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Diagnosis and Treatment

Vision Information pages

We present the following information pages as a way to help our visitors learn more about low vision issues. This will also be useful for the general public to gain insight into visual limitation challenges.

  • How Vision Works

    Basic vision information and parts of the eye.

  • Doctors and Eye Examinations

    Information on types of vision care professionals and what to expect when they do an examination.

  • Solutions

    Covers some possible solutions for Aniridia or assistance ideas for low vision problems. Also describes and shows types of visual aids.

  • Challenges

    Discussion about some of the challenges we face both due to the physical appearance difference and having to deal with visual limitations.

  • Public Awareness

    Helpful information for the general public on how to interact with people who have low vision. (more…)

Vision Conditions

This section contains information about other vision and/or medical conditions that are not directly related to Aniridia.

AMBLYOPIA

Amblyopia is a term used to describe an uncorrectable loss of vision in an eye that appears to be normal. It’s commonly referred to as “lazy eye” and can occur for a variety of reasons. A child’s visual system is fully developed between approximately the ages of 9-11. Until then, children readily adapt to visual problems by suppressing or blocking out the image. If caught early, the problem can often be corrected and the vision preserved. However, after about age 11, it is difficult if not impossible to train the brain to use the eye normally.

Some causes of amblyopia include:

  • strabismus (crossed or turned eye)
  • congenital cataracts
  • cloudy cornea
  • droopy eyelid
  • unequal vision
  • uncorrected nearsightedness, farsightedness or astigmatism

Amblyopia may occur in various degrees depending on the severity of the underlying problem. Some patients just experience a partial loss; others are only able to recognize motion. Patients with amblyopia lack binocular vision, or stereopsis – the ability to blend the images of both eyes together. Stereopsis is what allows us to appreciate depth. Without it, the ability to judge distance is impaired.

SIGNS AND SYMPTOMS

  • Poor vision in one or both eyes
  • Squinting or closing one eye while reading or watching television
  • Crossed or turned eye
  • Turning or tilting the head when looking at an object

Note: Children rarely complain of poor vision. They are able to adapt very easily to most visual impairments. Parents must be very observant of young children and should have a routine eye exam performed by the age of 2-3 to detect potential problems.

DETECTION AND TREATMENT

When amblyopia is suspected, the doctor will evaluate the following: vision, eye alignment, eye movements, and fusion (the brain’s ability to blend two images into a single image). The treatment for amblyopia depends on the underlying problem. In some cases, the strong eye is temporarily patched so the child is forced to use the weaker eye. For children with problems relating to a refractive error, glasses may be necessary to correct vision. Problems that impair vision such as cataracts or droopy eyelids often require surgery. Regardless of the treatment required, it is of utmost importance that intervention is implemented as early as possible before the child’s brain learns to permanently suppress or ignore the eye.

Ref: http://www.stlukeseye.com/Conditions/ambylopia.html

Cystoid macular edema (CME)

Cystoid macular edema (CME), or swelling of the macula, typically occurs as a result of disease, injury or more rarely, eye surgery. Fluid collects within the layers of the macula, causing blurred, distorted central vision. CME rarely causes a permanent loss of vision, but the recovery is often a slow, gradual process. The majority of patients recover in 2 to 15 months. In this retinal photograph, the swelling is the yellowish spots (arrow) in the macula.

SIGNS AND SYMPTOMS

  • Blurred central vision
  • Distorted vision (straight lines may appear wavy)
  • Vision is tinted pink
  • Light sensitivity

DETECTION AND DIAGNOSIS

It is very difficult to detect CME during a routine examination. A diagnosis is often based on the symptoms of the patient and a special dye test called a fluorescein angiogram (FA).

TREATMENT:
The first line of treatment for CME is usually anti-inflammatory drops. In certain cases, medication is injected near the back of the eye for a more concentrated effect. Oral medications are sometimes prescribed to reduce the swelling.

Ref: http://www.stlukeseye.com/Conditions/cme.html

How Normal Vision Works

Outer eye:
The light reflected from objects travels through the air. What we see are the light rays which strike the retina in the back of our eyes. In order for the vision process to produce a good quality image for the brain to interpret, a lot of things have to function properly to correctly focus the light rays onto the retina. The process is called refraction.

First, the light goes through the conjunctiva, which is a thin membrane that covers the cornea. The main purpose of the conjunctiva is to provide a seal which keeps debris from entering the eye.

Anterior Chamber:
The next group of parts make up the anterior chamber, or the frontmost structures in the eye. Right behind the conjunctiva is the cornea, which is the first stage of refraction in the eye. The normally smooth hemispherical shaped cornea is responsible for starting the process of refraction by directing light rays toward the lens so that the lens can more easily focus them on the retina. The cornea has more refractive ability than any other part of the eye.

Right behind the cornea is aqueous humor fluid. This is a fluid that nourishes the cornea and helps to protect the iris, pupil, and lens. The fluid body is constantly being recirculated with entire replacement taking about four hours. It is delivered behind the iris, flows through the pupil, and leaves between the iris and cornea.

After light passes through the aqueous humor, it goes through the pupil to the lens. The purpose of the pupil is to control the amount of light which is allowed to strike the lens just behind it. The size of the pupil is controlled by the iris which detects intensity of incoming light and adjusts the size of the pupil accordingly. The iris contracts the pupil to limit intense light and expands the pupil to allow maximum light entry in darker instances. The iris is a sphincter (ring-shaped) muscle.

The iris is visible as the circle of color in the eye, while the pupil is the black circle in the center of it. The color of the iris depends upon the pigment deposits within it combined with the purple to black surface of the rear of the iris. The pigment deposits range from yellow to reddish brown and can sometimes include some white. When there is little pigment, the eye color appears as bluish.

The lens refracts the light rays that pass through it so that the light is focused on the retina at the back of the eye. When viewing distant objects, the lens is almost flat. While viewing close objects, the lens becomes more curved as the distance range becomes narrowed.

Posterior Chamber:
The adjusted light travels from the lens through the vitreous fluid to the back of the eye. The vitreous fluid is the gel like material which gives the eye it’s sphere shape and holds the retina in place.

Lining the back of the eye is the retina, which is the term for the collective group of rod and cone cells. At the center of the retina is the macula which is used for more reliable vision in bright light. The macula only contains cone cells. Due to the natural flow of light through the eye, the image as it strikes the retina is a reversed copy of the actual image being viewed.

The rod and cone cells contain chemicals which are activated by light. These cells convert the light which strike them into electrical impulses, which will be transmitted to the brain for processing. It is important to note that Vitamin A is used by these cells to produce the chemical conversion. If a person has Vitamin A deficiency, their vision in darker situations may be compromised.

The rod and cone cells get their names due to their shapes. The rod cells measure about 1/400th of an inch in length and are about 1/100th of an inch thick. There are about 120 million rod cells in each eye. These cells are responsible for the black and white part of the image production and work with dim light.

The cone cells are shorter and thicker than rod cells. There are about 7 million cells in each eye, which are responsible for the color portion of the image creation. Cone cells work with brighter light than the rod cells do.

Beyond the eyeball:
Once the light has been converted to a stream of electrical impulses, the information flows from the eye to the brain via the optic nerve. Because the opening of the optic nerve is located within the retinal area, a tiny blind spot naturally occurs. This blind spot is not normally noticeable within the image.

Because the sharpest vision occurs at the macula, the brain is constantly adjusting the eyeball to have the object of attention to be in the center of the image.

All during the time our eyes are open, there is a steady stream of light flowing in and being processed. The eye is also constantly being positioned for target and the lens adjusted for focus. It is simply overwhelming to try comprehending the amount of work our eyes do to provide us with vision!

Other parts of the eye:
We have covered the parts of the eye that are directly involved in the flow of light and conversion to electrical impulses. Now we will touch upon a few other parts which deal with maintenance and positioning of the eyes. These also play a huge role in the overall health of the eye and therefore the quality of the image you perceive. The names may be helpful in case s doctor mentions one of them in a discussion.

