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Searching for Those Elusive Magic Glasses

What Are Magic Glasses?

Show of hands or better yet, clap if you like to make fundamental changes in the way you do everyday, daily living activities! Are you one of those folks who relish the idea of throwing away the computer mouse and trackpad to rely solely on keyboard shortcuts to do your work? Or suddenly read your favorite books and magazines by listening to them? Abandon your usual mode of transportation and just switch to Uber, public transportation, or a bicycle? A couple of you are clapping, but the rest of us recognize these changes will be time-consuming and inconvenient at best. Even the most adventuresome of us may find some of these fundamental changes in our lifestyle can be disorienting, have a negative impact on doing routine tasks, and be anxiety-provoking until we learn other ways to accomplish what used to be everyday activities.

More than one vision rehabilitation therapist has used the term "magic glasses" to describe the as-yet-unavailable procedure, technology, or optical device that will reverse an individual’s vision loss. In this era of high technology and miracle drugs and cures, it is hard to imagine that there is not some procedure, optical refraction, implant, or drug that will correct or reverse vision loss from macular degeneration, glaucoma, diabetic retinopathy, and other causes of vision loss! "Magic glasses" is a metaphor to describe the fast or easy solution to returning to a world that we understood, with the ability to recognize familiar faces across the room, drive independently from here to there, see the mouse arrow on the computer screen, and all the other visual daily activities often just taken for granted.

Magic Glasses and Assistive Technology

The notion of the "magic glasses" has taken on new meaning in the past several years in the world of assistive technology (AT). Glasses are becoming an integral part of some of this technology. Glasses are now being used to mount miniature video cameras, converted into wearable computer displays, or both. The integration of this technology to glasses has led to them being referred to as "smart glasses."

woman wearing OrCam device, a wearable, smart camera attached to her glasses

Two of the most popular smart glasses include the Aira (pronounced eye-ra) glasses and the OrCam. Both utilize cameras mounted on the glasses that are connected to a pocket-sized computer about the size of a smartphone. The glasses resemble a regular pair of glasses—only a close look reveals the addition of a small camera. In fact, the OrCam camera and speaker are simply mounted to the arm of a regular pair of glasses. Until relatively recently, OrCam and Aira offered quite different services.

The OrCam

Using hand gestures, the OrCam user has a powerful OCR (optical character recognition) system at their disposal. Users look at text they wish to read, take a picture using a hand gesture, and listen to the text being read back nearly instantaneously. The OrCam can tackle street signs, menus, newsprint, etc. Human faces and favorite products can be saved into the OrCam memory for recall the next time the person or product is seen. The OrCam MyEye 2.0 retails for $4,500.

The Aira

Aira utilizes a video camera mounted on a proprietary pair of glasses. Users summon a human assistant when needed via a high-speed Internet connection. The human assistant remotely sees what the user is looking at and offers assistance as needed. For example, if a user wanted to read the board in an airport showing arriving and departing flights, the Aira assistant might instruct the user to move her head until the board was located then read the information seen through the video camera. The assistant is available for clarification or to provide real-time research, such as look up an airport map to locate the nearest restroom or coffee shop.

Aira offers subscriptions to users based on monthly blocks of usage minutes. Subscriptions start at $89 per month for 100 minutes and also include $129 per month for 200 minutes, $199 for 400 minutes, and $329 per month for unlimited usage. The smart glasses and hardware are all included in the subscription price.

aira agent looking a computer with view of what aira user is seeing in street crossing

The NuEyes Pro

NuEyes is a head-mounted display that resembles glasses, with a video camera mounted on the front. It appears less discreet than some of the other smart glasses because the "lenses" are opaque. NuEyes also has an OCR built in and a barcode scanner. It differs from both the OrCam and Aira in that it can magnify the image from the video camera up to 12X on the glasses display and add contrast by changing the foreground and background colors, much like you would expect on a video magnifier.

NuEyes is based on an Android operating system that appears to be built into the glasses, as opposed to a separate pocket computer or smartphone, which will certainly make them heavier than either the OrCam or Aira glasses. The advantage, however, is that NuEyes are wireless and don’t need to be cabled to a remote processor, as is the case with the other two.

