Vision impairment affects about 12 million Americans aged 40 and over, according to the Vision Health Initiative of the Centers for Disease Control and Prevention (CDC). Vision loss is considered one of the top 10 disabling conditions among persons aged 18 and above. The economic impact of vision loss in adults aged 40 of age and older is $145 billion per year.
There are four major eye conditions – macular degeneration, diabetic retinopathy, glaucoma, and cataracts. Each has different causes and treatments, and affects vision in its own way. Although many of them have no cure, there are compensatory techniques that can enable people to live with vision loss. You can learn to do the same activities, just in a different way.
This is caused by deterioration of the macula, the center part of the back of the eye. The macula is on the retina, the tissue that lines the inside of the eye. Sometimes the condition is called Age-Related Macular Degeneration (ARMD), as it tends to affect people as they age.
Functional symptoms include distortion or loss of central vision (known as a blind spot), which might make it difficult to recognize the faces of friends in social situations. Visual acuity or loss of detailed vision could make it a challenge to thread a needle, for example. When close-up or near vision is impaired, it can cause problems with reading. Decreased color vision makes it harder to distinguish blue from black pants.
There are two forms of macular degeneration – dry and wet. Dry has no treatment. The wet form can consist of abnormal new blood vessel growth, and the treatment consists of injections of a substance that reduces new blood-vessel growth. Specific dietary supplements called AREDS2 can sometimes help to slow down the progression of ARMD. You need to talk to your eyecare physician to determine if these supplements will benefit you.
This is a disease of the retina and can cause swelling of the macula called macular edema. It can cause mild blurring or decreased visual acuity, which might make it difficult to see markings on a syringe, for example. Irregular patches of vision loss would make it difficult to determine the quantity of onion chopped on a cutting board or locate a mailbox on a street. It can cause severe vision loss to outright blindness.
Treatments are based on what stage of diabetic retinopathy a patient has reached. There is no treatment for the initial form, which does not feature any abnormal blood-vessel growth, but you will not experience any vision loss. However, treatment is required when new blood vessels form. This could be laser surgery, to shrink abnormal blood vessels, or injections to reduce new blood-vessel growth on the retina and reduce swelling in the macula. Also, because blood in the gel of the eyeball blocks vision, your eyecare physician will remove this as well.
This is called the “thief of sight,” because most cases of glaucoma are painless and go unnoticed. It is caused by increased pressure in the front chamber of the eye, due to too much fluid being produced or an obstructed drainage system.
Glaucoma results in a loss of peripheral vision, ultimately leading to tunnel vision that causes the victim to experience difficulty locating a food product in a pantry or skirting around a coffee table. Difficulty with nighttime vision or low-light conditions is also noted, making it difficult to walk into a restaurant with “mood” lighting, or just walking outside at night. Vision can be blurry, and ordinary lighting might cause you to see halos.
Medical treatments include medication, pills, or drops, which can help the eye to develop less fluid, or help fluid to drain. Laser surgery may be performed to open the drainage system in the front of the eye, to allow fluid to drain more effectively.
This is the only eye disease for which there is a cure. Cataracts occur when proteins clump together, clouding the lens.
General blurring caused by cataracts makes it difficult to read and do leisure tasks such as knitting and playing bingo. A significant problem is sensitivity to bright light and glare. As a result, driving or being a passenger in a car at night time on a wet, snowy day or reading a glossy magazine is a challenge. Contrast sensitivity, or the ability to distinguish an object against its background, is decreased. Difficulty will be experienced when descending carpeted or concrete stairs, or trying to see black coffee in a dark cup.
The only medical treatment is surgery, to remove the cloudy lens and replace it with an artificial implant.
Making life easier
There are various things people can do to help them live with impaired vision, and these methods can be applied to all eye diseases.
- First and foremost, enhanced lighting is key to living with vision loss, and the following techniques can be adopted:
- Use room lighting consisting of ceiling fixtures, wall sconces, floor lamps and end table/nightstand lamps. These will help you to see large shapes and objects and walk around them.
- Task lighting is a lamp that has an adjustable gooseneck or flex arm to direct light on the activity being completed, helping to read, write, identify clothing, cut food, write a check, play cards and other detailed tasks. Bring the task lamp closer to the activity when needed, or use an additional lamp if in a dark area of a room. Place the lamp on the side of the best-seeing eye.
- If not enough light is present, you can use natural sunlight when available, but limit excess brightness and glare with shades or blinds.
- Consider cleaning your fixtures and bulbs, which can make your room up to 20% brighter. Use a brighter bulb if the lamp or fixture permits.
- Try a different kind of bulb – LED, Daylight, compact fluorescent, or halogen.
- Use a lightshade to allow more light to be emitted to brighten up a room.
- Second, reducing glare – light that has an adverse effect on visual comfort or clarity of an image – can also be beneficial. It can be caused by structures in the eye, small particles in the air, highly reflective surfaces, and poorly controlled light. Compensatory techniques to deal with glare include:
- Having cataracts removed
- Wearing sunglasses
- Covering shiny surfaces with a runner or tablecloth, or using matte finish polishes
- Using blinds, sheers or shades
- Wearing a hat or visor, or using an umbrella
- Finally, other methods that can be adopted include using contrasting shades – placing light objects against dark backgrounds, and vice versa – and cutting out visual and physical clutter, for instance by minimizing objects with a pattern, avoiding untidiness, and keeping fewer household items.