Tools Available to Help Gain Independence by Dr. Kevin Huff O.D. Independence Despite Visual Impairment, low vision, and macular degeneration. When a person is diagnosed with visual impairment, the biggest fear that most people are forced to face is loss of independence. To face the challenges that come from visual impairment, patients must embrace the tools available. What is “Low Vision”? Any chronic uncorrectable visual impairment that limits daily functioning Vision cannot be corrected with medication, surgery, contact lenses or “regular eyeglasses”. Better term for what we do is Vision Rehabilitation.

1. TOOLS AVAILABLE TO HELP
GAIN INDEPENDENCE
Kevin Huff O.D.
Viewfinder Low Vision Resource Center
www.ViewFinderLowVision.com

2. INDEPENDENCE DESPITE
VISUAL IMPAIRMENT
• When a person is diagnosed with visual impairment, the
biggest fear that most people are forced to face is loss of
independence.
• To face the challenges that come from visual impairment,
patients must embrace the tools available

3. INDEPENDENCE DESPITE
VISUAL IMPAIRMENT
• Decreased visual acuity does not have to lead to a
loss of independence
• There are many tools available to help gain
independence when facing visual impairment.

4. WHAT IS “LOW VISION”
•Any chronic uncorrectable visual impairment that limits
daily functioning
• Vision cannot be corrected with medication, surgery,
contact lenses or “regular eyeglasses”
•Better term for what we do is Vision Rehabilitation

5. DEFINITION OF LEGAL
BLINDNESS
• The term “legally blind individual" means an individual whose
• (1) central visual acuity cannot read any letter on the 20/100 line in
the better eye with best correction, or
• (2) that the widest diameter of the visual field subtends an angle no
greater than 20 degrees.
• Don’t let the term legal blindness scare you into thinking you are blind
• “Tax” Term, not a functional definition

6. INDEPENDENCE=
20/20 VISION???
• Menu at McDonald’s requires 20/80 vision
• Microwave controls require approximately 20/100 vision
• Newsprint requires 20/50 vision
• Grooming requires 20/50 – 20/100 vision
• Independence is threatened when vision falls below 20/60

7. USE YOUR EYES!
• You cannot damage your vision by using your eyes
• Nor can you preserve your vision by not using your
eyes.

8. TOOL #1
ENHANCE CONTRAST

9. ENHANCE CONTRAST
• Most people with visual impairment see
better if objects are black and white.

10. ENHANCE CONTRAST
• Do not use heavily decorated plates as food
becomes difficult to identify
• Do not use clear glasses or dishes as they
become invisible

11. ENHANCE CONTRAST

12. ENHANCE CONTRAST
• Set dishes on
contrasting
placemats
• Utensils with
contrasting handles

13. ENHANCE CONTRAST

14. ENHANCE CONTRAST

15. ENHANCE CONTRAST

16. ENHANCE CONTRAST

17. ENHANCE CONTRAST

18. ENHANCE CONTRAST

19. ENHANCE CONTRAST

20. ENHANCE CONTRAST

21. TOOL #2
INCREASE ILLUMINATION

22. INCREASE ILLUMINATION
• A person in their 80’s 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

23. INCREASE ILLUMINATION
• Sunlight or white light is preferred - enhances contrast of
print
• Incandescent in gooseneck lamp
• GE Reveal Bulbs
• Halogen – rarely used anymore

24. INCREASE ILLUMINATION
• Fluorescent
• Standard fluorescent lighting is harsh and does not
increase contrast of text
• Use Warm or Daylight Fluorescent
• Does not create shadows and is good for overall room
illumination
• Does not create heat

25. INCREASE ILLUMINATION

26. INCREASE ILLUMINATION
• Top photo … 100 watt can
flood lights 12 feet above
counter top
• Bottom photo … same
flood lights with 75 watt
task lamp 12 inches from
page

27. INCREASE ILLUMINATION

28. INCREASE ILLUMINATION

29. INCREASE ILLUMINATION

30. INCREASE ILLUMINATION

31. INCREASE ILLUMINATION

32. INCREASE ILLUMINATION

33. INCREASE ILLUMINATION

34. TOOL #3
CONTROL GLARE

35. CONTROL GLARE
• Glare can further reduce vision and cause eye fatigue
• Decrease glare
• Lighting
• Windows
• Sun

36. CONTROL GLARE
• Tinted Lenses
• Fitovers, Slip-ins, Clip-ons, or actual tinted lenses
• Transitions
• Anti-reflection coatings

37. CONTROL GLARE
• Hats, caps, visors
• Yellow acetate filters over shiny pages
• Lighting from behind
• Pin-hole contact lens for aniridia patients

38. CONTROL GLARE

39. CONTROL GLARE

40. CONTROL GLARE

41. TOOL #4
Use Sound

42. SOUND

43. SOUND
• There are many products available that use
sound.
• Examples: Talking watches/clocks, talking
scales, audio books, new CCTV’s with OCR
technology

44. SOUND
• Unfortunately, if your hearing is not good,
these products are not helpful.
• The old belief that when one sense goes
away, the others take over is not usually
true.

