The Care Journal : Seeing Things Anew

Ageing in Place

Seeing Things Anew

For the past 11 years, 76-year old Mr Joseph Ong takes a bus to the polyclinic almost daily to serve as a volunteer for hundreds of patients who are there for medical appointments. The spritely senior talks to patients, brings cheer to those who are unwell and guides them to the correct places, just like any volunteer.

However, what is not visible is this: Mr Ong has low vision. He cannot see well due to the loss of peripheral vision as a result of glaucoma. He also has problems seeing in low light conditions.

He recounted one or two harrowing experiences. “It was at night when I boarded a bus. There were many buses at the bus stop. I realised after a while that the bus wasn’t going to my destination,” he recalled. “I alighted and had to cross the road to take the correct bus. But it was very dark and I could not see.” Thankfully, Mr Ong managed to ask a student to guide him across the road and find his way to the right bus stop.

Rehabilitating a low vision senior

“Statistics show that most patients start to lose their sight in their 60s. As Singaporeans live longer, this means many years of living with low vision, while still being physically healthy. Hence, there is a need for a rehabilitation plan to help these patients maintain quality of life,” said Lisa Ong, Principal Optometrist at the Singapore National Eye Centre (SNEC).

The Temasek Foundation Cares – Senior Eye Rehabilitation (SEER) programme is piloting such a rehabilitation model for low vision patients. A partnership with the Agency for Integrated Care, National University Hospital, Singapore National Eye Centre, Tan Tock Seng Hospital and community service providers, SEER employs a structured care model that involves a multidisciplinary team of Ophthalmologists, Optometrists, Occupational Therapists and Social Workers to help older persons with low vision cope with their condition and maintain functional abilities at home.

Dr Yvonne Ling, senior consultant in charge of SEER at SNEC, said: “Before SEER was introduced, there was no coordinated programme in Singapore providing a seamless flow in low vision rehabilitation from the eye clinic to the home and community. Without a multi-disciplinary approach, there was a limit to how the ophthalmologist and optometrist could help the patient realise his full potential.

“Now, the ophthalmologist and optometrist can work with the occupational therapist and medical social worker to help the patient regain his independence in his day-to-day environment.”

In April 2017, Mr Ong was referred by his doctor at SNEC to an occupational therapist in Singapore General Hospital (SGH), under SEER.

SGH Senior Occupational Therapist Tan Yanwen was Mr Ong’s therapist. “Mr Ong’s main difficulty was bumping into people and objects,” explained Yanwen. “My role was to help him fine-tune his skills. The skills include, for example, judging steps, scanning the environment and being more mindful of the different environmental features.” As part of his session with Yanwen, Mr Ong learnt visual scanning strategies and how to turn his head to check his ‘blind spots’. These are especially useful in a crowded situation, and important for an active senior like him.

Occupational therapist Tan Yanwen first taught Mr Joseph Ong visual scanning strategies on paper, before bringing him into a community setting to practise these strategies.

Functional support can also come in the form of visual aids such as magnifiers which help low vision patients continue to read. Modifications can be made in the home using four key principles. Chen Xuanyu, Senior Occupational Therapist of the National University Hospital, explains:

  • Bigger: use enlarged words to write important information, like telephone numbers of family members;
  • Bolder: use heavy, black felt-tip marker pens to write on a non-glossy white background, to make words thicker and have better contrast;
  • Brighter: depending on certain eye conditions, lights could be added to the room. Or, use brightly coloured accessories such as vases and lamps so that furniture can be easily to locate.
  • Be organised: place items of the same category together; for instance, water and medication can be placed in the same area, or have the keys always placed in the same place.

Caring for the emotional well-being of those with low vision

Besides learning functional skills, low vision patients have to contend with the grief of losing their sight, fear of coping with limited vision and the stigma of ‘going blind’. As visual impairment is not apparently visible all the time, family and caregivers may not fully appreciate what low vision patients are experiencing.

Medical social workers like Candice Ow (SNEC) are there to mediate, counsel and provide emotional support to the patient, caregivers and family. Through sharings in counselling sessions, family members may discover how the patient really feels about his condition, or what is happening at home while family members are away at work. “When patients and caregivers are willing to talk – whether it is with healthcare professionals or within the family – the healing process for the patient can begin,” said Candice.

Besides keeping communications open within the family, Xuanyu also highlighted the importance for caregivers to be trained to help and support seniors with low vision so that they live their lives more meaningfully. 

Ultimately, a positive attitude can help the low vision patient adjust to his condition. Perhaps no one can give better advice than Mr Ong: “Don’t be afraid, but go and see a doctor quickly. If you feel better in your heart, you will be better!”


Other strategies to support low vision patients in the home

These strategies can serve as a guide to help a low vision patient enhance his daily activities. They may not be suitable for all people with low vision - it is best to check with a medical professional.

Lighting in the home

  • Ensure living halls and rooms is well lit and the illumination is uniform. Similarly, reading materials and work surfaces can be lit with adjustable lamp so as to avoid casting shadows.
  • Use night lights or motion sensor lamps to avoid having to look for switches.
  • Minimise glare by using curtains or blinds to adjust amount of natural light flowing into the room, and position mirrors so that light isn’t reflected off them.

Use colour contrasts

  • Mark the edges of all steps and ramps with paint or tape of a highly contrasting colour.
  • Install door knobs that contrast in colour with doors, and paint the woodwork of the door frame in a contrasting colour from the wall, to make them easier to locate.
  • To make identifying keys an easier task, use coloured rubber rims or nail polish to mark them.

    Eliminating hazards

  • Tape down or remove loose rugs or electrical cords.
  • Replace worn carpeting and floor covering. Use non-slip floor mat.
  • Keep desk chairs and table chairs pushed in. Move large pieces of furniture out of the main traffic areas.

    Other tips to consider

  • Make use of other senses: For example, embossed or tactile stickers can be put on the main button of appliances or indicator on dials. In addition, consider kettles with whistling sounds, talking clocks or handphones with audio outputs.
  • Reduce confusion: avoid upholstery and floor covering with patterns such as stripes and checks.
  • Enlarged fonts: use clocks and telephone keypads that has larger numbers.