Insight into Low Vision

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6 Reasons Why the Visually Impaired Refuse Low Vision Aids

Written by Terri Cyr in Adjustment,The Experience of Vision Loss

young male leaning in very close to reading with magnifying glass

Refusing low vision aids most commonly involves the psycho-social hurdles of denial, depression, resistance to change, self image, failure of previous experiences, and cost. To truly empower ourselves, we must confront the psychological and social barriers that hinder us.

Accepting our disabilities, adjusting our lifestyles, and utilizing tools are important steps towards adaptation. The quality of life is dependent on your capability to adapt.

Do you see yourself or a loved one with any of the following limitations?

1. Denial. 

They truly believe they do not need any kind of visual aids.  The reason why they don’t see something is because it is too small, or it is somehow the fault of the thing they are trying to see.  The other reason is the doctor, who they blame for not giving a very good prescription or something is wrong with the glasses.  Using a visual aid is admitting they have a disability. There is no convincing them.  They would rather give up activities (reading for example), than admit to needing help. 

2. Depression. 

These are the people who have given up.  They are not motivated to learn or to even try.  They are not ready to accept the changes and adjust their thinking.  They are grieving their losses.  Accepting the visual aid is another step to giving in to the disability.  Psychosocial counseling is needed to help them move forward.

3. Resistance to New Things. 

This is a personality trait.  Some people just assume it will be too difficult and they just don’t feel they can devote any brain power to learning something that complicated or challenging.  The hope is that they realize that it is not really that tough, and it is well worth the time and effort.

4. Self-Image. 

The resistance to using visual aids is a part of their desire to appear ‘normal’.  They may find it embarrassing to draw attention to what is different about them, and fears that someone will start asking questions.  Using a visual aid will stigmatize them as blind, a perception that can be damaging to the self-esteem. 

5. Previous Experience. 

While out shopping at the department store, or perhaps given to them by a well-meaning family member, the visually impaired acquire magnifiers.  They tried them, and they ‘don’t work.’  Of course they don’t work.  Standing in a store, with bright fluorescent lights for two minutes, with what is probably an inexpensive magnifier designed for short-term spotting, is not the way to select a visual aid that can help you adapt. Department store magnifiers tend to be a lower power, and may not be the best optical grade. 

6. Cost. 

During my career as an optometrist, I was always dazzled by patients that would buy a designer handbag but wouldn’t spend the same amount of money on a pair of glasses that they put on their face every day.  I was also puzzled by parents that took their kid to Disney World, but didn’t want to spend a reasonable amount of money on good quality eyewear for the kid.  Specialized visual aids are expensive, and you have to weigh cost vs. benefit.  This is another reason for getting a low vision evaluation.  It gives you the opportunity to get professional guidance through  the selection process and allows you to try them out in the office under more normal conditions.  This may save you from making a costly mistake.

Those that have Devices and Just Don’t Use Them

In my experience with low vision patients, I’ve often presented them with a range of low vision devices and technologies that have the potential to transform their lives, reigniting their interests in activities they once loved. However, despite initial interest, many of these patients find themselves lacking the motivation to fully embrace these aids. They’ve settled into a life adjusted to their disability, putting their hobbies and interests on the back burner due to the perceived difficulty of adopting new compensatory techniques

Magnifiers that rest against the chest. suspended from the neck, used for reading and crafts.

Take, for instance, someone who quilts may need to use a magnifier positioned between their eyeglasses and the needlework. This arrangement may require them to hold the needlework at a closer working distance. They may need to set up better lighting for both the chair they sit in and increased lighting and magnification for their sewing machine. They may need to learn new compensatory techniques for cutting fabric. All of these adaptions require the purchasing of new tools and learning how to use them. (FYI, here is a good article on quilting techniques for Low Vision.)

So, what sets apart those who persevere and those who give up? Motivation plays a significant role. Are individuals willing to invest the time and effort required to learn new methods? Generally, younger low vision patients are more open to learning and adapting, while seniors may struggle more with the idea of making significant adjustments.

Furthermore, the concept of secondary gains can impact motivation. Some individuals may find it challenging to see the immediate benefits of adapting to low vision aids, which can dampen their drive to make changes.

An essential aspect of accepting and utilizing low vision aids is adequate training and reinforcement. Providing a refresher course on how to use a device can make a substantial difference. I’ve encountered patients who, after initially receiving a device, return for follow-ups only to discover they’ve forgotten how to use it properly or are not utilizing it to its full potential.

