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National Reading Month: Reading with Visual Impairment, Part II

by Steven Kelley, CVRT, VisionAware Contributor

Books flying into a tablet (metaphor for ebooks).

Continuing our discussion of reading options, let’s look at some of the reading alternatives available today.

Lighting

If you have low vision, lighting is a critical component of reading. VisionAware has lots of information on this topic, including a video series entitled Better Lighting for Better Sight. This series by Bryan Gerritsen, CLVT, covers types of lighting as well as proper positioning of lighting. Positioning of the light source is as important as the type of light you use for a task

Magnification

You may find that regular size print, such as newspaper print, is readily accessible again with some magnification. There is a much greater choice and strength of magnifying devices (optical or electronic) than what you find in the local pharmacy or big box store. Before buying anything, consider getting an vision assessment from a low vision doctor, certified low vision therapist (CLVT) or certified vision rehabilitation therapist (CVRT) to help determine which device might be most useful for your reading needs.

A good quality handheld magnifier with LED light is just one possible solution for magnification. Desktop and handheld video magnifiers (CCTVs) are also very useful particularly if changing the color of text from black on white to white on black or other color combinations makes it easier to read. Additionally, some of the newer video magnifiers incorporate text-to-speech, permitting the device to read printed material out loud. Also, a comprehensive list of resources for magnification may be found on the Library of Congress website.

Talking Books

If you have a loss of vision, or other disability that affects your ability to read, you may qualify for the National Library Service (NLS) Talking Book Program. Applications may be requested over the telephone by calling 1-888-657-7323 or on the NLS website. Consumers eligible for NLS Talking Books receive an easy-to-use digital audio player, and audio books are mailed to subscribers through postal delivery. Each delivery contains a reusable shipping box with return postage provided. Books and magazines may be ordered based on a preferred genre such as westerns or romance, or by a specific title. One of the best features of this program is that there is no cost to eligible consumers!

The NLS Talking Book program does not require access to a computer to use. If, however, consumers have access to a computer or Apple iDevice (iPad, iPod, or iPhone) books and magazines may be downloaded directly from the National Library of Congress BARD website.

If you are an Apple iDevice user, the free app called BARD Mobile will allow you to download and listen to books within minutes. The controls on the app look very similar to what you use on the actual NLS Talking Book player, so it is an easy app to learn to use. And, for other tablet and smartphone users, a BARD app will be coming for Android devices very soon!

Newspapers

  1. One of the simplest ways to regain access to the newspaper may be through a local or state Radio Reading Services. Typically, this type of service is accessed through a radio receiver provided by the reading service or through a secondary audio channel available from a local cable service. Increasingly though, consumers may access reading services through a computer or tablet connected to the Internet. Newspapers and magazines are often read by human readers, and listeners tune in at a specific time to hear the broadcast of their favorite newspaper or section, such as editorials or obituaries. For more information about a reading service in your area, contact the International Association of Audio Information Services online or by calling 1-800-280-5325.
  2. Using a computer or tablet connected to the Internet, two services in particular offer great access to a wide variety of publications: AIRS LA, and iBlink Radio. AIRS LA offers a number of national newspapers and magazines archived as audio files or "podcasts" that may be downloaded and played on a variety of devices. iBlink Radio offers a menu selection titled "Reading Services" with a comprehensive listing of state reading services that may be played using a Mac, tablet or smartphone. Both AirsLA and iBlink Radio offer free apps that will work with both Apple iDevices or Android devices.
  3. Another option for newspaper reading in many states is the National Federation of the Blind (NFB) Newsline. NFB Newsline provides access to newspapers for both high tech, and low tech consumers with a vision loss. There is no cost to the subscriber as costs are covered by grants,donations, or state rehabilitation funding. At the most basic level subscribers may use a landline telephone (no smartphone required!) to dial a local number or toll free number. The dialing pad on the phone is used to select reading options, such as the newspaper, section, reading speed, etc. Unlike the radio reading services, however, most of the newspapers on Newsline are read by text-to-speech computer voices. This has the advantage of speeding up the reading to skim through articles if you wish, but lacks the quality and intonation of a good human reader. One of the greatest features of Newsline, is the flexibility the service offers for consumers who are computer users. With a computer or tablet, users may access newspapers using a Web browser, or through an app on their tablet or smartphone. In this way, text can be enlarged to read visually, read by a screen reader, emailed, or converted to an audio file that may be downloaded to another portable reading device. In a nutshell, Newsline offers many different ways to customize how a subscriber chooses to access their newspaper and take it with them on the go. You can even access

