The older you get, the more things go wrong. Your joints start to ache in rainy weather. You get tired more quickly than you used to. You have trouble hearing what people are saying. And your eyes start to dim.
Glaucoma, diabetes and macular degeneration are all vision-stealing diseases of aging. Until recently, there was little eye doctors could do to fix these problems. They'd prescribe stronger glasses, or perhaps urge you not to drive. But there is a treatment, called vision rehabilitation.
In a converted San Francisco apartment, the National Association for the Visually Handicapped has set up a rehabilitation shop, lined with shelves of magnifiers and computer reading aids.
Counselor Jeannine Toussaint meets there with residents from a nearby retirement community where so many have minimal sight they formed their own support group. These seniors tell Ms. Toussaint they want to be able to read again. "Any (size) print," one says. "I can read one word at a time. It's not good. A lot of it's blurry."
For millions of seniors with low vision, the culprit is macular degeneration, which damages the light-sensitive retina at the back of the eye. This treatment-resistant disease blurs central vision to such an extent that patients can't read or see fine details. In past years, those with such minimal sight have been trained as if they were blind - using Seeing Eye dogs and canes. But today's rehabilitation teaches them to use whatever sight they still have with the help of bright lights and magnifiers.
The therapy techniques can be surprisingly simple. Poorly sighted seniors cannot pour milk in a white cup and see when it overflows… but when they learn to use their peripheral - or side - vision and switch to a black cup… they don't spill a drop.
Dr. Daniel Schainholz is one of the few eye doctors who has specialized in low vision rehab, which he uses to "teach a patient to learn to read again, learn to use their residual eyesight effectively, live independently." He shows the partially sighted how to recognize people by the outline of their hair, or the way they move as they walk toward you. Vision Therapists like Jeannine Toussaint also insist that seniors use high intensity light for reading, because "by the time we are in our 70s," she tells her clients, "we need 7 times the amount of light to see the same amount."
Without such therapy, seniors with progressive vision loss can't drive, read, or see their TV, and they may stop participating in daily activities. That's what happened to Joan Burton when her eyesight dimmed three years ago. The 80-year old former schoolteacher was trapped at home, until vision rehabilitation taught her to get around by bus.
As they lose their independence, seniors with low vision are more likely to suffer depression than patients with heart disease or cancer. When John Madison was diagnosed with macular degeneration, he says he just sat around and, as he put it, "stewed." He says his doctors did not offer him any treatment. "There was absolutely nothing that was mentioned to me in regard to support services available."
So he found those services on his own. He's in a support group for seniors with low vision. Of its 12 members, not one had heard about vision rehabilitation from their eye doctor, even though medical researchers have found that this therapy can teach sight-impaired seniors to recognize faces, read street signs and even newsprint. "I now have the use of a reading machine," Mr. Madison says, "(so) at least I can read mail, bills and things of that sort. So that has made life much better."
And life is likely to get better for other older Americans with limited vision. In January, the American Academy of Ophthalmology launched a Smart Sight Initiative, to persuade their members to routinely offer low vision rehabilitation.
Academy president Dr. Susan Day says "We want to help our patients use the vision that remains. It's another part of the ophthalmologists' responsibility." She hopes the initiative will help poorly sighted seniors avoid the medication mix-ups, falls and depression that often put them into nursing homes.