Ross Crain's ResumeReturn To Handbook IndexWELCOME  TO
CRAIN'S PERSONAL PAGES

               

A blind man can see forever -- there are no horizons, no walls, no limits to what you can do

MY VISION LOSS PAGE
         Never Give Up

Use this INDEX to go to topics on this page that interest you. Left-Click your mouse on the topic to move directly to the item.

0. Introduction
1. Ross's Helpful Hints
2. How The Eye Works
3. Vitamins For Your Vision
4. RETINITIS PIGMENTOSA
5. RETINAL DETACHMENT
6. MACULAR DEGENERATION
7. GLAUCOMA
8. DIABETES AND THE EYE
9. CATARACTS
10. DAISY Format Audiobooks

INTRODUCTION

This is an unofficial website offering advice and information for the blind and visually impaired, their family, friends, and caretakers. I am not a doctor, so please consult an appropriate professional for diagnosis and treatment of ANY form of vision loss.

This site is NOT affiliated with any government agency, commercial enterprise, or non-profit organization that offers services for the blind and visually impaired.

It is no secret that I have been legally blind for many years, caused by retinitis pigmentosa,  so I don't get around like I used to. In spite of this, I run a consulting business and a ranch. I write books and papers on petrophysics,  build model railways, and love old time radio (OTR) and audio books. So life does not stop with loss of eyesight. If you are interested in my life story coping with and overcoming the obstacles of vision loss, see my "Travels In Purgatory" page.

One in ten seniors is experiencing vision loss severe enough to affect daily activities. Many younger people suffer vision loss from disease, accident, or genetic defects.

The aim of those suffering vision loss is to maintain independence and quality of life. I hope this webpage offers some basic inform-ation and helpful hints for dealing with vision loss. Everyone copes with vision loss in different ways. My way will not appeal to all, but the information contained here may reduce some of the fears and frustrations.

Except for Ross's Helpful Hints and my review of DAISY format, all the material was provided by Canadian National Institute for the Blind. Click Here to go to CNIB website.

Go Directly to Index

 

1. Ross's VIP Helpful Hints

I am not an expert in vision loss and I do not offer medical advice. However, there are many practical and behavioural aspects of vision loss that I have learned by hard experience.

These hints are taken from a monthly column I wrote for a local paper. Some are directed to friends and family of the visually impaired person, some are for the person who is blind. If you know someone who might benefit, please read appropriate portions of this webpage to them.

Good health and good nutrition can retard (not cure or reverse) vision loss. Take your vitamins and minerals, eat your veggies, quit smoking, stay active, reduce exposure to direct sun, wear sunglasses – do all the things your grandma told you to do when you were younger.

Speak UP!  If you need help, don’t be bashful or embarrassed, ask for it. Family and friends may not appreciate your needs. Tell them. If a business or a bank or a utility makes life difficult for you, tell them what they can do to make your life easier. Whether it’s large print invoices, a helper at the grocery store, or better handrails on the steps, only you know what you need.

When greeting a visually impaired person, introduce yourself by name. Most of us can’t recognize faces and only a few voices can be memorized. When asking a question, use the VIP’s name again, as we can’t see your body language that might indicate to a fully sighted person that you are addressing them. Finally, when you leave, let the person know and make sure they are oriented well enough to continue on to their next activity.

It’s no surprise that most visually impaired persons don’t read much, but there are alternatives of course. The most obvious are books or periodicals on cassette tape or compact disc. The  Library has a good supply and CNIB has more. Recordings for the Blind and Periodicals for the Blind are non-profit organizations in the USA that will mail cassettes weekly or monthly for a small donation. Why not offer to take your favourite VIP to the Library and assist in audio book selections, Better yet, read a story or  newspaper out loud.

Find out if you or a family member are “Legally Blind”. There are certain advantages to being legally blind: there is an income tax deduction, you get to ride public transit for free or at reduced rates, and get significant fare reductions on Greyhound and some airlines when traveling with a sighted companion. You might even get to “see” a movie at a theater for free. Ask anytime you go anywhere if there is a price break for the blind – don’t be bashful or embarrassed – these  programs were set up especially for YOU!

When assisting a visually impaired person, don’t pull or push them. Let the guided person take your elbow or shoulder. Walk at a normal pace and mention obstacles as they occur, such as curbs, stairs, doors, or rough terrain. If you’re not sure if assistance is needed, just ask!

Go Directly to Index


2. How The Eye Works

Go Directly to Index


3. Vitamins For Your Vision

One common point of interest among many seniors is the role nutrition plays in macular degeneration. With all the available research on nutrition, it is often quite difficult to get the information you need in a concise and easy-to-understand manner. My hope is that this article will summarize for you the importance of vitamins, nutrients, and antioxidants in relation to macular degeneration. Please remember you should check with your personal physician before changing or adding supplements to your diet.

