Vision Rehabilitation for Diabetic Eye Disease
What needs to happens to a person with low vision?The care for people with low vision due to diabetes is still mainly medical. Often, there is limited awareness (even amongst eye health professionals) that people can greatly benefit from low vision care and vision rehabilitation, including counselling. Close collaboration with, and referral to and from, low vision and community based rehabilitation services and organisations for people with disabilities will ensure that more can be done after visiting the eye health or diabetes clinic.
Low vision: Assessing persons with diabetesPatients with diabetes have many special needs that are related to the use of vision, for example :
- To fill insulin syringes
- Read labels on medicine bottles
- They may also have tingling or numbness, which affects their hands and feet, making it difficult to handle their injections, monitor their blood sugar levels or take care of their feet.
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Diabetic Eye Disease: Building Capacity To Prevent Blindness
- Vision changes due to blood sugar fluctuations
- Sensitivity to glare (e.g., not able to walk around safely when the sun shines)
- Their vision levels may fluctuate during the day
- Loss of contrast sensitivity is common, and this may affect many daily activities such as recognising friends, outdoor mobility, sewing and, cooking
- Loss of colour vision, especially blue-yellow loss
- Visual field loss, either central or peripheral field loss, or a combination of the two, results in e.g., difficulty reading labels and newspapers and walking around
- Control of light: Reduce glare outdoors by wearing a cap, using an umbrella or wearing sunglasses outside. Increase light, using a well-directed reading lamp, for tasks such as cooking or reading.
- Increase contrast (and use colours to create good contrast) in and around the house and at work. Use dark tape around a light switch; cut coloured vegetables on a white or very dark surface; put dark stones or plants on the sides of the light-coloured paths around the patient’s house.
- Organise a cupboard with food items in a way that is good for the individual client, e.g. sequence items alphabetically or use large size, good contrast labels – remember vision may fluctuate during the day.
- Mobility training: The first thing to learn by the person and a family member is what the most appropriate and safest way is of being guided around. This training can easily be given by eye health staff as they also need to guide patients in their clinic. Mobility training (without or with a cane) to move around more independently, is beneficial to many and increases independence and self-respect. Find out where this is available near the clients’ home.
Guidelines for eye health workers and other helpers assisting blind and visually impaired persons.
- Spectacles to correct refractive errors, including presbyopia, should already have been prescribed by the eye health services or clinical low vision service.
- Telescopes are useful for distance tasks such as watching television.
- For clients with central visual field loss, it may be necessary to first learn to use eccentric viewing to learn to look around areas of decreased vision, before starting to use magnification. Find out who can provide this kind of training; low vision services should be able to help.
- After the low vision professional has determined how much magnification is needed, the kind of device that helps the client to do the activities he or she needs and wants to do can be discussed. The main question to ask is: “For what activity is it needed?”
- Simple hand magnifiers are often used for reading labels, recipes, prices.
- Stand magnifiers may be good for longer periods of reading.
- Should the device be hands-free, e.g. to draw up insulin? Spectacles with a high + diopter lenses for magnification mean a patient can keep both hands free.
- Does the device need to provide additional lighting? Illuminated hand or stand magnifiers may help.
A case study:How can low vision and rehabilitation services support Mr Solomon? His best corrected distance visual acuity is 6/36. With a 3x telescope he can watch TV at a distance of at least 2 metres, see most of the TV screen and he now does not block the view of other household members. His near vision was 3.2M (size of a large headline) at 25 cm. He was first prescribed +3.00 dioptres reading glasses. He can now read 2M at 25 cm, a size that is 2x smaller than 4M. He was prescribed and taught to use 2 different magnifiers: 1. A +24.0 D illuminated stand magnifier with which he can read even the smallest print in newspapers 2. A 24.0D hand magnifier for reading his mobile phone, seed packets, medicine labels and prices. He also uses it to find the place where he needs to sign a document. Handheld magnifiers are useful for many tasks and are easily portable. He was advised to wear a cap to reduce glare from the sun. Advice on improving lighting and contrast in his house was given by a visiting staff member of a community-based organisation for people with disabilities. He now feels much more independent and is a happier person. The family members are happier too! Other considerations for selecting a device for near activities:
- Does the device need to give viewing choices (such as vertical and horizontal screen)?
- Does the magnification power need to be adjusted?
- Can the image be frozen to give more time to read or look?
Can colour and contrast be changed?
Diabetic Eye Disease: Building Capacity To Prevent Blindness
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