What low vision specialists can do for diabetes patients

Whether you have cataracts or glaucoma, vision loss doesn’t mean saying goodbye to your daily routine. With help from a low vision specialist, people with diabetes and vision loss can manage their health and continue to live fulfilling lives.

Diabetes can cause vascular changes in the retina, which can cause blood vessels to leak blood products, and if they leak into the center of the retina (known as the macula) it can cause blurry, distorted vision. Diabetes can also increase the risk for developing other conditions such as glaucoma and cataracts.

That’s where the low vision specialist comes in. While optometrists perform exams and check-ups, low vision specialists are key for patients who want to monitor their vision loss and find new ways to continue their daily routines.

“The comprehensive eye examination has been done by others. We’re focusing on visual function and trying to help our patients do what they need to do on a daily basis,” says Dr. Philip Silver, the low vision specialist at the Joslin Diabetes Center.

Dr. Silver, who has worked at Joslin for more than 20 years, helps people with diabetes maintain their current level of vision and adapt to whatever vision loss they experience.
“Just improving patients’ quality of life by maximizing their vision keeps me going every day,” he says.

Low vision specialists help determine if factors aside from a patient’s diagnosis could be contributing to vision loss. Some patients may be diagnosed with diabetic retinopathy or degeneration, but not discover until later that they also have cataracts and glaucoma. Cataracts can make the lens cloudy, and glaucoma can damage the optic nerve, both causing more vision loss if left untreated. Detecting other conditions early on could make the difference between a patient having 2200 vision (legal blindness) and going completely blind, Dr. Silver says.

“It’s not just focusing on one disease that a person was diagnosed with,” he adds. “There are other things that have to be ruled out too.”

Technological advancements have made controlling diabetes, and thus one’s vision levels, easier for patients. Today patients can use insulin pumps and glucose monitors to maintain normal glycemic levels and blood sugar levels.

However, low vision specialists do not only monitor the effects of diabetes on vision. They also must assess patients’ current vision levels and their goals. By learning those details, low vision specialists can direct them to the right devices and therapy options to adapt to their vision loss.

Among the most common tools are magnification glasses or handheld magnifiers. One of Dr. Silver’s patients who loves to travel has a telescope mounted in her glasses to read gate signs. She also uses bifocals so that she can read. Other patients may use large print labels on their medications or household items, as well as smartphone applications that help with reading or labeling.

Low vision specialists may also send patients to occupational therapists who may help make their houses more adaptable or help them use certain devices at home.

“We’re not going to restore your vision, unfortunately, but we are going to try to maximize the vision that you have left,” he says. “There’s so much that can be done for a patient who is either losing vision or has lost vision that they owe it to themselves to get a low vision exam.”

WATCH: An Introduction to low vision optometry

Running Blindfolded

Post by Elizabeth Mattey

Years ago if you had told me that I’d be running a mile blindfolded, let alone a 5K alongside thousands of other runners, I would not have believed it. “That’s terrifying,” I would have said. “How can you run without seeing where you’re going?”

Fast forward to today: I found a job working for the Massachusetts Association for the Blind and Visually Impaired, and for the first time in my life found myself working with and alongside visually impaired individuals everyday. I realized that these individuals could do pretty much anything a sighted person can do, if given the proper support: I met blind finance executives, lawyers, IT professionals and yes, even runners. I met people who’d lost their vision and then decided to run marathons and complete triathlons – if they could find great guides to be their “eyes” on the race course, then they could compete alongside the sighted athletes, no problem.

If they can do it, I thought, then why can’t I?

So I decided to do the Blindfold Challenge, an event co-sponsored by four Boston-area blindness organizations: the Carroll Center for the Blind, the Massachusetts Association for the Blind and Visually Impaired, National Braille Press, and Perkins. The Blindfold Challenge is to run a 5K race blindfolded, teamed up with a sighted guide, to simulate the experience of running blind. This year’s Blindfold Challenge was held at the B.A.A. 5K, located at the end of the historic Boston Marathon course, a sold out race at 10,000 runners.

I chose my boyfriend Giulio as my teammate, so for us the Blindfold Challenge doubled as both an exercise in teamwork and couples communication. Before race day we went to a training: my friend Joe Q., an NBP staff member who is visually impaired, trained us how to run as a blind/visually impaired runner-sighted guide team. Joe explained how to use a shoelace as a tether to connect the two runners, how to give verbal commands to guide the blind runner, how to navigate a race course without relying on sight. Giulio and I decided that each of us would practice being the blindfolded runner and the guide, since we each wanted to experience running blind.