Macular degeneration is associated with many risk factors including age, genetics, hormones, environmental factors, and lifestyle factors such as smoking and diet. Although some of these factors are beyond our control, fortunately the choice to eat healthy foods is something you can control!

Lutein and Zeaxanthin

You may have heard that eating colourful vegetables and fruits may help to slow the progression of macular degeneration and vision loss. It is true, so make sure you have a high intake of spinach, collard greens, kale, oranges, corn, nectarines, summer squash, and mustard greens. Specifically, these foods contain two powerful antioxidants which are found in the macula: lutein and zeaxanthin. It is believed that lutein acts like a pair of sunglasses and zeaxanthin produces a thick protective macular pigment. Therefore, a reasonable approach for those of you who have macular degeneration would be to increase the levels of these two antioxidants in your diet.

Vitamin C and Bioflavanoids

We have all heard of Vitamin C, but what on earth are bioflavanoids? Bioflavanoids help our bodies absorb Vitamin C and they also help strengthen connective tissue throughout the body. Bioflavanoids are found in lemons, grapes, plums, black currants, apricots, cherries, onions, chocolate and rose hips. Vitamin C, in turn, is essential to the health of our eyes because taking extra Vitamin C when you have the dry form of macular degeneration helps prevent broken blood vessels and new blood vessel growth across the macula. So, make sure you’re eating enough citrus fruits, melons, berries, peppers, potatoes cabbage, broccoli, and tomatoes. An appropriate daily dosage of Vitamin C is 2000 mg.

Beta-carotene and Vitamin A

Mom was right when she told you that carrots are good for your eyes! The reason is that they contain lots of Vitamin A, which can prevent cataracts from forming and may have a role in preventing blindness from macular degeneration. You can get Vitamin A from carrots, cold-water fish, fish oils, liver, sweet potato, kale, red pepper, mango and cantaloupe.

Vitamin E and Selenium

The retina is at risk of oxidative damage, which may lead to the progression of Macular degeneration. Normally, the retina has a high amount of antioxidant vitamins and nutrients, including Vitamin E and selenium that help prevent this damage. Taking Vitamin E every day will help fight oxidation and keep blood vessels to the eyes healthy. Vitamin E is found in broccoli, mangoes, almonds, avocados, peanuts, sunflower seeds and egg yolks. Selenium also helps in the protection from oxidation. You can find selenium in Brazil nuts, tuna, brown rice, yeast, whole grains and seafood.

Zinc

Zinc plays a couple of roles in preventing the progress of macular degeneration. First, it helps release Vitamin A from the liver. Second, it helps antioxidant vitamins and minerals do their job. Zinc can be found in barley, chicken, oysters, crab, beef, lamb, wheat and turkey.

Garlic

Garlic not only clears the sinuses but it helps prevent blood clots from forming in the small blood vessels of the retina. As with any nutrients and vitamins, it is best to get the benefits directly from food sources as opposed to supplements. However, if you don’t like garlic or out of respect for your family and friends, garlic may be taken in the form of an odourless capsule.

Magnesium

This mineral helps maintain fluid balance by aiding in blood flow to the eye. You can find magnesium in almonds, spinach, sunflower seeds, halibut, tofu, wheat bran, avocado and beans. Magnesium is also a buddy of calcium as it helps us to absorb it.

Eating the right foods in order to get all this "good stuff" mentioned is not an easy task. Cooking extravagant meals is also a challenging task when one is adjusting to vision loss; however, it is not impossible to add a variety of foods to your diet.

Another Study Sheds New Light On An Old Problem

From: Vision Quest Magazine, A Publication of the CNIB

Results from the Age-Related Eye Disease Study (AREDS) show that taking daily supplements containing high levels of antioxidants and zinc significantly reduced the risk of vision loss associated with age-related macular degeneration (AMD). The study followed 3,640 subjects for six years. Each individual was assigned randomly to one of the following daily regimens:

Antioxidants (Vitamin C 500 mg, Vitamin E 400IU & Beta Carotene 15mg)

Zinc 80 mg and Copper 2 mg

Antioxidants and zinc

Placebo – a pill with no therapeutic effect.

The scientists found people at high risk of developing advanced AMD reduced their risk of developing advanced stages of AMD by 25% when treated with the combination "antioxidants-zinc". The antioxidants-zinc combination also reduced the risk of central vision loss by 19% in the same group.

Go Directly to Index


4. RETINITIS PIGMENTOSA

Retinitis Pigmentosa (RP) is the name given to a group of degenerative diseases of the retina. The retina, at the back of the eye, is a thin sheet of interconnected nerve cells including the light sensitive cells (cones) and dark sensitive cells (rods). It is here that light is converted into electrical signals to the brain where "seeing" takes place.

In RP the rod and cone cells degenerate. Depending on the type of RP, the rate of progression varies.