Additionally, the perceived usefulness of a low vision device is crucial. Video magnifiers, for instance, have revolutionized magnification. However, if a video magnifier is cumbersome to handle or offers too small a visual field, it becomes ineffective for tasks like reading a newspaper. The selection of low vision devices should be personalized to the individual’s needs and tasks at hand.

Understanding Those Who Refuse to Use Low Vision Devices

It is important to understand that the type and extent of vision loss can greatly influence an individual’s willingness to adopt low vision aids. Those with central vision loss, such as macular degeneration or Stargardt’s disease, often respond well to low vision adaptations, especially magnification.

Conversely, individuals with other forms of visual field loss, like glaucoma or retinitis pigmentosa, may struggle more with adaptation and will not find traditional magnification devices as beneficial. This diversity highlights the necessity of tailored guidance from low vision specialists and therapists in selecting appropriate aids. (Ref: Abandonment of Low Vision Devices in an Outpatient Population Opens in a new tab..)

Helpful guidance in the selection of low vision devices by low vision specials and therapists is important in that respect. The trial-and-error technique of finding helpful devices or expensive gifts from well meaning loved ones, is not the solution. Trying devices and techniques that ‘don’t work’ is frustrating and leaves the individual with a sense of hopelessness.

Understanding the needs and expectations of those with low vision is paramount. Vision loss is not just a physical challenge; it’s deeply emotional. The reasons behind refusing low vision devices are primarily psychological, with cost being an exception. Much of the resistance stems from a lack of knowledge and experience, coupled with a negative self-perception.

Therefore, it’s important to approach the issue with empathy and a willingness to educate. By addressing these emotional and psychological barriers, we can help individuals with low vision overcome their resistance and embrace the tools that can significantly enhance their quality of life.

In the End…

The challenge of unused low vision devices often stems from a combination of factors: motivation, adequate training, and device suitability. Overcoming these challenges requires a willingness to learn, ongoing support from professionals, and careful consideration of device selection. By addressing these barriers, individuals with low vision can unlock the full potential of these aids and enhance their quality of life.

It is hard to fail, but it is worse never to have tried to succeed.

Theodore Roosevelt

How to Adjust to Vision Loss, 7 Keys to Coping

Written by Terri Cyr in Adjustment,The Experience of Vision Loss

photo of hands shaking overbooks for low vision rehabilitatin

Adjusting to vision loss is a transformative process that revolves around embracing abilities rather than disabilities. This step-wise approach encompasses vital aspects such as stress reduction, cultivating a positive attitude, nurturing social connections, stimulating the mind, continual learning, professional guidance, and, of course, keeping humor alive.

Adjusting to vision loss can be a challenging journey, one that requires a shift in perspective towards focusing on ability rather than disability. As you navigate this path, it’s important to acknowledge the areas where challenges arise. While not every obstacle can be overcome, accepting what you can change within your circumstances is a important first step.

1. Reduce Stress

Adjusting to vision loss can bring about significant stress, both emotionally and practically. However, there are strategies you can employ to ease this burden and navigate this transition with more resilience. Here are some key ways to reduce stress as you adapt to vision loss:


How to Reduce Stress While Adjusting to Vision Loss

Adjusting to vision loss can bring about significant stress, both emotionally and practically. However, there are strategies you can employ to ease this burden and navigate this transition with more resilience. Here are some key ways to reduce stress as you adapt to vision loss:

  • Organize Your Environment: Simplify your living space by organizing items in a consistent manner. Labeling drawers, using tactile markers, and keeping frequently used items easily accessible can reduce frustration.
  • Utilize Assistive Technologies: Embrace the various tools available to assist in daily tasks. Screen readers, magnifiers, and voice-controlled devices can empower independence and alleviate stress associated with inaccessible technology.
  • Practice Mindfulness and Relaxation Techniques: Engage in mindfulness practices such as meditation or deep breathing exercises. These techniques can help manage anxiety and promote a sense of calm amidst challenging moments.
  • Seek Emotional Support: Connect with friends, family, or support groups who understand your experience. Sharing your feelings and experiences with others who can empathize can provide immense emotional relief.
  • Set Realistic Goals: Break tasks into manageable steps and set achievable goals. Celebrate small victories along the way, recognizing the progress you’re making despite the challenges.
  • Maintain a Healthy Lifestyle: Physical health directly impacts mental well-being. Aim for regular exercise, balanced nutrition, and sufficient sleep to bolster your resilience against stress.
  • Engage in Enjoyable Activities: Make time for hobbies and activities that bring you joy. Whether it’s listening to music, crafting, or spending time in nature, these pursuits can offer a welcome respite from stressors.
  • Practice Self-Compassion: Be kind to yourself during this adjustment period. Understand that it’s okay to feel a range of emotions, and acknowledge the strength it takes to adapt to significant life changes.
  • Plan Ahead and Stay Organized: Create routines and systems that work for you. Planning ahead for appointments, outings, and daily tasks can reduce last-minute stressors.

