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Coping With Visual Impairment

When someone loses their sight, their family and friends lose something as well.  A person who has always behaved in a predictable and normal manner may now act strangely as a result of the physical and the emotional effects of blindness. That said, there are a number of ways to help.

Observable Signs of Vision Problems


Many adults are uncomfortable seeking help and even more so discussing health issues with others. Often it becomes the function of a family member or friend to observe the following changes in behavior of a person who may be experiencing the early stages of visual impairment.

The AFB Senior Site has enumerated these observable signs:

Has he/she begun to:

  • Bump into things?
  • Move hesitantly or walk close to the wall?
  • Grope for objects or touch them in an uncertain way?
  • Squint or tilt the head to see?
  • Request more or different lighting?
  • Hold books or other reading matter close to the face?
  • Drop food or silverware when eating?
  • Have trouble making out faces, the lettering on signs, etc.?
  • Not notice stains on clothing or wear mismatched clothes?
  • Act visually disoriented or confused in a familiar place?
  • Trip on area rugs?


Has he/she been saying things such as:

  • I see halos or rings around lights?
  • I have migraine headaches that give me blurry vision?
  • I can't see anything at night?
  • There are spots in front of my eyes?
  • My eyes hurt?
  • I keep seeing flashes of light?
  • I sometimes see double?
  • Everything looks distorted?
  • I need more light?


Role of Family and Friends


A family member or friend of a visually impaired person becomes important as a partner in the long process of rehabilitating someone who is losing vision.

According to the American Foundation for the Blind, “whether the problem occurs suddenly or gradually, it is bound to cause stress, anxiety and vision-related physical limitations such as writing or driving. But the next step is to approach it as a team effort, with planning and decision making in the hands of the visually impaired person, assisted by others in the group plus specialists in the vision rehabilitation field.”

The most valuable help that a family member or a friend can give are:

  • Encouraging self-reliance
  • Building self-confidence
  • Recognizing progress
  • Avoiding over-protectiveness


With regard to helping the visually impaired person continue being independent and productive, the following tips are recommended by the AFB Senior Site:

  • Take the initiative – ask directly how you can best be of assistance.
  • Ask before acting – if you see your loved one having trouble with a certain task, don’t step in before asking if it’s okay.
  • Be available – let your loved one know that you are there when he/she needs you, and identify the specific kind of help that you can provide.
  • Talk about it – learn how to discuss and work out solutions to identified problems together.


Providing assistance by learning as much as you can about visual impairment is another way to be involved as a family member or friend of a visually impaired person. The AFB Senior Site enumerated the helpful tips below:

  • Things you should know about eye examinations
    • Ensure that your loved one is thoroughly examined by an ophthalmologist, a medical doctor who specializes in eye diseases.
    • Also consult with a low vision specialist, an ophthalmologist or optometrist with a specialization in low vision.
    • A specialist can help your loved one make the most out of his/her remaining vision by prescribing handheld magnifiers, high-intensity lighting, and other low vision devices.
  • Things you should know about vision rehabilitation services
    • Rehabilitation services for the visually impaired are provided by both public and private agencies.
    • Rehabilitation usually includes independent living skills training as well as orientation and mobility training.
    • Before talking to your loved one about rehabilitation, gather as much information as you can by contacting your state or local private agency who serves people with vision loss.
  • Things you should know about supporting your loved one during rehabilitation
    • Talk to your loved one about rehabilitation by sharing information that you’ve found, encouraging participation; yet leaving the final decision to him/her all the time.
    • Get involved in independent living skills training.
    • Learn about adaptations that can make a home environment safer and more functional for a loved one who is visually impaired.
    • Remember that rehabilitation is always a family affair. Encourage discussion about vision loss and its impact among all family members including young children.
    • Support your loved one’s desire to continue daily activities and cultivate new interests.
    • Look for opportunities for your loved one to provide assistance, not just receive it all the time.
    • Ask your state or local agency about support groups for people newly experiencing vision loss and their families. If there are none in your area, why not start one?


How to Deal with It


According to the National Eye Institute, “when a loved one becomes visually impaired, you are likely to feel overwhelmed. You may also experience a range of feelings, from sadness to guilt, and there are many day-to-day adjustments to make. You may find yourself putting aside your feelings and needs to focus on helping your loved one cope. Yet, in many cases, you may feel alone and at a loss about what to do or how to help. It is important to communicate your feelings with others. By sharing your feelings, you are in a better position to be more accepting of yourself and understand what you and your loved one are experiencing is not isolated and unique.”

