Samantha Danz, MS, OTR/L
Occupational Therapist, Southeast Wisconsin

Are you one of those people who reach for your phone or the clock in the middle of the night and can’t see? Or even during the day and you have to squint to read? Now add glaucoma and or cataracts on top of that. 

I am currently working with a patient who moved into an SLC after her heart surgery as she couldn’t tolerate going up and down the three flights of stairs in her home anymore. Not only could she not climb stairs as efficiently, but she also had a hard time standing long enough to participate in one of her favorite occupations — baking. She has some additional comorbidities, one of them being glaucoma, and she wears glasses to help with her vision. With the change in environment moving from her home to the SLC, she wasn’t able to successfully use her oven. She desperately wanted to bake cookies for Christmas so her grandchildren could decorate them with her, as they have for the last 15-20 years. So now what? 

Our older adult patients have a hard enough time with the physical decline that comes with aging.  As clinicians, we need to find creative ways and interventions for them to remain as independent as possible and allow them to participate in as many ADLs and IADLs as they desire. One area in which can assist is vision. 

Intervention Ideas for Patients with Low Vision

One of the interventions I used with this patient was placing small circular stickers — the kind you would use at a rummage sale — just off center of the desired button. Using the brightest color, yellow, I numbered them in black sharpie in the order she needed to push the buttons. 

The first, labeled “1”, was for the power button. The second, labeled “2” was the temperature. I used up and down arrows on those stickers to allow her to comprehend which one to press to increase or decrease the temperature. I placed more numbered stickers to set the timer if required. Finally, I created step-by-step instructions on matching yellow-colored paper with black sharpie to specifically correspond the numbers with the action that they would cause. I then laminated and placed the sheet next to the stove to improve her success. 

I was able to do the same thing for her laundry machine so she could line up the dial to start the desired wash. Sure, we had to do additional treatments to improve her aerobic capacity and standing tolerance, but that is for another article. But my patient’s low vision was now one less issue to deal with.

While using the oven and doing laundry may not be considerations for every one of your patients with low vision, there are still plenty of other interventions you can introduce. Here are some other ideas for around the home:

• Bright colored paper and dark lettering for signage. Note that you may need to rotate the colors when the patient becomes accustomed to looking at that visual prompt.
  
• Keep the commands simple on a prompt, do not use full sentences, and try to decrease the verbiage.
• Use contrast to promote their visual field quickly.
• For patients with very low vision, use tactile input in the form of “bump dots.” These can be used on buttons for appliances and other devices like the microwave, power buttons, and phones. 
• Block out undesired buttons. For example: On a remote, cut out paper to block out the numbers not required to decrease scanning and input. Or find a larger remote with bigger buttons. These can easily be programmed to most televisions.
  
• Add Wite-Out to the areas surrounding the desired button. Do this for the buttons your patient will use most often — the power button, volume, and channel selector.
  
• Plug in motion lights to outlets for getting up and out of bed at night, in hallways, and in the bathroom.
  
• Implement a magnifying glass and keep one in different areas of the home
  
• Switch to large print books, playing cards, and other paper materials
  
• Trial a large pill box with images instead of text. For example, a “sun” for morning medication and a “moon” for evenings in a dark color on top of a clear compartment to further improve recognition
  
• Educate your patients on books on tape for less eye strain. Many are available through their local library.
• Switch out clocks for ones with larger displays.
  
• Implement an Alexa or other Voice Assistant if the patient is able. This allows them to make verbal commands instead of having to read and type.
• Change the setting on their smartphone or tablet to large text size.
  
• Organize their closet by shirt types — short sleeves, long sleeves, jackets/cardigans, and pants if they hang them up.

Safety Concerns for Patients with Low Vision

Any time there is low vision, the risk of falling significantly increases. Review the areas that the patient travels most frequently and make sure it is clear of debris, well lit and that their AD, if applicable, can safely maneuver in small spaces. 

Don’t be afraid to modify your patient’s environment. Move furniture to better promote full turns of their walker. Educate them on removing their throw rugs and assess for other thresholds in their home. If oxygen tubing is a concern, train on safe placement in hand/on a walker or maybe recommend the new smaller and portable tanks that run on batteries. 

If someone is legally blind, training them on counting steps between rooms, placing commonly used items within reach, keeping furniture minimal and out of the way, and slowing down their mobility will all be important!

Public Resources

The advice above is a great place to start, but there are plenty of state and national resources for anyone to use! Here are a few: 

• American Printing House
• American Diabetes Association
• American Foundation for the Blind
• American Macular Degeneration Foundation
• Vision Aware
• U.S. Department of Veterans Affairs (if applicable)
• Check out your local or state services.

With a few simple modifications and interventions, clinicians can counter the effects of low vision and make their patients’ living spaces that much safer.