2. Attitude Adjustment

Your attitude towards your impairment can greatly influence how you cope. Consider where you fall in these categories:

  • The Deniers.  You can easily spot them because they are the excuse-makers.  It is always the fault of something, or someone else in their mind.  Deniers won’t accept or deal with their loss and refuse to make the changes necessary to lead a new ‘normal.’  These are the people who will not accept low vision devices.  Often they live in the closet, meaning they don’t tell  others about their vision loss.  The deniers may remain hopeful that a change in lifestyle will help or that a cure is just around the corner.  They end up being frustrated, unhappy people.  There are a lot of deniers out there.  They need a reality check, and  to seek the professional help needed to lead that normal life and to keep moving forward.
  • The Angry People.  Life is a negative for them.  They cannot get past the impairment to see that it is, what it is, and you can rant and rave, but it doesn’t change anything.  These people need to turn anger into action. 
  • The Helpless. This individual feels so sorry for themselves, and languishes in their own helplessness.  They are giving up, and look to others to make it easier for themselves. These individuals may realize the benefits of secondary gain.  That is, their helplessness garners them more attention and concern from others.  Family or friends that overindulge the helpless, are enabling them to remain helpless.  The helpless can benefit from the professional help of rehab specialists and counselors.
  • The Resigners These are the people that sadly accept their impairment and shut down those more difficult parts of their life, assuming nothing can be done or it is just too hard.  They live in mourning of their loss and unrelenting depression,  “Woe is me,” Eeyore.  These people are part way there.  They have accepted their vision loss, now they need to do something about it to ensure a positive quality of life.
  • The Adapters.  Finally, there are those that see their impairment as a challenge, and as something they just have to deal with.  They have accepted it, they are adjusting, and are adapting.  Life goes on. “Everybody’s got somethin’.” What doesn’t kill me makes me stronger.” These individuals have a willingness to accept the help of low vision professionals and accessibility  devices.

You might experience several different changes in attitude through the process of vision loss.  Realize where you are emotionally, and set a goal to learn to accept, adjust, and adapt.

3. Social Interaction is Important

The psychology of vision loss with its accompanied fears, social stigma, loss of independence, and depression can lead one to live a life in isolation.  The less you interact with others the more inward you turn.  Feelings of unhappiness, loss of self-worth, lack of self-esteem, lack of confidence, and that overwhelming sense of being alone, becomes magnified.

You are not alone.  Even if you have a great family  support system, communication with others with vision loss, or even other disabilities, is helpful in knowing  how they are dealing with life.  Family and friends may listen and try to understand your fears and concerns and try to help where they can.  But be aware that there may be an expiration date on their capability to listen to complaints, rants, whining, and demands on their time.  They love you, but…

Talking with others can help you sort out your own feelings.  Support groups were created for this reason.  Commiserating with others, listening to how they cope, learning that their fears are similar to yours, and that  you are not so unusual.

If support groups are not your thing, consider talking to others who have disabilities other than vision impairment.  Often those with vision impairments don’t know anyone else with vision problems.  There is a common thread among those with disabilities regarding psychological and social issues.  Even if you think you have nothing in common with others, friendships can be built by sharing war stories of disability challenges.  You can learn from others with disabilities, not only about how to cope, but about your own strengths and weaknesses.

If your living situation is one in which you cannot access outside support, online message boards and blogs related to various types of low vision and even specific eye diseases are out there.  It can be helpful just to be able to read about someone else with the same concerns as you.  These sites are also a good source of coping information. 

4. Engage Your Mind

Do you wake up in the morning and drag around the house, really not getting anything done.  So you turn on the TV, thinking “I’m doing something….I’m watching or listening to  TV.”  Ok, that’s good for awhile, then what? 