The following questions from the National Eye Institute may help a family member or friend of the visually impaired person express his/her thoughts and concerns:

  • What feelings have you experienced since your loved one became visually impaired?
  • In what ways has your life changed since your loved one's vision loss? Are there things that you've had to give up? How do you feel about these changes?
  • What feelings are most difficult for you to accept and deal with?
  • What do you do with these feelings? Are you able to share them with your loved one?
  • Has your loved one's vision loss brought you closer together in any way? If yes, how?


Communication Tips


It is important to remember that effective communication involves both verbal and nonverbal behaviors.  However, the nonverbal aspect becomes a challenge when a person is communicating with someone who is visually impaired because the gestures, nods, facial expressions and other visual cues are no longer visible to reinforce what is being said.

The following steps are highly recommended by the AFB Senior Site in order to effectively communicate with a visually impaired person:

Keep communication lines open

  • Say what’s on your mind as sensitively as you can.
  • Don’t be afraid to have the hard conversations. Take time to think about what you want to say and how before starting the conversation.
  • Break the ice but stay on the topic. Be careful not to overwhelm your loved one with too many issues at once.
  • Confront tough topics directly but be sensitive too.
  • Give your loved one your complete attention when in conversation.
  • Postpone difficult discussions when tensions are running high or when you may be otherwise distracted.
  • Ask your loved one for help when you need it.

 

Make casual conversation

  • Identify yourself by name when you start talking. For example, “Hi Jordan, it’s Emily.”
  • Speak clearly and directly, and look at the person when addressing him/her.
  • Use natural conversational tone and speed, unless the person has a hearing impairment too.
  • Address the person by name, so he/she immediately knows that you’re talking to him/her rather than to someone who happens to be nearby. (If you don’t know the person’s name, give a light touch on the arm to let him/her know that you are addressing him/her.)
  • Be an active listener. Give the person opportunities to talk. Respond with questions and comments to keep the conversation going. Keep in mind that a visually impaired person cannot necessarily see the interest on your face, thus, vocalize your interest. For example, “I understand…Yes…I see.”
  • Always answer questions and be specific or descriptive in your responses.
  • When you enter a room, announce your presence so the visually impaired person knows you’re there. Similarly, if the person enters a room you’re already in, let him/her know that you’re there.
  • Say when you’re leaving the room and where you’re going, if appropriate. For example, “I’m going to the kitchen to get a drink of water.”
  • Indicate the end of the conversation so that the person you are talking to is spared the embarrassment of talking to someone who is no longer there. For example, “Nice talking to you, Sam. I’ll see you later.”


Below are some strategies from the National Eye Institute that can prove helpful when communicating effectively, especially in difficult situations involving strong emotions and conflict.

  • Listen to what the other person is saying as well as the feelings behind the words. This type of listening is hard when you may not want to hear "anger" or "frustration," when you are feeling "attacked" or "criticized," or when you disagree with the other person. At these times, it is helpful to let the person finish what he or she has to say before responding.
  • Express your feelings or point of view with the use of the word "I." For example, "I feel upset about" or "I see it differently" rather than "You are being unfair" or "You are wrong."
  • After each person has a chance to share his or her feelings and point of view using "I" statements, ask each other: "Are there areas of common ground?" Sometimes, you may have to agree to disagree and come back to the issue at a later time.


Helping a Loved One with Vision Loss or Blindness


What to say?

The Braille Institute of America has suggested some things to discuss with the person affected by visual impairment. Initially, it is important to talk about the degree of sight loss with him/her. Ask what they can still see and do. For most people, blindness does not mean total darkness, and with understanding, counseling and retraining, there is hope.

  • Ask whether the person needs help. Don’t insist on helping if help is not asked.
  • Don’t hover over them and repeatedly ask, “Can you see this?”
  • Ask probing questions and observe them, in order to determine what they can and cannot see.
  • Find out if there is a hobby or task that the person misses, such as reading, cooking, etc. and assure them that there are ways to continue doing these things.
  • Ask them whether their eyes have been checked recently by a doctor.
  • Don’t avoid using such words as “look”, “see” or “blind.”
  • Assure them that transportation can always be arranged for them.

 

What to do?

On the other hand, the U.S. Department of Health and Human Services gave a quick guide to health literacy for adults who have problems with vision.