Bookshare

Bookshare is a rapidly growing library of over 300,000 books and magazines available for subscribers with a vision loss or other print disability. A subscription to Bookshare is free for any US student and student status includes Adult Education such as courses in the community or distance education such as Hadley School for the Blind. Non students pay a one-time registration fee of $25, and annual subscription rate of $50. A free or paid subscription entitles subscribers to download hundreds of books annually at no additional cost. Books are formatted into an electronic format called DAISY (an acronym that stands for Digital Accessible Information SYstem) that may be read using a wide variety of electronic devices. Bookshare may also be read using the NLS Talking Book player, a computer, tablet, smartphone, stand-alone DAISY player like a Victor Reader Stream, or a device with a braille display. Bookshare has a very comprehensive resource on how to play DAISY books. You can sign up for Bookshare online or call 1-650.352.0198.

Two popular apps for Apple iDevices to read Bookshare books include Read2Go and Voice Dream. Both offer many options for reading, including increasing the text size, color and background of text, voices used for reading text, etc. In addition, users may highlight and bookmark text.

Other Options for Reading

A relative newcomer to the iPad is an app called Spotlight Text, which focuses on ease-of-use. Text may be read in a single line scrolling across the screen (Marquee mode) or as several lines of large print scrolling from bottom to top (Teleprompter mode). Users may choose the size of the text, the speed it moves across the page, and whether or not the text is read out loud. The user interface on Spotlight Text is simple to use with large buttons, making it a good choice for users new to using an iPad or reading electronic books.

For Android tablets and smartphones, GoRead and Darwin Reader are two popular apps that work with Bookshare titles. GoRead is a free app with basic features most suited for reading with text-to-speach. Darwin Reader offers more flexibility with text settings for the low vision user who prefers to read with large print.

This is by no means intended to be a comprehensive list of the many ways individuals experiencing vision loss might return to reading or expand reading options. The focus here is really on low cost and ease of access. Choose any one of these suggestions and you will begin reading again, or increase your many options.

Additional Resources

Reading and Writing

Top Book Reading Apps for Braille Users

Impact of Talking Books

Low Vision Optical Devices

Common Non-optical Devices

Voice Dream Reader


Topic:
Reading

National Reading Month: Reading with a Visual Impairment Part I

by Steve Kelley, CVRT, VisionAware Contributor

A neatly-stacked group of books set between a pair of headphones.

The month of March is designated National Reading Month, making it the perfect opportunity to highlight the expanding options for readers with a vision impairment. As a vision rehabilitation therapist, one of the most common complaints clients experiencing a vision loss report to me is that they are no longer able to read the newspaper, books for leisure, or the computer screen.

Several years ago, in a Low Vision Tech audio recording, optometrist Dr. Bill Takeshita described his personal efforts to return to reading after gradually losing his vision. He described some of the many options available for reading as a blind or visually impaired consumer, and discovered, after a period of transition, that he was reading a great deal once again. It was also equally clear, listening to this broadcast with Dr. Bill, that there was a significant adjustment process, both emotionally and educationally, as he learned which adapted methods of reading worked best for him.

With this in mind the VisionAware peer advisors have started a new topic area Reading to Enhance Mental Health and are encouraging readers to suggest or review books that they have found helpful in adjusting to visual impairment. Audrey Demmitt, R.N. introduces the topic stating, "No matter what, our engagement with literature and written word has the potential to change us, calm us, inform us, inspire us and heal us. In its most simplistic form, this is known as bibliotherapy. Exposure to books, poetry, writing, and even film and videos can be therapeutic and beneficial in helping us process our own life experiences. In other words, literature can be used to help us figure life out, heal emotional traumas, and change thoughts and behavior."