What are the symptoms?

Usually the rod cells are the first to be affected. They are concentrated away from the centre of vision in the retina and are responsible for seeing in dim light. Thus, one of the earliest symptoms is often night blindness followed by loss of peripheral vision leading to "tunnel vision". Cone cells in contrast are concentrated in the centre of the retina and are responsible for brightly detailed colour vision. In cases where the cone cells degenerate first, central vision becomes blurred and loss of colour perception occurs. Peripheral vision is initially retained. Although the majority of people with RP do not suffer from associated disabilities, it does happen. Deafness associated with RP, in a condition know as Usher’s syndrome, is one such disability.

Whom does it affect?

The symptoms of RP may occur at any age but most commonly they appear in young adults. Generally speaking, the earlier the disease begins the more severe the symptoms. Occasionally the disease is present at birth and can be diagnosed with appropriate testing at the time. It is recognized as one of the most common inherited causes of blindness in people between the ages of 20 and 60.

How quickly does it progress?

Most patients have very gradual progression of symptoms, often over many years or decades. Generally, when other members of a family are affected the rate of vision loss is usually similar. Different forms of RP advance at different rates.

Can the progress be halted and is there a cure?

To date there is no known way to halt the degeneration of the retina or cure the disease. Transplants of the retina are not possible at this time and there is no convincing scientific evidence to demonstrate benefit from any treatment methods currently available.

How is it diagnosed?

Whenever RP is suspected or is a concern, a person should be evaluated by an ophthalmologist (medical eye doctor). The disease is usually most difficult to diagnose in the earliest stages. Depending on the stage and type of the disorder, tests of vision function such as visual field, dark adaptation, and electroretinograms (ERG) are made to determine the precise state of the retina.

How is it transmitted?

Fifty percent of cases of RP are sporadic with no previous family history and the cause cannot be explained. Other cases are inherited and fall into three main groups:

Autosomal recessive forms of the disease occur when both parents are unaffected carriers of the same defective gene. The chance of a child of theirs being affected is 1 in 4 (the affected child must inherit the defective gene from each parent). The chances of the parent having an unaffected child who, like them, would be a carrier of the defective gene is 1 in 2. The chance of such parents having a child completely free of the RP gene is 1 in 4.

Autosomal dominant forms of the disease are characterized by expression of the disease in either males or females when only a single copy of the gene is defective. In such cases, it is typical that one of the parents is affected by the disease. Since the affected parent has one normal and one defective gene, the chance is 1 in 2 of any given offspring being affected by the disease.

X-linked (or sex linked) recessive forms occur in offsprings in two ways. The fathers can be affected or mothers can be carriers of the defective gene. IF the father is affected, all sons will be unaffected and all daughters will be carriers. If the mother is the carrier, 1 in 2 sons will be affected and 1 in 2 daughters will be carriers.

How is the type determined?

Family history is the single most important factor to determine the type of RP. Family members should be examined by an ophthalmologist. For example, some female carriers of the X-linked form can be identified by slight pigmentary change or golden reflex in the retina.

What action can be taken by those affected?

Those affected by RP should seek the best information available from ophthalmologists about their particular condition. Depending on the condition, further action may be appropriate in the field of education, training and family planning.

The RP Research Foundation

RP was first described in 1850, but only since 1970 has there been a concerted effort to study and carry out research on the disease.

The RP Research Foundation was founded in 1974. Its purpose is to promote and support, financially and otherwise, research directed to finding the cause, a treatment, and cure of RP and other retinal degenerations. The Foundation is now the largest private source of funds in Canada for eye research. It has, since its inception, made available nearly $6 million to research scientists at universities and teaching hospitals from coast to coast.

RP societies also exist in many other countries. The Foundation is a member of the International Retinitis Pigmentosa Association (IRPA) under whose aegis scientists from around the world convene on a regular basis to discuss their work and findings.

The RP Research Foundation encourages the formation of local chapters in Canada to help create public awareness of the work and needs of the Foundation and to provide a format which RP families can respond to the needs of each other.

Go Directly to Index


5. RETINAL DETACHMENT

Retinal detachment is a serious problem that usually affects middle aged or older people. It is more likely to develop in nearsighted people and those whose relatives have had retinal detachments. It may also be caused by a hard, solid blow to the eye. Occasionally, it is hereditary. If not treated early, retinal detachment may lead to impairment or loss of vision.

The retina is a thin, light sensitive tissue that covers the inside back portion of the eye. It works like the film in a camera. In most cases retinal detachment is caused by the presence of one or more small tears or holes in the retina. These tears may be due to thinning of the retina with age, but more often they are caused by shrinkage of the vitreous, a clear, gel-like substance that fills the inside of the eye. The vitreous helps maintain the shape of the eye and allows light to pass through to the retina.

