Orli Weisser-Pike, a doctor of occupational therapy and a certified low vision therapist is the guest speaker. She has over eighteen years of clinical experience in a wide variety of settings and has for the past decade specialized in helping people affected by low vision.
Spring Cleaning: Making Your Home Safer for Low Vision
March 30, 2016
Transcript of Teleconference with Orli Weisser-Pike, OTR/L, CLVT, SCLV (University of Tennessee Health Science Center)
Please note: This Chat was edited for clarity and brevity.
GUY EAKIN: Hello everyone, and welcome to our monthly BrightFocus Chat, presented by the BrightFocus Foundation. My name is Guy Eakin, and I am the Vice President for Scientific Affairs at the BrightFocus Foundation. Thank you for joining us today.
Our topic today is “Spring Cleaning: Making Your Home Safer for Low Vision.” This will be a discussion with Orli Weisser-Pike, who is a doctor of occupational therapy and a certified low vision specialist. She has more than 13 years treating people who are coping with vision loss. Some of you who have been on for a while may recognize Orli’s name and voice from a previous BrightFocus Chat. So, Orli, thank you for agreeing to come back for an encore performance today, and we are happy to welcome you back!
ORLI WEISSER-PIKE: Thank you so much for asking me back, Guy. I really appreciate the work that you and the team from the BrightFocus Foundation are doing to help people cope with low vision from macular degeneration, plus all of the rest of the work that you do. Thank you so much.
GUY EAKIN: So, spring is here, and—at least in the DC area—this time of year makes us think of spring cleaning. With that in mind, we are going to put a low-vision spin on this concept. We have recent data from the Centers for Disease Control and Prevention—the CDC—that shows that the most common place for injuries to occur is actually inside our house. So, this is 38 percent of women’s injuries and 26 percent of men’s injuries. There are a number of simple modifications to our living spaces that can help prevent falls or other types of household injuries. So, Orli, let’s get this started. What are some overall, high-level recommendations or rules of thumb that would apply to most of the rooms of the house?
ORLI WEISSER-PIKE: Thanks, Guy. With respect to low vision, we want to think about three specific strategies. The first strategy is to improve the visibility inside the home by using adequate lighting and by, of course, reducing glare. The second strategy is to use bright colors and contrast so that objects stand out against their background. The third strategy is organization. This means getting rid of clutter, grouping items that belong together, and always returning them to the same place. These three strategies—lighting, contrast, and organization—will go a long way to helping make your home safer.
GUY EAKIN: Maybe we should start right from the top of those. What can you say more specifically about lighting? We are talking about lighting inside of our home in this conversation.
ORLI WEISSER-PIKE: When someone has low vision, he or she typically needs about three to four times as much light as someone without vision loss. In general, we consider two situations when we need light: One situation is for getting around, like walking down a hallway; the other situation is for doing detailed tasks, like reading a medicine label or chopping vegetables. The amount of light we need for moving around is typically less than the amount of light we need for seeing details. Of course, the question is, how do we get more light?
Now, most people make the mistake of thinking that if they use a light bulb with higher wattage, they will get better lighting. The truth is that increasing the wattage of the light bulb is very dangerous, because you can burn your house down by putting in a light bulb that has more wattage than the maximum wattage rating on the fixture. All fixtures have a sticker in them that tells the maximum wattage that you can use, and for ceiling fixtures this is usually about 60 watts. Nowadays we have energy efficient bulbs that use a lot less wattage or power to produce the same amount of brightness than the old style incandescent bulbs. I recommend using compact fluorescent bulbs, because they are easy to install and they are relatively inexpensive. They also don’t get quite as hot as the older style bulbs.
Also, one thing to keep in mind is that light bulbs come in different color temperatures. We see bulbs labeled as soft white or bright white or daylight. Now, soft white bulbs produce a yellower‑looking light, which is great for creating a warm atmosphere or creating a decorative vintage look—similar to candlelight. However, it isn’t a useful color temperature for reading or other detail tasks. For reading or chopping vegetables or putting on makeup or doing crafts, you want a bulb with a color temperature that mimics natural daylight.
