Enhanced vision webinar coping with visual impairment

Coping with Visual
Impairment
Kevin Huff O.D.
ViewFinder
Low Vision Resource Center
www.viewfinderlowvision.com
1830 S. Alma School Rd. #7-131 10001 W. Bell Road
Mesa, Arizona 85210 Sun City, Arizona 85351

My Qualifications
 Optometrist
 Limited to Low Vision Optometry.
 All of my patients are visually

impaired.
 Have included many direct quotes

from actual patients

My Qualifications

 Personal
 Visual impairment in my family.

Vision Loss
 Fear
 Gallup poll 1998, 42% of adults
listed blindness as the most feared
disability.
 Other studies show blindness is

more feared than death.

Vision Loss
 Vision is our most dominant
sense.

 Many people equate loss of
vision with a loss of
independence.

Emotional Reaction to Loss

 A person with vision loss often
goes through the same process
of emotions a person with a
terminal illness goes through.

Stages of Grief
 Shock
 Denial

 Anger

 Depression

 Bargaining

 Acceptance

Acceptance
 This is the last stage.

 It is making peace with the
permanence of vision loss, and
moving forward with all possible
treatment options considered.

Acceptance
 Some people take weeks to
get here, some take years.
 Examples: AION patient and my
grandfather

Acceptance
 It is our job to try to help
patients get to this stage as
quickly as possible.

Shock
 This is typically the first
stage a patient goes
through when a diagnosis
of permanent vision loss is
made.

Shock
 It seems as if the brain
stops gathering new
information and is just
stuck in time.

Shock
 Patients will often say that it took
them a few days to process what
the doctors have told them.
 “I didn’t even know what was
going on. All of a sudden, he was
putting a needle in my eye!”

Shock

 This is a normal response
to an emotionally painful
situation.

Shock

 Usually the shortest stage
people go through.

Acceptance
 Shock: This is hard to help with.
Patients often get through this
quickly.
 Family: Just be there for the patient.
Giving patient facts etc. will not help
because patient will not process them.

Denial

 Patients will often doubt
the diagnosis.

Denial
 “Are you sure it is not just
my glasses prescription?”

 “I need another opinion.”

Denial
 “I just didn’t sleep enough last
night. If you test me tomorrow,
I’ll see better and you won’t
think I have macular
degeneration.”

Denial
 “They told me I have dry
Macular, not wet. So, I can’t
be bleeding. Are you sure
you aren’t just seeing things?”

Denial
 “Those doctors have never told
me I have macular degeneration!”
 Doctor’s response: “What did you
think the shots in your eye were
for?”
 Patient: “To help my eyes.”

Acceptance
 Denial: Help patients understand
your expertise in this area.
 Family: The more they trust that you
understand what they are going
through, the easier it will be to help.

Acceptance
 Denial: I gain this trust by explaining
medical conditions, scotomas,
acknowledging flaws in typical
refractions, and why patients have
good and bad days.

Acceptance
 Denial: Once patients trust that
you understand what they are
going through, and can come to
terms with their diagnosis, they will
be able to move on past denial.

Anger
 This often begins with the
question “Why Me?”

 There is usually no real answer
to that question.

Anger
 With no person or thing to
blame for the vision loss,
patients sometimes are
resentful of others who have not
experienced this loss.

Anger

 Patients often make very
emotionally charged
comments.

Anger
 “If you tell me I can’t drive, you
might as well chop my legs off!”

 “Reading is my life. If I can’t read
I should just die!”

Anger
 Patients can often display
their anger in irrational and
uncharacteristically mean
comments.

Anger
 “If I had been a younger man
when I met that cataract
surgeon that did me in, I’d be
in jail for assault right now.”

Anger

 It is perfectly normal to feel
anger about vision loss.

Anger
 We need to help identify when
someone is holding onto anger
about their visual impairment,
and help them deal with it.

Anger
 If the anger is out of control or
hurting relationships, it may be
necessary to see a counsellor
or therapist.

Acceptance
 Anger: Patients should understand
that anger is a normal response.
However, we need to help them
deal with it in a healthy way.
 Family: Identify areas of misplaced anger
and help people realize the true cause of
the anger.

Depression
 Depression often follows anger.

 Again, this is a normal reaction
to vision loss.