The vitreous is firmly attached to the retina in several places. As people get older, the vitreous shrinks and often separates from the retina. By the age of 50 years the vitreous has separated from the retina in about 50% of all people. As the vitreous shrinks, it may pull a piece of the retina away with it, leaving a tear or hole in the retina. Abnormal growth of the eye (sometimes a result of nearsightedness), inflammation or injury may also cause the vitreous to shrink.

When a retinal tear is present, watery fluid from the vitreous space may pass through the hole and flow between the retina and the back wall of the eye. This separates the retina from the back of the eye and causes it to detach. The detached portion of the retina will not work properly, and there will be a blur or blind spot in the vision.

In some cases retinal detachment is caused by other diseases of the eye, such as tumors, severe inflammations and complications of diabetes mellitus. In these cases there are no tears or holes in the retina, and treatment of the disease that caused the detachment is the only treatment that may correct the detachment.

Symptoms

In some cases the sudden appearance of spots or flashes of light may indicate substantial shrinkage of the vitreous, with tears in the retina. In other cases the person may notice a wavy or watery quality in their overall vision or the appearance of a dark shadow in some part of their peripheral vision. Further development of the retinal detachment will blur the central vision and create significant loss of vision unless the detachment is repaired.

Occasionally, retinal detachment occurs suddenly, and the person will experience a total loss of vision in one eye. Similar rapid loss of vision may be caused by bleeding into the vitreous, which may happen when the retina is torn.

Detection and treatment

A detached retina cannot be seen from the outside of the eye. Therefore, if symptoms are noticed, an ophthalmologist (a medically trained eye doctor) should be visited as soon as possible. People who are very nearsighted or who have a family history of retinal detachment should have regular eye examinations by an ophthalmologist so that any changes in their retina or vitreous may be detected early and retinal detachment prevented.

If the retina is torn, prompt treatment may prevent retinal detachment from developing. If there is little or no retinal detachment, the tears are sometimes sealed with a laser light (laser photocoagulation). The laser places small burns around the edge of the tear. These produce scars that seal down the edges of the tear and prevent fluid from passing through. Laser photocoagulation is often done as an outpatient procedure, without the need for admission to hospital, and requires no surgical incision.

Freezing the back wall of the eye behind the retinal tear (cryopexy) will also stimulate scar formation and seal down the edges of the tear. Cryopexy is often done as an outpatient procedure, but local anaesthesia is needed to numb the eye.

If the retina is detached, it must be repaired surgically by an ophthalmologist. Retinal detachment can be repaired in over 90% of cases; occasionally, more than one operation may be needed. Sometimes fluid must be drained from under the retina to allow the retina to settle back onto the back wall of the eye. Often a silicone band or pressure pad is placed on the outside of the eye to gently push the back wall against the retina. Either cryopexy or a laser, or the heat of diathermy (an electric current applied through a needle) is used to produce a scar to seal the retinal tear.

In more complex cases it may be necessary to use a technique called vitrectomy. The ophthalmologist cuts the vitreous away from the retina and removes the vitreous from the eye. If the retina is severely shrunken and puckered, the ophthalmologist temporarily fills the vitreous cavity with air or gas to push the retina back against the wall of the eye. Eventually, clear fluid from the blood seeps into the vitreous cavity to fill it permanently.

Approximately 40% of people with successfully repaired retinal detachment achieve excellent vision within 6 months of surgery. In general, the results are not as good when the retina has been detached for a long time or when there is a fibrous growth on the surface of the retina. The remaining 60% of people attain various degrees of reading or traveling vision. Unfortunately, because of continuous shrinkage of the vitreous and the development of fibrous growths, the retina cannot always be reattached. In such people the eye will continue to lose sight and will ultimately become blind.

Go Directly to Index

 

6. MACULAR DEGENERATION

Macular degeneration is the leading cause of blindness in Canada, accounting for one-third of all cases of vision loss. Most people with the condition have a mild form. The most common form of macular degeneration occurs in people over age 55 years and is known as age related macular degeneration.

What is macular degeneration?

At the back of the eye there is a thin layer of light-sensitive nerve cells and fibres called the retina. We see things because light entering the eye strikes the retina and is turned into an electric impulse that the brain understands as an image.

Near the centre of the retina is a small spot about the size of a pea called the macula. The macula processes the details in the central part of the image that the brain receives. The macula needs good light to work efficiently and works best in daylight.

The rest of the retina is responsible for side, or peripheral, vision. It is especially sensitive to dim light, which makes night vision possible.

If the macula deteriorates for some reason, the retina becomes like a camera with a spot on the film. The centre of the field of vision blurs, and all detail is lost. This condition is called macular degeneration.

There are two types of macular degeneration. In the dry type there is gradual degeneration of the tissue cells that make up the macula, and symptoms tend to develop over many months or years. In the more severe wet type, leakage and often hemorrhage occur under the macula, causing the symptoms to develop over a relatively short period.