The retinal arteries are responsible for blood flow to and from the eye. They enter the eye through the optic nerve and terminate within the vitreous body.

The sclera is basically the casing of the eyeball. It is made up of tough white tissue and contains tiny blood vessels. The white part of the eye surrounding the colored iris is part of the sclera. This whiteness can appear to be bloodshot if the blood vessels within become expanded due to eye irritations (caused by fatigue, dust particles, some medications or drugs, and alcohol).

The outside of the eye is cleaned with a fluid produced at the lacrimal gland, which is located just above the outer corner of the eye. The fluid is distributed over the surface of the eye during blinking, helping to wash dust and particles away. The eye has a glossy appearance when the fluid is washed over the conjunctiva. The tear fluid exits the eye at the lacrimal sac, located in the lower corner of the eye nearest the nose. It drains through the nasolacrimal duct, in the nose.

The eyelids are comprised of skin which covers the eye while it is closed. They help to protect the eye during sleep or if the brain instructs them to close if it senses objects are too near to the eyes. They also help to distribute the tear fluid during blinking, which is a rapid closure and reopening of the eyelids.

The eyelashes are the short hair groups on each eyelid. They help protect the eyes from particles and dust. These only live for a few months, but new lashes are constantly replacing old ones. There are about 200 lashes on each eye.

Eye muscles:
The eyes are positioned for best viewing by a group of muscles that move in unison in both eyes. Positioning the eye itself is more of a fine tuning operation because more often we turn our entire head in the direction of the object(s) which we want to view. However, the job of eye positioning is still very important since making the constant slight adjustments with the eye saves a lot of wear and tear on neck muscles.

The rectus inferior moves the eye downward, the rectus lateralis moves the eye to the side, and the rectus superior moves the eye upward. Also, the superior oblique moves the eye sideways with some slight rotation as does the inferior oblique muscle. The eyelids are controlled by muscles also, with the levator palpebrae causing the lid to open and the orbicularis palpebrarum which closes the lid.

That wraps up the basics of how the eyes work. There is a lot more detail that isn’t covered here though. Hopefully you have learned something in the text above and it will help build a foundation upon which you can further the quest for information.

Doctors and Exams

Because good vision is such an important part of life, it just makes sense to get regular checks of vision and general eye health. Vision problems often start with few signs of their existence and may only be detected by the time they become severe. Regular doctor visits not only help to show early indications of problems, but also allow a better relationship between the doctor and their patient.

Frequently people say they had a vision test which revealed they need glasses. They often don’t understand the vision problem the glasses fix, they just know they have better vision again. This is sad. It is hard to know what questions to ask, but a person should really try to know what is going on with their own body. If one doctor doesn’t explain the condition to you, keep trying others.

Here we will take a quick look at the kinds of eye doctors which are available and then a brief trip through a basic examination session.

Who treats your vision:

There are three main classes of people who specialize in vision care; opticians, optometrists, and ophthalmologists. These classifications are subdivided into specialty fields, such as an ophthalmologist becoming just a cataract surgeon. It is not uncommon for a patient to visit more than one person to treat a vision (or other medical) problem.

It is important to note that any one doctor will not know everything relating to a patients care. You may need one appointment for regular vision exams, another to further diagnose changes or problems, and yet another to help you obtain the best visual aid for correction. While referrals are commonplace, it is almost always up to the patient to research assistance aside from the basic follow-up as instructed.

Optician:
An optician manufactures and/or dispenses eyeglasses, contact lenses or visual aids. They are not qualified to perform real vision testing, but work with the prescription needed provided by a vision exam. They can note your vision with the visual aids to insure they work properly.
Optometrist:
An optometrist is a Doctor of Optometry (DO) trained in all areas of optics and vision science. They are qualified to give a complete vision exam and diagnose all types of vision problems. They can treat vision problems with the use of glasses, contacts, or other visual aids and (if licensed to do so) may also prescribe drug treatments. They may also refer patients to an ophthalmologist or another type of medical doctor for further diagnoses or treatment.
Ophthalmologist:
An ophthalmologist is a Medical Doctor (MD) qualified to perform complete vision tests and diagnoses. They can treat vision problems either physically (visual aids), medically (drugs), or surgically. They are qualified to also detect other possible medical problems revealed during a vision exam and refer the patient to other medical specialists.
Low Vision Specialists:
Within the optician class is a less widely known group of people called Low Vision Specialists. These are people trained to help match more powerful visual aids with those who suffer from severe vision loss. A low vision specialist knows many types of visual aids and how they work. They may perform their own style of vision testing on patients as well as get to know a patients daily needs and lifestyle. There is a wide range of devices that can assist in improving vision, but sadly most doctors who diagnose vision problems do not refer patients to obtain the visual aids which could benefit them greatly.

Just as important as picking the right type of doctor is picking the right doctor for your personal care. Doctors are people too, meaning they have different personalities, styles, and levels of training. The patient should not only trust and respect the doctor, but should feel very comfortable with the office visit. If the patient is uncomfortable or feels the doctor is not serving them well, the patient has every right to seek another doctor. Both the patient and the doctor benefit from a good relationship during the visits.

Basic eye exam:

Examinations provide two important functions for the patient and the doctor. The immediate return is a determination of current conditions and abilities of the patient. The long range benefit is that a doctor can use prior history information to determine how a known condition is progressing or to recognize gradual diminished capacity, often before a patient notices anything. Yearly exams are very strongly recommended for both children and adults, but are essential for people over 40 years old.

There are many aspects of examinations, but they are designed to check on three situations; the quality of vision, the health of the eye, and the possible presence of other health concerns. Not all vision problems are caused by eye problems and not all eye problems inhibit normal vision.

It is also interesting to note that a doctor can inspect the blood stream of the body by looking at the blood vessels in the retina. By using high powered magnification and bright light, a retinal artery examination is the only place a doctor can view the blood stream without cutting open the body. This portion of the exam may help a trained doctor to recognize the presence of some existing health problems that have not been detected previously. An eye examination is not just for the benefit of vision information.

What actually occurs at each examination depends upon many different factors. The presence of vision or eye conditions will likely increase the number or types of tests performed on a patient. If this is the first visit to a doctor, they will probably do a more complete exam (opposed to a quicker routine exam by a regular doctor) so that they may get an understanding of personal situations. An examination will also be extended if the doctor notices any change in vision or eye health from previous exams.

We will discuss some of the common aspects of an examination to give a better understanding of why each part is performed. Most doctors will explain the steps as they go along, but you should ask any questions you might have (however trivial you think they are) at the time you think about them. As the patient, you do have the right to know. Some patients also write down questions or symptoms prior to an appointment so they don’t forget anything. Some even take notes during an exam for later reference.

Discussion:

Usually you will be visited first by the doctors’ assistant. Often the first order of business is a causal style discussion about why the patient is there. Is it a routine visit, any new problems, any other change in overall health aside from vision, changes in lifestyle or work, etc. Patients are asked to describe (in detail) any changes and their symptoms or problems so that the doctor can deal with them.

Beyond the scope of information gathering, these interactive sessions are also used to put a patient at ease or to establish a common trust. A patient is easier to examine if they are calm and comfortable with the staff and surroundings.

The eye chart:

The first real test for the patient is the session of reading letters from the eye chart. The chart can be a physical chart mounted on the wall or some doctors use a chart projected onto a wall or mirror. If the examining room is small, the system of mirrors can help to increase the distance of the chart from the patient. Some doctors also use handheld charts with bigger type for patients with low vision. Whatever the chart consists of, the goal is still to get an idea of the visual acuity. Some doctors also use charts that have colored letters to test for colorblindness or have different backgrounds to check contrast recognition.

Normally a doctor will have you read the chart three times; once with both eyes, once with only the left eye, and once with the right eye only. Sometimes the doctor will change the chart for each test to help prevent ‘cheating’. The visual acuity is recorded for each eye so that future tests may be compared to them for both eyes individually.