Are These the New Magic Glasses?

Are these the magic glasses? While this is not a comprehensive list of the glasses being promoted for individuals with vision loss, it is safe to say that none will completely compensate for all the daily life activities that vision loss can impact. On the other hand, there is also no doubt that at least one of the features offered might be a handy or a welcome addition to an assistive technology toolkit. A recent tour of another smart glasses product, not mentioned above, which retails for $10,000 got me thinking. The whole notion of the magic glasses and the vulnerability we may have as consumers for some of these new devices made me pause. On my tour of the eSight website, I was a bit disheartened by the "Moments" link with stories and videos highlighting the first time a child saw his mother or the Easter bunny, wearing the eSight glasses, or the first time a person with an acquired vision loss saw family members "clearly" in decades. I wondered how many of these moments might have also happened with a quality monocular or a desktop video magnifier for a fraction of the cost? As I filled out the form to request more information on how to "Experience eSight: At Home," there were a great number of questions related to how I might potentially pay for the eSight smart glasses. I didn’t gush about my funding options and never received a reply to my request.

It is my hope that our search for the magic smart glasses doesn’t override our savvy as smart consumers to ask practical questions about these devices and take the opportunity to try them in real life situations at work or in the home. Take a little time to research these devices in a reputable journal like the American Foundation for the Blind’s AccessWorld Magazine or consult with a local assistive technology professional or vision rehabilitation therapist who may provide an unbiased assessment and help you develop a strategy for resuming daily living or working activities with or without the "magic glasses."

Additional Information

Seeing Ai App

Be My Eyes App

Low Vision Optical Devices

Electronic Magnifiers


Topics:
Assistive Technology
Helpful Products
Low Vision
Online Tools
Personal Reflections
Planning for the Future
Reading
Social Life and Recreation
Technology
Video Description

Coping with Geographic Atrophy, the Advanced Stage of Dry Macular Degeneration

How Macular Degeneration Affects Vision

A simulation of the effects of macular degeneration

A progressive eye disease, age-related macular degeneration (AMD) may occur in one or both eyes and may advance very slowly or quite rapidly. While the condition can be devastating, ophthalmologists reassure patients that macular degeneration alone will not lead to total blindness. The reason is that both the dry and the wet forms of macular degeneration affect the central part of vision but peripheral, or side vision, is preserved.

As a vision rehabilitation specialist, I help people who have visual impairments better understand their eye conditions. Frequently, my clients are confused by what they can or cannot see. Family members may be mystified by the fact that 75-year-old Aunt Millie needs a magnifying glass to read a menu, yet she can navigate a crowded restaurant with ease and even spot a dropped spoon on the floor.

Millie has the dry form of AMD, the most common cause of age-related vision loss. Cells in the central part of her vision called the macula have deteriorated, so Millie struggles to do things that require very sharp vision, such as reading, playing cards, or chopping vegetables. But Millie often surprises herself when she can see things out of the corner of her eye. Millie’s visual functioning varies depending on the task she is doing and whether she is using her damaged central vision or relying on intact peripheral vision.

Patients with AMD Can Maximize Usable Vision

As part of vision rehabilitation training, I can teach Millie to look at an object using her peripheral vision in place of her central vision. Finding that "sweet spot" in the peripheral field is a technique called eccentric viewing (also known as Preferred Retinal Loci (PRL)) that takes some effort to learn but gets easier with practice. Already Millie has discovered that she can read the clock on her bedside table if she looks slightly to the right of it.

Millie can make the most of her remaining vision with increased, high-quality lighting. I recommend LED light bulbs that are labeled "warm" or "soft," terms that describe the color of the light, not the brightness. These yellow tones are not only easier on the eyes than the blue light of "daylight," "natural," or "cool" lightbulbs, but they will also provide better contrast so that print will tend to stand out from the page. Loss of contrast sensitivity (the ability to detect differences between light and dark areas) is a hallmark of AMD, so Millie should use contrasting colors to keep objects from fading into the background. Instead of pouring her black coffee into a navy blue mug, she might start using a light-colored cup. Millie knows white pills on a dark tray or napkin are easier to see, and she sets her pastel-colored dinnerware on a dark-colored placemat.

