Safety and Independence with Low Vision

BrightFocus Foundation
Safety and Independence with Low Vision
October 25, 2017
Transcript of Teleconference with Dr. Orli Weisser-Pike
1:00–2:00 pm EDT

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.

Please note: This Chat has been edited for clarity and brevity.

MICHAEL BUCKLEY: Hello, I am Michael Buckley from BrightFocus Foundation. Welcome to today’s BrightFocus Chat, “Safety and Independence with Low Vision.”

If this is your first time on a BrightFocus Chat, welcome. Let me take a moment to tell you about BrightFocus and what we will do today. BrightFocus Foundation supports some of the top researchers in the world. These are researchers who are trying to find cures for macular degeneration, glaucoma, and Alzheimer’s disease. We share the latest news from these scientists with families who are impacted by these diseases. We have a number of free publications and plenty of materials on our website, www.BrightFocus.org, that offer tips for living with diseases such as macular degeneration. The BrightFocus Chats, such as today, are another way we share this information with families.

Let me tell you about today’s guest. Dr. Orli Weisser-Pike is a doctor of occupational therapy and a certified low-vision therapist. Dr. Pike has over 18 years of clinical experience in a wide variety of settings. For the past decade, she has specialized in helping people who are experiencing vision loss. Dr. Pike may be familiar to some of our Chat listeners. She has joined us on two occasions over the past couple of years and has been a real delight to have a conversation with. She offers a lot of helpful tips and advice. We are thrilled to have Dr. Pike back. Orli, I would like to start off by asking you how you ended up in this line of work.

DR. WEISSER-PIKE: Hi everybody! Thank you so much for having me on this Chat. It is a real honor to be here for the third time. Thank you. How I ended up in this line of work—that’s a great question. I got interested in occupational therapy in my early 20s, and I got my degree in 1996. I came to the United States for my first job as an occupational therapist in 1997. That’s where I really first got exposed to school students who had vision problems. As a new occupational therapist, I didn’t really fully understand how vision impacted school performance. One of my peers who actually worked in the same company as I did, she also came from South Africa, became my mentor.  So I became very interested in the world of vision and how vision impairment can significantly impact a person’s ability to engage in their daily life activities.

I started to study more about vision and about low vision. About the same time, low vision was identified by the American Occupational Therapy Association, which is my professional organization. Our national organization recognized low vision as a great area of need where occupational therapists needed to expand their practice. Very early, in those days, I became more and more involved with my professional organization.

I also became involved with the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). That is a different national organization that certifies professionals in the field of vision rehabilitation. They certify low vision therapists, as well as vision rehabilitation therapists and orientation and mobility specialists. I became involved with both organizations, studied a lot, got a great mentor in the field of low vision, and I’ve been involved ever since. In 2008 I was recruited to an eye institute here in Memphis, Tennessee, specifically to provide low vision rehabilitation. I’ve been exclusively a low vision clinician since 2008, and now I am teaching full time at a university practice. I still have a clinic,—much less time than I would like, but I’m now involved in many other things, teaching as well as research.

MICHAEL BUCKLEY: Is there something about it that has been the most rewarding aspect of your career?

DR. WEISSER-PIKE: For me, really the most rewarding part is that I think that after a client has gotten the worst news possible—that they have vision loss that can’t be restored back to normal—I find my role is to help people to foster hope, to find a way, to show them what can be done. Most of the time people are extremely grateful to know that there is hope. I really find that very rewarding.

MICHAEL BUCKLEY: That’s great. Over the next 20 minutes or so, I want you to go through a lot of the specifics of having a safe home and living independently. Before we start, I was wondering, do you have a big-picture philosophy or rule of thumb for how people can stay safe at home?

DR. WEISSER-PIKE: I think that there are a number. Certainly we recognize how important the home is as we all age. We want to stay at home. Nobody wants to be shipped off to a nursing home or an assisted living facility. The biggest rule of thumb is to stay active. Exercise—you’ve probably heard that before—but find an exercise program that is right for you. Regular exercise keeps you stronger, and it keeps your joints flexible. We know that weight-bearing exercises can help slow down osteoporosis. Stay active. The more active you are, the better your chances are of being able to stay at home.

