Jain isn’t surprised. Having studied and treated eye problems that lead to significant vision loss in older adults (including glaucoma, macular degeneration, and diabetic retinopathy, which are not correctable) he’s seen firsthand the psychological impacts of low vision.
Redefining vision ‘quality’
“Older adults with low vision gradually stop reading and watching TV,” Jain says. “They eventually stop driving and then cut back on their social activities. They find it harder and harder to handle basic activities of daily living, like dressing themselves or cooking. All of this leads to social isolation and ultimately depression. It also increases anxiety, due to their loss of independence.”
Don’t forget there are issues beyond vision focus. How good is your ability to see contrast and depths? “One of the reasons we hear so much about falls among older adults is their inability to see the contrast of one step from another, or to judge the depth of the stairs,” Jain says.
“If we reevaluated ‘success’ in vision correction from ‘Which lines can you read on the eye chart?’ to ‘How independent do you feel?’ we would have a new definition,” he adds.
Be willing to acknowledge needs
It’s one thing to fit people in a nursing home with glasses, but what happens when an independent person simply refuses to acknowledge a problem? “I’ve had patients who can barely count fingers and yet when I ask if they’re having difficulty seeing, they tell me, ‘No. I can do what I want.’ The question really is whether they are actually doing what they want,” Jain says.
“On the standard eye chart, if your vision is 20/200 despite corrective lenses, you are legally blind. Thanks to surgery or vision aides we now have, I might be able to increase your vision to 20/80. That’s significantly better,” Jain says.
That doesn’t mean you’ll be satisfied with your quality of life. At 20/80, you may no longer be able to enjoy doing the newspaper’s crossword puzzle. Perhaps you loved to cook, but can’t read the labels in your pantry anymore.
Easy tests to start yourself
Jain recommends a simple eye test—the National Eye Institute Visual Functioning Questionnaire (VFQ). You can find it at
www.agingeye.net under Online vision tests.” Have a loved one download it and, if necessary, read it to you.
Among the test’s questions are issues you may not have thought about lately. For example, how difficult is it for you to handle hobbies like sewing or working with hand tools? How hard it is for you to find items on a crowded shelf? Any score under 90 (out of 100) means you have at least some vision impairment.
Remember, glaucoma affects peripheral (side) vision before frontal vision. A simple test is to keep moving an object off to the side and have a friend note if (and where) you eventually lose sight of it. (Or have your friend control the object.)
The caregiver’s role
“Pay attention to whether your loved one’s interest in things, like puzzles or model building, for example, has slackened. That may be a sign of vision problems,” Jain says.
Take your loved one to an ophthalmologist, someone who specializes in eye disorders. If he or she is in a nursing home, see if an ophthalmologist makes rounds. For non-correctable disorders, seek out low-vision centers. “These centers can direct you to tools to help and sometimes retrain the eye how to see,” Jain says.
The good news is your problem may not even lead to the low-vision center. A willingness to look for, and then correct, simple vision problems can enhance your life, or that of someone you love.