The most important thing when you are using light for detail tasks is to bring the light where it is needed, using an adjustable desk lamp or a floor lamp or even a small handheld flashlight. You can get four times the amount of light by bringing it two times closer. That is called “the inverse square rule.” You don’t necessarily have to increase the wattage of the bulb, but by bringing the light closer it illuminates a whole lot more.
One last point to think about is cleaning the bulbs. Over time, lights and fixtures get dirty, so you want to clean the bulbs and fixture covers pretty regularly. Dust and critters that accumulate in the lens covers can dim the amount of brightness that the light or fixture can produce. Even though a lot of light bulbs say that they are guaranteed for a certain amount of years, the filaments also decay within the light bulb. Replacing bulbs that look like they are starting to dim is a good idea. Periodically replace those bulbs.
GUY EAKIN: That is wonderful. I think that there is a lot of information there that one might not necessarily find just looking around on the internet. I don’t think I had heard anyone describe the differences, or what the advantages are, between soft white and bright white and all of these brand descriptions that you see on light bulbs when you walk down the aisle at the store.
Let’s follow up on that idea of bright colors and the idea of contrast. Can you give some examples of how to use color and contrast to make your home safer?
ORLI WEISSER-PIKE: Yes. So, people with low vision often have diminished perception of color as well as reduced contrast sensitivity. Contrast sensitivity is the ability to see an object against a background with a similar color or tone. Bright colors are easier to see in general than pastel colors that look more washed out. We discussed lighting earlier, and a good light intensifies the appearance of colors. Solid colors are easier to see than patterns. For example, it is easier to see food on a solid colored plate than on a plate that is covered in a pattern—like a beautiful Wedgewood porcelain plate with blue and white illustrations. Using color and contrast can be as simple as installing a dark electrical outlet cover on a light colored wall or as simple as pouring milk into a navy blue bowl.
GUY EAKIN: That’s interesting. I think that with the amount of time we have for lighting, we want to make sure we move at a good clip. You mentioned organization as one of the strategies for safety in the home. Do you have any specific suggestions about organization?
ORLI WEISSER-PIKE: Yes. Of course we all want to feel safe and comfortable in our homes, and we like to be surrounded by all of the things that bring us comfort. But nothing is more frustrating than having to spend time looking for stuff that we can’t find. We rely a whole bunch—rely greatly on our vision for seeking and finding items in our surroundings. When vision loss occurs, it is even harder to rely on this sense for finding the items that we are searching for. It is very important to eliminate clutter wherever possible in all areas of the home.
I know that some people have great difficulty getting rid of stuff because they either can’t part with it for sentimental reasons or they can’t decide if it should be kept or eliminated. A simple way to eliminate clutter is to go room by room with three boxes. One for items that are currently in use. One for items to store, to put away. And the third for items you would like to donate. A good example for this is in your clothes closet. Decide which items of clothing are in use and put them in the first box. In the second box you can place items that are seasonal, like winter coats and sweaters—especially now that we are coming up upon summer—and you can store them for later. In the third box you can place items that you have not worn for the past year and are unlikely to wear again in the future, and you can donate those items from that third box.
For the remaining items that you are going to keep, you can use the concepts of color and contrast that I discussed earlier. For example, in the closet you can hang items of clothing by color, and you can separate items of similar color that are difficult to distinguish. For example, brown and black. You can decide to hang the brown clothes on one end of the closet and the black clothes on the other side, so you can tell them apart and keep them apart.
GUY EAKIN: I may just be doing that in my own closet when I get home. Those are wonderful suggestions. I know in our house we have some areas that may be more problematic than others. One that comes right to mind is the kitchen. What do you suggest about moving around the kitchen and preparing food in a way that is safer and more efficient?
ORLI WEISSER-PIKE: One of the simplest ways to make food preparation easier is by making sure that you can identify the food products easily and efficiently. Nothing is more frustrating than opening a can of corn instead of a can of peaches for dessert. You can make yourself simple labels using index cards, a bold marker, and some rubber bands. All you need to do is write—in large print—the name of the product in the can. You can fasten that index card to the can with the rubber band. Keep your pantry organized this way. You can also do this with frozen dinners. You can place an index card with the name of the food and the number of minutes that you’ll need to heat it in the microwave.