I encourage all my clients with dry AMD to follow their doctors’ advice about AREDs. As noted in VisionAware's AREDS article, there are stipulations for taking the vitamin of which you need to be aware. This vitamin and antioxidant formula may help prevent the onset of the wet form of AMD. Less common than the dry form, wet or exudative AMD can result in significant vision loss due to leaking fluid or blood under the retina.

Geographic Atrophy, The Advanced Form of AMD

A fundus photo showing geographic atrophy associated with dry age-related macular degeneration.

Some people will not notice much of a change in their vision as time goes on, but what happens if vision deteriorates rapidly? Imagine I meet Millie three years later. She has contacted my vision rehabilitation agency because her magnifying glass no longer seemed strong enough. She reported that her eyes fatigue quickly as she fights to keep her place when reading the mail. Often, she can make out only a few letters in each word. When she is reading a label on her canned goods, she can’t be sure if she is looking at a can of peas or peaches.

Millie assumed that her deteriorating vision was caused by the wet form of AMD. Instead, her ophthalmologist explained that her symptoms were typical of someone in the advanced stages of dry macular degeneration known as Geographic Atrophy (GA), the most severe and advanced form of dry AMD. GA involves patches of cells in the retina that have degenerated or died off. Atrophy refers to the degeneration of the deepest cells of the retina, called the retinal pigment epithelium (RPE). Geographic refers to the shape of the atrophied portion of the retina, which resembles the irregular outline of a land mass (geography). The RPE helps to maintain the health of the retinal photoreceptor cells, called rods and cones. These photoreceptor cells are triggered by light to set off a series of electrical and chemical reactions that help the brain to interpret what the eye sees. The degeneration of the RPE cells also leads to the death of the rods and cones.

At present, there is no medical or surgical treatment for geographic atrophy. Millie’s vision has worsened in part because she has developed a scotoma in her macula. Scotomas are often described as blind spots, but they are not actually dark areas that block our view but rather the absence of vision itself. Scotomas will cause letters in a word to disappear, and objects might suddenly vanish. For example, Millie can be looking directly at her easy chair but miss the kitten curled up against the pillow.

New Treatment for Geographic Atrophy in Clinical Trials

While the promise of stem cell therapy lies on the distant horizon, there are currently no medical treatments that can regenerate retinal cells that have atrophied. Ophthalmologists are only able to offer medications, injections, or surgeries that preserve existing vision or slow the progression of an eye disease. Patients with wet macular degeneration, for example, may benefit from injections of an anti-VEGF drug. These injections won’t improve eyesight but will inhibit the formation of new blood vessels which could lead to more vision loss.

There is no approved treatment for Geographic Atrophy (GA), but research is underway. The biopharmaceutical company Apellis Pharmaceuticals has announced that APL-2 may slow the advancement of GA. In Phase 2 Clinical Trial (FILLY) of APL-2 completed earlier this year, patients received intravitreal injections which seems to reduce the rate of degeneration. The FILLY trial involved over 40 clinical sites in the US, Australia, and New Zealand and successfully demonstrated that APL-2 is both safe and effective. Apellis has refined the protocol for Phase 3 trials, which should be underway by mid-2018.

As time goes on, there will undoubtedly be more clinical trials coming out. Learn more about how to evaluate them and protect yourself, as not all are legitimate.

Solutions for Patients with Geographic Atrophy

woman using a video magnifier, looking back at the camera

Millie will not likely reap the benefits of a breakthrough medical treatment that restores her vision. Still, I can assure her that vision rehabilitation training and low vision services will help her maintain independence and continue doing many of the things she used to enjoy. Millie’s 5x handheld magnifier may no longer serve her, but Millie may be able to use a video magnifier to significantly enlarge reading material. A video magnifier, also known as a CCTV, uses a camera to project reading material on a screen the size of a computer monitor. Millie may also rely on adaptive aids such as bump dots. By placing these raised tactile dots on her microwave, she can feel for the button she needs instead of relying on her vision.

Mixed Bump Dots. Image courtesy of MaxiAIds.