Another important thing, in terms of big picture, is to get rid of clutter in your home. If you haven’t used things for a long time, you probably don’t need them. Clutter is a big problem and can lead to a lot of hazards in pathways. Get rid of the clutter and keep the pathways clear in your home.

I know we will probably talk a bit more about lighting, but I will just say that as a general rule, make sure that all of your light fixtures are intact and that they have good light bulbs and the right light bulbs in. Also clean your light covers. Sometimes the lenses or the covers of the fixtures get dirty. So make sure that you clean those once in a while.

Have an accessible phone and make sure you have a list of contacts. Those are all more or less the big-picture things for your home stay.

MICHAEL BUCKLEY: I appreciate that. I am glad you brought up lighting. You would think that a lot of people’s initial reaction to vision loss around the house is to just turn on more lights or make them brighter. Is that a common sense reaction? Or is it a little more complicated than that?

DR. WEISSER-PIKE: It is definitely more complicated. It is very hard for people with normal vision to know what it is like for a person, particularly with macular degeneration—what it is like through their eyes. I always say, “Let’s just listen.” If somebody has macular degeneration and their first instinct is to turn on more lights, I would say just listen. They might be right. We know with macular degeneration that people can experience blind spots. There are some cells in the retina that do respond to brighter light. Some people have relative blind spots and dense blind spots. The right amount of lighting can definitely improve the quality of life and functional independence of individuals, particularly with macular degeneration.

Another thing is that with normative aging there are changes that occur that require increased lighting. For example, one of the changes is that the pupil becomes smaller. A typical aging eye requires two to three times the amount of light that a younger eye needs. For people with macular degeneration and other ocular diseases, they need even more lighting.

MICHAEL BUCKLEY: I did not know about that need for two to three times more.

DR. WEISSER-PIKE: That is typical aging. I wanted to say to people who are listening, if you are caring for someone who has a visual impairment, then remember that you may be younger than them. You may not have an eye disease. So what you may feel is adequate may not be adequate for the person you are caring for who has macular degeneration. If you are listening to this and you are a person with an eye disease, and you feel you need more lighting, then trust your instincts. You probably do need more light for specific tasks.

MICHAEL BUCKLEY: That’s good to know. So it’s not just like fighting over the thermostat—it’s fighting over the light switches! I wanted to briefly walk through a typical apartment and what unique challenges you might find in each room to staying safe and remaining independent. I wanted to start first with the bathroom. Do you have any specific safety tips to share with our listeners today about the bathroom?

DR. WEISSER-PIKE: I do. Bathrooms have a lot of hard and slick surfaces. In bathrooms there is tile or marble, porcelain, cast iron. When those surfaces get wet and soapy, they can be very slippery. Falling in a bathroom on these hard surfaces can definitely lead to broken bones. It is very important to think about safety in the bathroom. A lot of bathrooms are typically designed without contrasting features. A lot of bathrooms are designed to be one color—all beige, or all white. It is important to introduce contrast and colors that are opposite from each other into the bathroom to be able to see thresholds easier, for example.

Another thing about bathrooms—not only are they typically designed without contrast, they are also given the least consideration when it comes to lighting. Often times there is just a single ceiling fixture, which is inadequate. Lighting is very important in the bathroom. It’s not just important for seeing where the slick and wet spots are, but also it is the place where most people—that I know of—do their personal grooming, where they put on their makeup or shave or do their hair. It is important to think about lighting not just for general purposes but also for seeing detail.

So lighting fixtures need to be considered. If you are doing a remodel of your bathroom, you may want to think of adding some vertical fixtures or sconces that are mounted on either side of the mirror. That is the best positioning of a light source for casting an even light across the face, for example, for doing makeup or shaving. For overall lighting, if you are replacing the fixture in the ceiling, then you want to choose a fixture that diffuses the light rather than a type of fixture like a track lighting, which provides a directional light.