External exam:

Once the level of vision for each eye has been established, a doctor will perform a series of tests (in any order they choose) to determine the working condition of each eye. Results from these tests will give the doctor an insight into possible eye problems. The tests include (but are not limited to); eye positioning, visual field, pupil reaction, and outer eye health.

Eye positioning is usually checked by having the patient face forward and following an object (pen, pencil, or whatever) without moving their head. The doctor will notice if both eyes are tracking the object equally or if one eye is out of alignment. Even an eye with greatly diminished vision will track the object as long as it is able to perceive it. This test may be performed at varying distances if the patient has either nearsighted or farsighted conditions.

Visual field is tested by having the patient face forward and stare at an object directly in front of them. The doctor then slowly moves another object into view from the sides, top, and bottom. The patient tells the doctor when the object can be identified. This test is done for both eyes individually and sometimes again using both eyes. The doctor may repeat the tests several times to insure accurate results.

Pupil reaction is tested by shining a bright light into the eyes to see if the pupil quickly restricts (close) to limit the amount of light entering the eye. Each pupil should have a similar reactive time and should also open quickly again once the light has been removed.

Outer eye health tests simply consist of checking normal blinking ability, the appearance of the eyelids (if they close tightly or leave a gap), and external abnormalities such as redness or swelling. Many problems of this type will get you a referral to a medical doctor for treatment of problems not associated with the inner eye.

The biomicroscope:

With the vision and performance tests out of the way, the doctor will look at the inside of the eye. In order to do this, a device called the biomicroscope is used. The biomicroscope is a high powered magnification unit which enables the doctor to see detail of the inner eye. A vertical beam of light inside of this device can be moved around to allow the doctor to inspect any area of the inner eye which is visible from the front. Because the exam is done with this vertical beam of light, it is often referred to as the slit lamp examination.

The patient places their chin on the chin rest of the biomicroscope and the doctor looks through eyepieces on the other side of the unit. The doctor will ask the patient to look in different directions at times to obtain a view of different parts of the eye.

Sometimes a doctor will also use a ophthalmoscope, which is similar in function to the biomicroscope but is a hand held unit rather than a big machine. It uses a less intense light and offers more flexible movement options for the doctors viewpoint.

The pressure test:

Abnormally high intraocular pressure (called Glaucoma) is a very serious condition which can eventually lead to total blindness if it is not treated in a timely manner. The doctor uses a device called a tonometer to test the pressure inside of the eye. This device is usually mounted on the biomicroscope unit and the test will normally be performed right after the inspection of the inner eye.

The patient is given anesthetic eye drops (which remove pain sensitivity) and then fluorescein (a dye) is applied to the eyes. This dye coats the front of the conjunctiva during blinking. Once the patient is back into the biomicroscope chin rest, the white light is changed to a blue light and the tonometer is slowly brought forward until it touches the front of the eye. The doctor will see a pattern as the pressure of the tonometer matches the intraocular pressure.

Pressure readings can change during the day and accordingly from exam to exam. This is one good reason for having regular exams. Once a normal range is established on a patients record, a doctor can more easily determine if a notable change is occurring. If the pressure is abnormally low or high, the doctor might schedule a follow up exam to recheck the reading.

Other tests:

There may be other tests that a doctor performs due to other conditions which may be present or likely to occur. The history of the patient or family tree might encourage more in depth testing. Modern technology is producing more advanced testing devices as well as treatment options.

Vision Solutions

VISION CORRECTION INFORMATION

The first thing we need to cover is visual aid prescriptions. Understanding what the specifications mean helps to guide a persons best match. Terms relating to power and diopter need to be covered.

Magnification power:

Magnifying or reading glasses usually have their magnification power listed as a number followed by an X, such as 2X. The “X” means that is the power rating, or the size of enlargement. A 2X magnification makes items appear to be twice as large, 4X yields four times, etc.

When choosing visual aids, keep in mind that the trade off for the enlarged object is a loss of total visual area. It is best to pick the lowest amount of magnification needed to comfortably view an object so that more area of the object is available at any given time.

Diopters and focal length:

A diopter is the measurement of refractive strength, usually marked as a number followed by a D, such as 10D. A plus or minus sign before the number indicates a positive or negative property.

A lens rated at one diopter (+1D) will focus at a distance of about 40 inches (one meter) from an object. The distance (in inches) of best focus (or focal length) can be calculated by dividing 40 by the diopter value. A +60D lens (such as the average human eye) will focus at 40/60 or 2/3 of an inch (just over 22 millimeters).

Focal length is an important factor because it determines how close an object must be to the lens. A person would want to choose a visual aid with a realistic working distance in mind. Many visual aids have two focal length ratings, one for the distance between the object being viewed and the aid and one for the distance between the aid and the eye. The second value is usually not posted for glasses and contact lenses as it is usually a standard measurement.

Binocular and telescopic ratings:

Binoculars and some visual aids are marked with specifications similar to 8×21. In this example, 8 is the power magnification and 21 is the size of the front lens in millimeters. The size of the lens determines the amount of light which can enter into the system.

Visual aids:

Now that the properties are defined, we shall look at some of the available visual aids. There is a huge variety of styles and options in each one of these groups. The types and abilities are also always changing.

Here we will cover the more common visual aids. Glasses and contacts, magnifiers and binoculars, sunglasses, and finally surgical options to improve vision.

Glasses:

When the eyes are not able to clearly see objects, glasses might be a good solution. Glasses contain convex or concave lenses depending on whether they are treating a near-sighted or far-sighted condition respectively. The power level of the glasses is determined by the severity of the bend of the lens. The lens in glasses are designed to perform the same basic function as the lens of the eye, but the lens of the glasses help to start the focus process to make up for what the eye cannot do.

Bifocals are glasses with two different prescription values on one lens. Usually one part is for help with distance viewing and the other for close work such as reading. It is possible to need different prescriptions for each eye as well.

Contact lenses:

PLEASE NOTE: While contact lenses are widely popular in todays society, they are normally not recommended for people with Aniridia or other corneal problems. This is because the air and moisture properties of the cornea are severly limited with contact lenses as well as the possibliliyt of irritation or abrasion to the conjunctiva or cornea.

Serving the same basic function as regular glasses above, contacts are popular with people who don’t want to wear glasses due to appearance or possibility of the glasses falling off. Contacts are placed on the eyes surface and held in place by the eyelids and the eye fluids. Contacts are made to meet prescription specifications just like glasses.

Contacts need to be kept very clean since they rest on the surface of the eyes. Some people may experience allergic reactions or sensitivity to the chemicals used to clean contacts or problems with the eye adjusting to the new addition.

Contacts require much more maintenance than glasses. Most contacts are worn through the day but must be removed during sleep periods. Extended use contacts can be worn longer, but still need regular removal for cleaning. Some people have difficulty putting in contacts and it is possible for contact lenses to fall out accidentally.

Rigid contacts are made of shaped solid transparent material. Since they are not flexible, they can take some time to adjust to. They can also cause eye fatigue and may even scratch the eye or eyelid if they move around. These also inhibit the proper flow of oxygen to the conjuctiva, which can become a problem.

Gas-Permeable contacts are much like the rigid contacts, but are designed to allow oxygen to flow through them. They are also a bit more flexible which allows for a better fit.

Soft contacts are even more flexible and are designed for a more comfortable fit.

Giant papillary conjunctivitis (GPC) can occur with soft contacts. It is an allergic reaction which may involve discharge from the eye and irritation. People affected by this should switch to the gas-permeable contacts or discontinue using contacts altogether. Episcleritis is a sensitivity reaction where the eye becomes red in one area. It occurs with rigid or soft contact lenses.

Magnifying glass:

Magnifiers come in a variety of shapes, sizes, and powers. These are made up of a convex lens (middle thicker than the edges) whose strength (magnification power) is determined by the severity of lens curve. A magnifier is often used for limited periods of time to do a specific task, such as reading fine print in a phone book.

