Dangerous Vision: Practical Advice for Those Living With Low Vision

Reprinted with permission.

My name is Randolph B. (Randy) Cohen.  I teach finance and entrepreneurship at Harvard Business School, and I am a partner in ExSight Ventures, a small money management firm that invests solely in technologies and therapies related to vision and blindness.  I created this site to share my experiences with vision loss.

One of my hopes for the site is that I and others can share practical advice with folks who, like me, are living with low vision.  I have received many valuable tips over the years from others with vision problems, and I’ve figured out a few things on my own, and I’d like to use this forum to share such ideas more widely.  Many of the most helpful pieces of advice I have relate to products, high and low-tech  both, that I use to be more efficient at getting around and getting things done.

In addition to technology, I’ll share thoughts on other choices one can make to minimize the ways low vision affects your life.  Plus I have a lot of stories about what it’s like living with this, some of which may help fellow sufferers feel less alone, some of which may give their friends and loved ones a sense of the experience, and some of which are just embarrassing enough to be pretty funny.  And I’ll feel free to ramble on about other subjects if I choose!  With luck I’ll also persuade friends and colleagues to pitch in with their thoughts and advice.

“Low vision” covers people in a myriad of different situations, all I can do is talk about what works for me and add the occasional comment about tweaks that might be valuable for people whose vision is poor in ways different from mine.  But I wanted to put this up because low vision is incredibly common but I haven’t seen that much written about managing it.  Most people who address sight disorders are addressing the challenges of the totally or almost-totally blind, and of course those folks are the most in need of assistance, so that’s fine.  But hopefully I can help some people in weird in-between situations like mine.

Some of the ideas here will be helpful to people who suffer total blindness, but in many cases people in that situation will find other products and services more helpful.
It may be useful for some users to know the perspective I am coming from.  I suffer from Retinitis Pigmentosa, a degenerative condition of the retina that is closely related to the more common ailment known as macular degeneration.  Many RP sufferers have 20-20 vision but with very narrow visual fields (“tunnel vision”).  My situation is quite different.  I have substantially reduced visual fields, but not really a “tunnel.”  In addition I have extremely poor visual acuity and high light sensitivity.  As a result I can see things better on a computer screen than in “real life,” but only if the computer is set to “inverted” colors, i.e. black background with white text, or some similar high-contrast scheme.  Once again, the solutions I personally recommend will be of most help to those whose visual impairments are most similar to mine, though some may be helpful to a wide range of users.

A note on nomenclature.  I will use terms like “low vision,” “partially sighted,” “legally blind,” etc. as seems appropriate to what I’m writing about, and I’ll make little effort to distinguish between these terms.  I will also use the self-mocking term “dangerous vision” to describe what I deal with, as seeing the way I do can be physically dangerous, to myself and to those around me, but also because of the positive sense of living dangerously — my eyesight makes life an adventure.  And of course the name is an homage to Dangerous Visions, the seminal fiction collection edited by the great Harlan Ellison.

Read more from Dangerous Vision. 

RandyCRandolph B. (Randy) Cohen is a Senior Lecturer in the Finance Unit at Harvard Business School.

Cohen will teach FIN 1 and FIELD 3 at HBS this year; he will also be teaching Investment Management as a visitor at MIT Sloan School of Management.  He has previously held positions as Associate Professor at HBS and Visiting Associate Professor at MIT Sloan.

Cohen’s main research focus is the interface between the actions of institutional investors and price levels in the stock market. Cohen has studied the differential reactions of institutions and individuals to news about firms and the economy, as well as the effect of institutional trading on stock prices. He also has researched the identification of top investment managers and the prediction of manager performance, as well as studying the market for municipal securities. 

In addition to his academic work, Cohen has helped to start and grow a number of investment management firms, and has served as a consultant to many others.

Cohen holds an AB in mathematics from Harvard College and a PhD in finance from the University of Chicago.

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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

Medication Management: Tips from an OT

Occupational therapist Anne Escher leans over the shoulder of a visually impaired elder during an occupational visit.