Millie has excellent hearing, so she might get around vision loss by doing things auditorily. For instance, she may use a handheld recorder instead of writing out shopping lists. Millie will be surprised to learn that in addition to talking watches and clocks, there are a host of medical devices from clinical thermometers to blood pressure monitors and glucose meters that talk as well.

An avid reader, Millie can enjoy her favorite mysteries and romance novels by subscribing to the National Library Service for the Blind and Physically Handicapped. This government agency provides customers with an easy-to-use Talking Book Player that plays audiobooks on cartridges delivered to your home. The service is free and available to U.S. residents who are unable to read or use regular print materials as a result of temporary or permanent visual or physical limitations. This includes those who are blind or have a visual or physical disability that prevents them from reading or handling print materials. NLS serves patrons of all ages. Some schools and medical facilities are also eligible to apply for service as institutions.

Contact a Vision Rehabilitation Specialist Near You

Learning to adapt to life with vision loss can be overwhelming. No one should go it alone. If you or a loved one feels that they are having difficulty maintaining their quality of life because of a visual impairment, I encourage you to seek vision rehabilitation training. Search our directory to find services in your state.

Additional Information

Research on Treatments for Dry Macular Degeneration and Geographic Atrophy

Series on Low Vision Services

Blog Topic Macular Degeneration


Topics:
Health
Low Vision
Macular Degeneration
Planning for the Future

Smart Speakers: How They Can Help People with Vision Loss

In a very short period of time, a whole new genre of devices has evolved called, "smart speakers." It started with the Amazon Echo a couple of years ago, spread to the Google Home, and now, there is the Apple Home Pod, the Sonos One, and more. The major differences are in the sound quality, the smart assistant responding to the user’s verbal questions, and the price.

Google Home and Amazon Echo

google home device pictured next to packaging box

Google Home sitting on a table next to the Google Home box

Let’s keep it simple here and focus on the market leaders, the Amazon Echo and Google Home. For readers new to these devices, the smart speaker is a stand-alone speaker that connects to the WiFi in the home, has very few controls on the surface of the device, and primarily is used by speaking to it. For example, you might alert your Echo by first using the wake word "Alexa," followed by a question: "What’s the weather forecast this week in Maine?" Almost instantaneously, the Echo would speak the weather forecast. The Google Home works in much the same way with a wake phrase of "Hey Google."

Both devices require an initial setup using a computer, tablet, or smartphone, but after that, there doesn’t need to be much additional use of the computer for day-to-day use. For this reason, after the initial setup, these devices are ideal for someone with limited computer knowledge. Additionally, because most models don’t have a screen, all the interaction with the device is verbal.

Amazon Skills Versus Google Intuition

echo beside table lamp

Second Generation Amazon Echo

Both devices have evolved quickly in a short period of time, adding features, and simplifying their use. For example, the Amazon Echo uses what it calls "skills" to enable certain functions. In order to listen to streaming radio stations, you might have to first enable a skill on the Alexa app, using the computer or tablet app. Once enabled, you need to recall a specific phrase to make an app work. An example of this might be using the skill called "Simple Radio," which can play thousands of radio stations. Once the skill is enabled, the user might find a station by saying, "Alexa, ask 'Simple Radio' to play BBC music." As a result, for skills that are used every day, these phrases are easily remembered, but for those used less frequently, recalling these phrases might be more difficult! To some degree, it seems as though both devices have become a bit more intuitive overall and understand user commands that are less precise.

The Google Home’s approach to applications or skills is somewhat different. During the setup process, if you were interested in streaming music, you might select one of the services Google integrates with like Spotify, Pandora, Google Music, etc. These are listed in "Settings" under "Music." As a rule, there are far fewer options than what is available on the Echo, however, the Google Home seems more intuitive by offering suggestions or opening an application by voice. An example of this was asking Google Home the following, "Hey Google, can you read a verse from the Bible?" The reply was, "For that, you might want to try 'YouVersion.' Want to give it a try?" Answering, "Yes" opened the app, and in a short time, I could specify specific books, chapters, or verses. The Alexa app lists over 70 skills that read Bible verses. Any of these can be enabled from the Alexa app on a tablet or smartphone, but none can be added by voice as the Google Home did. While there was less choice in this particular example with the Google Home, it was easier to add by voice.