You may say, but how can I access these books and others of interest to me? Stay tuned for my next post on alternatives to reading.

Picture of books.

Topic:
Reading

91-year-old Inventor with Visual Impairment Designs for Her Generation

ski poles modified with red and white tape to be used as mobility canes

91-year-old Barbara Beskind is the toast of Silicon Valley as well the toast of the media, with interviews on National Public Radio and the Today Show. In the high tech industry where youth reigns, Beskind has a coveted job as a designer at IDEO, a world-renowned consulting firm perhaps most famous for designing the first Apple mouse. Beskind is living her dream, though it was a dream deferred. As a resourceful 8-year-old during the Depression, Beskind built a hobby horse from old tires for her friend who couldn't afford one. By high school, Beskind knew she wanted to be an inventor, but her counselor told her flatly that women couldn't go to engineering school. Beskind earned a degree in Home Economics and enlisted in the army towards the end of World War II. She trained as an occupational therapist and helped badly burned soldiers regain the use of their scarred hands. After twenty years, Beskind retired as a Major and opened the nation's first free-standing occupational therapy clinic in 1966. Known for her innovative rehabilitation techniques, she has published textbooks under the name Barbara Knickerbocker. Beskind has several patents, including one for an inflatable therapeutic device that assists children with balance issues.

Read the entire story about this remarkable woman with macular degeneration.


Topics:
Employment
Macular Degeneration

Introducing Stuart Carduner, Glaucoma Patient and Advocate

Editor's note: Just in time for World Glaucoma Week, VisionAware is introducing a new Patient's Guide for Living with Glaucoma, written by a person who has glaucoma from his perspective.

By Mary D'Apice, VisionAware peer advisor

Author of Patient's Guide to Living with Glaucoma Is Both Patient and Advocate

Stuart Carduner, author of the Patient's Guide to Living with Glaucoma, knows that many patients enter the ophthalmologist's office with a good deal of anxiety and fear. They want to understand what is happening to their eyes, and they want to know what to expect from office visits. They wonder what the prognosis is for their vision and how they will maintain independence if they lose more sight. Through his online guide, Carduner provides coaching to VisionAware readers who have been diagnosed with glaucoma or who are going through the assessment process.

Glaucoma, The Sneak Thief of Sight

Glaucoma is often called the "sneak thief" of sight because it can go undetected for a long time. Carduner was completely unprepared for his own diagnosis. "I went to the doctor for a regular eye exam about three years ago because I thought I needed new glasses. The doctor told me I had very advanced glaucoma. I had no idea." The news came as a shock and Carduner felt that he didn't know what questions to ask. It was an emotionally charged situation and, understandably, Carduner said that it was "hard to think straight." Even after he saw specialists, he felt like he wasn't getting all the information he craved and so he went to the internet. "I am a researcher at heart and kept on digging. I really got educated."

Carduner had been a classroom teacher for a while and then developed software training programs. About ten years ago, he created an online resource for teaching people about Buddhism and mindfulness meditation. Now that he is retired, he is applying his skills as a writer and teacher to educate people about glaucoma. Carduner believes that when patients have enough information about their diagnosis, treatment options and prognosis they are better able to advocate for themselves.

Guide Describes Assessment Tools

Carduner's guide meticulously describes the various assessment tools used in glaucoma tests and explains exactly what part of the eye the doctor is examining and why. For example, he describes the ophthalmoscopy examination used to detect damage to the optic nerve head and retinal nerve fiber, a critical part of detecting and diagnosing glaucoma. Carduner explains that patients should expect to have their pupils dilated with eye drops and reassures the reader that is not a painful test. When they can anticipate what will happen during the exam, patients are more relaxed and better able to articulate concerns.

Guide Includes Questions to Ask Your Doctor

The Patient's Guide to Living with Glaucoma provides a well-thought out, thorough list of questions patients may ask from the initial diagnosis to treatment options. "Even at the most prestigious hospitals, doctors have a very short time frame in which to see patients," says Carduner. The guide will help patients do their homework before the visit so they can make the most of their time with their doctor.

