Enhanced vision webinar coping with visual impairment

Coping with Visual

ImpairmentKevin Huff O.D.

ViewFinderLow 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 LossFear

Gallup poll 1998, 42% of adults listed blindness as the most feared disability.

Other studies show blindness is more feared than death.

Vision LossVision 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.

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

ShockIt 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!”

This is a normal response to an emotionally painful situation.

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.

This often begins with the question “Why Me?”

There is usually no real answer to that question.

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

Patients often make very emotionally charged comments.

“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!”

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

“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.”

It is perfectly normal to feel anger about vision loss.

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

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.

Responding to Patients 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.

Responding to Patients 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.

Responding to Patients The 3.0 Response is a great

tool to use when patients say emotional things.

“You feel_______, because _________.”

Responding to Patients 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.”

Responding to Patients “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.”

Responding to Patients 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

(888) 811-3161www.enhancedvision.com

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

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.

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.

Merlin LCD & HD

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(888) 811-3161

Excellent option for near tasks

Reading

Writing

Looking at photos

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

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

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

Reading

Writing

Working with hands

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

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

Features

Similar Advantages to Acrobat LCD with a few extras

Even more portable

Able to capture images

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. 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(888) 811-3161

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

Lightweight Portable CCTV Ideal size for patient to carry with

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

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. 2 year warranty (888) 811-3161

To Schedule a

Free – No Obligation in Home Demonstration

Call: 888-811-3161

Email: marketing@enhancedvision.com

Enhanced vision webinar coping with visual impairment

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