Now, with regards to the microwave, the seconds on the microwave and toaster oven—where you heat your food—those can be marked using adhesive tactile round bump dots that help you to feel where the start and stop buttons are on your appliance. You also may need someone to help you place the dot in the right spot.
Another easy fix for appliances is to make an enlarged diagram of the various buttons and settings that you can refer to on a piece of paper. You can slip it inside a little plastic sheet cover. You can use this instead of having to lean over hot burners or lean into a hot oven to read the dials and the settings.
You might also want to consider using a desk lamp on the counter to help bring more light to the area where you prepare food. Even though you might have a great light coming from the ceiling, it might not be enough to illuminate your work surface, and you may even be creating a shadow on your countertop if your ceiling light is behind you. I would also recommend having a small flashlight inside your kitchen cabinets. Cabinets are dark spaces that are often difficult to see into. A flashlight can go a long way toward illuminating the darkness that is inside the cabinets.
Also, with respect to kitchen safety, most kitchens have a variety of work surfaces at different heights. If possible, place the most frequently used supplies and equipment between eye level and hip height. That will help you to avoid unnecessary bending, reaching, and lifting. This is particularly true when considering the height of the microwave. I have seen many homes and many kitchens where the height of the microwave is high—at eye level. So, consider lowering the position of the microwave onto the counter if it is high—onto a hip-height level if it is high. A microwave that is installed at eye level makes it harder to reach inside and carry hot food out of the microwave, and that could potentially lead to a dangerous spill situation or a burn when hot food is removed from the appliance. Also, consider storing heavy items within easy reach rather than low down or at the back of a cabinet.
Finally, in the kitchen, think about safety when pouring liquids. Now, I know that low vision can make it difficult to measure and estimate liquid levels. A quick and easy solution is to always pour liquids over a tray or a basin or a sink—something that can catch liquid spill so that if a spill occurs, it is already contained and can easily be cleaned up.
GUY EAKIN: Thank you. All of those are wonderful suggestions. As you talk about bringing new light into the kitchen, one of the things I reflect back on is the idea of spring cleaning and clutter. In the kitchen—especially, for instance, on kitchen counters—that’s a likely place to get clutter, and I wonder if you have suggestions about how to limit clutter, especially on those kitchen counters and other high-traffic areas in the house.
ORLI WEISSER-PIKE: Decluttering is very important, especially with low vision, like I mentioned before. Finding items becomes more difficult if there is a lot of clutter. We know that it is really important that things and objects have a place to store away in the same place, and—especially when people have low vision—it is very important to keep things in the same place so that they can easily be found. It is also important to make it easier to find things that we use on a daily basis. I would recommend keeping items that are used on a daily basis within reach on the counter in a designated area. For example, keep your coffee-making supplies on a tray on the counter, but put away any boxes of cookies you may not eat every time you make yourself a cup of coffee.
GUY EAKIN: When I think about the advice in the kitchen, I imagine that the other places where we have a lot of opportunity for accidents are in the bathrooms. Let’s move the conversations to the bathroom. What type of modifications do you think are appropriate to make bathrooms safer in the context of low vision?
ORLI WEISSER-PIKE: Here I’ll go back to the original discussion about lighting. It is very important to have really good, clean, bright light in the bathroom because light makes it easier to see potential fall hazards. Remember that bathrooms are places with shiny and slippery surfaces that can lead to glare and falls, so having good lights throughout the bathroom is essential, and I often recommend daylight bulbs and fixtures in the bathroom.
You can also use a bright solid-colored floor mat with nonskid backing. I would recommend getting one as large as possible to set the floor area and perhaps a carpet with a heavier gauge to keep the edges from rolling over. A thin area rug will roll and wrinkle more easily, and that creates an uneven, potentially hazardous floor surface. Think about a solid color, a large, heavy carpet with a nonstick backing for the area rug in the bathroom.
Grab bars can be added for safety, but here I would strongly advise you to have these professionally installed. They need to be installed into the stud, or they need be installed so they can actually bear the weight of the person using them. There are many varieties of grab bars in different lengths, diameters, and different finishes. I would even recommend going so far as to exchange the towel rack for a grab bar because many people mistakenly use the towel rack for support. Speaking about towel racks, you should never lean on the toilet paper holder by your toilet or on a soap dish, because these can easily rip out of the wall.