Self-help advocates will tell you that to feel self-worth and satisfaction we need to feel a purpose.  Setting goals, creating things (work), hobbies, activities both physical and mental, and responsibilities, can help fend off feelings of despair. You will not completely forget your disability, as a matter of fact, it will emerge to remind you of  it’s presence throughout the day, but it is how you deal with it that is a measure of your capability to cope.

5. Knowledge is Empowering

I have always believed in knowledge as a source of power.  The more you learn and the more you know, that information can make a big difference.  A college professor once said to me that you can argue any point with your professor, if you do your homework.  I am not saying that you need to become an expert in the field of low vision or the medical nuances of your particular disease, but you can learn to understand the disability, its impact on your visual function, and how to compensate. You can best help yourself by learning how to help yourself.

The information is out there, more so than it has ever been in history.  Assistive technology is far more sophisticated and accessible than ever.  Public understanding, although it still has a ways to go, is opening up opportunities for those with disabilities.

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.”

Matthew 7:7 New King James Bible.

6. Seek Professional Guidance

No one has all the answers. Various professionals specialize in different aspects of disability, offering tailored support.   These professionals each have an area of expertise to offer.  Your needs will change as you reorganize your life and deal with the psychological and social issuers.

A good source of information is the low vision specialist team.  They are very knowledgeable about state agencies, community support groups, and organizations that offer help to those with disabilities.  You just need to know about them in order to find them and access their services.  The person best qualified to advocate for you is you!

7. Maintain a Sense of Humor

Years ago, I listened to a pop-culture self-help CD in which a woman said she helped herself through cancer by watching funny movies and making sure she laughed all day.  Well, I don’t know about laughter curing cancer, but I do believe it is good for the soul. 

While it is easy to allow all the negative emotions that come along with a life disabled, lifting ourselves up is much harder.  Maintaining a sense of humor does not mean that you need to come up with a comedy routine, but it is a mind set of  having the capability to put the negative thoughts aside and opening yourself up to  the humor of life’s situations.  It can mean looking for enjoyment and pleasure in life, whether it is a stress releasing activity, a positive friendship, loving pets, or enjoyable entertainment.  Seek out those things that make you smile  and laugh.

In the End…

As you navigate the journey of adjusting to vision loss, it’s important to remember that you are not defined by your disability. It’s merely a part of who you are, not the entirety. You are still a person capable of enjoying life’s pleasures and sharing in laughter.

Start by not taking yourself too seriously and welcoming positive thoughts into your life. Remember, your impairment does not diminish your worth or the richness of experiences that await you. So, as you move forward, embrace your full self, disabilities and all, and continue to live a life filled with laughter, joy, and resilience

If you are struggling, it is not unusual. I have written another article: Low Vision, Depression, and Anxiety

Understanding Eyestrain and Headaches in Low Vision: Causes and Solutions

Written by Terri Cyr in Eye Health,Low Vision Aids,The Experience of Vision Loss

iI am sitting at a desktop comuter with my glasses in my hand and my forehead resting on my wrist. The posture indicates headache and eyestrain.mage of a me sitting at a desktop computer with my head bowed holding my glassesand head resting on my wrist

Eyestrain and headaches can be complex, arising from a blend of visual, physical, and mental stresses rather than a singular cause.

For individuals with visual impairments, the experience differs due to several reasons:

  • Increased magnification usage.
  • Closer working distances.
  • More frequent screen movements.
  • Eccentric viewing.

It’s not merely a matter of declining vision; new obstacles emerge in adapting to the “new normal.” Learning to utilize assistive devices and compensatory techniques becomes essential for improved vision. However, it’s common for individuals to experience eyestrain and headaches as they adjust. Consequently, these symptoms may lead to reluctance in using adaptive devices and a tendency to avoid tasks like reading, which is particularly problematic for students and professionals.

The widespread accessibility and convenience of computers have rendered them almost indispensable for many of us. However, prolonged periods of screen time, especially with LED backlit displays, can lead to Digital Eye Strain (DES), also known as Computer Vision Syndrome (CVS).

Symptoms of Digital Eye Strain

The symptoms of DES are:

  • sore, tired, fatigue, unable to keep eyes open,
  • headaches,
  • burning, redness, tearing,
  • blurred vision, and occasionally double vision.
  • Sore, tired, watery, or burning  eyes,
  • Blurred or double vision,
  • Sore neck, shoulders or back,
  • Increased sensitivity to light,
  • Headache,
  • Sleepiness and/ or difficulty concentrating.