Depression
 A patient’s self image or self
worth may decrease with vision
loss because they may feel that
they can't do the things they did
in the past.

Depression
 “I’m pretty much worthless now.
He/she does everything for me.”

 “I can’t even sign a check
anymore.”

Depression
 “I feel like I’m in first grade when I
try to read.”

 “I always had perfect eyes. I don’t
understand how this happened to
me?”
 Pilots

Depression
 Signs of Depression
 Changes in sleeping patterns
 Changes in eating habits

 Changes in activity level

Acceptance
 Depression: We need to try to help
patients continue to lead as
independent a lifestyle as possible.
 Family: When depression is identified, help
patients obtain the assistance they need.

Bargaining

 Patients will often try to
negotiate a treatment.

 “What about stronger glasses?”

Bargaining
 “I saw a guy who had these special
glasses that he could read with,
and he was blind. Why don’t you
just give me those?”
 There are no “magic” glasses.
 If there were, my grandpa would

have them.

Bargaining
 If we don’t recognize when patients
are bargaining with us, instead of
truly accepting the treatment
option, they will end up with
devices they don’t use.

Bargaining
 “Sure… I fully understand that
I’ll have to hold things closer
with these new glasses.”

Bargaining
 Patient then returns glasses after a
few days saying “I knew I had to hold
things closer, but not that close! ”

Bargaining
 Patients often try to
negotiate terms to continue
driving.
 Family: We must be willing to
discuss difficult topics like this.

Bargaining
 “I only drive in my comfort
zone.”
 High percentage of accidents
happen close to home.

Bargaining
 “I scan my eyes all the time
when driving.”
 Usually said by patients with peripheral
defects.
 What happens when you are looking
right and something comes from the
left?

Bargaining
 “I’ve driven for ______ years
without any accidents or
tickets.”
 How many of those years were you
visually impaired?

Bargaining
 “I just need to drive ____
blocks to go visit my spouse
in the nursing home.”
 High percentage of accidents
occur near the home.

Bargaining
 “I just need the license in
case of an emergency.”
 You don’t want your first time driving in
several years to be when you are
driving your spouse to the hospital.
 Use an ambulance!

Bargaining
 “I’ll know when it is time to stop
driving. Believe me, I’m not one
of those reckless people!”
 Must ask: “What measures will you
use to know?”

Bargaining
 “My wife tells me when it is
safe to turn.”
 Self explanatory

Bargaining
 “I know I don’t see well, but I only
drive on isolated roads. If I crash,
I won’t hurt anyone else.”
 Said to me by a patient who later died
in a one car accident.

Acceptance
 Bargaining: We must recognize
when patients are bargaining
instead of accepting and adapting.
 Family: Help patients have realistic
expectations for their low vision aids.

Responding to Patients
 This part of Webinar is to help family
learn how to talk with loved ones
about their vision loss

 If you have vision loss, these tools
can help you think differently about
your loss


 We need to be able to respond
to patients in a way that helps
them cope with their vision loss.

 Stressful life situations often
accompany vision loss.
 Passing of spouse
 Other physical ailment, i.e. hip

surgery

 Patients will equate these
events with their loss.
 Doctor: “Do you do much reading
anymore?”
 Patient: “No, I haven’t read much

since my spouse died.”


 Patients will use bad medical
outcomes to explain all
future problems.

 “Ever since that doctor botched
my cataract surgery, I can’t read
the newspaper.”
 Even though the surgery was on the worse
eye, and the patient read for several years after
the surgery with the better eye.

Patient still blames the surgery, when in reality
they have developed macular degeneration in
the better eye.

 When patients make these
comments during the exam, we
have to acknowledge what they
have said.
 If it is not addressed, it can be a
hindrance to accepting treatment
options.

 I have learned that I have to be
willing to stop an exam and have
these conversations with patients,
or else they will not be successful
with their adaptive aids.

 The 3.0 Response is a great tool
to use when patients say
emotional things.

 “You feel_______, because
_________.”

 The 3.0 Response acknowledges
the emotion and the cause of the
emotion.
 We can’t just acknowledge the
emotion.
 i.e. “I understand you feel angry.”

 “You feel angry because your vision
was worse after cataract surgery than
before.”