Binoculars And Telescopes:

Like magnifiers, binoculars and telescopes come in a variety of shapes, sizes, and powers. They are different though in that magnifiers are designed for enlarging close objects while binoculars are designed for enlarging distant objects. Most binoculars have magnification powers of 8x to 15x with some models having a range of adjustable power (called zooming). Personal telescopes have magnifications of 250x to 750x and are used for even farther distant objects, such as astronomy viewing.

Most binoculars are hand held devices that require both of your hands to control (one hand needed for focusing or zooming). Now you can also get binoculars that have head-mounting ability or even some which clip on to the frames of glasses and flip out of the way when not in use.

Sunglasses:

Believe it or not, sunglasses are considered to be a visual aid as well as eye protection, especially for people with Aniridia. Sunglasses have shading material that limits the amount of light which is allowed to enter the eye. This provides relief from bright sunlight causing glare or eye fatigue. In addition to help with shielding of bright visible light, many sunglasses now protect from harmful ultraviolet (UV) light which can be present even on overcast or cloudy days. Protecting the eye from ultraviolet light is said to increase its life expectancy for normal functions. Always read the labels on sunglasses to determine the level of UV protection they offer.

Also available are glasses that combine glasses prescription with shading qualities. There is also a style of sunglasses available which changes its shading as the light intensity changes. They provide less shading in lower light environments and more shading in bright light. Be sure to inquire about the reaction time of these before purchase.

Surgery:

While surgical correction methods offer the best cure for vision problems, the subject is far to complex to cover all of them here. Surgery is an issue best left discussed between a patient and doctor.

There are two main types of surgery, incision and laser. Incision surgery is where a doctor operates by hand and uses tools within the eye. Laser surgery involves a machine which uses a laser beam to perform the operation. Laser surgery often requires very little incisions, usually just the conjunctiva and cornea is peeled back for this.

People with Aniridia will often face surgery to correct problems associated with the condition. Kerato-Limbal Allograft (KLA or KLAL) surgery is incision surgery to replace some of the corneal (kerato) stem cells (limbal) with good stem cells from donor cornea. Many people with Aniridia also develop cataracts which is a clouding of the lens. Cataract removal surgery is usually an incision surgery for Aniridics as the surgeon may recommend replacing the damaged lens with an artificial one during the operation. Glaucoma (high internal eye pressure) is another condition which Aniridics face that may be addressed by surgically placing a shunt in the eye drainage canal.

It is VERY important to consult a physician or surgeon who is very familiar with your particular condition(s).

Visual Aids

In this section, we will show you pictures of some of the visual aids that are currently available. The picture quality is not the best in the world, but at least you can get an idea of the size of these devices as well as their general physical styles. Along with the pictures, we have included some text for each device to help you to better understand what it does best and its other important properties.

 

This picture shows eleven different visual aids side by side so that you can compare them by size. The size and design of each device is as unique as its intended benefit, natural limitations, and cost. No visual aid that I am aware of is best suited for all situations or conditions.

 

 

 

The first visual aids we will discuss is a regular pair of binoculars. It might seem trivial to people with good eyesight, but this device helps people with low vision to see things from a distance that others could see without it. It could be used for watching birds and looking at scenery on trips. It will not help to read small print nor would it be useful for most everyday duties.

 

 

Pictured here is a colllection of assorted styles of magnifiers. The lower power magnifiers can be used to read material that is just a bit too hard to read without an aid. The higher power devices come in handy for reading from the dictionary or phone book. The one problem with all of these devices pictured is that they require the use of one hand to hold them. You cannot hold a book and turn the page while holding a visual aid in place all at the same time.

One device not in this picture (but is in the picture of all devices together, (bottom righthand corner) is the flat page magnifier. These may come with a stand. It is very useful for placing over the page of a book and being able to read without holding the magnifier in place or having to move the magnifier back and forth as you read.

Pictured here is a colllection of assorted loupes, often called Jewelers loupes because they are commonly used in fine jewelery work. These are available in a range of sizes, styles, and magnification powers. Some of these have multiple lens sections that can be combined to allow many magnification powers from the same device, such as the square white loupe in this picture.

Loupes are more useful for reading minimal amounts of material at a time because of the small lens size. For example, you would use a loupe to read your favorite recipe rather than reading the whole newspaper. Some people use loupes for reading thermometers, dial settings (on stoves, washing machines, etc), and have a CCTV (see below) for reading books or other printed material.

The Beecher Mirage was one of the first visual aids available that was worn like a pair of glasses. They are still available today from low vision centers. It is said to be similar to opera glasses in power and style. The device is just like a pair of binoculars, except that it mounts on a headband for handsfree usage. This device can be useful for watching TV and movies. The front lens is higher than eye level, which allows you to see your regular view around the small eyepieces where the magnified view appears. Reading caps can be obtained for the Mirage that slip on the front lens and allow for reading instead of distance viewing.

Spotting scope A spotting scope is a monocular (for one eye) device which offers up to 50x power magnification. It is the largest and heaviest visual aid that is covered here, but it also offers over three times the magnification of the second best pair of binoculars here. It would be useful for distance viewing such as bird or wildlife watching or looking at scenery.

 

 

 

 

 

 

Here are two other binoculars which are smaller than what we have discussed above. They offer easier portability and can be used while traveling to read street or business names.

 

 

 

 

This monocular mounts to glasses (either prescription or clear) and can flip up out of the view with the motion of one hand. Because it mounts to glasses, it offers hands free usage. It is also very light and does not cause much added pressure to the nose in extended wearing.

 

 

Monoptic (front) This is another view of the device mentioned above. One very nice feature of this device is that it allows one hand focus ability, which will also quickly adjust between distance and close (reading distance) viewing. It closely matches the Mirage mentioned above, but is much lighter and less obstructive in the normal view.

 

 

This is a CCTV (closed circuit TV) device made to magnify text and objects. There is a camera which points toward asection of the movable tray. The picture on the monitor can be controlled with a few adjustment knobs for focus, magnification, contrast, and even some line reading guides. The device can greatly enlarge small print and will also allow visually impaired people to trim their own fingernails and other difficult tasks. Almost anything which can be placed between the camera and the tray can be greatly magnified with this device. In this picture, the screen shows the lowest magnification setting while viewing dictionary print. This shows 20 lines and 53 characters from this dictionary.

 

 

In this picture, the screen shows the highest magnification setting of the CCTV above while viewing the same dictionary print. It shows 3 lines and 7 characters with this setting. For reference, the measurements of a standard character in this dictionary is 1/16″ wide. The character was 1/4″ wide on the screen at lowest magnification and 3/2″ at the highest magnification. This means the magnification power of the device is 4 to 24 times the size of the original object.

 

 

Newer CCTV devices usually feature a larger flat screen which is less bulky than the old style monitors. Pictured here is an Acrobat LCD with a flat panel monitor and the camera mounted on a moveable arm to provide for viewing of objects at different angles or places.

Some of the modern units allow for close or distant object magnification. The device pictured here can enlarge text on material using the reading mode, help with personal grooming with the mirror mode, and zoom in on the stage during a presentation with the distance mode.

These units allow for a wide range of magnification levels as well as different color or video modes.

It is possible to take these units with you when you travel, but they have to be plugged in to an outlet while in use (they do not use batteries). Some of these come with a travel case or you may be able to purchase a case as an option. The case is about the size of a suitcase and many have wheels so you do not have to carry the device.

Those seeking more portable devices now have a variety of “Video Magnifiers” to choose from. These compact hand held devices have an LCD screen on top with a camera underneath. You simply position the device over the material you want to enlarge and view it on the screen. Unlike the desktop devices described above, these require that the material is very close to the camera. They are not for distance viewing. Pictured here is a Pebble video magnifier.