Make information easy to see

  • Effective materials have a simple design with sharp contrasts between text and background
  • Use a large font size, preferably 16- or 18- point
  • Try 1-inch margins and at least 1 ½ blank spaces between lines of text
  • When using a table, make it simple and easy to follow

 

Design web sites that are senior-friendly

  • Web sites for seniors require readable text presented in a carefully organized format
  • Font type and size, spacing, justification, color and backgrounds all need to be planned with older audiences in mind

 

Consider using Braille, audio-taped information or other technology whenever necessary

  • Braille and audiotape are necessary for some adults with low vision or blindness
  • Be sensitive to individual needs.  Degrees of impairment vary, as do the ways people overcome such challenges. Ask older adults with vision problems if they want assistance with these issues and, if so, how can one help.
  • Research visual aids such as magnifiers to understand how they might help.

 

Giving Directions

Below are some tips from the AFB Senior Site for giving directions to a visually impaired person:

  • Describe the environment in detail – if you tell the person that the train station is two blocks to the left, he/she will probably get there. But it’s always more helpful to paint the picture a bit. For example, is there a bakery next to the station? If yes, then say, “When you smell fresh bread, you’re right there.” Do not forget that if the person uses a cane to travel, he/she will want to know any changes in ground texture, from concrete to grass, carpet to tile.
  • Do not say, “it’s right there” or “it’s over here” – remember that “here” and “there” are meaningless to a visually impaired person. If he/she asks you where the elevator is, do not answer, “It’s over there to your left.”  A better answer is, “If you walk straight down the long corridor to your left approximately 100 feet, you'll pass a set of water fountains that make a loud humming sound on your right. Just when you feel the carpet change to tile, you'll find the elevator is directly in front of you.”
  • Point out potential danger points along the way – passing on information such as a sudden, steep incline in the sidewalk ahead or a tricky, busy intersection to cross will greatly help the visually impaired person arrive at his/her destination faster and safer.


Giving Meaningful Assistance


There are many, easy-to-learn ways to give meaningful assistance to someone who is visually impaired. The Braille Institute of America has outlined several sight guide techniques that will help make assisting the blind or visually impaired person easier.

Getting from Here to There

If you meet a blind person who seems to be “off course” while crossing a street, perhaps out of the crosswalk, remember that most have been taught to respond to verbal instructions such as “go left” or “go right." But be sure to refer to the person's left or right, not yours, if you are facing them.

Making Contact

When approaching someone who is blind, introduce yourself and ask whether they would like your help. Do not grab or pull at them. If they indicate that they would like assistance, verbally offer your arm and brush it against them.

Grasp

The blind person should grasp your arm just above the elbow with their fingers on the inside near your waist and their thumb on the outside. The grasp must be firm to be maintained while walking, yet not so tight as to cause discomfort. If the grip is too tight, say so.

Children’s grasp

The standard grasp often is too high for children, so it may be best to have them grasp your wrist or hold your hand. This gives you and the child greater comfort and sense of control.

Doors

When approaching a door, assume the narrow-area stance and tell the blind person in which direction the door opens. This allows them to help you by holding the door with their free hand while passing through it. Do not try to turn around to hold the door open. This is awkward and diverts your attention.

Stance

Hold your arm relaxed and steady at your side. The blind person’s arm is at a 90-degree angle and held close to his or her side. They should proceed by being one half step behind you. They will follow your movements. Do not steer them.

Narrow-area stance

When approaching an area that is crowded or narrow, such as a doorway, move your forearm and hand so that they rest against the lower portion of your back, with your elbow at a 90-degree angle and your palm facing outward. The blind person will take this cue, slide their hand down to your wrist and move directly behind you at arm’s length while still maintaining a firm grip. Take smaller steps and slow down as you move through the narrow area. For comfort, have the blind person move her or his grasp from above your elbow to your wrist. After walking through the narrow area, return your arm to the guide position and walk normally.

Taking a seat

When possible, approach a chair from the front or side. Tell the blind person they are at the front or side, and slowly bring them up to it until their knees or shins touch the seat. Say whether the chair has arms. Place your hand on the chair back and let them follow your arm down to locate it with the hand they have been grasping your arm with. Allow them to seat themselves. Do not help them physically or move the chair or other furniture unless they ask you to. Let them know if there is a table. Unless they are frail or otherwise disabled, blind people are capable of getting up from a chair without help. Once the person is standing, use the correct stance and grasp techniques described above.

Support grasp

Some blind people are frail. Others have balance problems that make the standard grasp inadequate. Rather than holding your arm above the elbow, a blind person may prefer to link an arm with yours. This will decrease the space between the two of you and provide added support. To accommodate a blind person’s unsteadiness, you likely will need to slow your walking pace.