Making Phone Calls at Last!

One of the biggest breakthroughs, for both devices, happened last fall with the ability to make phone calls using the Google Home or Amazon Echo. The Amazon Echo had the ability to call another person with an Amazon Echo from early on in its development, as long as that person was listed in a user’s contacts. Now, however, a phone call can be made from either device by simply saying, "Hey Google (or Alexa), call…," and providing the number to call. If, for example, you wanted to call customer service at the American Printing House for the Blind (APH) using the Echo, you would say, "Alexa, call 800-223-1839," and the call would be placed over the WiFi Internet.

While there are many similarities between the Google Home and Amazon Echo, making phone calls is just one of the areas where there are some subtle but dramatic differences between the two. Both devices make it easy to find the number of local businesses. To get a phone number for the Maine nonprofit agency providing vision rehabilitation services, either device will provide a phone number when asked, "Alexa (Hey Google), what’s the phone number for The Iris Network in Portland Maine." Only the Google Home device can take the next step to call the number, eliminating the need on the Amazon Echo to record the number first. In fact, the Google Home can make a phone call just by using the command, "Hey Google, call the Iris Network in Portland Maine." The Echo can look up the number and make the call if you speak the number but is not yet able to call by requesting the business name only the way the Google Home does.

Is Texting Next?

In addition to making phone calls, the next big hurdle is the ability to send and receive text messages. The most recent update to the Amazon Echo permits users to link a phone for text messaging to the account. Like the earlier version of calling with the Echo, users have been able to send messages to other people with an Amazon Echo for some time. The recent update now allows a text message to be sent from the Echo to a phone, regardless of whether this person has an Echo or not. Just as with making phone calls, the command for texting requires using the phone number or the contact name if listed in your contacts. For example, the command might be, "Alexa, send a text message to Uncle Albert," if he is listed in your contacts, or just provide a phone number where the text is being sent. As of this blog post, the Google Home does not send text messages yet, but you can bet this is high on their priority list of upcoming features!

The drawback, right now, for texting with the Echo is that for those users who are not also smartphone or tablet users, there is no way to receive and listen to a text message, and like with phone calls, if you are texting or making calls to an automated service that requires entering numbers after the call, there is no way to input those numbers. So if the primary goal is to enable a user to text by voice, the Amazon Echo is not quite there yet, but getting closer. Of course, if sending and receiving texts by voice is a goal, Siri can do this on the iPad, iPhone, and iPod Touch, and the "OK Google" app can do this on both Android and iOS devices, but that’s another article!

Alexa,"Read My Book!"

Other recent improvements include expanded book reading, primarily for the Amazon Echo. The Google Home will play books from its own service, Google Play, which is extensive, but trails the competition—Amazon and Audible. The Amazon Echo was able to play Audible audiobooks from very near the beginning of service and recently added the ability to play narrated Amazon books as well. Audible is a service that charges a monthly fee, which entitles users to a certain number of credits, with which to use to purchase audiobooks. Books may be downloaded and played on a computer, tablet, smartphone, Victor Reader Stream—virtually anything that will play the native MP3 file format. On the Echo, these books are streamed to the Echo and can be paused, fast-forwarded, and rewound using a voice command. The last reading location is recorded so the next time a user says, "Alexa, read my book," reading begins where it left off. Both Kindle narrated books and Amazon book titles are stored in the cloud, meaning any of the books in your library are available from the Echo.

Books are certainly not the only way to read using the smart speakers. The Echo offers two skills, Audio Reader and Sun Sounds of Arizona related to radio reading services for the blind. Radio Reading Services historically have been regional services comprised of volunteers reading the local newspaper and broadcasting live on local radio stations specifically for listeners with a print disability. Both skills, of course, must be enabled from the Alexa app, but once enable, simply saying, "Alexa, open Audio Reader (or Sun Sounds)," begins the streaming live broadcast. Although the Google Home does not have specific skills for radio reading services like the Echo, if selected during setup, the Google Home will stream many live broadcasts from services like TuneIn Radio. As a result, some of the radio reading services now streaming on TuneIn, like Triangle Radio Reading Service and Mountain Area Radio Reading Service will play live, using the command, "Hey Google (Alexa), play Triangle Radio Reading Service on TuneIn." TuneIn is certainly not limited to radio reading services for content; many podcasts like Cool Blind Tech can also be streamed on the Echo and Google Home using TuneIn or other radio services.