Nowadays we can also talk about light bulbs and energy efficient blubs. You may want to think of a light bulb that emits a more white light rather than the soft white light which usually looks like a yellow tint. In the bathroom, you want to consider the color of the light and the color temperature to be closer to the daylight spectrum.

Another thing about bathrooms is that you want to consider using a nightlight or some kind of low-level strip lighting for night time. This will help illuminate a path to the toilet.

MICHAEL BUCKLEY: Like on an airplane. That’s interesting.

DR. WEISSER-PIKE: Exactly. Those are lighting considerations for the bathroom. I do want to talk about balance safety in the bathroom. I think that’s really important. It’s very important that people know—don’t use the toilet roll holder or the towel rail for balance. Those are not intended, they are not installed, to bear the weight of somebody pulling on them. You want to, rather, install grab bars that are specifically designed for a bathroom. You want to have those professionally installed because they need to be installed into studs.

Another consideration for balance is that oftentimes toilet spaces can be very tight. If you have trouble getting on and off of the toilet—we know a lot of people, as they age, their leg muscles are a little bit weaker and they have more trouble getting on and off the toilet—so you may want to invest in some kind of grab bar near your toilet, or a toilet safety frame. This can be mounted onto the toilet base so that you don’t have to drill any holes into walls. There are, like I said, toilet safety frames that have handles on both sides. You can have toilet seat handles that will help you if you need to use them as you’re getting up or getting down. You can also elevate the toilet seat. There are a variety of different products that you can use. You can actually install something over the toilet seat or you can have a base that—what you do is you raise the entire toilet base, and it is a platform that can be installed just over the opening for the toilet on the floor that elevates the entire toilet. That can also be helpful.

I spoke about contrast and also introducing contrast into the bathroom. You can do that using towels that are a bright color or a contrasting color to your countertops or your walls. You can place a contrasting-colored towel over the side of the bathtub if you have trouble getting in and out of your bathtub, if that is where you take your bath. If you use a shower or a step-in shower and there is a threshold, you may want to think of putting down a contrasting little rug on the floor and butt it right up against that threshold so that you can tell where it is that you need to step over into the shower. Just make sure that the bottom of that carpet or that little rug has some nonskid rubber grips on the underside so that it doesn’t slip.

Another thing to consider in the bathroom is just prepare the items that you need in advance. Make sure that you have your towel ready, your soap, and your shampoo. Soap—you may want to consider an old fashioned product called “Soap on a Rope.” If you can’t find Soap on a Rope, then you can just slip a bar of soap inside of a colorful stocking, and you can have that attached to your faucet. That can help you locate the soap and make sure that it also doesn’t fall and slip from your fingers, and then you have to bend over and we get into safety situations.

A shower seat is also very useful. Know how far you need to turn your faucets and start with the cold first—if you have two faucets start with the cold and then turn the hot faucet on. These are just some basic safety principles.

I do also want to mention something about a walk-in tub. I know in the past few years it has become all of the rage. A lot of people invest high dollar amounts into remodeling their bathrooms and installing one of these walk-in tubs. If you don’t know what that is, that is a tub that has a built-in swing-open door, and it seals itself. You enter it, so you don’t have to step over a high threshold like people traditionally do to step into a tub—basically, it lowers that threshold. One of the issues that you may want to think about and consider is that getting out of that walk-in tub can become an issue. When you’re done soaking or washing, you need [to] wait for all of the water to drain out of the tub before you can open the door and let yourself out. That is a consideration that you should know about, as well as during that time, the water is likely going to get cold while you are waiting for it to drain. That can be unpleasant. That is just something that you may not know or know to think about if you are speaking with a contractor. It is just a little bit of advice and a safety tip.

MICHAEL BUCKLEY: Thanks so much, Orli. I want to turn to the kitchen, both about being safe while cooking, but also how things are stored. Do you have any advice for our listeners today about the kitchen?

