Low Vision: The Growing Challenge

By JoAnne Sommers

It is already being called an epidemic and with the rapid aging of Canada’s population, vision loss is sure to become a far greater concern in the near future. According to CNIB, someone in this country develops blindness or vision loss every 12 minutes. An estimated 836,000 Canadians — one in 38 of us — are currently self-identified as living with blindness or partial sight. In addition, more than three million other Canadians live with some form of age-related macular degeneration (AMD), diabetic retinopathy, glaucoma or cataracts. While they may not have experienced vision loss yet, if left untreated most of these people are at high risk.

After age 40, the number of cases of vision loss doubles approximately every decade, reflecting the fact that many causes of low vision are age-related. Statistics Canada says that by 2026 one out of every five Canadians will be a senior, which means the incidence of low vision will almost certainly rise dramatically.

Defining Low Vision
Almost everyone can manage their activities when their vision is between 20/30 and 20/60. If a person’s vision falls between 20/60 and 20/190 they are considered partially sighted or as having low vision. At 20/200 or worse, they may have some vision but are classified as “blind”. (Note: some people may be classified as blind if their field of vision is less than 20° across, even if their vision is better than 20/200.)

“Fully 90 per cent of those we serve still have some usable vision,” says Dawn Pickering, professional practice leader for Low Vision Services with CNIB in Toronto. “Only 10 per cent of our clients have no vision at all.”

The Causes of Low Vision

A variety of disorders that affect the eye and the visual system may cause low vision, including birth defects, injuries, inherited diseases and conditions such as AMD, glaucoma, diabetic retinopathy, cataracts, refractive error and optic nerve damage.

The most common cause of vision loss is AMD and age is its greatest risk factor. While it may occur during middle age, studies show that mature adults (people aged 60+) are clearly at greater risk than other age groups. A study by the U.S. National Institutes of Health (NIH) found that people in middle age have about a two per cent risk of getting AMD; that figure increased to nearly 30 per cent in those over age 75. An estimated one million Canadians have some form of AMD.

Glaucoma is the second most common cause of vision loss among Canadian seniors. The onset of glaucoma generally occurs later in life and people over 60 are six times more likely to get it than the younger population, according to the U.S. Glaucoma Research Foundation.

Diabetic retinopathy, which affects 500,000 Canadians, is the leading cause of vision loss in those under 50. Nearly all Canadians with Type I diabetes and 60 per cent of those with Type 2 develop some form of diabetic retinopathy during the first 20 years they have the disease.

More than 2.5 million Canadians have cataracts, which, fortunately, can be surgically removed and vision restored.

The High Cost of Low Vision
Low vision has a tremendous impact on quality of life: those who suffer from it sometimes lose their ability to drive, read, enjoy leisure, recreational and social activities, and even distinguish different colours. Studies have suggested that many people will become clinically depressed after a diagnosis and that those with vision loss are often socially isolated.

Low vision also exacts an enormous financial toll. A 2009 study by CNIB and the Canadian Ophthalmological Society called “The Cost of Vision Loss” found that it has the highest direct health costs of any disease category in the country — greater than diabetes, all cancers or cardiovascular disease. Vision loss costs Canadians $15.8 billion every year, a staggering $4.4 billion of which comes from lost productivity due to underemployment and unemployment. Everyone bears these costs: taxpayers (through federal and provincial/territorial governments), employers, individuals with vision loss, their families and friends.

One major contributor to the lost productivity cost is the very low employment rate among Canadians who are blind or have vision loss — 32 per cent. The CNIB study notes that this is much lower than the employment rate for Canadians with disabilities in general. Although most Canadians with vision loss are well educated, many of them face numerous barriers to employment, particularly attitudinal ones. A diagnosis of vision loss as an adult can also have a devastating impact on an existing career.

Low Vision Services
While little can be done to restore the lost sight of someone with low vision, many services are available to assist them. The first step, says Ryan Heeney, is a proper diagnosis. “Anyone who has low vision should have a comprehensive eye examination by an ophthalmologist,” says Heeney, national sales manager for Canada with Eschenbach Optik ofAmerica.

Once the cause is identified, the ophthalmologist may make a referral to other low-vision and rehabilitation specialists, such as CNIB. CNIB’s vision support services are the most comprehensive inCanada, ranging from low vision assessments and indoor and outdoor travel training, to training in the use of adaptive devices for computers and providing access to a full range of specialized library services, all at no charge.

CNIB has 60 low vision specialists across the country who provide functional assessments of visual abilities designed to identify the individual’s needs and goals, and make referrals to appropriate resources – either within CNIB or with community agencies.

“We get to know them, determine which services are best suited to them and develop a rehabilitation plan designed to meet their needs,” saysPickering.

CNIB provides life skills training to help manage the essentials of daily living, with an emphasis on maintaining independence – from safe and effective methods of cooking and doing household tasks such as laundry, to banking, writing and personal care.

“People with low vision are able to live with much greater independence than in the past, thanks to improved medical treatment and major technological advances,” she says.

Those advances include desktop, handheld and portable magnifiers, digital book players, screen magnifiers and talking GPS systems.

Technology has come a long way in its ability to assist the visually impaired, agrees Ken Patterson, Calgary-basedWestern Canada sales representative for Human Ware, which manufactures assistive technologies for those with visual and learning disabilities.

“The field is changing quickly,” says Patterson. “In the past we only had desktop devices but today there are many more portable devices available in all shapes and sizes.”

It’s important to remember that no single solution will meet every need, he says. “The only way to find out whether something works is to use it and see if it allows you to do what you want it to do. Everyone sees differently and you have to try things out before you can determine their suitability.”