 “You must have felt a huge loss when
the spouse you loved and shared all
those memories with passed away.”

 Once we have acknowledged the
emotions and the cause of the
emotions, patients will be more
willing to separate them from the
treatment options being presented.

Family
 Find the balance between
helping and hindering.

 Can be very difficult to do.

Family
 Help patients not fall into the trap of
becoming dependent on family
members.

 Becoming dependent on others can
be more disabling than the disease
itself.

Family
 Families need to support patient’s
independence by encouraging
them to try new things.

 Help patients realize that they
should be willing to purchase
necessary tools.

Regaining Independence

 Our ultimate goal

Regaining Independence
 With the correct tools, almost
every one with a visual
impairment will be able to do
more than they think they can
do.

Key to Successful Low
Vision Rehabilitation

 Use the correct low vision
aids and use them correctly.

Key to Successful Low
Vision Rehabilitation

 The most significant barrier to
improvement is often a resistance
to learning something new.

Electronic Devices
 Advantages
 Large range of magnification (up to 75X)

 Increased Contrast

 Decreased Glare

 Increased Working Distance

 PC Compatible (888) 811-3161
www.enhancedvision.com

Electronic Devices

 Advantages
 Portable

 Capture images

 Distance vision

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Electronic Devices
 Disadvantages

 Cost: Many options available to help with this

 Portability: Not a problem anymore

 Hard to use: this is a myth

(888) 811-3161

Electronic Devices
 Types of Electronic Devices
 New HD and Text-to-speech (OCR) CCTVS

 Desktop

 Portable

 New Type I call the Acrobat Class
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(888) 811-3161

 DaVinci is a high performance desktop video
magnifier (CCTV).
 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. (888) 811-3161

 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.
(888) 811-3161

 Merlin elite is a high performance
desktop video magnifier (CCTV).
 Featuring HD and text-to-speech.
 HD provides a beautiful crystal clear
picture and vibrant color.
 Experience the joy of reading with the
push of a button. (888) 811-3161

 Sony HD auto focus camera – work on hobbies and
see small details.
 Read any printed text with the push of a button.
 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.
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Merlin LCD & HD

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 Desktop CCTV
 Combines large magnification range with large
field of view

 Enhances Contrast

 Tray allows for smooth reading even at higher
magnification levels

 Controls are very easy to use
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 Excellent option for near tasks

 Reading

 Writing

 Looking at photos

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 Simple, easy to use controls
 Long lasting LED lighting for truer picture and color
 19”, 22” and 24” Monitors
 Magnification 2.4x to 85x varies with monitor size
 Screen easily pivots, both horizontally and vertically
to provide the most comfortable viewing position
 You can personalize with 7 viewing modes
 3 year warranty
(888) 811-3161

 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 (888) 811-3161

 Moving camera head allows patient to
use this device for multiple tasks

 Reading

 Writing

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 Working with hands www.enhancedvision.com

 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

(888) 811-3161
 Distance vision www.enhancedvision.com

Features

 Auto focus 3-in-1 camera for seeing yourself up close,
reading and distance viewing
 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
(888) 811-3161

 Similar Advantages to Acrobat LCD with
a few extras

 Even more portable

 Able to capture images

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 Excellent option for students or people
who attend presentations/
conferences often

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 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.
 28 custom color select modes
 Battery operated - up to 4 hours
 Built in LED lighting
 Auto install software/ plug & play
 2 year warranty (888) 811-3161

 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
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 Crisp, high-definition image
 Lightweight and portable
 3.5x to 14x magnification
 Large 6.5” anti-glare LCD screen tilts for most comfortable
viewing angle
 Large field of view allow the reader to see more of the
reading area
 Freeze frame with adjustable size and contrast
 6 viewing modes to optimize contrast and brightness
 2 year warranty (888) 811-3161

 Lightweight Portable CCTV
 Ideal size for patient to carry with them

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 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

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 Adjustable magnification 2x to 10x
 Lightweight design
 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.
(888) 811-3161
 2 year warranty www.enhancedvision.com

To Schedule a
Free – No Obligation in Home Demonstration

Call: 888-811-3161

Email: marketing@enhancedvision.com

(888) 811-3161

Enhanced vision webinar coping with visual impairment

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