Giulio runs blindfolded tethered with Elizabeth, who guides

It was time for us to practice running. First I guided Giulio, leading him around the track at Joe Moakley park, calling out when to turn left and right. Giulio was a natural, having little difficulty eliminating his vision and running ahead fearlessly. When it was my turn to don the blindfold, however, I was … pretty much a mess. The minute I started walking forward blindfolded, I realized I had no perception whatsoever where I was going. My usual lack of spatial perception can actually get worse – without my sight. Once my vision went dark, I started tuning in more accutely on my other senses: I became more focused on my hearing, feeling as if the sounds of the park around me were suddenly magnified, much closer to me. The sounds of the lacrosse game next to us became louder for me, disorienting.

“Are we going through the game?” I began to panic. Apparently running blind wasn’t easy at all.

“No, we’re still on the track – you have to trust me, Elizabeth!” Giulio replied. It all came down to that: trust. A blind athlete running the Boston Marathon has to put complete trust into his or her guide, relying on them to anticipate obstacles, lead to water if needed, basically ensure their safety on the course. So if we were going to be successful in the Blindfold Challenge, we were going to have to trust each other completely.

The morning of the race I woke up at dawn, my stomach doing flips in anticipation. We decided to run to the 5K course from our Cambridge apartment to warm up our muscles before the race and get in some last minute practice – after my disastrous reaction to being blindfolded at our training, Giulio figured I could use all the preparation I could get. As we ran alongside the Charles just after sunrise I began to relax, getting in to my stride.

When we arrived at the 5K start it was a madhouse – we crammed in the chute alongside thousands of other people. I knew that once the race started even with our bib with “guide” written in red letters, it was still going to be tough. I was running blindfolded first: we agreed to trade of at the halfway point on the course so we could each get the experience. The national anthem began and I knew it was time. I put on the blindfold.

We began to run – well, shuffle, at first – forward. Giulio led me through the crowd slowly, until finally we got out into enough space to run. I began to pick up my feet faster. One foot before the other, I told myself. Hold the tether. Follow Giulio. He will guide you. My eyes clenched shut underneath the blindfold, I tried to focus on my breathing and not the sounds of the race around us.

“We are turning left in 10 kilometers,” Giulio warned me, and I began to ease into the turn. I felt the tension of our tether tighten as he guided me along the course, I felt the ground beneath my feet and the wind in my ears. “Is this pace ok for you?” He asked me cautiously.

“I’m good,” I said, surprising myself. “Actually I can go even faster!” We began to pick up more speed, move from a jog into a run. I’m actually doing this! I’m running blindfolded!

“I have to admit, I am impressed you are doing so well,” Giulio remarked as we passed the first mile. “You are much better than the first time at the training.”

“I just needed the practice,” I said. “And I have a great guide.”

As we approached the underpass on Comm. Ave Giulio warned me that the ground was sloping downward. All around me runners began to whoop and cheer, their screams echoing off the cement walls of the cavern. For me the sound was jarring, disorienting, impossibly loud. I grabbed Giulio’s arm and he guided me through the chaos.

We were getting to the halfway point already. Time to switch. Quickly I took off the blindfold and handed it to him: now it was my turn to be the guide. As we came to the first turn I called out in anticipation, “we’re turning, stay close to me!” Now with the blindfold off I realized how close we were to so many other runners all around us.

A woman darted out directly in front of us, oblivious with her headphones on and paying no attention to our tether and guide bib. She jumped close in front of Giulio and he smacked into her.

Luckily she didn’t fall. “Blind runner!” I yelled, looking back as we passed her. “She just wasn’t paying attention, I’m sorry – it happened so quickly!” I pulled on the tether to keep him closer as we cut through the crowd. We turned on to Beacon Street and a lane of open space opened up. “We can pick up the pace!” I said, and Giulio happily began to run faster.

I could see the Marathon finish line up ahead of us, the bleachers set up, the overhang, the bright yellow painted “Finish” on the road before us. “We’re coming to the marathon finish line!” I told Giulio excitedly. Up ahead of us people were stopping to take pictures at the famous spot, which after last year’s bombings have become almost iconic. We were getting closer, I felt my heart leap into my throat. Would I tear up? Don’t get emotional and run Giulio into a pole or something. I had to keep it together, to keep guiding Giulio through the crowds.

When our feet touched down to cross the bold yellow line, I didn’t cry. Instead I let out a whoop of joy. “We just crossed!” I yelled to Giulio, and he put up his fist into the air. We barreled along ahead, running as fast as we could. Finally we’d reached the end of the course, and we slowed, back in the chute. Giulio took off the blindfold.

“You did it!” I said.

“We did it,” he replied.The couple smiles after the race

We finished 5K in 30 minutes, a couple minutes slower than I would have had we not been running with the blindfold. Yet more than any other race that I’ve run, I felt an amazing sense of accomplishment: I had tested myself in a way that I once would have never thought possible, and proved that even I could do it. I experienced firsthand the challenges that blind individuals experience every day, and I have that much more respect – it’s not easy, in fact it’s hard work. But with the right support, anything is possible.