Vision Loss: Caring for Vision-Impaired Seniors

Aging often is accompanied by changes in a person's ability to interpret what he or she can see. The most common causes of age related visual impairment in the elderly are presbyopia, cataracts, macular degeneration, glaucoma and diabetic retinopathy. Untreated visual impairment leads to physical handicap, increased incidence of falls, social isolation and dependency. Active screening for visual loss in the elderly should be part of the health examination. One in six Americans age 45 or older — representing 16.5 million people reports some form of vision impairment. Sometimes, in younger persons with Alzheimer's disease similar changes occur. People may experience a number of changes in visual abilities. For example, they may lose their ability to comprehend visual images. Although there is nothing physically wrong with their eyes, people with Alzheimer's may no longer be able to interpret accurately what they see because of brain changes. Also, their sense of perception and depth may be altered. These changes can cause safety concerns.  

The person for whom you provide care should be evaluated periodically by a physician for any such changes that may be correctable with glasses.  

Most older adults experiencing low vision, will be affected by one of four conditions: macular degeneration, glaucoma, cataracts and diabetic retinopathy .

Macular degeneration	vision loss in the center of the eye; blurred vision; straight lines look wavy; need for more light; affects one or both eyes
Glaucoma	gradual loss of peripheral, or side vision; difficulty driving at night; loss of contrast
Cataracts	hazy vision; difficulty driving at night; double vision; trouble distinguishing colors; sensitivity to glare
Diabetic retinopathy	blurred or changing vision; difficulty reading; floaters; affects central or peripheral vision

Below are some caregiver tips for reducing vision related problems:  

• Create color contrast between floors and walls to help the person see depth. Floor coverings are less visually confusing if they are a solid color.  
• Use dishes and placemats in contrasting colors for easier identification.  
• Describe the place setting and food arrangement on the plate in terms of a clock face so the person can participate in meal time confidently.  
• Mark the edges of steps with brightly colored strips of tape to outline changes in height.  
• Place brightly colored signs or simple pictures on doors to important rooms (the bathroom, for example) for easier identification.  
• Be aware that a small pet that blends in with the floor or lies in walkways may be a hazard. Your loved one may trip over the pet.  
• Control glare by using appropriate window coverings and adjustable lighting.  Use bold, sans-serif fonts and white or light yellow paper for handouts such as activity calendars and high contrast, tactile signage.  
• Provide enlarged, tactile versions of games, eg. playing cards, bingo cards and board games. Such games are available through specialized catalogs.  
• When walking with your loved one with vision loss, offer your arm for the person to hold onto.  
• Walk about 1/2 step ahead of the person so that you can avoid objects in the pathway. 
  
  The National Eye Institute and the American Academy of Ophthalmology recommend that everyone over age 60 get a full, dilated eye exam every two years, or more often if there is an eye disease involved.

  The Family Caregiver Alliance reminds us that if your loved one experiences the symptoms of low vision, such as blurred vision or sensitivity to glare, he or she should seek the care of a low vision specialist—an optometrist or ophthalmologist with particular expertise in this area. This specialist will do a vision assessment and then make a referral for specific treatment, vision-related training and/or assistive devices.

  It is important that your loved one continues to see the vision specialist every year to catch any changes in vision. The sooner such changes are found and possibly treated, the better the chance that your loved one will still be able to retain his or her vision and live as independently as possible.