These units usually have a few levels of magnification and some different color or video modes. Some units can capture (freeze) an image on the screen, which is handy for viewing items away from you, such as on the top or bottom shelf at a store.

The benefit of the video magnifiers is that they are lightweight and operate on batteries (usually rechargeable batteries come with the unit). They do a wonderful job of enlarging price tags or product labels at the store. These can also be used to help write checks or fill out forms, some units include a stand to provide a hands free operation.

 

Another option for portable use is the Jordy, which is pictured here. The Jordy is a light weight head gear visor, wornmuch like a hat. This provides for a hands free operation.

The Jordy visor has two small LCD screens (one for each eye) and a camera that points forward. While wearing the device the screens show images just like you are looking at them in normal situations. This offers a more “natural” feel over the effect provided by desktop magnifiers.

The unit is controlled by a seperate box, which can clip onto a belt or pocket. Using this you can adjust the level of magnification, color modes, and other settings. The small rechargeable battery pack attaches to the control box.

The Jordy provides for either close or distance viewing. With the reading lens closed you can view material from about a foot away. Without the reading lens you can view distant objects, much as like with binoculars. Although this allows you to view distant objects better, it is NOT recommended for walking or driving (any activity where you are in motion) due to the much smaller “field of view” which restricts the abiltiy to safely navigate around objects.

While the Jordy’s main benefit is its head worn use, there is an optional Stand for the visor which allows it to operate much like a desktop style magnifier. The Jordy can also be connected to a television or any device which has video inputs.

There are many more visual aids available. This is just a sampling so that you can get an idea of what each type might look like and the tasks they would most likely be useful for.

Vision Tools

TOOLS TO ASSIST VISION

Not all vision problems can be treated or corrected by visual aids. Therefore, it is only logical to mention other tools or methods which can improve the quality of life.

Basic speech recognition

For those people who do not want to spend the money for a full professional speech recognition program some of the newer operating systems include basic speech recognition abilities.

For example; Microsoft Windows Vista and Microsoft Windows 7 packages come with basic speech recognition utilities which can be used to both control basic computer functions as well as allow basic dictation and editing abilities.

In order for a person to use speech recognition software, a microphone is required to be installed on the computer. There are many types of microphones available. digital microphones (plug into the USB port) are the best for speech recognition. Among these, headset microphones are the preferred microphones as they stay right by the mouth even with head movement. However, a qood quality desktop or clip-on microphone should perform well as long as the voice is directed toward it.

A fast processor (1.5ghz or greater) and plenty of memory (2gb or greater) is also a requirement for reliable recognition. Many people who use speech recognition also use screen reader software, in which case a sound card with headphones or speakers is also required.

Speech recognition works by matching patterns in the voice spoken through the microphone with a set of patterns for letters or word combinations. Therefore training is required for proper recognition. A person must speak clearly to provide reliable recognition. Even after several hours of training, there is a good chance that mistakes will be made in the recognition process. The software will continue to learn as it is used and will also learn as corrections are made to recognition results.

People with low vision may find the use of speech recognition to be very helpful to them while performing routine tasks or creating basic text documents. Using voice to select objects on the screen is often faster than locating the mouse pointer. Using voice to enter text into documents is also faster than locating keyboard keys and can be useful for having the speech recognition software enter the text with proper spelling automatically.

Keep in mind that there are limitations to speech recognition advantages. For example, I used speech recognition to create the text of this document. However, I was not able to enter in the HTML codes as none of these are in the dictionary used by the software. The best advice is to use speech recognition where practical and fall back on traditional keyboard and mouse activities in all other situations.

Braille:

Braille is a system of using raised dot patterns to indicate letters or words. Once a person learns the patterns and their meanings, they have access to a growing supply of braille ready material. Reading braille requires a decent amount of sensitivity feeling in touch to accurately interpret the patterns.
Books on tape:

Several libraries offer books on tape. There is a growing number of titles that are available. There are even some services which provide mail delivery service, which allows the person to receive and send back these tapes from their own mailbox.

Check guides:

Many places that sell visual aids also sell tools that help people perform common tasks. There are plastic templates designed to put checks into which make it easier to distinguish where each field for writing is. Several other templates are usually available for other types of paperwork.

Computer software:

There are several places which sell items such as screen magnifiers, screen readers, and even document readers (usually using a flatbed scanner). The readers usually include an external box which speaks the text, although some use the computers sound card. The quality of available voices has improved over the last few years.

Many of these places will also carry voice recognition software. This allows the user to speak commonly used commands instead of typing or clicking. These are usually restricted by the number of commands they can store and the ability to detect speech. If you have a cold for instance, they may not pick up the commands.

Guide dogs:

Guide dogs (formerly seeing eye dogs) have been used for quite some time to assist people as they move around. These trained dogs can also retrieve items such as a ringing telephone. They can give an audible indication of certain situations also. Other animals can also be used to perform some tasks.

Identity devices:

Some people use little plastic molds that can resemble many different objects. Some are related to food objects and can be strapped around canned goods with rubber bands to identify what is in the can. Others can be used on boxed goods to indicate what is in the box, etc.

Brightly colored stickers can also be helpful in identity of products. Some people can identify the sticker but could not read the label. This type of marker system has been used for a variety of products such as buttons on tape recorders (red for record, blue for play, etc) and the controls on microwave ovens (green for start, red for stop, blue for timer setting, etc).

Stamps:

Many office supply stores sell rubber stamps that are used with ink pads. These stamps can have a wide range of information impressed into them to replace having to write out common things. One of the most popular is the signature stamp, which a person can use most of the time they need to perform a signature. People should check with their bank before using stamps on checks or credit card purchases as some banks don’t feel a stamp is a valid signature.
Talking devices:

More appliances are being made to speak to us lately. Talking watches and clocks have been saying the date and time for many years. Talking thermometers and weather stations came around later. Today some bigger things can speak, such as refrigerators, ovens, microwaves, washing machines, and even dishwashers. Many talking devices have a interactive menu system and some even have braille coded keypads to help in the navigation.

Tape recorder:

One favorite device of visually impaired people is the simple tape recorder. You can get a micro cassette recorder that easily fits in the palm of your hand for portable use. These can be used to record any thoughts or information on the spot without the need to write down things. Playback replaces reading what would otherwise be written down. Bigger, less portable recorders can be used on the desktop for easy access and can be used for short or long term storage of messages. In this way, a person can avoid having too much information on the portable unit which would take more time to find certain recorded items.

Some recorders use cassette tapes. Digital recorders are widely available today, but usually have limitations on the length of recording time or the way you have to go about storing and retrieving messages.

These are just a few of the many tools available to help. Since technology is always expanding the options, be on the lookout for more options in the future.

Vision Terminology

NORMAL VERSUS AVERAGE:

Over 12 million Americans are visually impaired, but only about 10% of those are fully blind. While the figure is overwhelming, it is worth mentioning that the majority of non-blind people can experience at least some vision improvement with treatment or visual aids which help to bring their vision closer to average. Better technology continues to offer more hope for those conditions previously untreatable.

Notice that the word average is used instead of the more accepted term normal. In this document, normal vision is what each of us has individually when all is well with our particular vision. Average is the vision which a majority of people have during their normal periods. It might sound trivial, but it is an important difference to consider.

VISION RATING:

Did you know that a vision rating of 20/20 only means that a person has average eyesight? Yet some people brag about it like they are the only ones who could achieve that lofty goal. The most common vision rating system is the Snellen system, named after Hermann Snellen. The rating is a combination of two factors; the distance from the eyes to a chart, and the smallest size of the letters on the chart at that point where they can be correctly identified.

The first number (usually 20/) is the distance (in feet) away from the chart. The second number (/20) indicates the size of the type which can be read on the chart. The letters on the chart are sized according to the ability an average person would be able to read them at certain distances. The 20 foot line is sized for reading from a distance of 20 feet away (letters about .45 inches high). The 15 foot line is sized so the average person can read it at 15 feet, etc.