Lower Prices

Before the holiday season, Amazon’s most recent second Generation Echo debuted with a significant price drop at $99. The second generation Echo is somewhat smaller, seems to have a better quality speaker, and is almost half the cost of the original Echo! A smaller version, the Echo Dot, is available for $49 and does everything the larger version does but lacks the better speaker. There are several more versions and configurations available from Amazon, but these are the most popular.

Google Home is $129 for the full-size model and offers a mini version for $49. Like the Echo, the mini version lacks the larger speaker but performs all of the functions the larger version does.

It is no surprise the smart speakers are showing up everywhere! Once set up, they make a simple way to access a great deal of information and services that used to be only available to those who were able to use a computer or smart device. They are so convenient that even if you are a savvy computer user, you will quickly bond with the convenience of using a quick verbal command to answer a question, read a book, or play some music. With the recent ability to make a phone call using either the Amazon Echo of Google Home completely by voice, each has demonstrated what a handy household device they can be. Add this to the other features like reading a book, sending a text, listening to a newspaper on a radio reading service, plus the many other entertainment and information services available, either device makes a great addition to home or office.

Additional Articles

Google Home

Comparitng Digital Personal Assistants


Topics:
Assistive Technology
Online Tools
Social Life and Recreation
Technology

Disarming Glaucoma, the Sneak Thief of Sight: Wills Eye Hospital’s Glaucoma Detection and Treatment Program

Only Comprehensive Eye Exams Can Detect Disease

According to the Glaucoma Research Foundation, glaucoma is a leading cause of blindness in the United States, but only 50 percent of those affected are aware they have the disease. Often referred to as the "sneak thief of sight," glaucoma is normally painless, and vision loss may progress so slowly as to be undetectable. The disease affects peripheral, or side vision, first. Therefore, patients may unconsciously turn their heads to compensate for a field deficit that is not yet obvious to them. Although there is no cure for glaucoma, early detection is the best defense against vision loss because medications or surgery can slow its progression. Unfortunately, many Americans do not schedule routine eye exams that screen for eye diseases. We speak of visiting the "eye doctor" when we have trouble reading or watching a movie and need corrective lenses, but, in fact, the opticians who fit us for glasses do not have the medical credentials of an optometrist or ophthalmologist who can assess the health of our eyes with a comprehensive exam.

The CDC’s Vision Health Initiative Glaucoma Detection Program

The fact that Americans are losing vision to preventable eye diseases is recognized by the Centers for Disease Control and Prevention (CDC) as a public health dilemma. In 2012, The CDC launched the Vision Health Initiative (VHI) Glaucoma Detection Program to identify glaucoma symptoms among high-risk populations including those with diabetes or extreme near-sightedness, people over 60 years of age, those with a family history of glaucoma, and certain ethnic groups. Hispanics, Afro-Caribbeans, and, particularly, African Americans have a genetic predisposition to the condition. In fact, African Americans are six to eight times more likely to be blinded by glaucoma than Caucasians and are much more likely contract the disease at a younger age.

Through the VHI Glaucoma Detection Program, federally-funded grant programs are empowering local hospitals and universities to find innovative ways to educate the public about the need for routine eye exams and bring state-of-the-art diagnostic tools and medical treatments to underserved populations in urban areas. Among VHI’s original partners is the Wills Eye Hospital in Philadelphia, Pennsylvania, which is now in its third year of a five-year program entitled the "Innovative Community Outreach Program."

A doctor sitting at the reading center examining images of a patient's eye

Wills Eye Hospital’s Glaucoma Detection and Treatment Program

L. Jay Katz, MD, Chief of the Wills Eye Glaucoma Service and a Professor of Ophthalmology at Sidney Kimmel Medical College is the Principal Investigator for the Philadelphia Glaucoma Detection and Treatment Project. In Phase I, the program successfully connected hundreds of people in disadvantaged neighborhoods to glaucoma screening and medical treatments through focused outreach efforts. Non-physician educators participated in local health fairs and gave lectures at senior residential communities, senior centers, and churches. The program succeeded in raising awareness and correcting misconceptions. "We discovered that many people did not know about glaucoma and some thought it could be 'cured' with eyeglasses," Dr. Katz said.