45. TOOL #5
Magnification

46. MAGNIFICATION

47. THREE TYPES OF
MAGNIFICATION
• Relative Distance Magnification
• Relative Size Magnification
• Angular Magnification

48. RELATIVE DISTANCE
MAGNIFICATION
• Get closer to objects.
• This magnifies by enlarging the angle
that the object subtends on your retina

49. RELATIVE DISTANCE
MAGNIFICATION

50. RELATIVE DISTANCE
MAGNIFICATION

51. RELATIVE DISTANCE
MAGNIFICATION
• Getting closer to the television will not hurt
your eyes!

52. 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.

53. RELATIVE SIZE
MAGNIFICATION
• Make things physically bigger, i.e. Large Print
Items

54. RELATIVE SIZE
MAGNIFICATION
• Bold paper
• Felt tip pen

55. RELATIVE SIZE
MAGNIFICATION
• Bold print on white
label attached to
medicine bottle

56. RELATIVE SIZE
MAGNIFICATION

57. RELATIVE SIZE
MAGNIFICATION

58. RELATIVE SIZE
MAGNIFICATION

59. RELATIVE SIZE
MAGNIFICATION

60. RELATIVE SIZE
MAGNIFICATION
• Computer
• Use a larger monitor
• Both Windows and Apple operating systems have
settings for people with decreased vision
• Windows Mouse with magnifier

61. RELATIVE SIZE
MAGNIFICATION
• Computer
• Large Print (LP) Software with or without speech
output
• LP Software with scrolling of text
• Braille - hard copy and refreshable
• Optical Character Recognition

62. RELATIVE SIZE
MAGNIFICATION

63. 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

64. ANGULAR MAGNIFICATION
• Hand magnifiers
• The stronger the magnifier,
the smaller the lens
• Always use an illuminated
magnifier
• LED Illumination

65. ANGULAR MAGNIFICATION
• Stand Magnifiers
• The stronger the
magnifier, the smaller the
lens
• Good for patients with
tremors

66. ANGULAR MAGNIFICATION
• Telemicroscope
• Better working distance
• Narrow field of view

67. 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

68. ANGULAR MAGNIFICATION

69. ANGULAR MAGNIFICATION
• Bioptic Telescopes
• Steadier view than hand
held
• Some are able to
walk/drive with them

70. ANGULAR MAGNIFICATION

71. ANGULAR MAGNIFICATION
• Video Magnification-
CCTV’s

72. ANGULAR MAGNIFICATION
• Advantages of video magnification
• Magnification 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

73. ANGULAR MAGNIFICATION
• Advantages of video magnification
Increased Working Distance
PC Compatible
• Portable
• Capture images
• Distance vision

74. ANGULAR MAGNIFICATION
• Disadvantages
• Cost: Many options available to help with this
• Portability: Not a problem anymore
• Hard to use: this is a myth

75. ANGULAR MAGNIFICATION
• Types of Electronic Devices
• New HD and Text-to-speech (OCR) CCTV
• Desktop
• Portable
• New Type I call the Acrobat Class

77. • Merlin elite is a high performance desktop video magnifier
(CCTV).
• HD provides a beautiful crystal clear picture and vibrant color.
• Text-to-speech
• Experience the joy of reading with the push of a button.

78. • Sony HD auto focus camera – work on hobbies and see small
details.
• 24” High resolution HD LCD.
• 28 viewing modes allows you to personalize Merlin elite-
perfect for reading newspapers, magazines and doing
crossword puzzles.
• Screen easily pivots horizontally and vertically-providing the
most comfortable viewing position.

79. MERLIN LCD & HD

80.  Desktop CCTV
Combines large magnification range with large
field of view
Enhances Contras
Tray allows for smooth reading even at higher
magnification levels
Controls are very easy to use

81. • Excellent option for near tasks
• Reading
• Writing
• Looking at photos

82. • Long lasting LED lighting for truer picture and color
• 19”, 22” and 24” Monitors
• Magnification 2.4x to 85x varies with monitor size
• You can personalize with 7 viewing modes
• 3 year warranty

84. • When the Acrobat LCD was introduced, it created
the standard for a new class of CCTV
• The portable desktop CCTV
• Ideal for patients who travel for extended periods of time,
i.e. winter visitors in Arizona
• No longer have to purchase two desktop CCTVs

85. • Moving camera head allows patient to use this
device for multiple tasks
• Reading
• Writing
• Working with hands

86. • Moving camera head allows patient to use this device
for multiple tasks
• See their own face, i.e. makeup, shaving etc.
• See others faces, i.e. grandchildren
• Distance vision

87. Featu
res
• Auto focus 3-in-1 camera
• Detachable camera for use at multiple work stations
• 19”, 22”, & 24” provide up to 82x adjustable magnification (varies
with LCD size)
• 28 available viewing modes to optimize contrast and brightness
• Line markers, object locator, remote control and more…
• Two Year Warranty

89. • DaVinci is a high performance desktop video magnifier (CCTV).
• Has taken the next step in the “Acrobat” class
• Featuring HD, text-to-speech and
a 3-in-1 camera.
• HD provides a beautiful crystal clear picture and vibrant color.
• Experience the joy of reading with the push of a button .