A person with a 20/15 rating can read the 15 foot line from 20 feet away, giving them better than average eyesight. A rating of 20/40 means the person 20 feet from the chart can only read the line which should be readable at 40 foot.

This rating system does not take into account such problems as nearsighted or farsighted conditions nor does it measure many other very important aspects of sight such as visual field or perceptions. All it does is measure what a person can read from 20 feet away while looking straight ahead. Even a person with a 20/20 (or better) rating can still experience other visual limitations. While the rating system does have a useful place in vision reports, it is far from the ultimate showing of perfect vision.

Many doctors use additional charts or methods to measure vision ability under different circumstances. However, the rating is almost always expressed in the same format as described above.

LEGAL DEFINITION:

Although the term blind is defined as meaning “without any sight”, the term legally blind is defined as “having a vision rating of less than 20/200 in the better eye while using corrective lenses (glasses or contacts). So the standard legal way of determining sight limitation is based upon a incomplete vision rating system. Fortunately, extremely reduced visual field also merits the legally blind definition, covering persons having a visual field below 20 degrees.

VISUAL FIELD:

The visual field is the area (measured in degrees, either horizontal or vertical) of view a person can see without turning their head. The best example of the degree measurements would be using the face of a clock. 180 degrees is the area from the 12 to the 6. 90 degrees is the area from the 12 to the 3. 30 degrees is the area from the 12 to the 1, so 20 degrees would be two thirds of that distance.

Visual field includes both the central and peripheral vision. Central vision is the area of attention, or what it is we are looking at. Peripheral vision is the surrounding area that can be perceived but is not being concentrated on. The eyes focus on the object(s) in the central vision, but the brain can still detect and react to things happening in the peripheral vision.

As this text is being read, the central vision will include the word being read at any given time and the peripheral vision would be the other words, the monitor (or paper) and whatever other objects are around. Reading can be interrupted by any number of events occurring in the peripheral vision.

The visual field is determined by the characteristics of the eye and the persons body. While the body does not normally impact central vision, it can limit peripheral vision. Long hair in front of the face, the nose, and eyelashes are the most common obstructions of the vision caused by the body. Most of the impact on the visual field is due to the shape and quality of the eye itself.

VISUAL LIMIT:

The term visual impairment refers to any visual condition that is of less than expected quality. The term visual limitation involves any visual condition that limits or restricts the view. For example, it is possible to have a visual limitation which provides less than an average visual field but still have good vision (not impaired) in the visual field which is present. A visual impairment becomes a visual limitation if the area affected provides less than a reasonable quality of vision.

TOGETHER YET SEPARATE:

People tend to think that most vision problems affect both eyes together in that what impacts one automatically impacts the other. While some vision problems are shared in both eyes (due to genetics, chemistry, or injuries), most problems affect just one eye or affect each eye in different ways. It is really not uncommon for a person to use visual aids that have different prescriptions (properties) for the left and right eye.

Many people with minimal vision problems affecting just one eye often do not realize it until a vision exam reveals it. This is because the brain has two images (one from each eye) to work with and it usually compensates for many minor problems in one eye with the information provided by the other eye. In fact, these people often involuntarily rely on one eye for much of their daily vision.

The two eyes work together not only to help cover each others problems, but to provide for depth perception. Even though the angles are so slightly different, there is enough difference for the brain to pick up on and make us see images with depth. Visual depth problems can result from differences between the images. Convergence errors can provide the brain with two very different images to deal with. Refractive errors can also unbalance the vision between the pair of eyes.

VISION OVERVIEW:

The eyes are hard at work from the moment we awake to the moment we fall asleep. The eyes gather light from the world around us, convert it into electrical impulses, and send those impulses to the brain where they are interpreted into the images that we see. The two eyes gather images independently, but the brain has the ability to control both eye positioning together as well as merge the input from both eyes so that only one image is perceived.

Light is reflected off of or absorbed by all of the objects in our world. The more light that is reflected, the brighter the object appears to be. Objects that absorb most of the light that impacts them appear to be very dark or black. Different colors are created by different light rays in the light spectrum being reflected or absorbed. Our eyes are capable of processing a large part of the light spectrum but not all of it.

Low Vision Challenges

Challenges We Encounter

Aside from the obvious problems such as difficulty in reading documents, writing checks, signing receipts, and reading maps or phone books, there are some other challenges left to deal with. First off, we need to cover challenges with medical records and medical professionals being informed.

Be your own best medical advisor:
Know your medical condition(s). Everybody should have at least a basic understanding of their known medical problems. At absolute minimum, the medical name(s) and description. The more depth of the knowledge, the better the person will be to explain it and live with it. There may be times when a person encounters a new doctor or emergency worker who will not be familiar with them or the condition. Better treatment will occur if these new people are enlightened about these conditions right away rather than treatment waiting for medical records to arrive.

Know your medications:
Some people carry a card in their wallet which lists the medicine they take, often including dosage and symptom information. This can prove valuable in the event the person is not able to communicate during an emergency situation. Sometimes the card can also list medical conditions. A person should have an understanding of what the medication treats, the possible side effects which can occur, when and how to take it, and if there are restrictions or reactions to other medicines or foods. Think about it, the more you know about what you put into your body (be it food, drink, or medicine), the better equipt you are to have a healthier life.

Medical ID bracelets, tags, or jewelry can also be a lifesaver. Emergency workers on the lookout for such things can obtain useful information in the event you are unresponsive. Some places that sell medical ID products also have a service to provide your medical history to emergency workers. Such devices and services can be found in our Webstore.

Know your reactions:
Communicate ANY changes in your life that may be a result of medication reaction or symptom difference. Such events include (but not limited to):

drowsiness
dizzyness
breathing trouble
energy loss
weight gain or loss
pain

If the doctor feels the reactions merit attention (sometimes they are considered normal), the medication dosage can be adjusted or alternate medications may be available with less reaction ratio. Tests may be conducted to allow the doctor to analyze what is going on medically. Since the doctor is not with the patient except for office visits, it is the responsibility of the patient to understand themselves and commuicate freely.

Get your medical records:
You have the right to request your medical records from your doctor(s). These records contain the medical codes or terms for conditions, but can also list results of routine tests performed during each office visit. This can be helpful to monitor the progress of a condition or recovery.

Get your own facts:
Consult books, websites, or pharmacists to gain further understanding of the condition(s) and medication(s). This not only helps to confirm that a diagnosis is valid, but many sources will say things in a different manner which might be easier to understand. Again, the more you know the better off you are.

Communicate with insurance companies:
Like everything else in life, things have a better chance of going smoother if good communications is used. Insurance companies have policies of what to cover, how much to pay, etc. You may not like their policy, you may not like the way they run their business, but if you don’t work with them you are just asking for even more problems.

You should know the basic coverages of insurance at the time of signing up for a policy (even if it is provided through work). You should know what doctor(s) you are allowed to visit under the plan, what co-pay or deductible will be charged, what examinations are covered, etc. There may be special instructions for emergency care reporting after the fact.

You should call the insurance company for details about other events, such as a planned upcoming surgery or an emergency event which happened recently (many have time limits on reporting). This not only helps the insurance company to know an event is in progress, but provides a way for you to get the details on what it might end up costing you or what things you need to do for coverage.

Always be prepared to give doctor(s) names, addresses, and phone numbers when calling an insurance company. Dates, places, and times are also commonly asked questions. The more information you provide, the better your chances of having a smooth (although maybe not lovable) experience.

Make sure you, your doctors and the insurance all have the same facts. Don’t just assume things are handled for you. Double check inportant issues. Review paperwork and ask questions if in doubt about anything. The more order you can provide in the mess of paperwork, the better off you will be in the long run. It isn’t fun, but it is in your best interest.