The symptoms of DES are common, not only for the normally sighted, but more so for the visually impaired.  Those with low vision  use the technology differently from others by using: 

  • Increased magnification,
  • closer working distance, and
  • more screen movement.

To the list of symptoms of DES, we can add for those with low vision:

Motion sickness, and Feeling of eye muscle strain.

Causes of Eyestrain and Headaches

Eyestrain and headaches can stem from various factors, often a combination of visual, physical, and mental stresses.

For individuals grappling with low vision, everyday tasks can become more challenging and time-consuming . While the mental stress of school or work is something many can relate to, it’s magnified for those balancing the added complexities of utilizing adaptive techniques and assistive devices to complete tasks. When headaches and eyestrain are added to the equation due to optical and physical adaptations, the mental stress of “seeing” can hinder concentration and comprehension.

Physical stress manifests in how the body adjusts to accommodate digital or assistive technology usage. Some positions required are unnatural, such as leaning in to view a screen at a closer distance or hunching over an assistive device to peer through a lens or screen. These positions can lead to neck and shoulder pain with prolonged or repetitive use. Muscles in the shoulders and arms can become sore or fatigued from holding magnifiers or mobile devices for extended periods, potentially resulting in headaches.

Optimize Technology to Reduce Eyestrain and Headaches

Eye strain and headaches associated with low vision and modern digital technology are multifaceted, with causes varying by individual, assistive technology used, and environmental factors. Here is a step-by-step approach:

1 .Consult with an eye doctor or low vision specialist to obtain the optimal eyeglass prescription (if needed) and select a low vision assistive device tailored to your needs. The difference between over-the-counter reading glasses and prescription glasses is substantial; improper power selection or mismatched prescriptions for each eye can lead to eyestrain and headaches. You may select a power that is too strong or too-weak. Also, not all eyes are equal. The lenses of common store-bought glasses are both the same power. While the prescription for your eyes may differ from the left eye to right eye. If not properly balanced, this can cause eyestrain and headaches.

2.  Determine the most comfortable magnification level and the best method to achieve it. Optical devices require a close working distance, but you should avoid hunching forward or squinting while reading. If using low vision digital devices like video magnifiers, seek guidance from your low vision specialist for optimal selection.

3. Explore options such as short-wavelength-blocking eyeglass lenses or computer screen filters to alleviate eyestrain associated with digital devices. Blue light-blocking lenses and software applications like Apple’s “Night Shift,” Android’s “Twilight,” or Microsoft’s Night light can reduce blue light exposure.

4. Address issues like burning, dry, or watery eyes by consulting an eye doctor for a dry eye evaluation. Simple strategies like remembering to blink regularly or following the 20/20/20 rule (taking a 20-second break every 20 minutes to look 20 feet away) can help alleviate symptoms.

5. Assess the lighting and glare sources in your environment. Lighting that is too bright or too dim can exacerbate visual strain, while shiny or glossy surfaces and computer screens can cause reflections that increase eye fatigue and discomfort.  

6. Pay attention to the ergonomics of your work setup. Head, neck, and shoulder pain may indicate the need for adjustments to your workspace to ensure greater comfort. Avoid prolonged periods of hunching over digital or low vision devices to prevent strain and discomfort.

Eye Muscle Pain Associated with Eccentric Viewing

Eccentric viewing is a technique used by individuals with low vision to optimize their remaining vision for various tasks, such as reading, writing, or viewing objects. Those with low vision often have impaired central vision due to conditions such as macular degeneration or diabetic retinopathy.

Image of Retina with areas for eccentric viewing circled

Instead of relying on central vision, eccentric viewing involves training oneself to use a peripheral area of the retina called the preferred retinal locus. This is a specific spot adjacent to the central blind spot where vision may be clearer or less affected by the visual impairment. By shifting their gaze away from the center and using this peripheral area, individuals with low vision can make better use of their remaining functional vision.

The preferred retinal locus refers to the peripheral area utilized for eccentric viewing. However, relying on this alternative retinal area as the primary site for eccentric viewing necessitates holding the eye muscles in an unnatural and uncomfortable position for extended periods. Consequently, this can lead to eyestrain, headaches, fatigue, and pain.

While eccentric viewing may require some time and effort to master, it can significantly enhance functional vision and improve independence for individuals with low vision in their daily activities.

IN the End…

For those with low vision, managing eyestrain and headaches, especially when incorporating adaptive techniques and assistive devices, can create a complex landscape to navigate.