If you need to step over the side of the tub to get into your bath or shower, you can put a bright, solid-colored towel of the side of the tub to make it easier to tell how high to lift your feet over the side. Or, better yet, you can just sit on the side of the tub and just swivel your feet into the tub to get in—you just pivot around on your bottom while you’re sitting down. That is an easier way to get in and out of the tub.
While you’re bathing, to differentiate between the shampoo and the conditioner, for example, as they are in similar bottles, you can put a rubber band around one of the bottles so that you can tell them apart. You just need to remember which one is which. If you put the rubber band around the shampoo, you’ve just got to remember that.
Another way to keep yourself safe is to use soap on a rope. You don’t find a lot of that anymore. You can even make yourself a little soap inside a sock, actually: If you can’t find soap on a rope, you can get a bar of soap and put it inside a sock that might be missing its mate from your laundry, and that is another way to keep your soap safe and easy to find. If you take a bath and it’s hard for you see how far your bath is filled up with water, you can put something bright that floats in the water while it is filling up to help you tell how high the water is.
GUY EAKIN: Orli, one of the things I always enjoy talking to you about is the creativity that comes up. As I mentioned earlier, there are so many things that you might not read on the internet or on the pamphlet that you find in the doctor’s office, and certainly I think soap in a sock is one of those things. I don’t think I’ve ever heard that one before, so I know that there’ll be plenty of people who might be trying that in the near future.
Maybe on that theme, what are areas that you think, in your experience, are frequently overlooked or that don’t really make it into the lists that you sometimes see on the pamphlet at the doctor’s office? If I were thinking personally, I would think maybe a laundry room or a garage. I don’t see much about that out there. How about you? What do you think is overlooked when we consider low vision in the home?
ORLI WEISSER-PIKE: Those are really good rooms to talk about. Let’s talk about the laundry room and the garage. So, laundry rooms are definitely spaces that need good, bright light. Having a good, bright light can help you sort your laundry into dark and light colors. Having a good, bright light can help you identify and treat stains. Light can help you put together matching clothes as they come out of the dryer, and, of course, light can help you see the settings on your washer and dryer. If you don’t have enough light in your laundry room, keep a small LED flashlight by the washing machine and use that.
You can also mark your frequently used settings using a brighter piece of label or a bump dot, which I mentioned earlier when we discussed the microwave. Earlier, I also mentioned using an enlarged diagram of the appliance dial. These can help you select the right settings for your washer and dryer.
Another recommendation I would say is to use laundry detergent capsules instead of loose powder detergent or liquid detergent. You just put these capsules directly into the dirty clothing in the washing machine, and you don’t have to bother with pouring or measuring detergent.
Now let’s talk about the garage. With respect to the garage, many people enter and exit their homes from the garage, so in addition to making sure the garage is well organized and that the path from the garage into your home is clear, I would recommend that you place something on your house key to easily identify it from your other keys on your key chain. Something like a rubber ring. If you have an alarm key pad at the entrance to your home from the garage, then you can mark the number 5, which is typically the number in the middle of the grid, like a tic-tac-toe grid. That’s how the numbers are laid out—with 1-2-3 in one row, 4-5-6 typically in the middle row, 7-8-9 in the third row, and then the 0 is underneath that, so, the number 5 is usually in the middle. And I would put a bump dot or something to be able to see that number 5, and then memorize the position of your fingers on your alarm code so that you can rely on your sense of touch to key in your alarm code when you enter your home. You want to practice that so that you can arm or disarm your alarm without relying on your vision.
There is one other area that you didn’t mention that I would like to talk about, which are closets. We kind of talked about them a little bit when we talked about color and contrast, but I do want to talk about closets again. Clothing closets, because they are notorious for having poor lighting. Now, if you’re lucky enough to have a walk-in closet or a closet that has a light in it, often there is only one light fixture, and usually the maximum rating for that bulb is about 60 watts. Like I mentioned earlier, many people make the mistake of putting a much stronger light bulb in the closet, and this is very dangerous because high-wattage bulbs create a lot of heat, and fixtures are not properly insulated from that heat, so you could have a situation where you have flammable clothing with a heat source, and that really is not a good idea. I recommend an energy-efficient bulb, and I recommend it in the daylight color spectrum. You can get a bulb that is equivalent to 100 watts. These types of bulbs—like the compact florescent bulbs—they only use 26 watts, but they give the brightness of a 100-watt bulb.