Review paperwork and receipts. Save all paperwork:
Medical records, receipts, letters, and history are all part of the big medical picture. Although some of these should be saved for a minimum of seven or ten years (legally it depends on where you live), future generations would probably appreciate these being saved and passed down in the family history. Paperwork isn’t one of those things that we look forward to storing or moving, but medical information also ranks as more priority than the electric bill from years back.

It takes just a short time to review and compare the paperwork from the doctors office with what actually happened. Another short time to check the insurance billing with the office receipt. Not much of a hassle to be sure the same figures are being used. Mistakes can happen. It is a good idea to compare paperwork.

In the USA, medical bills may be tax deductible when you itemize the income tax form. This may include medications, travel expenses and services needed for certain cases. Saving receipts allows you to claim everything more accurately.

EMOTIONAL ISSUES

Vision is often considered to be our most important sense since most of the information humans possess enters the brain through our eyes. Even what we hear, touch and smell are associated with an image to identify them. It follows that people with vision problems must bear increased hurdles in life as opposed to those with average vision.

One very important topic is the emotional aspects of vision loss. Therr are two key parts of this which include dealing with the vision loss itself and dealing with the often accompanying loss of self-esteem due to public opinion.

Good vision is something that far too many people take for granted. And since vision is such an important sense, it is often difficult for people to cope with its deterioration. It becomes even harder to cope when the loss is quick or severe. The world becomes a much different place with new challenges and learning experiences. Toss in the fact that many people do not understand their new condition (medically) and it is hard to ask a doctor good questions about it when you do not even know what has happened.

Also, there may not be many other people who truly understand a persons new view on life because they have not experienced it themselves. The feeling of being the only person with a vision problem just adds to the emotional mixture.

As if it weren’t enough to suffer though vision loss by itself, many people find they also have to deal with negative public opinions. Children who need glasses during school are a prime target for other kids to pick on. Children and adults who have an outwardly show of vision loss (such as close reading or use of visual aids) can also be targets for comments. That is very sad since nobody really wants less than average vision, but does want to use whatever is available to help them regain as much vision back as they can possibly get.

Sometimes we experience a lot of negativity due to the fact that our eyes look different even from the outside. Usually the best way to deal with comments about it is to judge the basic attitude of the person and respond accordingly. Those who ask about it out of concern or genuine interest may be told about the conditions which affect us. Those who try to avoid the issue are allowed to do so. Those who attempt to make fun of us should be treated with politeness while explaining that we have no control over the way we were born.

Each person will have to develop their own style of dealing with situations. If they are handled with dignity, the chance for real progress is improved. Accept the fact that some people seem to exist just to cause trouble and will never change and there is no reason to drop to their level in a response. For all of the other people, just be honest and as informative as the encounter merits or you feel comfortable doing so.

The process of coping with any medical problem should not have to be complicated with self-esteem issues also. Look at it this way, everybody has some problems or flaws (rarely just a few, but not all are outwardly noticeable). Some people deal with hearing loss, some lack mobility, others have any of assorted medical or emotional troubles. Somebody with vision problems really shouldn’t feel like they are abnormal humans, just that their affliction is different.

Earlier it was noted that over 12 million Americans have some degree of visual problem, so visually impaired people are not alone after all. So let those who want to be mean be as mean as their hearts desire and lets all just proceed with making our own lives as comfortable as possible.

Public Awareness

FOR PARENTS OF DISABLED:

Raising a child is a huge responsibility. Raising a child with a disability is even harder. We have a lot of sympathy for parents who must deal with these extra issues. We also have a great deal of respect for parents such as my own, who handle the matter with dignity. This is written for visually impaired disability, but can reasonably apply to any disability.

Parents who have similar conditions as their children (genetic inheritance) have some advantage of experience and understanding of what the child will be going through in life. It still won’t be easy, but the techniques used by the parent can often be used for the child.

For parents who do not share a condition with their children, it is not so clear what the child is or will be experiencing. That adds to the uncertainty of the route to help the child become all they can be. With this in mind, we share a few things that might be helpful.

First off, don’t feel guilty about the fact that you have brought a child into the world with a disability. The human body isn’t perfect. ALL of us have problems, just that some are more noticeable. Some parents say their child is “special”, well EVERY life is SPECIAL. There is a potential in just about every life, no matter what hurdles will be in store for that person over the years. Communicate this attitude with the child.

Don’t overcompensate and play favorites to any child. Yes, there will be some things done differently to meet certain needs, but this applies to all children rather than just disabled ones. Nobody is better or worse, loved any more or less, or just as much worthwhile. We are all equal in existance, just have different abliities to get us through.

Be open and honest about the facts. Do not avoid the issue or make it appear less of an issue. To the child, it is an important issue and a huge part of life. There should be no shame in having a disability (although our society seems to insist there should be). The real shame is not doing everything possible to accept it and deal with it as best we can.

Share with the child what you can see. Ask the child what they see. Compare differneces and openly discuss them. This helps the parent to gain understanding of the childs experience as well as learning better how to modify things for the child.

Use your experience with your child to teach others about how to interact with them. Communicate with teachers and school staff about what your child can see and do. Talk to the parents of the childs friends about the condition and effects. The goal is to make life easier due to better understanding by and interaction with others.

FOR EDUCATORS OF DISABLED

This section is written to teachers and school administrators. The job of such people is to educate all of the students. It has to be a very difficult job, but that IS the job at hand.

Some teachers just ignore children with a disability for lack of knowing what to do with or for them. There also may not be enough time for a single teacher to devote an effort needed. Or a teacher may not want to draw attention to a childs needs for fear of the reaction of other children. In smaller schools there may not be training or resources available to teachers to help them deal with such cases.

Some administrators see a disabled child simply as extra money for the school if they can label them as a “special needs” student. Sadly that extra money usually is not devoted to helping that child. Sometimes a school staff with also feel that a disabled child is a burden for them.

But then there are some teachers and staff who look beyond a disability and seek out the potential talent. They knew when a child is doing the best they can on their own and offer help during the times it is requested or needed. They never make children feel like they are anything less than any other student. The following paragraphs are ideas that may help you to be one of these kind of people.

Use of blackboards:
Limit the practice of writing things on the blackboard when there is a visually impaired student. If you MUST make use of the blackboard, ALSO clearly verbalize the information. Although some teachers place visually limited students near the blackboard, this is not a good solution for emotional reasons. A better alternative would be to provide the student (or maybe ALL students?) with a paper copy of whatever was written on the blackboard.
Large print books:
Large print books are a great tool for those that truly benefit from them, but they are also an added burden (heavier weight, bigger pages). The use of these should be done with the cooperative agreement between the educators, parents, AND the child. Studies have shown that children who are raised on large print material have a more difficult time in the business world as there are no (or very few) business materials in large print. This is not to say that large print resources should not be considered, but rather information when making such decisions.
Tape recorders:
Since visually impaired children take longer to write notes it is often a good idea to encourage them to record a teachers verbal lessons for later playback and note taking. Optionally, the student may use the recorder to verbally record their notes, although this can be somewhat disruptive to the rest of the class.
Visual aids:
Believe it or not, some schools do not allow the use of non-standard visual aids (only glasses or contacts). The theory behind this is to protect the child from being bullied. Visual aids are often the only link a child has to be somewhat independant and if there are problems with other childrens attitude then the OTHER CHILDREN need to be educated about tolerance and politeness. NO child should have to suffer because someone simply wants to make fun of them. If the child needs visual aids, let the child use them. Some teachers have even informed parents about visual aid products that are available in case the parents did not already know.

The point of this is to allow students to communicate issues with a teacher and tell them what is in the students best interest. Then the teacher or staff should follow it up as best they can. As long as there is an open channel of comminication and a willingness to work together, it is a win/win situation. THAT is the way it really should be.

INTERACTING WITH THE DISABLED:

We encounter people with various disabilities often. When you know the person, they are easier to deal with because you know more about their abilities and their method of doing things. Interacting with somebody you don’t know can be much more difficult. However, there are things that can make the experience easier and more comfortable for both of you.