Guide Helps Patients Understand How Glaucoma Impacts Functional Vision

Simulation of scene as viewed by a person with glaucoma. The scene is of two boys each holding a ball. In this scene, the faces of the two boys, which are in the central part of the picture, are distinct and in focus. However, the rest of the scene on the periphery is dark and cannot be distinguished.

Carduner's guide also supports patients by helping them understand not only how glaucoma impacts the health of their eyes but also how the disease impacts functional vision, in other words, the way a person sees. "You would think that people understand their vision but they don't. People realize that they are tripping over steps but there is no way for them to know that it is because they have a scotoma (blind spot)." An ophthalmologist can learn a lot about a patient's eyes using an array of assessment devices but to really appreciate how a patient sees, a doctor can learn the most by asking a person about his or her everyday experiences. The guide poses questions about a person's daily activities aimed at revealing possible vision loss, for example: Do you have trouble finding something on a crowded shelf? Do you have trouble recognizing faces, even of friends and family? Do you have trouble driving at night?

Vision distortion from glaucoma blind spots. Source: Courtesy Karanjit Kooner MD and William Anderson, photographer, University of Texas Southwestern Medical Center, Dallas.

Guide Stresses Importance of Doctors Asking About Vision

Sometimes, doctors can get caught up in examining the anatomical and structural integrity of the eye but forget to ask the patient about their vision. Says Carduner, "One doctor told me that I had 20/25 vision, which is near perfect acuity, but never tested me for contrast sensitivity. (A person who has reduced contrast sensitivity finds that objects don't always stand out from their background. For example, white rice will disappear on a white plate and a curb might blend into a similarly colored street.) Doctors might neglect to measure a person's contrast sensitivity because it's not a diagnostic tool used in tracking the progression of glaucoma. However, loss of contrast sensitivity can make it harder to get around, read, or locate objects that seem to blend into the background. Carduner encourages patients to engage in dialog about their visual functioning and even request tests like the one for contrast sensitivity. Once patients understand the nature and extent of any vision loss, they are better able to pursue solutions. Their ophthalmologist or his staff members should refer glaucoma patients to agencies that offer vision rehabilitation and the guide offers additional resources about glaucoma, as well. Carduner also discusses the future of glaucoma research and treatment.

Guide Highlights Critical Importance of Effective Partnerships with Doctors

As someone living with glaucoma, Carduner recognizes that doctor appointments can be stressful. The Patient's Guide is an effective remedy to feeling frustrated and overwhelmed. In addition to educating readers about glaucoma, Carduner reminds patients that it is their responsibility to establish effective partnerships with their doctors. Ultimately, patients who ask their doctors questions and discuss any changes in their vision, are most empowered to take an active role in managing the treatment of their condition.


Topic:
Glaucoma

Diabetes Education Can Help You Lower Your Blood Sugars and the Risk of Diabetic Retinopathy

Editor's note: Diabetes Alert Day comes in March. According to Healthy People 2020, diabetes has been identified as a major public health issue that affects an estimated 23.6 million people in the United States. It can lower life expectancy by up to 15 years and is the the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.

This is the first of a series on this critical topic that peer advisor Audrey Demmitt, R.N. will be writing. So stay tuned for more in this series.

By Audrey Demmitt, R.N.

Simulation of a street scene as seen by a person with diabetic retinopathy. People are crossing a street, street construction is occurring on left in the background, and there is a building to the right behind the people who are crossing the street. As seen by a person with diabetic retinopathy, the whole scene is hazy and there are several spots that block vision in those areas. The young men's faces are totally obscured by a large spot. The woman walking behind the men and to the left and the construction area on the left are visible but blurred. There is a large spot obscuring part of the building. The rest of the building is blurred.