If you don’t have a light fixture in your closet, then you can hang a small flashlight on a chain or on a rope—or I even suggest a dog leash—and just attach it to a clothing rod and use it to find the outfit that you need. You keep clothing of similar color groups together. You can also alternate groups of dark clothes with light clothes to make it easier to differentiate between the colored groupings of clothing.
GUY EAKIN: We have some questions from listeners, and there are couple of them that reflect on this daylight coloring that you just mentioned in the closet. They’re asking if there are different types of daylight color, or are there different daylights that you recommend for different areas of the house? How do you know what’s the right daylight spectrum to put in one area of a house versus another, or are they all kind of the same?
ORLI WEISSER-PIKE: You’re going to have different manufacturers’ bulbs, but the daylight refers to the color temperature of the bulb, so it is a certain portion of the light spectrum. I am not a physicist, so I can only explain it in layman’s terms, but in general there is a selection of three types of color temperature bulbs. There is “soft white,” which is that kind of yellow light. You have “bright white,” and then you have the “daylight,” which is a crisper—I don’t want to say “blue light”—but it is a crisper, whiter light. As I mentioned earlier, there are some areas of the home where you want to have a more decorative, atmospheric light for ambience—maybe in your lounge. But in your bathroom, you probably want a daylight bulb. So in your lounge you may have the soft white bulb, but in your bathroom where you want to be able to see really well and apply makeup or shave, you want a daylight color temperature bulb so that you have a much whiter, cleaner light that is better for seeing detail. Regarding whether one brand is better over another, there isn’t one brand I would recommend over another. I would just recommend trying to get 100-watt equivalent, which are only 26 watts, and I am pretty certain that those would meet the maximum rating for most fixtures in the general residential setting.
GUY EAKIN: That’s great, and I think we see these words on the labels of the bulbs fairly often, so you will see “soft light” or “daylight” advertised on the bulb packaging.
ORLI WEISSER-PIKE: I tell patients that it is kind of like ice cream flavors. It’s like vanilla, strawberry, and chocolate. So it is like flavors. They’re just colored temperatures, but it is important to know that they do impact how well you see. So for anything that requires you to see a lot of detail, always go with a daylight bulb portion of the spectrum. The daylight temperature.
GUY EAKIN: That question maybe segues into another question. Sometimes people have trouble adjusting when they move from one area of a house to another, or entering and exiting their homes, especially if you’re moving from a dark place to outside—to a bright sunny day. That’s a challenge. Do you have any experience helping people adapt to that challenge?
ORLI WEISSER-PIKE: Yeah, that is a really great question. One of the visual functions that slows down as we age in general—without regard to having an eye disease or not—is the ability to quickly adjust our vision as we move from bright light into darkness and, vice versa, from dark into a light situation. This might happen if you’re outside on a sunny day and you go inside to get a drink of water, or if you’re in a dark movie theater and you come outside into the daylight.
The time it takes for our eyes to adjust declines with age—so it takes longer, and it can be even slower and take even longer when we have an eye disease. Of course, using sunglasses or other kind of frames that fit over clear prescription glasses is very helpful, not only in reducing glare when we’re outside but also in helping lessen the time it takes for our eyes to adjust to darkness. That transition time for adjustment will take less time if we use shades correctly. There is actually a correct technique for using these types of shades. If you’re in a bright environment and you’re wearing the shades, take them off only once you’ve entered into the darker space. A lot of patients will tell me they use shades, and when I ask, “Well, where are they?” they say, “Oh, they’re outside in the car.” So they take them off in the car, and then they’ll get out the car back into the brightness and come into the building, so that’s really not effective. You want to wear your shades all the way until you’ve actually entered the building, where it is a little bit darker.