Causes and symptoms

Although the specific cause of the deterioration is not understood, age related macular degeneration seems to be part of the normal aging process. As the eye gets older, the membrane separating the macula from the retinal blood vessels that supply it may break down. At the same time, new, abnormal blood vessels form that may bleed and displace the macula. Cut off from its source of nourishment, the macula is permanently damaged.

Although macular degeneration is usually associated with aging, it may be linked to other conditions, such as infections, high blood pressure, arteriosclerosis and general diseases like diabetes mellitus. Children and adolescents may be affected by hereditary macular degeneration. Myopia, or nearsightedness, is a contributing factor, and excessive light and eye injuries leading to retinal detachment may also damage the macula.

The course of the condition may be slow or rapid, but the deterioration generally occurs over a period of a few years. Peripheral vision will remain normal, but the person will have difficulty seeing at a distance or doing detailed work. Faces may begin to blur, and it becomes harder to distinguish colours. Distortion or wavy lines may accompany or precede the blurred vision.

Treatment

Treatment begins with an eye examination to try to determine the cause of the condition. Unfortunately, because so little is known about the direct cause of macular degeneration, effective treatment is not possible in all cases.

Lasers are sometimes used to seal damaged blood vessels in the early stages of the wet type of macular degeneration. To determine whether laser treatment can help, a test called fluorescein angiography may be necessary. This test, which involves injecting a dye into a vein and then photographing the circulation of the dye, is ordered by an ophthalmologist (a medically trained eye doctor) and is usually performed in a hospital.

Although macular degeneration cannot be reversed, people with the condition can usually continue their daily activities using their peripheral vision and making the best use of their remain detail vision. Devices such as high-intensity reading lamps and magnifiers help compensate for the loss of detail and make some fine work possible again. People with macular degeneration almost never go completely blind.

If you experience blurred of distorted central vision, you should visit your doctor immediately. Everyone over the age of 45 years should have regular eye examinations by an ophthalmologist.

Go Directly to Index


7. GLAUCOMA

Glaucoma is a disease affecting 1 of every 100 Canadians over 40 years of age. It is one of the most common causes of blindness. Although associated with increased age, glaucoma may develop at any age from infancy on.

The basic cause of glaucoma is unknown, but a number of risk factors have been identified. These include age, heredity, myopia (short sightedness), general disease such as early heart attack and stroke, and raised intraocular pressure (IOP).

Raised IOP is found in most types of glaucoma and is the main target for control of the disease. When there is a balance between fluid (aqueous) pumped into the eye and the amount that escapes from the eye, the IOP is normal. Raised IOP occurs when fluid outflow is obstructed. Visual loss in glaucoma is thought to be caused by raised IOP and other influences on the optic nerve, located at the back of the eye. The gradual loss of nerve function causes loss of peripheral, or side vision painlessly and without notice.

There are many misconceptions about glaucoma. The following statements are all false:

If I can see, I don’t have glaucoma.

Glaucoma is caused by pressure or anxiety.

Glaucoma is caused by poor nutrition or lack of vitamins.

Glaucoma is a form of cancer.

Using your eyes can make glaucoma worse.

Open-angle glaucoma

Open-angle glaucoma is the most common form of glaucoma. Patients rarely notice any symptoms until the disease is very advanced; it is truly a "silent blinding disease". Those affected can drive, read and perform most tasks because the visual loss usually is not a black cloud or a blurring of the vision. Because this loss is permanent and cannot be reversed by treatment, early detection and treatment are necessary to preserve remaining vision.

Tests for glaucoma are painless and take little time. The IOP is measured with a tonometer, and the optic nerve is viewed through the pupil with an aphthalmoscope. More elaborate tests may be required, depending on the results.

Treatment is begun with eyedrops and sometimes pills, which decrease the IOP. It may be necessary to change from one type of drop to another. This lifelong disease must be constantly monitored to ensure the best treatment. All the medications are short acting, and a strict schedule is outlined by the physician.

Good control may be limited by improper administration of medication by the patient because of poor understanding. If control is not achieved with medication, laser therapy, performed during an outpatient visit, may be required. If this also fails to decrease the IOP, surgery may be advised.

As one’s general health may influence the disease, it is important to attend to these problems as well. To prevent drug interactions, you should inform your family doctor and ophthalmologist of all medications you are taking.

Closed-angle glaucoma

Closed-angle glaucoma is less frequent than open-angled glaucoma. It usually is manifested by the sudden onset of dull, aching pain over one eye associated with a change in vision – blurring and haloes (rainbows around lights. This happens within half an hour and should not be ignored – it is an emergency! The structure of the eye that can lead to this problem can often be seen beforehand by a health professional. In this case laser therapy may be advised to prevent the attack.

