Low Vision and the White Cane: A Tool for Fall Prevention

By Mary D'Apice
Orientation and Mobility Specialist

The Long White Cane: A Useful Tool

Fear of falling: It's a serious concern many older adults share. Seniors who have low vision are understandably more anxious about tripping over objects or missing curbs. Regrettably, many older people simply stop venturing out because they are afraid that a fall may lead to serious injury.

But most people do not realize that the white cane, also known as the long cane, is a wonderful tool that is available to those who have some remaining vision and are not totally blind. If a traveler has some sight but doesn't always trust his or her vision, a white cane can help by detecting obstacles or elevation changes. The white cane will also alert others to the fact that the traveler does not see well.

An orientation and mobility (O&M) specialist can fit an individual for the cane and provide specialized training in how to travel safely, efficiently, and confidently in one's own neighborhood and beyond. I'd like to share a few scenarios in which the use of the white cane can contribute to peace of mind and help people who have visual impairments maintain their quality of life.

Using the Cane to Detect Obstacles and Elevation Changes

Meet Mrs. Morimto, Who has Glaucoma

A vibrant, upbeat woman in her 60s, Mrs. Morimoto has glaucoma. As a result of her shrinking field of vision, she sees the world as if she is looking through a cardboard tube. Mrs. Morimoto still has a lot of usable vision in her central field of view. On a walk around the neighborhood, she can read street signs, admire the neighbor's garden, and recognize a friend riding by on her bicycle. Because she has "tunnel vision," however, she can easily miss recycling bins at her feet or may scrape up against low hedges.

An unfolded long cane with a rollerball tip

Mrs. Morimoto used to enjoy a brisk walk every morning, but now she walks very slowly and cautiously. Her back hurts from being bent over as she nervously checks the area just in front of her feet. Sometimes, she is so focused on the ground that she misses a tree branch at head height. What's more, her attention is so concentrated on the sidewalk that she forgets to look up and enjoy the view.

Mrs. Morimoto always thought that a white cane was reserved for people with no vision at all so she was very surprised when her ophthalmologist said she would be an excellent candidate for training with the cane. She went to a local center for the visually impaired and began working with an O&M Specialist. In time, Mrs. Morimoto found that she could trust the cane to do the work of detecting obstacles and drop offs in her path so she could focus her vision elsewhere.

The O&M Specialist also taught Mrs. Morimoto how to scan for traffic at intersections in a way that made the most of her usable vision and kept her safe. An added benefit of using the cane was that Mrs. Morimoto was once again able to walk upright with her head held high. Her pace increased and as her posture improved, her back felt better and once again she was able to look around at the scenery. Instead of staring down at the sidewalk; once again, she is able to smile and wave at the kids running around the school yard on her daily walks.

Using the Cane as a Verification Tool

Meet Mr. Alvarez, Who has Macular Degeneration

Mr. Alvarez is an active 73-year-old gentleman living with macular degeneration. Mr. Alvarez enjoys meeting friends at the senior center and singing in the church choir. Since he lives in the city, he has always been able to walk or take public transportation to do his errands.

With the help of extra lighting and low vision optical devices he purchased from a low vision clinic, Mr. Alvarez is able to read his mail, pay bills and remain independent at home. But one day on the way home from church, he missed a curb and twisted his ankle. After that, he was very anxious about going out, particularly on cloudy days. Mr. Alvarez contacted his eye doctor at the low vision clinic who put him in touch with an O&M Specialist.

Mr. Alvarez learned that macular degeneration often results in loss of contrast sensitivity. In other words, objects in the foreground seem to blend into the background if they are similar colors. For example, someone with macular degeneration would have a hard time seeing the edge of curbs or spotting a gray planter on a concrete patio. Loss of contrast sensitivity is often more pronounced in dim light, so cloudy days, darkened stairwells, or dimly lit restaurants and lobbies are more of a challenge to navigate.

The O&M Specialist taught Mr. Alvarez how to scan ahead for potential objects or drop-offs in his path and then use his cane to verify what he suspected may be there. Now if Mr. Alvarez notices a dark patch on the sidewalk as he approaches an intersection, he uses his cane to explore the area and keeps his eyes focused on cars and the traffic signals.

The cane can tell him if he needs to avoid a gaping hole, step over a puddle, or simply walk over a harmless shadow. The cane is also useful for judging the depth of a curb or checking to see how big a step he needs to take off the city bus onto the sidewalk. Mr. Alvarez is very pleased that the cane continues to provide him the freedom to go out and do the things he loves to do.

Using the Cane for Identification Purposes

Meet Mrs. Gould, Who has Diabetic Retinopathy

The fashionable 92-year-old Mrs. Gould is frail, but still loves going to the bustling, downtown shopping area with her daughters. Because Mrs. Gould has diabetic retinopathy, an O&M Specialist trained Mrs. Gould's family members to be effective guides. Her daughters know not to pull Mrs. Gould by the hand but instead offer her an arm to hold on to. Using human guide techniques, they can pass through doorways smoothly, go up and down stairs safely, and help Mrs. Gould into a chair with dignity and grace.

A lightweight identification cane

Recently, however, Mrs. Gould has become more uncomfortable in crowds as her vision has worsened. She worries that baby strollers will knock her over and is very embarrassed when she accidentally bumps into someone. Her O&M Specialist introduced her to a white cane used for identification purposes. This "ID cane" is thin, lightweight, foldable, and easy to grasp. (See photo at left.)

While Mrs. Gould occasionally sweeps it across the floor to check for obstacles, she mostly relies on it to communicate to others that she is doesn't see well. People are more likely to get out of her way and, when she does bump into someone, they are quick to offer apologies first.

Mrs. Gould used to worry that her acquaintances would think she was rude or standoffish because she was no longer able to recognize them on the street. The cane reminds her friends to identify themselves when they greet Mrs. Gould. Since she has been using the cane, Mrs. Gould is much more relaxed and continues to look forward to her outings.

Think about Using a Long White Cane

The long white cane is an essential tool for people who are blind but it is also increasingly recommended for people who have low vision. Please don't stop going out because you worry about falling! As an Orientation and Mobility Specialist, I have witnessed first hand how a white cane can restore freedom and independence. Contact your nearest center for the visually impaired and find out if the white cane make a difference in your life.

Acknowledgments

An unfolded long cane photo is a Wikimedia Commons file, used in accordance with the Creative Commons Attribution 3.0 Unported license.

An identification cane photo is a Wikimedia Commons file, used in accordance with the Creative Commons Attribution 3.0 Unported license.

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