Even though people's conditions vary, people often share some similar problems. The following are some frequently asked questions and my answers.

Question:

I stopped looking for answers to my problems years ago. I've been under the continual care of an eye doctor and even been to see a retinal specialist. I've had laser treatments on several occasions. Although they did everything they could for me, when they finished, I was led to believe that nothing more could be done. Now several years later I've discovered alternatives to dependency merely by chance. I'm a little bitter that I was led to believe nothing more could be done, when in just a matter of minutes you've shown me several things which are very useful and I'm convinced that my life is going to get better. How can this be?

Answer:

I certainly don't have all the answers, but understand that the work I do is different from what your eye doctors do. Perhaps you might be more receptive to what I offer now, because you've stopped looking to get your vision back.

I make you accountable for your own rehabilitation. I show you that there are options. You agree to accept them as alternatives to dependency despite their limitations. I can exceed your expectations because you thought nothing more could be done. My approach is to help you function better. My work is practical. I deal with specific issues, one at time. I help a person work through the rehabilitation process, step by step. It takes a lot of time to teach patients what they need to know. It's a very complicated and stressful matter to face up to one's limitations. Discovering alternatives makes it easier to accept limitations because now you have options you didn't know you had. Things don't need to be as bad as they were, or could be in the future, when you know what needs to be done, and you're given the tools to do the job. The tools enable you. Those with limited vision need not be of limited vision!

Your situation is not uncommon. Unfortunately your eye care practitioner either didn't know to make a referral or wasn't prepared to provide the necessary services. If you want your eye care practitioner to know how necessary these services are then tell him or her just how much they have meant to you. This will make it better for everyone who is having problems with their vision. Over time more and more eye care practitioners will better manage the vision of those whose eyesight is less than perfect.

Question:

What is meant by legally blind? Does it mean that a person can't see anything at all?

Answer:

The definition of legally blind is used to qualify a person for legal reasons. An eye doctor is responsible for making this determination and filling out the necessary paperwork. There are tax and other benefits to being classified legally blind. This status may make you eligible for social services which will help you through the rehabilitation process. Once you have the necessary papers (the ones you get from your eye doctor), then present them to your tax accountant and the local State Commission for the Blind. The commonly used definition of legally blind is that a person must be able to see no better than 20/200 in the best eye with correction or have a field of vision no greater than 20 degrees in their best eye with correction. What does this mean to you? Well, some of my patients who are declared legally blind by an eye doctor have excellent peripheral vision and with only their prescription glasses they can even read the headlines in the newspaper, but they can't read any type smaller than about a quarter of an inch high. The figures vary, but fewer than 10 percent of those who are legally blind have no vision whatsoever. So you can see that many people with limited vision (or "low vision") may qualify as legally blind and many legally blind persons qualify as having low vision.

The important thing to remember is that of this 90 percent nearly all are capable of reading even newsprint when they are instructed in how to use and given access to vision aids.

Question:

I have macular degeneration. My doctor told me that I would never go totally blind but my vision seems to be getting worse. What might I expect of my quality of life in the future?

Answer:

From my experience the fullest progression of macular degeneration will usually leave a person with approximately 20/400 vision (if no other conditions exist); even though this is a rather severe condition it need not necessarily devastate your quality of life. The key to coping with this limited vision is adaptability. Many people who live with this type of vision are capable, when they develop alternatives, of maintaining their own households, holding down jobs, going shopping, reading, watching television, seeing people's faces, sightseeing and much more. However, people who live with this type of vision without seeking alternatives are not as capable of doing all these things. Basically those who pursue rehabilitation through vision aid services are capable of maintaining their quality of life. Unfortunately, many such persons, probably 75 percent, give up before they find the kind of help they need.