Occupational therapist Anne Escher leans over the shoulder of a visually impaired elder during a vision rehabilitation visit.

Anne Escher is an occupational therapist who teaches at Boston University Sargent College of Health and Rehabilitation Sciences. She specializes in acute care, low vision and rehabilitation.

As an occupational therapist I am always trying to help people be as independent and safe as possible with their daily activities. Each person is an individual and my clients demonstrate different levels of visual impairment as well as different daily routines they have already established. Appropriate OT interventions for medication management differ from person to person, but there are some “low-tech” ideas that could help many people. Continue reading

Focus on Function: The Low Vision Exam

Optometrist Jen Salvo offers insight into the low vision exam.

Optometrist Jen Salvo offers insight into the low vision exam.

This post was written by Dr. Jennifer Salvo, a low vision optometrist. She sees patients for MABVI in Holyoke and Springfield and also provides low vision care in Wellesley Wayland, and Hyannis through her private practice. For more information about Dr. Salvo and her low vision practice, visit www.metrolowvision.com  or call her at 508-740-0706 to schedule an appointment.

If you have impaired vision, and your eye doctor is unable to restore your vision with treatment or surgery, where do you go for help? When your doctor tells you, “There’s nothing more I can do” or “These are the strongest glasses I can give you”, what is your next step?

Many people give up at this point and become increasingly isolated and depressed due to their vision loss. However, there is help available, and your next step should be a low vision exam. A low vision exam is far different than the one you receive when you visit your retina doctor or glaucoma specialist. It is a functional assessment–meaning that the low vision doctor will assess your ability to perform daily tasks, hobbies and activities, and will also address safety concerns.

After performing various vision and reading tests, the low vision doctor will evaluate and prescribe appropriate devices and make recommendations for improving your functioning. The doctor may recommend LED magnifiers, high-powered reading glasses, telescopes, television glasses, or video magnifiers. He or she may also recommend in-home training with an occupational therapist who specializes in working with visually impaired individuals.

Although you may receive a new glasses prescription at the low vision exam, glasses will not restore vision that is lost due to retinal damage or eye disease. However, the low vision doctor can help you maximize the use of your remaining vision.  The low vision exam is the starting point for receiving the services and devices to help you regain independence  and maintain activities you enjoy.

Click here to hear Boston-area low vision optometrist Richard Jamara describe how he helps individuals living with vision loss.​

Holiday Cooking with MasterChef Winner Christine Ha

Photo Courtesy of Mitch Mandel/Rodale

Photo Courtesy of Mitch Mandel/Rodale

This holiday season MABVI brings you tips and tricks on how to get in the spirit. “MasterChef” winner Christine Ha, who is visually impaired, shared her holiday cooking tips for us! Ha is the author of the New York Times bestseller, Recipes from my Home Kitchen. She also offers some recipes from her blog, The Blind Cook.

On assumptions about vision loss and cooking:

Perhaps the biggest misconception blind people have about cooking is that it’s impossible. It’s not. Look at me. It’s about practice and adapting your kitchen and tools accordingly. My biggest accomplishment as a chef is obviously winning “MasterChef” Season 3. But more importantly, it’s relearning how to cook independently after vision loss. What I enjoy most about cooking is the same today as it was when I first began: learning how to improve, learning about new ingredients and techniques, just learning and improving in general—and, of course, feeding others.

 On getting back in the kitchen after experiencing vision loss:

It’s about practice and experience and not being afraid to make mistakes. Rather, you learn from them. Start with the small stuff: learn how a knife should feel in your hands. Cut something easy like a lemon or orange. Do it slowly and carefully. Make sure to curl your fingertips away from the blade. Begin by heating up a soup in a saucepan. Take baby steps and feel victorious over the little things.

As with anything around the house as a VI person, it’s important to be organized. Get a sighted person to help you organize your kitchen from the pantry to the cabinets to the fridge and spice rack. Buy some adaptive tools like a talking scale, talking thermometer and a liquid level indicator. Mark the “5”, “start” and “stop” buttons on the microwave with raised bump stickers. Mark the oven knobs and buttons, and stove burner knobs so that the functions and temperatures are easily functional for you.