Mobile Units Deliver Screenings and Treatments

Following the information sessions, participants were encouraged to return to the same venue at a later date for an eye exam on board a mobile unit—vans outfitted with all the diagnostic tools found in an ophthalmologist’s office. Once program participants understood risk factors and the imperative of routine eye exams, they spread the word. "Many people showed up to our mobile units with a friend or family member in tow," Dr. Katz said.

Wills Eye Hospital mobile detection van carrying equipment to the site

The search for individuals with glaucoma symptoms bore fruit. Approximately 40 percent of those tested were given a glaucoma-related diagnosis, and many opted to return to the mobile units for treatment with laser surgery.

Linking Primary Care Patients to Ophthalmologists Through Telemedicine

With Phase I now complete, Phase II of the Wills Eye Hospital glaucoma project integrates promising telemedicine technology. Instead of reaching potential patients through mobile clinics, the program enlists primary care doctors to work on the frontline of glaucoma detection. These physicians routinely see patients with conditions like diabetes and hypertension, which are risk factors for eye diseases. Yet primary care doctors do not have the capacity to provide comprehensive eye exams and far too many patients do not follow-up when they are referred to an ophthalmologist.

The Wills Eye Hospital facilitated access to eye care by establishing a program in primary care physicians’ offices to screen for undiagnosed glaucoma, glaucoma suspect, and retinal diseases using a special camera that photographs the optic nerve, retina, and macula. Technicians were also trained to use a tonometer, a hand-held instrument that can quickly and painlessly test for intraocular pressure. The images and data were then sent via a closed Internet system to glaucoma specialists and trained retinal readers who would determine the need for follow-up appointments. In many cases, glaucoma, glaucoma suspects, diabetic retinopathy, and other eye conditions were identified.

A camera being used on a patient to detect problems with the patient's eye

"We were also suspecting cataracts by noting the blurry quality of the eye images in certain patients. After that first visit, if an eye disease was identified or suspected, then a second visit was scheduled with an ophthalmologist and team that came in a mobile unit to the primary care doctor’s office to confirm the diagnosis," Dr. Katz said.

Patient Navigators Ensure Follow-Up

As with all initial diagnoses, follow-up is critical; yet, too many patients fail to pursue further care. Dr. Katz explained, "Some people might already be overwhelmed by serious health problems like diabetes or may have mild memory issues. Others simply give up trying to navigate the complexities of our healthcare system."

One research component of the Wills Eye Hospital program has been to find ways to remove barriers to medical care. One proven strategy is to assign patients a navigator who schedules necessary doctor appointments and facilitates transportation and other logistics to ensure that appointments are kept. Not surprisingly, initial findings suggest that patients assigned to a navigator are more likely to receive treatment for their eye condition than those who go it alone.

The Future of Eye Care Delivery Systems

The devastation visual impairment causes to individuals and their families is obvious, but Dr. Katz points out that blindness has an enormous impact on society. According to Katz, loss of jobs and independence for citizens who are blind cost an estimated three billion dollars a year in government services and state-sponsored aid. "Of course, preventing blindness is ethically the right thing to do, but we can also argue that investing in early diagnosis and treatments will save our communities money in the long run."

The Wills Eye Hospital Glaucoma Detection and Treatment Project has made significant inroads in promoting the eye health of Philadelphia’s residents. Dr. Katz and his team hope that the ripple effect will extend far beyond their city.

"Our overarching goal is to change the delivery system of eye care nationwide with an effective proactive screening program to identify those at risk for treatable eye diseases and prevent blindness," Dr. Katz said.

Additional Information on Glaucoma

Glaucoma: An Overview

Facts About Glaucoma

Risk Factors for Glaucoma

How Can I Detect Glaucoma If There Are No Initial Symptoms?

