Tactile Solutions for Color Vision Deficits

By Tiffany Lai, MA, OTR/L
Occupational Therapist, Virginia

As we all know, older adults are prescribed more and more medications over time. Though we typically take into account our patients’ low vision in terms of visual field and acuity, we often forget color perception. Several drug types frequently prescribed to seniors can potentially alter color perception, including:

• Furosemide: diuretic commonly prescribed for lymphedema in combination with cardiac medications         
• Lanoxin/digoxin: cardiac stimulant commonly used to treat various heart conditions including Atrial Fibrillation (A-fib)
• Sildenafil/viagra: erectile dysfunction drug
• Hydroxychloroquine/plaquenil: antimalarial drug sometimes prescribed for rheumatoid arthritis

Though literature on medication-induced color deficits is limited, most drug-induced color deficits seem to affect the blue-yellow axis, either tinting vision yellow or making it difficult to discriminate between blues, greens, yellows, and violets. Armed with this knowledge, we can then begin to tailor the compensatory strategies we use with our patients starting from the very first day of evaluation. 

Also, don’t forget that color perception deficits can also result from a variety of physiological abnormalities both systemic and organ-specific as well as congenital or acquired. We might take into account the visual field deficits of chronic diseases like glaucoma or cataracts, but other diseases like macular degeneration or diabetic retinopathy may also affect color vision.

How OTs Can Determine the Presence of Color Vision Deficits

Here are some things I like to ask about or keep an eye out for during my evals or any subsequent treatment sessions — especially if I spot the associated diagnoses in my patients’ medical histories:

• Medication list: diuretics, rheumatoid arthritis medications, etc.        
• How patients think their color perception has changed over time and the functional impact on their daily routines
• Whether or not family members or caregivers have noticed vision issues beyond visual acuity, ex. complaints of “bluish” vision

If you are able to determine that color vision deficits exist, what can we do when our go-to, high-contrast painters’ tape isn’t as effective as we were anticipating? Get creative! 

Accounting for Color Vision Deficits in Treatment

None of us are strangers to improvisation regardless of discipline. That’s especially true with the limited resources we are able to bring into or access in our patients’ homes. 

If you can’t rely on colors, a good alternative is touch. Here are some household items I’ve used in the past in lieu of color differentiation:

• Adhesive velcro – both the hook and the loop side   
• Hot glue dots or dashes
• Puffy clothing paint
• Add texture to your painter’s tape! Ruffles, twists, knots, etc.
• Tie small pieces of Theraband to objects – color may not be as apparent, but the extra traction and shape of the knot are still discernible

Make sure you integrate task-specific training with your patient to ensure success with any compensatory adaptations or modifications you utilize.  What are some of the situations you have come across involving color vision? What were your solutions?