The aim of treatment in an acute attack is to decrease the IOP before permanent damage occurs. A small opening in the eye (iridectomy) is then made to prevent another attack.

How to detect glaucoma

It is important to be aware of the possibility of glaucoma, particularly if you have any of the risk factors or have had a serious injury to the eye or eye disease. Some drugs, such as cortisone (steroid) drops, can cause glaucoma. Any visual disturbance that is uncorrected by glasses may be a sign of glaucoma. Everyone should undergo periodic screening by qualified professionals to prevent this blinding disease.

Go Directly to Index


8. DIABETES AND THE EYE

Diabetes is a condition in which the body does not properly regulate and use sugar (glucose) for its energy needs, usually because of a failure to produce enough of the hormone known as insulin. The disease may affect as many as 1 million Canadians, 50% of whom do not know they have it. It blinds 400 Canadians every year.

Diabetes may affect many organs in the body, including blood vessels, nerves, the kidneys, the heart and the eyes.

How does diabetes affect the eyes?

Poorly regulated and high levels of sugar in the blood can cause changes in the optics of the eye, resulting in blurred vision and changes in eyeglass prescriptions. The condition may also interfere with focusing of the eye. Control of the blood sugar level usually corrects these problems.

Diabetes can cause cataracts, a clouding of the lens inside the eye that blurs vision.

Diabetes can cause double vision when it affects the nerves that control the alignment and movement of the eyes. It can also cause the optic nerve to be more easily damaged by glaucoma.

The most important cause of the visual impairment in people with diabetes is diabetic retinopathy, a condition in which changes occur in the tiny blood vessels that nourish the retina (the light-sensitive tissue that lines the back of the eye and changes the light into nerve messages to be transmitted to the brain). In the early stages of diabetic retinopathy, called nonproliferative or background retinopathy, small blood vessels weaken and leak fluid or tiny amounts of blood, which distort the retina. At this stage the person may have normal vision or may note blurred or changing vision. Although 25% of people with diabetes have some degree of nonproliferative retinopathy, the condition does not progress to more severe problems in most.

In a more advanced stage, blood vessels in the retina are blocked or closed completely, and areas of the retina die. Proliferative diabetic retinopathy affects about 5% of people with diabetes and occurs when new, abnormal blood vessels grow to replace the old ones. These new vessels are fragile and often rupture and bleed into the eye, blocking vision. Scar tissue forms, shrinks and tears the retina, causing bleeding or detaching it from the back of the eye. This can result in severe visual loss or blindness. Fortunately, this occurs only in a small minority of people with diabetes.

The chances of having some form of diabetic retinopathy increase the longer a person has had diabetes. Retinopathy is present in 90% of those who have had the disease for more than 20 years.

Detection and treatment

Research has shown that severe visual loss from diabetic retinopathy can be prevented or delayed by laser treatment, but only if the retinopathy is diagnosed early enough. This is why it is important for most people with diabetes, particularly those who have had the disease for 5 years or more, to have an annual eye examination performed by a medical doctor trained to recognize the subtle early signs of diabetic retinopathy.

Diabetic retinopathy is precisely located and documented with special photographs of the retina called fluorescein angiograms. Treatment with laser photocoagulation is aimed at sealing leaky vessels and preventing the growth of new, abnormal vessels. Laser treatment has risks and side effects, which must be weighed against the benefits for each individual patient. In more advanced retinopathy, the benefits usually outweigh the risks.

Despite treatment, or for lack of it, some people with diabetes bleed massively into the eye and require a delicate, microscopic operation called a vitrectomy to remove blood and scar tissue from the eye. Others also need surgery for retinal detachment.

Research into diabetes and diabetic retinopathy is continuing and encourages the hope for prevention and better treatment.

Go Directly to Index


9. CATARACTS

Cataracts are a very common cause of impaired vision. Over 1 million operations for cataracts were carried out in North America in 1987. Fortunately, there have been significant advances in the treatment of this condition in the past few years, and most people with this problem can now expect to regain most or all of their vision.

What is a cataract?

A cataract is a clouding of the normally clear and transparent lens of the eye. IT is not a tumor or a new growth of skin or tissue over the eye but rather a fogging of the lens itself. When a cataract develops, the lens becomes as cloudy as a frosted window.

The lens is located near the front of the eye and focuses light on the retina at the back of the eye. Light passes through it to produce a sharp image on the retina. When a cataract forms, the lens may become so opaque and unclear that light cannot easily be transmitted to the retina. Often, however, only a small part of the lens is affected, and if sight is not greatly impaired, there is no need to remove the cataract. If a large portion of the lens becomes cloudy, sight may be partially or completely lost until the cataract is removed.