DR. WEISSER-PIKE: Sure. Again, we want to think about lighting. When you’re cooking, you need to see certain details. You need to be able to read a recipe, or you’ll need to look at the food packaging, the label, calorie content—you may be looking at instructions. Whenever we need to see detail, that is when we have to rely on a really good light source. General lighting in the kitchen, if it’s overhead lighting that may produce a shadow over your workspace, you want to think about having some kind of task lights—whether it’s an under-counter light that will help for you to see the detail of what it is that you’re doing while you’re cooking. It could be a pendant lamp that hangs over a food preparation area, or even a desk lamp that you use on your counter that should help you to see the detail as you are preparing your food or if you are measuring. Measuring cups—you want to make sure that you use measuring cups that easily show the increments that you need or just dedicated cups. If you’re using a recipe that calls for a half a cup of flour and a whole cup of something else, then get your measuring cups out that are dedicated to half a cup and one cup. These days they are pretty easy to find. Think about also using contrasting mixing bowls for ingredients. For example, if you are going to be mixing a light cake batter, then you may want to mix it in a darker contrasting bowl, and vice versa. If you are putting together the ingredients for a meatloaf, you may want to do that in a white colored or a lightly colored mixing bowl.

Let’s talk about the microwave. A microwave—many of them are mounted over the oven, which is actually quite dangerous because people often can spill hot liquids onto themselves as they are getting the food out from a higher surface. You may want to think about making sure that your microwave is on the counter or even underneath the counter. If you are having trouble seeing the setting on your microwave—for example, the numbers—you may want to mark the gridlines between the numbers so that it will be easier to distinguish those numbers. You can also ask somebody to make an enlarged diagram of the various buttons, like a visual map of the control panel for your microwave. This is true also for your oven. You may want to mark your panel for various settings for select features—like the start button, or the stop button, or the number five inside the number grid. I would say use caution or be judicious about what it is that you do mark. You don’t want everything marked because then that becomes visual clutter. It becomes a cluttered panel. You want to be selective about the features that you want to mark.

With an oven, if you are changing your oven or replacing an oven or cooktop, you may want to invest in one that has the panel in the front rather than the back. What happens with people oftentimes when they have vision impairment is that they want to lean and get close to see the appliance dials. We don’t want to be leaning over burners in order to try and see an appliance panel that is at the back of the appliance. You want to think of, if you are replacing an appliance, get one that has the panel up in the front.

These days, a lot of the interfaces are becoming touchscreen or touch interfaces. Those can be a lot harder. I still prefer and I certainly still recommend the old fashioned analog dials. It is much easier to turn a dial than to press and try to figure out the digital touchscreen interface. That is another thing to consider. You may want to think about using smaller appliances for cooking. That’s for safety. For example, a smaller toaster oven or a slow cooker or crockpot.

Let’s see what else. For pouring liquids, you’ve probably already thought about this, but pouring over a bowl or a sink so that if there are any spills it is easier to clean up. Cutting or chopping foods—you can get something called a finger guard. It is very inexpensive. There are also inexpensive appliances that you can use to protect your fingers. I have one that is made out of stainless steel for chopping. That is something that I can show patients who are afraid of using a knife. Contrasting cutting boards, so again, thinking about color reversal. If you are going to chop a white onion, you might want to do it on a chopping board that is a contrasting color that will bring out the shape of the onion. Maybe a wooden chopping block, dark wooden chopping block, a red one or black one. These days there are so many colored plastics that we can choose from.

MICHAEL BUCKLEY: This has all been really helpful. I think the kitchen is at the core of remaining safe and independent in the home. We have time for a few more points. You mentioned the point about clutter, which I think is humbling advice for all of us. How do you recommend keeping this organized, whether it’s finding your keys or wallet, keeping the house very operationally efficient?

DR. WEISSER-PIKE: That is a general rule that applies to everyone in all of our lives, whether we deal with vision loss or not. Getting rid of clutter is really important and keeping things in the same place, and certainly speaking with family members and having them respect your place for your items. I’ll give you an example. When I come home, I hang my keys on a hook by the door. They are always there and I never put them anywhere else. My husband comes home and he always takes his keys with him in the bathroom and puts them next to the sink. That would drive me insane, because I would think, “How are you going to find your keys?” But that’s where he knows he is going to keep them. I respect his decision and he respects mine. He uses my car and puts the keys back where he found them and vice versa. So having a regular routine is really important. Establishing your own method for organizing your life is very important. Get rid of clutter. Clear the pathways. Make sure you have good lighting.