Everyday tasks can are more time-consuming and challenging. The mental stress of school or work is compounded by the need to constantly adapt and find innovative ways to accomplish tasks.

By understanding the causes of eyestrain and headaches in low vision and exploring potential solutions, individuals can empower themselves to manage these discomforts more effectively. From utilizing assistive technologies to adopting healthy screen habits, there are avenues to alleviate these symptoms and improve overall well-being.

3 Best Supplements for Prevention of Macular Degeneration

Written by insightintolowvision@gmail.com in Eye Health

an aging eye

The AREDS formula, lutein and zeaxanthin, and resveratrol stand out as the most recommended eye supplements for optimal eye health and the prevention and progression of AMD.

Patients are always asking which vitamin supplements should they be taking to insure they can maintain good vision into old age. I will discuss here several eye vitamin options.  Keep in mind that needs vary by the individual, and their personal health status.  

Always discuss supplementation options with your physician, before launching into a new vitamin regiment.  What is appropriate for one individual may not be adequate for another.

Age-Related Eye Disease Study: AREDS and AREDS2 Formulas

Since the first study was released in 2001 (AREDS) and the second release in 2013 (AREDS 2), there has been much interest by doctors and patients regarding preservation of vision through supplementation. 

What’s the difference?

  AREDS AREDS 2
Vitamin C 500 mg 500 mg
Vitamin E 400 IU 4oo IU
Beta Carotene   15 mg      0
Zinc (zinc oxide) 80 mg  25 mg
Copper 2 mg  2 mg
Lutein   0 10 mg
zeaxanthin   0   2 mg
Omega 3s   0 350 mg DHA 650 mg EPA

Other studies had indicated that lutein, zeaxanthin, and omega 3 fatty acids (DHA an EPA) also had an effect on AMD progression.  Other questions arose around the use of beta-carotene and the high dose zinc used in the original study. For these reasons, the AREDS2 formula reflects these changes.

Bausch + Lomb, sponsors of AREDS

Who Should be taking an AREDS formula?

The study results show that those who benefit are:

1. Those with Intermediate AMD in one or both eyes, and

2. Those with Advanced, ‘wet’ or ‘dry’ AMD in one or both eyes.

So what that means is that neither AREDS 1 or AREDS 2 study did not find that taking the formula prevented the development of AMD, but was effective in halting the progression of the disease process in 25% of those individuals who already had vision loss secondary to macular degeneration. To put it another way, 1 out of 4 people with intermediate or advanced macular degeneration saw any benefits from the daily supplementation of the AREDS formula.

Supplements: Lutein, Zeaxanthin, and Meso-zeaxanthin

Lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ) are xanthophyll carotenoids found in high concentration in the highly specialized macular area of the retina. The macular pigment protects the macula by filtering high energy visible light which can damage the underlying retinal pigment epithelium and photoreceptor cells.  These carotenoids are also antioxidants which scavenge for free radicals to prevent oxidative stress of the highly metabolic macula. 

Supplementing Lutein, zeaxanthin and mesozeaxanthin:

The three carotenoids can serve a preventative role.  Studies have demonstrated that supplementing with these 3 carotenoids increases the macular pigment density and therefore are beneficial to increasing the protective macular pigment. These carotenoids have been shown to increase visual function by increasing contrast sensitivity. As there are no known negative side effects, aging adults benefit form increasing dietary carotenoids. Realizing this, and based on the studies of other researchers, you will note that the AREDS 2 formula incorporates lutein and zeaxanthin, which was not a part of the original study.

Dietary Sources of Lutein and zeaxanthin

AMD is the predominate cause of legal blindness in industrialized countries, like the U.S., U.K., Europe, and Australia. In developing countries, the number one cause is cataracts. Both of these diseases can be attributed to stress factors of aging, smoking, and poor nutrition, including the lack of dietary carotenoids.

According to an a Journal of Nutrients articleOpens in a new tab., the sources of food with the highest lutein and zeaxanthin content are green leafy vegetables, (like kale, broccoli, spinach, peas, and lettuce) and egg yolks. While greens and egg yolks are high in these carotenoids, think colorful vegetables(corn, carrots, peppers), fruits, and even fish (salmon) as sources of these essential nutrients.

