By Emily Mengle, OTD, OTR/L, LSVT BIG Certified Clinician
Occupational Therapist
Connecticut 1

As clinicians working in the home setting, there are many factors to consider during treatment including health conditions and aspects of the environment. Several visual conditions such as macular degeneration, glaucoma, cataracts, and diabetic retinopathy may be seen in the older adult population. Further, these visual conditions may lead to low vision, which further interferes with daily life and participation in meaningful activities. 

Low vision is defined as, “permanent loss of vision that cannot be corrected by eyeglasses, contact lenses, medication or surgical intervention or interferes with the performance of common age-appropriate seeing tasks.” Apart from specific visual conditions, visual acuity, in general, may begin to decline with age. Therefore, it is important to be prepared to address visual conditions because of how they interfere with participation in the home environment. 

Common Types of Visual Conditions Affecting Older Patients

There are a variety of ways in which visual conditions can present, but all have the potential to interfere with participation in everyday activities. Here are a few of the most common:

• Macular Degeneration and Cataracts lead mainly to blurred central vision, although cataracts can also affect peripheral vision
• Glaucoma may involve the loss of peripheral vision and blind spots
• Diabetic Retinopathy may result in blurry vision and floating blind spots 

Tips for Helping Patients With Vision Impairments

As occupational and physical therapists, we are qualified to help patients make changes in their homes and environments to reduce the impact that these visual conditions may have on their participation. Below are a few concrete ways to address vision in the home environment.

1. Increase Lighting

Making changes to lighting can help improve performance and quality of life in the home. In order to optimize lighting, lights should be turned on or made brighter during transitions between rooms and shadows around should be minimized. Making these types of adjustments facilitates safe movement around the home. 

To support near tasks such as cooking and reading, consider using task lights that point directly onto the activity. 

2. Utilize Magnification 

Encourage patients to switch to large print items such as books or utilize handheld magnifiers to help with any tasks involving numbers or reading small print. This puts less strain on their eyes and helps prevent fatigue. 

3. Reduce Glare and Increase Contrast 

Utilize lampshades and window shears to reduce glare on the floor. Add brightly colored tape to the edge of steps or over thresholds to reduce the risk of falls. Contrast can also be helpful in the bathroom to help patients see where the edge of the shower or tub is to further reduce the risk of falls. 

4. Encourage the Use of Touch

Tactile markers can be used on a variety of household items. These markers increase a patient’s ability to use these items without having to rely solely on eyesight. 

To facilitate ADLs such as dressing, safety pins or tactile markers can be applied to assist in finding items. Raised tactile markers can also be applied to appliances such as the microwave to aid in some cooking tasks. 

5. Use Auditory Cues Such as Voice Assistance

A variety of talking devices can be used in order to facilitate the use of auditory cues. For example, devices such as Alexa or Siri can be set up to aid in daily tasks such as medication reminders and turning lights on or off. 

6. Keep Things Organized

Patients can be taught a variety of organizational strategies to facilitate functional performance despite any visual conditions. For example, strategies such as removing clutter can maximize safety during functional mobility and aid in patients’ ability to find items around the home. 

Another helpful strategy includes keeping products in the same spot so individuals do not have to rely on their eyesight alone to find household items. Further, establishing a schedule throughout the day can help with the accomplishment of tasks. For example, patients can be taught to complete tasks at the time of day when eyesight is best and break large tasks into steps to make them more manageable. 

7. Teach Problem-Solving Skills

One of the most evidence-based ways to address occupational performance in individuals with low vision is to teach them problem-solving skills. Specifically, clinicians can teach patients the problem-solving approach, which involves defining problems in daily life, setting goals, finding solutions, and evaluating outcomes. The problem-solving approach is most effective when there is a large amount of patient involvement in the process. Problem-solving skills are useful in the long term because they can then be generalized across various scenarios that may arise. 

Visual conditions can manifest in many different ways. Talk with patients to identify what is most important to them and apply any of the above strategies that may be relevant to the achievement of their personal goals.