If you’re going outside, if you’re going out into bright sunlight and a brightly lit environment, you want to put the shades on while you’re still in the darkened area before you step over the threshold into the bright light. Doing this will help you avoid the extreme brightness or the extreme darkness, which can be blinding and disorienting.
GUY EAKIN: That’s really helpful, and I think, as we wrap up the conversation today, a lot of what we’re talking about are things that allow us to live in the place where we’re most comfortable for longer periods of time. As we look back on the discussion, are there things that we missed? Are there lifestyle changes or changes to the home that you find yourself recommending often that we haven’t discussed today but might contribute to safety at home?
ORLI WEISSER-PIKE: In general, if you’re planning to stay in your home for a long time, you might want to consider consulting a certified aging-in-place specialist to help you plan changes and modification to your home with the idea that your home will meet your needs for the remainder of your life. Essentially, you’re going to fit your home to your needs. I think most people will agree that they prefer to stay in their home rather than have to move into an assisted living facility or a nursing home because their home doesn’t fit them anymore. Most people are familiar and comfortable with their own community, and moving can be incredibly stressful.
Some general recommendations for aging in place would include having living areas all on one level even if you live in a home with two or more stories. That means that you would have a bedroom, bathroom, shower, kitchen, and living room all on the main floor. Also, there shouldn’t be any threshold between rooms, if possible. Hallways and doorways need to be at least 36 to 42 inches wide, and that’s to allow for a wheelchair to pass through if that might be needed in the future. You would want to clear as much floor space to avoid obstacles or tripping hazards. Another thing that can be done are round handles—knobs on doors and faucets can easily be replaced with lever-type handles.
I want to take a moment to talk about bifocals, trifocals, and progressive lenses. These types of glasses are convenient because they combine several types of glasses into one frame. For example, bifocals: You have the top section for seeing distance and the bottom section for reading. This convenience comes at a cost to your safety. Bifocals and multifocals are known to impair your ability to see obstacles when you’re walking around. If you’ve had cataract surgery, it is likely that you might not even need the top section of your bifocals at all, so consider removing your bifocals or your multifocal glasses when you’re moving around in your home. Use your glasses for near tasks, like reading or preparing meals, but take them off when you’re walking around. You can hang your glasses on a chain and use them when you need them for seeing detail.
Now remember, you alone are the judge of how well you see through your glasses and whether or not they actually help you, but if you see better without your glasses when you’re walking around, then take them off. Guy, I’m really glad that this recommendation is actually on the Center for Disease Control and Prevention’s web page on falls and safety.
GUY EAKIN: That and everything today, I really have to thank you. It has been a wealth of information. I’d like to give a big thank you to Orli Weisser-Pike for joining us today with these really outstanding tips and thank everyone on the call who did ask the questions. I hope we were able to answer them.
If you were not able to jot all the ideas you heard today down, never fear. We’ll be posting a recording and a transcript of the calls on our website. You can also listen to and download our past Chats on iTunes and SoundCloud or call in anytime and we can send you a transcript of the most recent Chat. The next Chat will be “Choosing the Right Doctor to Treat your AMD,” and that will be on April 27, 2016. We encourage you to re-register now and submit questions in advance, and we’ll also be sending anyone who registers today a reminder email. If you would like a copy of the transcript for this call, to share with someone or for yourself, you can always call BrightFocus at 1-800-437-2423. You can always find all of these resources on our website at www.brightfocus.org.
Orli, thank you again. We’d like to thank Orli Weisser-Pike for all of her insight on staying safe and avoiding injuries at the home. Again, if you want to leave a comment after the call, just stay on the line. Thanks from all of us at BrightFocus Foundation. Have a great day.
ORLI WEISSER-PIKE: Thank you.
BrightFocus Foundation: 1-800-437-2423 or visit us at www.brightfocus.org. Available resources include:
- Resource lists for people with macular degeneration
- Information on research funded by BrightFocus (www.brightfocus.org/research/macular-degeneration-research-program)
Centers for Disease Control and Prevention web page on falls and safety:www.cdc.gov/homeandrecreationalsafety/falls
The information provided in this transcription is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical, dietary, and/or exercise advice. Any medications or supplements should be taken only under medical supervision. BrightFocus Foundation does not endorse any medical products or therapies.
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