Question:

I'm a 65-year-old woman who is not legally blind, but many things have become more and more difficult to do over the years. I'm still driving but I won't drive at night because it's too difficult. My vision seems to be slowly failing me. My doctor has told me there was nothing more that she could do for me. She said my eyes were aging and I had presbyopia. I am sensitive to light. My mother is legally blind and in her eighties. I'm concerned that there may be a possibility of my having the same problems as she has. Is there anything I can do to improve my vision now and is there anything I may do to reduce the possibility of going blind in the future?

Answer:

The single most important thing you can do to preserve your vision is see your eye doctor regularly; every year is recommended. Many eye conditions are treatable and early detection is the key to maintaining your vision. Some potentially serious eye conditions have initial symptoms which are only detectable by specific tests performed by eye doctors. Only your eye doctor will know how to advise you about the health of your eyes.

It is important to stay alert to changes in what and how well you see. This may be your first clue that your vision is changing. Some of the changes to your vision are natural and can't be treated by medication or surgery. Many of these changes can be countered by "lenses of design"; some changes can be positively countered by "prescription lenses"; some of the changes can be countered by "nonprescription lenses". (These terms are defined, along with all others in quotation marks, in the appended glossary.)

Driving at night is one of those visual functions which is first to be most noticeably effected. Night driving places a great many demands on vision. An anti-reflection ("AR") coating on your eyeglasses lenses will help reduce some of the adverse effects of headlights and streetlights shining in your eyes from in front and from behind you. The AR coating will also improve the light transmission of the lens by about 7 percent. Between these two benefits your night vision will be better. If your eyeglasses' lenses are very thick on the edges and thinner in the center, you are nearsighted and an AR coating may be even more appropriate for your needs because the curved back side of your lenses directs any reflections into your eyes and this can interfere with what you are trying to see looking forward.

Some changes in your vision are a natural part of the aging process. One such change is called "presbyopia". Presbyopia effects all of us eventually. Its effects are basically confined to seeing things that are near us, text in a book, for instance, or information on a computer monitor. The eye requires extra strength when viewing things up close. Before presbyopia begins to set in, the eye can add extra strength as needed; this process is called "accommodation". There are many lenses which help with accommodation problems. All these lenses add extra strength to the lens and are called "the add". You may need a lens designed to alleviate your specific problems. It is important to consult with a qualified optician when trying to find the lens which is most appropriate for your particular problems. The add is designed to provided relief to the part of the eye which is now (that you are older) not as able to provide this extra strength on its own. In addition to providing relief, the lens also assists in the focusing ability of the eye. If things don't look clear to you it may very well be a matter of not using the lens properly, or of having the wrong type of lens. The older one gets, the more help is required to assist the eye with seeing up close. The stronger the add, the closer one needs to hold reading material (or whatever they are trying to see up close). One may need instruction in obtaining the most from glasses. It's quite natural to resist holding the reading material as close as it should be. Although it may be uncomfortable holding the reading material closer, the resultant better vision is usually worth the trouble of learning the alternative behavior. The amount of the add determines where the "focal distance" and "depth of field" may be found. This space as defined by the limitations of focal distance and depth of field is the area where your vision is most positively effected by the add. I call it the "sweet spot". The stronger the add, the closer and more confining the sweet spot. To find the sweet spot in front of you, look through the lower part of your lenses and slowly move the text in toward your face. Observe as the words come into focus; when they are sharp and clear you've found the sweet spot.

Adds are necessary for seeing up close but they are not necessary for distance vision. The stronger adds are going to adversely effect your ability to see down to the ground by your feet. Making up a second pair of glasses with the add removed will give you a pair which will be better for walking around in. Without the add you will be better able to see steps and curbs, etc. Many golfers will remove the add so they can see the golf ball better.

Your sensitivity to light may be effecting your ability to see because you may be avoiding light, and we all need light to see. Selective filters are the answer here. Those selective filters which block ultraviolet ("UV") and filter "violet light" are usually the best. As we age we need greater and greater amounts of light to see. An AR coating will improve the light transmission by 7 percent. During the day it is advised that you also improve the composition of the light. This is done with filters.

