the Johns Hopkins 2001 White Papers on Vision, after arthritis and heart disease, people who suffer from low vision are the second largest group of disabled people in the United States. Low vision is one of the most common chronic conditions that causes people over age 70 to need assistance with activities of daily living.
Losing the ability to see clearly can rob a person of the simplest pleasures--tending a garden or reading to a grandchild--as well as the ability to do the basic and necessary things in life. Driving, selecting clothes in the morning, reading mail, shopping or preparing a simple meal may all become difficult or impossible tasks.
The general public--and even many health professionals--are not always aware of the countless problems faced by the visually impaired nor the remedies available to help them. Organizations such as the National Eye Institute (NEI), the National Association for the Visually Handicapped (NAVH) and other nonprofit vision-related organizations are changing that.
Limited vision is not an obvious disability, and perhaps that is why it is so little understood. According to the National Eye Institute and other organizations, much remains to be done to enlighten and educate people about low vision. Although significant strides have been made, most people suffering from vision loss still do not understand their condition, know that help is available, or know where to get help. In fact the "hard of seeing" can benefit from many low vision services and devices offering hope, help and independence.
Resources: Organizations that provide information on low vision.
Visually impaired older people have been surveyed to learn how low vision is affecting their lives and what they know about the supports available. A number of respondents expressed sensitivity with regard to low vision because they considered it to be a symptom of old age. In fact, many said they had been told by their eye-care professional that their vision problems were diseases of old age, and there was little that could be done to help. Most believed that doctors were too busy to explain in detail about their conditions. And many caregivers surveyed did not believe that their family members and friends with low vision were in need of services and devices to help them cope.
But in fact, most are in need of help, and there are numerous supports, devices and aids that are available to suit their specific needs, in most cases. Some respondents knew of services but did not use these services because they did not perceive their vision to be poor enough to need them. They assumed that they would have to be totally blind before they needed special services. People were not quick to think about coping strategies that would help them--they were more likely to wish for cures or treatments for their problems.
Low vision specialist, Dr. Curtis W. Keswick divides his time between his private practice and the Veterans Affairs Palo Alto Health Care System Western Blind Rehabilitation Center, where he serves as chief optometrist. According to Dr. Keswick, probably 1 percent of ophthalmologists and 5 percent of optometrists are experienced in low vision supports and devices. "Twenty years ago there were even fewer," he says. Keswick believes that the specialty will grow along with public awareness and an ever-increasing population of older Americans. "All eye-care providers need to become more aware of the rehabilitation potential of low vision so that they can refer patients to low-vision specialists," Keswick says. Many eye care professionals are not aware of the many devices and supports available to assist the visually impaired. For example, field expanders for those who have lost side vision or spectacle-mounted telescopic devices for people with central vision loss.
The National Association for the Visually Handicapped does not consider anyone who has useable vision to be blind. It has been proven that those with residual vision can, with proper motivation, continue to lead independent lives. For a child born with visual impairment, or for young people who acquire problems at an early age, there is practically no profession one cannot achieve. Today there are visually impaired physicians, nurses, social workers, lawyers, teachers and other professionals. For the older person who experiences vision loss in later life, the National Association for the Visually Handicapped fosters the principle of "forgetting what was and working with what is."
Adjusting to low vision can be difficult and discouraging, but no one has to do it alone, and there is no reason for people with low vision to feel they just need to learn to live with the condition. Low vision rehabilitation programs provide services, tools and education to maximize the remaining vision a person has. In many cases, people can regain a fair measure of independence. Many of the rehabilitation and support services, and a remarkable variety of devices to assist sufferers of low vision are available at a nonprofit, free or sliding-fee scale rate through several local organizations. Most who take advantage of the numerous services say that a new world has opened for them.
This article is not intended to provide medical advice, which should be obtained directly from a health-care provider.
Rita Baum is a Los Gatos resident. She has a masters's degree in gerontology and has worked in the field of aging for more than 20 years.
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Saratoga, California Since 1955