Stairs

Six feet before reaching the first step, tell the person you are guiding that you are approaching stairs. Approach the stairs directly and in such a way that the person's free hand is closest to the rail. Mention whether the stairs go up or down and how many steps there are. Pause to allow them to locate the first step and the railing. Always remain a step ahead and proceed as you normally would. Remain to the right-hand side of stairs to avoid colliding with others. Pause at each landing to allow the blind person to stand beside you and to cue them that there are no more steps until you begin to move again. Tell them when you have reached the top or bottom of the stairs.

Maximizing Remaining Eyesight


According to Everyday Health, a person can still live well with low vision by making the most out of his/her remaining eyesight using the tips stated below:

Available Devices

There are numerous devices that are available to assist visually impaired people overcome their conditions, such as:

  • Magnifying glasses or lenses – available as hand-held aids or mounted in frames
  • Large-print objects – books, newspapers, magazines, telephones, thermostats, remote controls, bank checks, and playing cards are just a few of the many household objects that can come with larger type custom-made for the visually impaired; many computers are capable of magnifying text and pictures with a simple keystroke
  • Talking devices – watches, timers, and other household devices can be purchased in “talking” versions. Talking models of some medical devices such as the blood pressure and the blood glucose monitors are also available. Computer users can purchase screen-reading software that will read aloud words on a monitor. People with low vision can also purchase books on tape or borrow them from libraries


Making the Home Livable

Do not forget to make adjustments at home. Below are some tips:

  • Improve the lighting in the home – bright and glare-free light can make most tasks easier to accomplish for people with vision problems
  • Shield the eyes when outside – wear a wide-brimmed hat and sunglasses to protect the eyes from very bright sunlight outdoors
  • Redesign the environment for better visibility – choose colors that provide maximum contrast in the home for objects to be seen well. For instance, putting a dark light switch on a white wall improves the visibility of the switch, and placing light tape on the edge of a dark-colored stairwell helps avoid a fall. Eliminate carpeting and furniture with striped, plaid or checkered patterns as they can be visually confusing


Being Safe at Home


It is very important to maintain safety at home, especially if a family member is visually impaired. Below are some suggestions from the AFB Senior Site on how to avoid accidents occurring at home:

  • Do not use small throw rugs because they can cause a person to trip.
  • Make sure your bath mat has a nonskid backing.
  • Keep electrical cords as close to the baseboards as possible and out of walkways.
  • Keep floor lamps and small items such as low tables, magazine racks, plants, etc. out of walkways.
  • Label cleaning and toxic products to make them easily identifiable, and store them and any flammable or combustible items away from the kitchen or heating units.
  • When plugging a cord into an electrical outlet, first determine if the outlet is vertical or horizontal. For vertical outlet, place the plug at the top of the outlet, and then move it down to locate holes. DO NOT use your fingers to do this. If it’s a horizontal outlet, place the plug at the side of the outlet and move it sideways to locate the holes.
  • Install wall outlets and covers that contrast in color to your walls. This will make them easier to locate. Also, inexpensive standard outlets with recessed slots are preferable to the more expensive designer types that have a flat face.
  • Clean up spills immediately.
  • Close cabinet, closet and cupboard doors and drawers completely as soon as you’ve taken out what you need.
  • Install smoke, fire and carbon monoxide alarms and check the batteries regularly to make sure they are still working.
  • Know where your circuit breaker box and water turn-off valve are located and learn how to use them safely.
  • When visitors call, keep outside doors locked until visitors have identified themselves.
  • Mark thermostats with brightly colored fluorescent tape at the settings you typically use.
  • Pick up shoes, clothing, books and other items that you could trip over.


Sources:

www.health.gov/communication/literacy/olderadults/visual.htm#p1

www.everydayhealth.com/vision-center/the-healthy-eye/living-with-low-vision.aspx

www.afb.org/seniorsite.asp?SectionID=63&TopicID=289

www.afb.org/seniorsite.asp?SectionID=65

www.solutionsinsight.org/assets/uploads/09_aboutlowvision_assisting_someone_who_is_visually_impaired.pdf

www.eyeinfo.org/pdfs/CopingWithSightLoss2008.pdf

www.nei.nih.gov/lowvision/content/helping.asp

www.afb.org/Section.asp?SectionID=36

www.afb.org/seniorsite.asp?SectionID=64&TopicID=296&DocumentID=3226