The UV blocking aspects of these filters are necessary for the protection of your eye tissues. Some cataracts are caused by exposure to UV. There is speculation that UV light is also a contributing factor to the deterioration of the macular region of the retina. Ultraviolet light exposure is greatest in situations where the sun is shinning brightly but overexposure is also possible on hazy, overcast days. Places where UV is the greatest are areas where the light may be reflected, as in off the water and off the snow. High altitudes and low latitudes are also contributing factors.

Polarized lenses are effective in reducing reflected light. Commonly used for fishing glasses because they help to see into the water, these lenses are also especially useful for driving.

Question:

I'm legally blind with peripheral partial vision. I've always worn glasses. Since I was 40 I've had bifocals. Since I was 60 I've worn trifocals. Should I continue to wear my glasses even though I'm not sure they help and sometimes I think I can see better without them?

Answer:

My work with persons who have limited vision has taught me that those who have always worn glasses and have partial vision should continue to wear glasses. You may need new glasses that have the same prescription but are designed differently. I understand that many doctors will say that changing your prescription will not make any difference. This is true. However, how the prescription is made up, its "design", may make a difference in your ability to function. Corrective lens prescriptions usually only specify how strong the lenses are, not how they are designed. The vision you do have will be more functional when you are using it corrected. Your glasses will not restore your lost vision but they will promote the vision you do have.

One thing to remember here is that very often multiple pairs of glasses are better than one -- a pair for reading (if applicable), a pair for intermediate (arm's length activities like cooking, eating, writing, hobbies, etc.) and another pair for distance (walking). The pair for reading, if applicable, would be "half-eyes" "magnifying spectacles". The pair for intermediate is usually most satisfactory in a "full view" "single vision" lens that has only 60 percent of the add, which is used in addition to the distance prescription. The pair for distance should be in a full view single vision lens which would have your distance prescription only in the lenses. I know that this is rather technical, that is why you should rely on a qualified optician to fill, by design, your prescriptions.

The following are some options which may work for you. An AR coating may offer you some relief from reflections which interfere with your ability to see as well as you might. The AR coating should be applied on both sides of the lenses. A light special filter will help to promote contrast and therefore improved resolution. A dark special filter may help heighten contrast and promote comfort. "Polarization" will potentially reduce the reflected light you may be exposed to. Lens design options are worth considering as alternatives.

Question:

The magnifier I'm using now just isn't getting the job done any more. I know I'm going to need a stronger one. Is there a stronger one that I can get that will be big enough to cover a whole page? It's so annoying to have to move the magnifier back and forth.

Answer:

The magnifiers you may have heard about that cover a whole page don't magnify well enough to be as effective as a pair of "magnifying spectacles".

Laws of physics dictate that the stronger the magnifier, the shorter the "focal distance" and the narrower the "field of view". One way to see more through your magnifier is to hold it closer to you. When you do this you will also have to move the text closer to you. Try to position the magnifier half way between you and the text. The magnifier's focal distance is an equal distance on both sides of the lens. Stand magnifiers hold the lens off the page at their focal distance, try to view the text through the magnifier from a distance equal to that which the magnifier is from the page. A "lap desk", used upon a table, is a useful tool for holding the text at the proper angle so you don't have to lean over so far when looking through a magnifier. Remember to look through the magnifier not at the magnifier. I know it is annoying to have to get so close to the magnifier but when you do you are going to improve the field of view. The stronger magnifiers require one to use only one eye. Try to keep your best eye over the center of the magnifier. Knowing which eye to use is important. Usually one's most dominant eye is afflicted first and consequently more severely. If this is true for you and since you have always relied on your dominant eye for sighting, it is going to take modifying your behavior to adjust to using your other eye.

When productivity and comfort become issues you may consider using a "CCTV". They are the most productive and comfortable way to use magnification for your purposes.