Patient's Guide to Living with Glaucoma


Topics:
Glaucoma
Health
Low Vision
Planning for the Future

Celebrate National Library Week with a Vision Rehabilitation Therapist

Get Ready to Read This Month at Your Local Library

The week of April 8 through 14, 2018, is both National Library Week and Vision Rehabilitation Therapist Awareness Week. This is the perfect time to team up with the local library and a Vision Rehabilitation Therapist (VRT) to learn more about reading with vision loss. For some, particularly those with recent vision loss, the idea of reading and returning to the library may seem like a lost pleasure or an unattainable goal. The most common goal I hear from clients is getting back to reading local newspapers, prescription bottles, magazines, menus, mail, etc.

How Can You Read with Vision Loss?

A Vision Rehabilitation Therapist (VRT) is a highly skilled professional whose job is to maximize whatever functional vision you have and provide training on adapted skills of daily living, including reading. For example, if your vision loss prevents you from reading a printed newspaper, large print books, or reading the computer screen the way you once did, a VRT can perform an assessment of your functional vision. They can also develop a plan with you for exploring adaptations or alternatives for reading that you may not be aware of or be knowledgeable about.

For example, it is not uncommon for a newly referred client to have several magnifying glasses that were handed down from family members or were purchased at a local pharmacy or box store. Many over-the-counter magnifiers are inexpensive, have poor optical quality, rarely exceed 3 times magnification, and have an ineffective light, if they even have a light. Clients are often pleasantly surprised after participating in an assessment with a VRT and learning to use a magnifier of the correct magnification and lighting for their vision—often not something available at the local store.

Unless you have a family member or friend with vision loss, you may have no idea of the wide variety of technology available for reading with low vision or no vision whatsoever. Some of this technology can be found on the computer, smartphones, and tablets already in our homes or at no cost at the local library.

This Year’s Theme: "Libraries Lead"

Photograph of a talking book player.

This year’s theme for National Library Week is "Libraries Lead." This is a very appropriate theme for reaching out to patrons in the community who may not realize what a vital role the local public library can play in reconnecting readers to alternate reading formats, like Talking Books, enlarged print on electronic screens, or screen readers that convert electronic text into speech.

Visiting Your Local Library

Make a date with your local library during National Library Week to see what they have to offer patrons with low vision and blindness. If you don’t know about the National Library Service (NLS) Talking Book Program, ask the librarian to fill you in or call toll free 1-800-424-8567. If you are unable to read print, you may qualify for a Digital Talking Book player at no cost, and audiobooks and magazines delivered to your home by mail. The Talking Book player is easy to learn how to use, and if you need some training, a VRT can help.

This is a screenshot of a Kindle book on a Kindle Fire HD tablet with white text on black background.

Many libraries are now loaning books on tablets, iPads, Kindles, and other electronic gadgets. The advantage of using these devices for reading with low vision is that they often allow the text to be increased larger than what is often considered "large print." In many cases, even more importantly, the contrast can be changed so that the text can be light on a dark background on the screen and the screen lighting adjusted for optimal viewing. The local librarian may not be aware of the "accessibility settings" on some of these devices, but if you bring along a VRT, he or she may be able to teach you and the librarian how to magnify the text on the screen using the software magnifier built into the device or turn the screen reader on so that the computer or tablet reads the text out loud.

You may also be pleasantly surprised to learn that the library has an electronic magnifier called a CCTV or video magnifier. These devices come in a variety of sizes, from portable hand-held units to desktop units (like the one in the York, Maine Public Library shown below). Printed material placed beneath the camera on the device can be enlarged many times, and there are settings to enable the text to be enhanced with contrast, lighting, or to change the text and background colors. Additionally, many of the newer models also have a built-in screen reader so that they can take a picture of the reading material, process the picture in a second or two, and begin reading the text to you. Here’s a tip! Because these devices are not used by the vast majority of patrons in some libraries, these may be tucked away—ask the librarian if they have one and be prepared to describe what it is.

video magnifier in York Maine Library

Time to Celebrate

So with this information, I encourage you to mark your calendars and celebrate reading during National Library Week and locate a VRT in your state during Vision Rehabilitation Therapist Awareness Week in the VisionAware Directory of Services.


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