Recommended Daily Intake of Lutein and Zeaxanthin

Research (JAMA articleOpens in a new tab.) has shown that a typical US diet contains 1–3 mg/day of lutein and zeaxanthin. It has been studied and shown that approximately 6 mg/day have been related to decrease risk of AMD and cataract formation. Most of the commercially available L and Z supplements that I looked at have over 10 mg per capsule of each. While I prefer to get my nutrients from natural sources, food rich in carotenoids are lower than what is offered by supplementing. I could not find exact numbers, but it is like a pound or so of spinach or about 8 egg yolks. (Journal of FoodOpens in a new tab.)

To learn more: Meso-zeaxanthin : The Third Carotenoid for Macular Health

Resveratrol

The health benefit claims of red wine  can be attributed to the active component, resveratrol.  Resveratrol is a polyphenol found in the skins of grapes that has powerful anti-oxidant and anti-inflammatory properties. Oxidative stress and inflammation are the underlying cause of eye disease and are responsible for its progression.  

These destructive processes are responsible for age related eye disease such as macular degeneration, cataracts, glaucoma, and diabetic retinopathy.  Resveratrol, as a supplement, has the potential to prevent and delay the progression of ocular disease.

Resveratrol and Eye Disease

Glaucoma: Studies have found that it may have a neuro-protective effect on the retinal ganglion cells which are the cells destroyed by the disease process of glaucoma.

Age Related Macular Degeneration: Research has shown that resveratrol has the potential to play a role in the prevention of AMD because it is an anti-oxidant and has the ability to inhibit cell death.

Diabetic Retinopathy: Researchers have found that supplementation with resveratrol reduces inflammation, oxidative stress, and suppress retinal and blood vessel changes associated with diabetic retinopathy .

Micronized resveratrol

Who should be taking Resveratrol?

Fantastic claims are made regarding its health benefits: anti-cancer, anti-aging, immunity boasting, improves cardiovascular health, neuro-protective,, along with increased energy and endurance.  So far, studies have found evidence that it has beneficial effects against the processes of disease, principally the oxidative stress and inflammation associated with the onset and progression of disease, including ocular disease.  

There is no known side-effects or toxicity.  Although it is generally well-tolerated  except for nausea and diarrhea with high doses (5 g or greater).  It is known that it  inhibits platelet aggregation, so those on anti-coagulation and anti-platelet therapy would expect more bruising and bleeding.  Also, be wary if  taking anti-inflammatory like ibuprofen, aspirin, naproxen, and diclofenac.  It is a good bet it should be discontinued before surgical procedures.  Women who have estrogen sensitive cancers should avoid supplementation until more is known about its bioactivity.

For a more in-depth article on resveratrol see: Does Drinking Wine Help Prevent Eye Disease?

Learn about another supplement important for eye health: Do Omega-3 Supplements Help Your Eyes?

In the End…

Lutein, zeaxanthin, and meso-zeaxanthin play a important role in protecting the macula from harmful high-energy light and oxidative stress, both key factors in AMD progression. Studies have not only shown their ability to increase macular pigment density but also their positive impact on visual function, enhancing contrast sensitivity.

Moreover, the inclusion of lutein and zeaxanthin in the updated AREDS2 formula underscores their importance. As for resveratro as a supplement offers promising antioxidant and anti-inflammatory properties, potentially aiding in the prevention and delay of various eye diseases, from macular degeneration to cataracts and beyond.

For aging adults, increasing dietary carotenoids and considering supplements like resveratrol could be a proactive step in maintaining eye health. As research continues to shed light on these supplements’ benefits, it becomes clearer that they are not just adjuncts but essential components in the fight against age-related eye diseases.

The nutraceutical industry is unregulated.  As with most supplements, more research and study is needed to better define its potential and its limitations as a nutritional supplement.

Other articles on eye supplements:

Anthocyanins of bilberry, blueberry, Maqui berry, and black currant

Saffron and Eye Health

Acceptance, Adjustment, and Adaption to Vision Loss

Written by insightintolowvision@gmail.com in Adjustment

large green iris of the insight into low vision book

The key to living with vision loss is Acceptance, Adjustment, and Adaption. It is a step-wise process to living your best life.

Acceptance, Adjustment, Adaption

Acceptance of disease or disability is the most difficult.. Those of us with degenerative eye disease may deny, make excuses for not seeing, or avoid situations that demand we accept the limitations of our disability. Not accepting and not dealing with the loss of vision results in social isolation, loss of confidence, and unresolved grief. Acceptance means coming to terms with what is a new chapter in your life. Acceptance is ‘moving on.’ Things will never be the same, so what are you going to do now?