 On recommendations for easy holiday cooking:

Stuffing is a holiday staple. Many cooks often resort to packaged stuffing and dressing it up with added sausage, dried cranberries, apples, walnuts, onion, celery, etc. Or just simply follow the package directions, and voila. You’ve got an instant side dish for the holidays. Other simple holiday dishes include caramel dip for apples, roasted Brussels sprouts or squash, or a cheese spread.

Holiday Recipes from The Blind Cook blog:
Bring savory slices of prime rib to your dinner table with your choice of au jus and horseradish sauces. Ha recommends a digital meat thermometer to make sure the prime rib comes out perfect.
http://www.theblindcook.com/2010/12/22/prime-rib-au-jus-with-horseradish-sauce/

Bake soft and sweet gingerbread cookies without molasses. This recipe includes butterscotch pudding mix, ginger, cinnamon and brown sugar for that decadent taste.
http://www.theblindcook.com/2010/12/20/gingerbread-cookies/

How to Make the Holiday Season Brighter for Visually Impaired Relatives

This time of year, many family members and caregivers are facing concerns about how to make sure the holidays are a problem-free and joyous time for their visually impaired and blind relatives. Here are some tips to keep in mind this season to ensure the holidays are brighter for your visually impaired relative or loved one:

When decorating for the holidays, do not reorganize major items. Visually impaired adults rely on their knowledge of a home’s layout in order to navigate rooms and avoid bumping into walls or furniture, or falling down stairs. While hanging up lights and other holiday decorations, avoid rearranging furniture, belongings and other common household items. Consistency is vital for someone with vision loss. Moving things, especially necessary items such as medications and canes, can confuse and distress a visually impaired individual.

Opt for safe alternatives to decorations that can become dangerous. Candles, for example, can cause fires if the table they are on is accidently bumped by someone who is unable to see it clearly. Choose battery-powered candles instead, or set candle holders in a dish of water, just in case.

Use contrasting colors on and around the dinner table when planning your big holiday meal. For those with limited vision, items tend to blur into one another. If the floor in the dining room is a light color, a dark tablecloth will help distinguish the table from the floor and the walls so that the low vision individual will not bump into the table. To make it easier to eat, use dark colored dishes when serving light colored food and vice versa.

Photo Courtesy of Stock Exchange.

Choose and wrap holiday gifts with vision impairment in mind. Consider gifts that can help him or her live life more easily, such as products with larger-than-normal features and audio capabilities. Examples of gifts include large print playing cards, jumbo remote controls, a large analog clock, iPads or Kindle Readers, and audio books. Use gift bags instead of wrapping paper and ribbon, which can be difficult for low-vision adults to maneuver.

A MABVI large-print calendar would make a great gift for the holidays!

Narrate your holiday gatherings and parties. Be sure to verbally introduce yourself when you walk into a room or join a group conversation, as it is often difficult for a visually impaired individuals to recognize people by their voices, especially in a large group setting. When speaking, make an effort to be verbally descriptive and avoid pointing to things in the room with phrases like “over there” or “this way.” Describe gifts that are being opened and suggest that they might be passed around to ensure the low-vision family member feels a part of the ceremony.

Empower everyone to participate. For low-vision relatives, it’s incredibly frustrating not to be able to be as active during holiday celebrations as their sighted loved ones. Too often the visually impaired person is guided to the living room while everyone else gathers in the kitchen to work. Instead, give him or her a job – like folding napkins or drying dishes – so he or she can feel part of the group.

People gathered around a table

During the holidays and always, be supportive. Patience is key. Offer advice and resources without being overbearing. Actively listen to what the individual needs. If necessary, consult resources, like the Massachusetts Association for the Blind and Visually Impaired, who can connect you and your family with medical professionals that help visually impaired and blind adults live with confidence and dignity in their own homes.

Happy holidays from the Massachusetts Association for the Blind and Visually Impaired!