You also want to group items together. For example, cleaning supplies. Have them grouped together. You can put them in a box or on a caddie in certain space in your storage area, wherever you keep your stuff, keep those things together. In your storage pantry in the kitchen, keep all of the paper goods together on one side. Keep your canned goods in one section of the pantry. You may want to have some kind of system for organizing them, whether it is alphabetically or by canned fruit on one side, canned vegetables on another side, but keep it a systematic, routine organization system that works. Not every system works for everyone.

MICHAEL BUCKLEY: That’s great.

DR. WEISSER-PIKE: I mentioned lighting. I will say that flashlights—make sure that you have flashlights handy. Especially in darker areas if you have closets that don’t have lights in them. Keep a flashlight nearby. If you have a pantry that doesn’t have a light, then keep a flashlight on one of the shelves that is always there, or you can invest in a light that turns on when you open up the door. In clothing closets, a lot of clothes closets don’t have a light on the door. I tell people to get a little flashlight that attaches to some type of lanyard or even a dog leash and keep it on the clothes rod, attach it to the clothing rod so that it is always there and you always have your flashlight handy when you need it. We know that with macular degeneration we certainly need a lot more light in order to see detail, so make sure to have those lights handy.

MICHAEL BUCKLEY: We have an interesting question related to light. There is a person wondering how to best handle the change in light—the contrast when you go from dark to light or vice versa. For example, when you go from one room to another, or inside to out, or outside to in. Any advice for dealing with that contrast and somewhat sudden change in lighting?

DR. WEISSER-PIKE: That is a really, really great question. One of the ways that I like to describe it and explain it to my patients—I’m going to make an analogy to body temperature and clothing—wearing clothing. Regardless of the environment that we are in at any given moment, we like to be comfortable in the clothing we are wearing. We like our body temperature to be constant. If we are in our offices—right now I’m in my office, and I’m very comfortable. If I step outside and am very cold, I am going to need a jacket to stay comfortable and not to get too cold and exposed to the cold weather. Likewise, if it is really cold outside and I step into a warm building, come back into my office and it’s warm, I’m going to take my jacket off. This analogy is like wearing sunglasses. I’m talking about stepping into indoor light to stepping out into the bright sunshine. That is a big change. For a lot of people, they don’t tolerate that change very well. If you’re inside and you are about to step outside into a sunny day, just like you would if you were stepping out into the cold, if you would put a jacket on before you step outside, you want to do the same thing with your sunglasses. You want to put them on just before you step outside of the building into the light. That way your eyes are not exposed to this traumatic change in light, which is blinding for a lot of people. It takes a long time for the retina to adapt to the sudden change in the light.

The same thing happens when stepping back into a building. If we are out in the bright sunlight and then we step into a darker or darkened building, or certainly that feels darker, we will feel blinded like we can’t see anything. If you’re wearing your sunglasses outside, don’t take them off before you step into the building. A lot of people will leave their sunglasses in the car and then walk across this bright sunny parking lot, and then they feel blinded when they step into the building. Keep your sunglasses on all the way until you step into the building, then take them off. That way the change in level of illumination isn’t so dramatic and you’re not blinding yourself by doing that. It’s a great strategy.

MICHAEL BUCKLEY: That’s great advice. We have a few more points before we run out of time. We have a question that is very relevant to what has been in the news throughout 2017, that with all of the hurricanes, floods, and wildfires, do you have any tips of how people can stay prepared around the house—people who have low vision challenges? So that they can stay prepared if they live in a part of the country where it seems like a lot of us these days face some type of risk from weather.
DR. WEISSER-PIKE: Absolutely. I can tell you I live in Tornado Alley over here in Memphis. That is a very, very relevant question. The first thing that everybody should do is to do a self-assessment. Ask yourself these questions: Do you have a plan for an evacuation? What is your emergency management plan? Do your friends, your family, or relatives—do they know about this plan? That is the first thing. Do you know where the exits are in your home? Can you access them easily? Do you have smoke detectors that work? Do you have fire extinguishers? Do you know where they are in your home? Do you know where the gas and the water shutoff are? Can you shut off the gas or the water if you need to evacuate your home? Do you have a kit that you can take with you—an emergency kit? I’ll talk about the contents of that in a minute. Do you have a backup of your important papers?