There are many misconceptions about cataracts. For instance they do not spread from one eye to the other, although they may develop in both eyes at the same time. A cataract is not a film visible on the outside of the eye and is not caused by overuse of the eyes. Using the eye does not make a cataract worse. Cataracts usually develop gradually over many years; they rarely form over a few months. Finally, cataracts are not related to cancer, and having a cataract does not mean that a person will be permanently blind.

Causes and symptoms

There are many types of cataract. Most are caused by a change in the chemical composition of the lens. These changes may be caused by aging, heredity or birth defects, injury to the eye, or certain diseases or conditions of the eye or body.

The normal process of aging can cause the lens to harden and turn cloudy. These are called senile cataracts and are the most common type. They may occur as early as age 40.

Cataracts may develop in children as well as in adults of any age. When they appear in children they may be hereditary or many have been caused by infection or inflammation affecting the pregnant woman and unborn baby. These are called congenital cataracts and are present at birth.

Eye injuries can cause cataracts in people of any age. A hard blow, puncture, cut, intense heat or chemical burn can damage the lens, resulting in a traumatic cataract.

Certain infections or diseases, such as diabetes mellitus, may also cause the lens to cloud. These are called secondary cataracts.

Depending on the size and location of the cloudy areas in the lens, a person may or may not be aware that a cataract is developing. If the cataract is located on the outer edge of the lens, no change in vision may be noticed, but if it is located near the centre of the lens, it usually interferes with clear sight. As cataracts develop, there may be hazy, fuzzy and blurred vision. Double vision may also occur. The eyes may be more sensitive to light and glare, making night driving difficult. There may be a need to change the eyeglass prescription frequently.

As the cataract worsens, stronger glasses no longer improve sight. It may help to hold objects closer to the eye to read and do close up work. The pupil, which is normally black, may undergo noticeable changes in colour and appear to be yellowish to white.

Detection and diagnosis

Cataracts cannot usually be seen from the outside of the eye without proper instruments. If you notice blurred vision or other symptoms, you should visit an ophthalmologist as soon as possible for a comprehensive medical eye examination.

The ophthalmologist examines the eye with a variety of instruments to determine the type, size and location of the cataract. He or she also views the interior of the eye with an instrument called an opthalmoscope.

Treatment

When a cataract causes loss of sight that interferes with work or lifestyle, it is probably time to have it removed. The patient and the ophthalmologist decide together when removal is necessary, according to individual needs.

Surgery is the only effective way to remove the cloudy lens. Cataracts cannot be removed with a laser, an intense beam of light energy; ophthalmologic laser surgery can, however, be used after cataract surgery to open part of the lens membrane (the capsule), which may become cloudy after cataract surgery.

Although rapidly changing technology and research in recent years have improved the treatment of cataracts, eye drops, ointments, pills, special diets and eye exercises have not been proven to dissolve or reduce a cataract.

Fortunately, cataract surgery is highly successful, and over 90% of patients who undergo surgery regain useful vision. It is important to understand that complications may occur, and, as with any surgery, a good result cannot be guaranteed.

Once the cloudy lens of the eye is removed, the patient needs a substitute lens to focus light. Newer ways to restore vision include:

Somewhat thinner and lighter cataract glasses; they may still be thicker, however, than most ordinary glasses.

Hard or soft contact lenses that can be worn all day but are taken out at night.

Special extended-wear soft contact lenses that can be left in for 2 to 4 weeks.

Intraocular lenses (IOLs), which are permanent lenses surgically implanted inside the eye in place of the natural lens.

There are advantages and disadvantages to each type of lens replacement. The ophthalmologist helps the patient decide which lens or combination of lenses is best suited to the person’s lifestyle and will help provide the best vision.

Fortunately, people with cataracts no longer need become "nearly blind" before they can be treated, and sight can be restored.

Go Directly to Index


10. DAISY FORMAT AUDIO BOOKS AND MAGAZINES

DAISY IS here!! Who or what is DAISY? DAISY is the newest format for recording and playing audio books and audio magazines from CD’s instead of cassette tapes. Learn more about it here.

A LITTLE HISTORY
Over the past 100 years, both spoken word and music recordings have evolved through a multitude of technological advances. From the first wax cylinders, to shellac and vinyl record platters, wire recordings, open-reel tape, 8-track tape cartridges, cassette tapes, digital audio tapes, digital compact discs (CD’s), laser discs, to digital video discs (DVD’s). We have learned to evolve with them by acquiring the appropriate equipment to play the newest formats, while maintaining some of the older ones.

Even more confusing was the multitude of formats that each technology provided – the speed, number of tracks, stereo or surround sound, Dolby compression, and so on. As a result, our playback equipment became more and more difficult to use – too many knobs and switches, too many unused features that we didn’t really understand. All of this was pretty awkward when you could no longer read the tiny print on the faceplate of your hi-fi.