90. • Sony HD auto focus 3 in 1 camera – see near, far and
everything in between.
• Read any printed text with the push of a button.
• 24” High resolution HD LCD.
• 28 viewing modes allows you to personalize DaVinci - perfect
for reading newspapers, magazines and doing crossword
puzzles.
• Slide mechanism provides flexibility for various camera arm
positions.

93. • Similar Advantages to Acrobat LCD with a few
extras
• Even more portable
• Able to capture images

94. • Excellent option for students or people who attend
presentations/ conferences often
• Weighs less than three pounds
• 2.4x to 30x magnification (based on17” screen)
• Camera rotates 330 degrees reading, distance & self
viewing modes
• Connects to laptop, desktop computer or monitor.

95. • 28 custom color select modes
• Battery operated - up to 4 hours
• Built in LED lighting
• Auto install software/ plug & play
• 2 year warranty

99. • Large portable CCTV
• Extremely large field of view for portable CCTV
• Screen tilts up and down to allow for comfortable use
• Can be connected to TV Monitor for even larger field
of view
• Able to freeze images and adjust contrast and size

100. • Crisp, high-definition image
• Lightweight and portable
• 3.5x to 14x magnification
• Large 6.5” anti-glare LCD screen
• 6 viewing modes to optimize contrast and brightness
• 2 year warranty

103. • Lightweight Portable CCTV
• Ideal size for patient to carry with them

105. • Can be used for reading and many near
spotting tasks
• Reading menus
• Shopping- seeing price tags and labels
• Seeing household items like stove dials and thermostats
• Signing documents such as checks and receipts

106. • Adjustable magnification 2x to 10x
• 3.0”, 3.5” or 4.3” high resolution LCD
• Large viewing area in a small package
• Adjustable brightness
• 28 available viewing modes
• Foldable handle with comfort grip 3.5” and 4.3”
• Freeze image feature with capability to magnify and change mode.
• 2 year warranty

107. TOOL # 6
LEARN TO USE YOUR
EYES AND YOUR TOOLS
MORE EFFECTIVELY

108. 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

109. 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 don’t need a lot of
magnification
• You may not want to wait until your eyes are “stable“ to
start pursuing the tools you need for independence

110. 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

111. USE YOUR EYES AND TOOLS
MORE EFFECTIVELY
•Patients can be trained how to use parts of their
vision that still remain
•Eccentric Viewing Training

112. USE YOUR EYES AND TOOLS
MORE EFFECTIVELY
• Eccentric Viewing
• 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

113. 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

114. USE YOUR EYES AND TOOLS
MORE EFFECTIVELY
• Eccentric Viewing
• By using the “Clock Technique” identify the clearest
part of the peripheral retina.
• Don’t 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

115. USE YOUR EYES AND TOOLS
MORE EFFECTIVELY
• Exercises that involve tracing and identification will help to learn to
use this clearest part of the retina
• Detail 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

116. 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

117. USE YOUR EYES AND TOOLS
MORE EFFECTIVELY

118. TOOL #7
Become Familiar with
Community Resources

119. BECOME FAMILIAR WITH
COMMUNITY RESOURCES
• You are not alone
• Support Groups
• Counseling
• Transportation services
• Aging services

120. BECOME FAMILIAR WITH
COMMUNITY RESOURCES
• Community resources
• Talking book program
• Large print books
• Various agencies that service the blind and visually impaired
• DES Independent Living Services and Vocational
Rehabilitation
• Free telephone directory services
• Descriptive video services

121. BECOME FAMILIAR WITH
COMMUNITY RESOURCES
• Your family can be very helpful in helping you to
adjust to your vision loss
• Don’t fall into this trap of becoming dependent on family members
• Becoming dependent on others can be more disabling than the
disease itself
• You need to learn to use low vision aids and learn to do things
differently in order to become independent
• Your family needs to support your independence

122. BECOME FAMILIAR WITH
COMMUNITY RESOURCES
• If you view your vision problem as a challenge and are willing to be
flexible and learn new ways to do your daily living tasks, you will live
productively and independently
• The only significant barrier to your independence is YOUR resistance
to change and learning something new
• By using the tools that we discussed today everyone with a visual
impairment will be able to accomplish more than they thought they
could

123. FOR MORE INFORMATION
Visit: www.enhancedvision.com
Call: 888-811-3161