These are all questions that you should be asking yourself. Now is a good time to do this kind of self-assessment to prepare for an emergency evacuation. You want to have a plan, and you want to identify a place outside of your home where you can seek shelter. You want to do that now before the emergency hits.

If you use a service animal, you need to have a plan for your service animal as well. How are you going to take care of your animal? What are you going to do if your animal becomes afraid and can’t help you? How are you going to take care of it then? Do you know where your pet’s harness or leash is? What is your plan for that?

You want to keep all of your pathways clear so, again, get rid of clutter. You also want to ask yourself, can you rely on sound clues to get around? If you can’t see where it is that you need to go, can you rely on the hum of a vent, for example, or certain sounds? Remember, also, in an emergency situation you may have blaring tornado sirens, for example, or some other loud noises. You want to know how you are going to get around either relying on sound or other types of clues. Can you determine where your nearest exit is by counting your steps, for example? You also want to discuss who you will use as a contact person and let your friends and family know.

You should have an emergency kit. It is recommended that you have a 3-day supply of your medications, food, water, supplies for your service pet, have a flashlight with batteries, have toiletries, a change of clothing, maybe some cash or coins, important papers, and I mentioned food that is ready to eat. Also, very important, have a readable contact information list for friends, relatives, your pharmacy, and definitely a medication list. Have that with you. Prepare that in advance because we’ve had some terrible tragedies this year.

MICHAEL BUCKLEY: I think you’re right. This year has made everybody more aware of the importance of staying prepared. You give some great tips. One more question I think brings us back to where we all started with your rule of thumb about taking good care of yourself and exercise. We have a question from a caller who is wondering, do you have any tips for going out for a walk or basic recreation in your neighborhood or you community?

DR. WEISSER-PIKE: That’s great. Like I said, exercise is very important. Pay attention to the shoes that you’re wearing and make sure that they fit well and that they are not too big, not too small, and that you’ve got good soles. You want to also pay attention to the paving. I would definitely recommend using a cane. You can choose to use a walking cane, or a hiking stick, or a cracking pole. A long white cane can also help you. Any type of cane. A support cane is different from a long white cane. A long white cane, you really need to be trained to use one. That is not one that you lean on for any kind of support. A support cane, like a traditional walking stick, walking cane, or hiking stick—those can actually help with balance. It’s just another point of contact with the surface. It increases your base of support and provides a little bit more stability.

I also would say use polarized sunglasses or polarized filters. Those help to enhance contrast and reduce glare when you’re outside. In the autumn, the sun is lower in the sky, so the angle of the sun can produce a bit more glare, specifically in the twilight hours. Those are some tips for going on a walk.

MICHAEL BUCKLEY: That’s great. Unfortunately we are at the end of our discussion time.

Dr. Weisser-Pike, I just want to thank you so much for being so generous with your time. There were dozens and dozens of great suggestions that people of all ages can take to make their home safer and a more happy, healthy, and independent place. I want to thank you for being so generous and so specific for ways that people can remain safe with low vision. To our audience, I want to thank you for being with us today. We look forward to being with you on a future Chat. On behalf of the BrightFocus Foundation, thank you very much.

DR. WEISSER-PIKE: Thank you!

MICHAEL BUCKLEY: Thanks, bye.

BrightFocus Foundation: (800) 437-2423 or visit us at www.BrightFocus.org. Available resources include—

• Information on research funded by BrightFocus Foundation
• Update on Clinical Trials for Macular Degeneration (Article)
• Clinical Trials: Your Questions Answered (Publication)
• Healthy Living and Macular Degeneration: Tips to Protect Your Sight (Publication)
• Macular Degeneration: Essential Facts (Publication)
• The Top Five Questions to Ask Your Eye Doctor (Publication)
• Treatments for Age-Related Macular Degeneration (Fact Sheet)