1. Vision Loss Among Older People The Vision Rehabilitation Service Delivery System: What You Need to Know & How to Refer

2. Presented by Alberta L. Orr and Priscilla Rogers National Center on Vision Loss

3. Vision Loss Among Older People Because of the growth in vision loss in the older population in the U.S., vision loss has become a public health issue. There is a national vision rehabilitation service delivery system in every state. As staff of the Aging and Disabilities Resource Centers, you need to become familiar with these services so that you can become an effective referral sources for this population to the vision rehabilitation service delivery system.

4. The growing population There are already 6.5 million older people age 55 and older who experience age-related vision loss. This number is expected to double as the remainder of the baby boom generation reaches its senior years in 2030. The first set reached age 65 on January 1, 2006.

5. Leading Causes of Age- Related Vision Loss Most older people experience vision loss as a result of one of the following eye conditions: — Macular degeneration — Glaucoma — Diabetic Retinopathy — Cataracts — Hemianopia-vision loss due to stroke

6. Impact of Each Eye Condition on Vision Macular Degeneration People with macular degeneration lose their central vision which makes it difficult to read, recognize faces, and do other close-up work. NEI

7. Impact on Vision Glaucoma People with glaucoma lose the peripheral or side vision which makes mobility difficult. It can also make it difficult to find the next line of text. NEI

8. Impact on Vision People with cataracts experience overall blurring of their visual field, but cataract surgery has a 95% success rate. NEI

9. Impact on Vision Diabetic Retinopathy People with diabetic retinopathy also experience overall blurring but with dark spots which block vision. NEI

10. Impact on Vision Loss Hemianopia This condition is a result of damage to the optic pathways in the brain, which can result from acquired brain injuries due to stroke, tumor or trauma. It can cause vision loss in half of the field. Right Homonymous Hemianopia Lighthouse International

11. Assessing Vision Loss Suggested Vision Component for Assessment Instrument 1. Has your vision become worse in the last 3 months? ____Yes _____No _____Sometimes 2. Have you experienced any of the following problems? Sudden hazy or blurred vision Recurrent pain in or around the eyes Double vision Seeing flashes of light Seeing halos around lights Unusual sensitivity to light or glare Changes in the color of the iris Sudden development of persistent floaters in the eye

12. Assessing Vision Loss 3. If so, have you seen an eye doctor? ____Yes _____ No _____Unsure 4.______macular degeneration _____cataracts ______glaucoma ______diabetic retinopathy _____unsure 5. What is the severity of your visual impairment? (Select only one) ____ No Light Perception or LP only ____Other Legal Blindness ____Other Severe Visual Impairment ____ Declined to answer or doesn’t know

13. Assessing Vision Loss If you have not seen an eye doctor in the last few months or are experiencing problems with your vision, please complete the following questionnaire. The purpose of the questionnaire is to help identify people who may be experiencing a vision problem and who could benefit from seeing an eye care professional, either an optometrist or an ophthalmologist. People who use glasses or contact lenses should answer the questions in terms of how they see when wearing their glasses or contact lenses. (Note: This does not include the use of magnifiers or any other special low vision devices.) ( Source: Arlene R. Gordon Research Institute, Lighthouse International).Arlene R. Gordon Research Institute

14. Assessing Functional Vision Functional Vision Screening Questionnaire—on ADRC website http://www.adrc-tae.org/tiki-index.php?page=EligibilityPublic http://www.adrc-tae.org/tiki-index.php?page=EligibilityPublic Consists of a series of 15 questions to help you determine how the person is functioning visually—such as being able to read newspapers or books, being able to see faces, being able to see TV, to see prices when shopping, being able to get around home or neighborhood. Scoring and understanding the results: Scores are indicated next to the answer for each item. After completing the questionnaire, total the number of #1s the older person provided. People who score 9 or above should be encouraged to seek an eye examination from an optometrist or ophthalmologist and possibly to obtain vision rehabilitation services.

15. Vision Rehabilitation Services — Independent living skills training in adaptive ways to carry out routine daily activities — Communication skills such as reading & writing — Modification of the home environment to make it safe and functional — Outdoor orientation and travel skills training

16. Vision Rehabilitation Services Independent Living Functional Assessment Developed to Address IADL’s & Visual Impairments (PDF) or (Word) Independent Living Functional Assessment Developed to Address IADL’s & Visual Impairments (PDF)(Word) American Foundation for the Blind This tool includes major IADL items that generally affect persons with visual impairments. The American Foundation for the Blind developed the tool through its National Standardized Minimum Data Set project. It can be used as a pre/post instrument. http://www.adrc-tae.org/tiki- index.php?page=EligibilityPublic

17. Vision Rehabilitation Professionals Orientation and Mobility Specialists teach orientation to the outdoor environment and how to travel using a long white cane. Some also teach electronic travel aids. They teach people how to get to bus routes and frequent destinations.

18. Vision Rehabilitation Professionals Certified low vision therapists teach newly visually impaired older persons how to use magnification and telescopic optical devices for close up and distance vision. They work closely with a low vision specialist, either an ophthalmologist or optometrist with a specialization in low vision.

19. Vision Rehabilitation Professionals Rehabilitation teachers teach adaptive techniques for carrying out routine daily activities, such as pouring liquids, safety tips for cooking, and methods for household management, such as cleaning and person management, such as grooming techniques

20. Optical and Non-Optical Devices Optical devices such as magnifiers and telescopes mentioned above are designed to help an individual with low vision make the best use of his or her remaining vision. There are also many non-optical devices such as writing guides for signature, check writing and addressing envelops that can help make tasks easier. These devices can be found in specialty catalogs.

21. Collaboration Get to know your colleagues in the vision rehabilitation field in your state and in your community. There is a Chapter 2 program in every state. This will help you know what services they provide and how the services are delivered so that you can be an informed referral source. Make sure they know what you do too!

22. Resources http://www.afb.orgwww.afb.org The American Foundation for the Blind web site addresses the needs of family members, consumers and professionals. The site contains information about coping with age-related vision loss, how to find vision rehabilitation services in every state and location, and information about how to find specialized aids and equipment.

23. AFB’s Online Directory of Services http://www.afb.org/services.asp AFB’s directory has information on more than 1,500 organizations, agencies, and product manufacturers. It includes state and province listings of organizations in the U.S. and Canada. The online edition is fully searchable and includes a handy step-by-step “how to” guide, quick links to agency web sites.

24. Resources http://www.nei.nih.gov/www.nei.nih.gov/ The National Eye Institute website has a wealth of information on eye diseases and the latest research. It contains vision simulations to help you understand how people with a variety of vision problems see.

25. Resources http://www.visionconnection.org This web site, developed by Lighthouse International and sponsored by Pfizer Ophthalmics, contains valuable information for consumers and professionals about prevention, rehabilitation, research, and technology. Vision simulators are also available through this site.

26. Resources The Talking book program--Through a national network of cooperating libraries, the National Library Service administers a free library program of braille and audio materials circulated to eligible borrowers in the United States by postage-free mail. Eligibility: Any resident of the United States or American citizen living abroad who is unable to read or use standard print materials as a result of a temporary or permanent visual or physical limitation may receive service. Contact: 1-888-NLS-READ http://www.loc.gov/nls/index.html