Adjustment is the next step after acceptance. Like acceptance, it takes time and resolve. “I accept that life is different now.” It is the resetting of your life. Life without ‘normal’ vision is very different. You need to depend on others more. There is some loss of independence. Activities like school, work, hobbies, and domestic duties seem more difficult and take longer.

Adjustment is doing these activities of daily living in a new way and understanding the limitations. Life goes on.

Adjustment is the psychological and social resetting of your life.  There are many factors that will affect how you adjust:  things like age of onset, rate and severity of disease progression, living situation, and financial concerns.

Coping is how we deal with the changes.  It is how we adjust and adapt  to the nuances of our psychological, social, and personal functional needs.  An individual’s coping mechanisms at the beginning of the disease are different from those at the various stages of the disease process.  Someone who loses vision suddenly will need to overcome the shock of sudden disability, while someone with a slow, progressive onset of vision loss may have years to adjust and develop compensatory techniques.  An individual with profound vision loss will need to work harder to compensate versus having to adjust to a milder vision impairment. 

One’s living situation, whether living alone or in a family unit, can impact the capability to cope, depending on the situation, either positively or even negatively.  Sadly, financial resources can impact the capability to cope.  While state and federal agencies provide some valuable services, those extras like electronic technology, transportation, and home assistance may be financially out of reach.

There are several emotional issues that can affect one’s capability to cope with a disability;

  • Grief
  • Depression
  • Negative Self-Perception
  • Loss of Independence

See: How to adjust to vision loss: The Adjustment ProcessOpens in a new tab.

Adaption is utilizing skills, techniques, and aids that can help you move forward to a new normal life. New skills are needed for reading, activities of daily living, and independent mobility. Some new skills will come naturally, but others may require you seek the professional assistance of trained therapists. Adapting is using both optical and non-optical aids.

Optical aids are commonly things like glasses, magnifiers, and telescopes. Non–optical aids are adaptions like better lighting, increasing contrast, color coding, and talking assistants. It has never been easier for the visually impaired to adapt. Technology developers have recognized the needs of those with low vision and have brought to market digital devices for most every need. Video magnifies, CCTVs, computer accessibility software like text-to speech and speech-to-text software, head-borne digital magnifiers, and smartphone apps to aid us on the go, have all paved the way towards integrating those with visual disabilities to lead ‘normal’ lives.

In the End…

Losing vision may change your life, but it does not change who you are. But there needs to be a willingness on your part to accept, adjust, and adapt to lead your best life. This process can be slow and difficult. The steps you take and your attitude will determine your success. My father had a saying; “You don’t know unless you ask.” The technologies, online resources, and trained professionals are there for the asking.

He is a wise man who does not grieve for the things he has not, but rejoices for those which he has. 

Epicretus

Still Alice The poignant narrative of Still Alice, a film depicting the journey of a woman with early-onset Alzheimer’s disease, we delve into the universal themes of acceptance, adjustment, and adaptation to life-changing disabilities.

Still Alice is a movie based on the book of the same name by Dr. Lisa Genova.  Still Alice is  about a woman who develops early onset hereditary Alzheimer’s disease. We get to know Alice; she is smart, well-spoken, a wife, a mother, and much loved by her family.

Initially, she knows something is just not right.  You can sense her denial, “How could this be? ” She lives a healthy lifestyle, but that is the tragedy of hereditary, degenerative disease; it doesn’t matter if you are wealthy or well-educated,  or eat all organically.  It is incurable, unstoppable, and it will change your life.  Anyone who has a hereditary disease, which goes off like a life changing time-bomb, can identify with Alice and her family.

The movie follows her disease process from diagnosis to disability.  Alice works at trying to maintain a normal life.  We are privileged to see someone else’s struggles, grief, and despair, to her final acceptance (whether she is able to acknowledge it or not).  While the disease portrayed in this story is Alzheimer’s disease, there is common ground for anyone afflicted with degenerative disease.

The quiet elephant in the room is evident in the looks on the faces of her children when they realize that this early onset Alzheimer’s  is inherited.  Stunned, they understand that  this could be their fate.

Those who similarly experience the onset of a disease process such as vision loss,  can identify with Alice.  There are several messages here; the tragedy of an incurable disease, the demise of a life as it was once lived, and the importance of family love and support.

Although we may identify with Alice’s struggles and despair, for the visually impaired there is hope.