The Center for Disease Control reports that diabetes is the leading cause of new cases of blindness in the U.S. among adults. Diabetes is on the rise and more people are living with vision impairment caused by its damaging effect on the eyes. Diabetic retinopathy is a disease that causes swelling, leaking and bleeding in the fragile blood vessels of the eye, resulting in vision loss. About one-third of all individuals with diabetes will develop it and if you are a male, or Hispanic, or black there is an even higher chance you will have this complication. Clinical factors that increase a person’s chances of developing diabetic retinopathy include:

  • Number of years living with diabetes
  • Chronically high blood sugar levels
  • The use of insulin
  • The presence of high blood pressure

So What Can You Do to Lower Your Risk?

The primary treatment goal for diabetes is to maintain healthy blood sugars and keep your A1c (long-term measurement of blood sugar over time) as normal as possible. In addition, it is very important to monitor and treat high blood pressures since this causes damage to small blood vessels in the eyes, kidneys and other vital organs. Managing diabetes is all about balancing healthy eating with the right amount of physical activity for you and taking your medications as prescribed. This is easier said than done as diabetes is complicated and requires constant self-care and daily vigilance. In my experience as a diabetic nurse educator, I have seen the barriers people must overcome in order to learn to manage their diabetes. Among the most common are:

  • Lack of information and training
  • Lack of access to proper medical care, classes, and services
  • The financial burden of treatment and supplies
  • The emotional impact of this disease including feelings of being overwhelmed, discouraged and even depression.

Vision loss and neuropathy make it even more difficult to manage one’s diabetes. How does a person read information to learn about their disease? How do they find the tiny drop of blood to test their blood sugars? How can they operate their glucose monitor or draw up insulin if they can’t see? Even difficulty with cooking healthy meals can impact the blood sugars of a person with diabetes. Managing diabetes effectively requires specialized education and training. And if you are experiencing vision loss as well, you may need additional support services and even specialized equipment, such as talking glucose monitors and blood pressure cuffs. Where can you turn for help and resources?

AFB Has Excellent Information on Diabetes and Vision Loss

A good place to start is here on this site. There is an entire section devoted to diabetes and diabetic retinopathy written by a diabetes educator, Debra Sokol-McKay.

Additionally, there are two different courses offered through the collaboration of AFB and the Diabetes Association of Greater Cleveland Clinic. The first is The Basics About Living With Diabetes. The second provides specific information about vision loss and diabetes and is called A Guide to Caring for Yourself When You have Diabetes and Vision Loss. Both are available as audio lessons with transcripts. They were produced for those who have trouble reading print. The second guide is also available in Spanish.

I found them very helpful as a lesson plan for people with diabetes and visual impairment. The topics include the 7 Self-Care Behaviors established by the American Association of Diabetes Educators: Healthy Eating, Being Active, Monitoring, Taking Medications, Problem Solving, Healthy Coping and Reducing Risks. These lessons are full of great information that can help you improve your knowledge and skills to control your diabetes. These guides will also be useful to diabetes educators to learn about adaptations to vision loss.

A Formula for Success

There is much to learn as a person with diabetes and it can be overwhelming. But this is the only way to manage your disease successfully in order to live well with diabetes. The time is now and whether you are new to diabetes or have had it for years, I encourage you to renew your commitment to practice good self-care. Seek updated information and education from a diabetes educator, dietician, and a vision rehabilitation agency if you are visually impaired. Consult the AFB directory to find these services in your area and ask your doctor about local diabetes classes, counseling and one-on-one consultation with a nutritionist. Set some goals and make an action plan. Consider what motivates you toward your goals. Is it your family and the desire for quality of life? Stay focused on your motivation for making changes. And lastly, ask for help and support from loved ones, healthcare professionals and others who are living with diabetes. Contact the local chapter of the American Diabetes Association and ask if there are any support groups in your area. Some vision rehabilitation agencies offer support groups for people with diabetes and vision loss. You will learn about many local resources that can offer you support if you reach out for help.

Education + Motivation + Support = Improved Blood Sugars, Fewer Complications and Increased Quality of Life

Other Resources

You may also want to read Managing Diabetes from Head to Toe and

You can read all the latest on research on our VisionAware blog.


Topic:
Diabetes and diabetic retinopathy

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