Act naturally:
Most disabled people appreciate being treated like everybody else. Avoid staring at those who are disabled or making a big deal out of their situation. It is acceptable to inquire about their situation, but keep it on a sincere level and do not push it too far. Usually if people want to talk about their condition(s) they will do so openly and show you they have no problems discussing it.
When to offer assistance:
The degree of disability usually coincides with the degree of assistance that will be required. The more severe the condition, the more likely there will be a need. Do not force help on anybody. Most people who want assistance will request it. However, if you see somebody struggling with something (such as opening a door) you may offer your help, but do so verbally first without just doing something. Often people will need something done in a particular way and if it is done differently will often make things more difficult.
Communicate:
Communication is very important in life, but especially when dealing with a disabled person. As above, verbally communicate with them before helping at least until you get to know what they want. It is also important when dealing with a visually impaired person that you keep them informed of what is going on if they are unable to follow it themselves. The more you know somebody the better you will be able to work with them. If you are helping a stranger though it is better to give too much verbal information than not enough. They will usually tell you if they are aware of something you are telling them and then you can use this information while you continue helping them.
Work with THEM:
One of the worst things people do is ask others what the disabled person wants when they should be asking the person directly. We encounter this quite often when ordering food or trying to make a purchase when somebody else is with me. When it happens to me, the person with me usually tells them to ask me, which is the thing to do (unless the disabled person truly can’t perform the task).

Details, details:

While everybody will require different levels of assistance, there is a fairly well defined standard of how to bridge the gap between you and a disabled person. Many of the things discussed briefly here are related to vision loss, but can be useful in other situations also.

When leading a person, do so by having them take your arm directly above the elbow. Walk about a half step ahead of them at a normal pace. The visually impaired person will follow your direction by turning when you turn and stopping when you stop. You should stop before going up or down a curb or steps. Tell the person if you are about to step up or down or if you are at the top or bottom of a set of steps. You do not have to count the number of steps. Stop after you have reached the top or bottom of a set of stairs before proceeding. Always approach a curb or steps at a perpendicular angle to the curb or steps. Approaching at an angle can cause the blind person to misjudge how deep a step he or she is to take.
Never tell a person to take backward steps. This can be very dangerous.
When seating, take the person to the chair and tell them that the chair is in front of them. Allow the person to determine the orientation of the chair and sit down on their own. Do not try to turn the person around and back them into a chair.
When approaching a closed door, tell the person whether the hinge is on the right or left and if the door is to be pushed or pulled to open. For instance, if the hinge is on the left and and the door is to be pulled open, tell the person the door is a “left pull”. If the hinge is on the left and the door is to be pushed open then it will be a “left push”. You do not have to step aside and let the person go through first as he or she will simply follow you through.
The most important thing to remember as a sighted guide is to always allow for adequate leeway for the person you are guiding. It is very easy to forget that you have someone at your side and walk them straight into a stationary object.
Never move things around without informing the person first. Most visually impaired people know where they put things and if others move these things they are difficult to locate again. Also when putting something away make sure the person understands what it is and where it is being placed. This is most important at the persons home, but should also be considered when elsewhere.
Location guidance can be given in simple clock related terms. These are often used during meals to advise about food positions or as placement of materials on a table or desk. Twelve o’clock is straight ahead but a distance away from the person, three o’clock is to the right, six o’clock is straight ahead but close and nine o’clock is to the left. A typical meal layout would be something like: “On your plate the chicken is at six o’clock, the potatoe is at ten o’clock and the vegetables are at two o’clock. Around your plate the silverware is at nine o’clock, your drink is at twelve o’clock and has a straw and your salad is at three o’clock.” Some families use the term noon instead of twelve o’clock and some people just use the numbers with the “o’clock” part being implied like: “Silverware at nine, drink with straw at noon, and salad at three.”

Other helpful hints:

Perhaps the best way to understand what a disabled person goes through is to try dealing with their issues yourself. Even routine things can become a challenge and teach you about how life without certain abilities can be. For example, when you wake up in the morning, try getting out of bed with your eyes closed to simulate blindness. Warning, do this very carefully because you would be surprized at how different the experience is. While standing in front of the sink, close your eyes and try to obtain the toothpaste or soap. Think about how detailed directions would be helpful to you in this search.

Most disabled people express they want to be treated like they do not even have a disability. Everybody needs help now and then, but most of us like to be independant until we can not do something for ourself. Independence is what most visually impaired people want more than anything.

Fun Facts

Below are some interesting vision facts or myths debunked.

How do housef lies manage to land on the ceiling upside down?

Think about this one…When the fly is heading for the ceiling, it is flying right side up. When it lands on the ceiling it is upside down. At some point along the way it has to flip over. But when? And Where? And How?

Scientists dispelled the prevalent theory, that the fly performed a fighter pilot-like barrel roll just prior to landing, by capturing this momentous event on film. Freeze frames, from the high-speed cameras scientists used, proved that flies do not flip, but flop, as they land upon the ceiling. Prior to impact, the fly extends its forward legs over its head, makes contact, and uses the momentum it has gathered in flight to hoist the remainder of its body to the ceiling. Thus, the fly proves to be more of an acrobat than of a fighter pilot practicing his maneuvers.

Once the fly reunites all six feet on the ceiling, it keeps things dizzyingly exciting, by gracefully tiptoeing across the ceiling, securing itself by using sticky pads found under the two claws attached to each of its feet. It is because of these sticky pads and the hairs on the legs that the fly is such a carrier of disease germs.

Did you know? The entire life of a house fly is spent within a few hundred feet of the area where it was born.

Ref: http://www.coolquiz.com/trivia/explain/docs/flies.asp

Why do animal eyes glow in the dark?

In dark, the pupils are dilated, so that maximum amount of light enters the eye. When suddenly, light is shone in the animal eyes, it is reflected from the Tapetum lucidum. This is the reflecting layer behind their rod-rich retina. That is the reason why animal eyes glow in dark.

What is the red eye effect in a photo?

The red eye in the photo, is because the light when shone from a certain angle gets reflected from the choroid. The choroid has many blood vessels and therefore appears red. The ‘red eye effect’ can be avoided by changing the direction of the camera.

Do some animals have no eyes?

Some salamanders that live in dark caves and certain fish that live near deep Ocean beds have no eyes! This is because they do not need eyes, since in light never ever reaches them! Some of them have rudimentary eyes with permanently closed eyelids over them, while in some the eyes are totally absent.

We do not see some colors in flowers. Is that true?

That is true, though flowers look vividly colored, yet they are better than they appear! Flowers, like daisies, have an attractive colored zone around center. This zone does not appear different from the surrounding color to us, but the butterflies can see more colors in that zone. This is a special gift to the butterflies, since they have taken up the job of pollination.

Can butterflies see more than human beings?
Picture of a monarch butterfly

That is true! Butterflies have compound eyes like many other insects. They see better than humans in ultraviolet range up to 300 nm. They require this ability to spot the central nectar bearing part of the flower. The flowers have a more colorful center, than what we can appreciate! This helps the plant in pollination.

Why can animals like cats and owls see well at night?

Nocturnal animals like owls have greater density of rods in their retina. The rods are responsible for vision in dark. Therefore they see better at night. Owls also have tubular eyes that increase the throw from the lens to the retina.

 

 

Is there a third eye?

Third eye is a very popular mythological concept. Did you know, the tumor Retinoblastoma can arise in the pituitary gland too? The Pituitary, is an endocrine gland that lies on the under surface of the brain. During development in the embryo, it lies very near the eyes, later ascends into the brain. Thus it can be considered as a third eye. In Yoga, it is considered as one of the important ‘power centers’! Some animals like certain lizards and snakes have a ‘third eye’, located in the center of forehead. This controls body temperature in response to light, rather than actually see.

Ref: http://members.tripod.com/manisha_b/FAQ/ fun_facts.htm#1

To get picture Pic Ref: http://www.meetdacosta.com/?p=417

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