GLAUCOMA EWAP JUNE 2023 49 3) Have you fallen in the past 6 months? If they answer yes to any of these, a referral is recommended. “If there is VA of 20/50 or worse, any contrast sensitivity loss, any field loss or scotoma, you should start having conversations with your patients about vision rehab,” Dr. Kaleem said. “Vision loss is both a spectrum and a journey, with some people experiencing improvements and declines in their vision over time,” said Omar Mohiuddin, OTR/L, CLVT. “When vision loss first begins to impact a person’s ability to do functional tasks a referral to vision rehabilitation services is recommended. Vision rehabilitation specialists will first evaluate to see if glasses maybe help improve vision before visual aids are introduced.” Traditional aids Mr. Mohiuddin said that while most people immediately think of magnifiers as visual aids, the first thing he recommends is proper lighting and glare control measures. “Simple sunglasses or blue light-blocking filters may help reduce glare, and certain color temperature lighting positioned in the right place may help illuminate a task or environment that may allow a person to see their best,” he said. “Common complaints we hear from patients with glaucoma when they notice changes in their vision include increased sensitivity to glare, everything appearing dimmer, or trouble seeing in low light conditions. Later in their vision loss, complaints may include total loss of vision or loss of peripheral vision creating challenges walking around and navigating environments safely.” Mr. Mohiuddin said he regularly demonstrates conventional and electronic magnifiers, handheld options, and glasses-mounted telescopic devices, as well as specialty filters for glare control and photosensitivity. He said there are a number of non-optical modifications as well, such as using contrasting tape to mark the edges of stairs and no-cut gloves or chopping aids, as a couple of examples. He said that he does not demonstrate high tech wearables, such as smart glasses and augmented reality headsets, frequently because there is often a learning curve. “I find that lighting solutions are often the most important thing I can recommend, and while my recommendations are individual, an LED gooseneck task lamp with adjustable brightness and color temperature and a Lil Larry flashlight are versatile tools that help many people with low vision see to complete different tasks,” Mr. Mohiuddin said. From a contrast standpoint, Dr. Kaleem said making things brighter can be helpful, as can something as simple as switching the background setting on a phone, making it have a dark background with white text instead of white background with black text. Bathrooms, Dr. Kaleem said, are often a location for falls, in part due to contrast issues. Many bathrooms have white tubs, white floors, and white sinks, making it difficult for people with contrast sensitivity issues. She recommends using high contrast, bright colors for bathmats on the floor near the step for the tub. Smart technology solutions Mr. Mohiuddin said that while the range of available assistive technologies has come a long way in the last few decades to help the visually impaired, the greatest difference has been the introduction of smartphones. “Our smartphones are capable of not only taking calls and photos but come equipped with digital assistants to help tell the time, weather, compose text messages through dictation, and accessibility features, such as voiceover, and may allow users to access emails and information on the web and different apps,” he said. Mr. Mohiuddin said there are apps that now use machine learning and AI that can help users identify objects, barcodes, and read print materials with text-to-speech (optical character reading) capabilities. “As technology improves and things become lighter weight, less conspicuous, and more affordable, that should help with the adoption and use of devices,” he said. “I find that my patients are more open to adopting and using mainstream technologies, such as smartphones and tablets, rather than proprietary low vision devices as they are more readily available and easier to learn to operate. No one size fits all While new technologies are always rolling out, Mr. Mohiuddin cautioned that no technology is one size fits all. “Not every new aid is going to help everyone, as it depends on their familiarity with technology, their level of vision, and what goals or tasks they are looking to accomplish,” he said. “When recommending aids and technologies, it’s important to understand that it’s often the low tech solutions that are easiest to adopt, and it depends on the individual and what tools they are most comfortable with learning to use and adopting to help do what it is they need to
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