Many audio books and some spoken word material, such as magazines, have come to the visually impaired in the form of standard cassette tapes using inexpensive tape players. Many came as specialized 4-track, slow speed cassettes that required special playback equipment. These were hard to get, expensive, and a little difficult to use. For several reasons, both kinds of cassettes are dying off and will disappear in the near future. Magazines on tape are already extinct and now come only in a special compact disc format that will not play on older CD players. That new format is called DAISY.

WHAT IS DAISY?
To describe DAISY, we have to back up a bit and describe normal compact discs. Standard music CD’s play for about an hour with very high quality audio. They have digital files with a particular format, called “CDA” format. Formats that compress more music onto the same space can also be recorded, such as the “MP3” and “WMA” formats that are widely traded on the Internet. Most computers, most portable CD players, most new home and automobile CD players now support “MP3” format. Older players will not support “MP3” so you may need new stuff.

An “MP3” disc can play from 2 to 20 hours of material, depending on the level of compression used to record the sound. Higher compression usually means lower quality audio reproduction, but this may not mean much if the audio is mostly spoken words instead of music. A single digital video disc (DVD) can hold up to 100 hours of spoken word audio (no video of course) and must be played on a DVD player with MP3 capability or on a computer with a DVD/CD disc drive.

But you can see the problem that is creeping in. How do you find what you want in the huge list of items on the CD or the DVD? On a standard CD, there are only 10 to 20 selections. On a CD/MP3 there may be 200 and on a DVD/MP3 there may be 1000’s. 

Enter DAISY. DAISY uses MP3 files of the spoken word material PLUS a legible, multi-level, table of contents. This table of contents is only accessible if you buy a special DAISY player or have the appropriate DAISY software on your computer. Using menu buttons on the DAISY player or the mouse on your computer screen, you navigate to the title of your choice on the table of contents. This assumes you can still see enough to read the table of contents or see a mouse. By using screen reader software, even this problem can be overcome when using a computer.

DAISY has other features that reduce the need to see well. You can start the book or magazine by pressing a single button or hotkey. You can stop and press another button to bookmark this spot and then restart later at the same place, just like a paper book. Although few technical books are available yet, DAISY is designed to let students use multiple bookmarks in complicated content tables for university courses.

For the visually endowed, DAISY may end up eliminating some paper-based media, such as print intensive magazines, technical journals, and newspapers. Don’t hold your breath – image-intensive advertisers may resist.

HOW DO I CONVERT TO DAISY?
First, you may not need to. DAISY files are actually MP3 files so they play on most computers and some newer CD players. These cost $90 in Sears Wishbook and may be less at discount stores. Be sure the CD player actually plays real CD’s. Some are only capable of playing music downloaded from a computer, but they go by the generic name of “CD Player”. Also be sure the box says “MP3 compatible” or “MP3Pro compatible”.

There is a hitch of course. The file names on the magazine articles are random characters so they are not useful titles. If you don’t mind listening to the magazine articles in random order, this is not a problem. If you want to find a particular article from the table of contents, see the next paragraph. Most audio books in DAISY format seem to have intelligent file names, such as “Chapter01”, so you can play each part of the book in order. If your needs are not too sophisticated, you can ignore DAISY and get on with life using a relatively cheap CD player or your existing computer.
If you want to read DAISYdiscs using the proper software, do a Google search for "Daisy free download".

A real DAISY players (sometimes called DAISY readers) are not available yet at retail or discount stores but can be obtained through the CNIB in Canada. In USA and elsewhere, type “DAISY Player” into your search engine to locate a non-profit or commercial business that offers DAISY Players for sale.

There are a couple of brand names available and they come in both large button and small button versions. The table of contents is displayed on a small LCD screen. That may not be great, depending on the particular form of your visual impairment. The tiny writing on the small button versions will require some memorizing of what each button does, but we are used to that, aren’t we? These players also play standard music CD’s and MP3 CD’s, and they are portable. Go to http://www.cnib.ca/ for specifications, prices and other info.

Unfortunately, DAISY players are moderately expensive (C$300 - C$500). If you are on a fixed income, investigate the CNIB STEP program, or your provincial Aids to Daily Living program, or contact local service clubs or family for financial assistance.

HOW DO I GET DAISY CD’S
Magazines and audio books in DAISY format are available from the CNIB Library. You must be a CNIB Client and you must register separately with the CNIB Library to receive this material. Contact the CNIB Library at 1-800-268-8818 or Fax 416-480-7700.  Email:
library@cnib.ca.

Some audio books on CD available from the local library contain both conventional CD’s as well as a DAISY version, although the word “DAISY” may not appear on the disc or the packaging. The format is so new that many suppliers have not figured out their marketing strategy. Free software is provided on the CD to play the DAISY version from the table of contents. You can also play the MP3 files directly using MediaPlayer on your PC.

Make a date with DAISY and get more fun out of life!

Go Directly to Index