Mr Javeed Khan MS FRCS (Glasg) FRCOphth Consultant Ophthalmologist CONTACT: 01983 526 699 (Mottistone Suite)
Mr Javeed Khan MS FRCS (Glasg) FRCOphthConsultant Ophthalmologist   CONTACT: 01983 526 699 (Mottistone Suite) 

Making the most of remaining vision

Is it difficult to read newspapers and price tags, set dials, or
manage glare? If so, here are some tips about lighting, contrast, and the tools, techniques and resources of vision rehabilitation. Losing vision does not mean giving up your activities, but it does mean applying new ways of doing them.

Patterns of Vision and Vision Loss:

Central vision is the detailed vision we use when we look directly at something. Macular degeneration (AMD) affects central vision. Diabetic retinopathy can affect central or peripheral vision.


Peripheral vision is the less detailed vision we use to see everything around the edges. Glaucoma affects peripheral vision first. Strokes can affect one side of the peripheral vision.


Contrast sensitivity is the ability to distinguish between objects of similar tones like coffee in a black cup or facial features. All eye problems can decrease contrast sensitivity.


Depth perception is the ability to judge the position of objects.
New vision loss in one eye can affect depth perception.


Visual processing: The lens in our eye, like a camera lens, focuses the image onto the retina, like camera film. Our optic nerve carries those images to our brain, which “develops” them. Impairments in each of these affect our vision differently.

The Experience of Vision Loss
It is always a shock to learn that your vision loss is irreversible. It is important to acknowledge the anger and frustration you may feel, to get help working through these feelings, and to apply the strategies of vision rehabilitation to stay active. Doing all of these will help you avoid depression, which may appear as fatigue or lack of interest. If depression occurs, address it with treatment and counselling. A good support group (see Macular disease society details in resources below) can help you recognize that your value to yourself and others does not depend on your vision and that you are worth the effort it takes to make the most of the vision you have.

The Phantom Visions of Charles Bonnet Syndrome (CBS)
About 20 to 30 percent of people with vision loss see lifelike images they know are not real. This is called Charles Bonnet Syndrome and it is not a loss of mental capacity, but just part of vision loss for some.

Making the Most of Remaining Vision
Finding and Using Your “Next-Best Spot”: Scotomas and PRLs
When the centre of your vision is obscured by a blind spot (scotoma), it is helpful to locate your "next best spot" (the Preferred Retinal Locus, PRL). To find your PRL, imagine that the object you want to see is in the centre of a large clock face. Move your eyes along the clock numbers and notice when you see the centre object most clearly. Use: that same viewing direction for other objects.

Making Things Brighter
Improve lighting.

Use a gooseneck lamp directed onto your task.
Carry a penlight. Reduce glare. Indoors, cover wood tables and shiny counters; wear yellow clip-on or fitover glasses.
Outdoors, try dark yellow or amber glasses. Visors can be useful indoors or out. Increase contrast. Use a black ink gel or felt pen, not a ballpoint.
Draw a dark line where you need to sign. Use a white cup for coffee, for example.

Making Things Bigger
Move closer. Sit close to the TV, and up front at performances.
Enlarge. Get large-print playing cards, bingo cards,
crosswords, phone dials, TV remotes, calendars, keyboards, and books.
Magnify. Magnifiers come in many powers and types, suited to different people and different tasks: hand-held for price tags and menus, stands and video magnifiers (CCTVs or closed circuit TVs) for sentences, magnifying computer mouse.

Designate spots for the items in your refrigerator, and for your
keys and wallet. Minimize clutter. Separate black clothes from

Mark thermostats and dials with high contrast markers from a fabric store; label medications with markers or rubber bands; safety-pin the labels of similar-coloured clothing.
Substituting: Let’s hear it for Ears!
Get books and magazines on tape free on loan, also talking
watches, clocks, calculators, glucometers, and computers. Use
reading services.

Don’t isolate yourself. Keep your social group, volunteer job, or
golf game. It might require lighting, large print cards, a
magnifier, a ride, or someone to watch your ball. Ask for the help you need. There is nothing independent about staying home to avoid asking for help.

For Family and Friends
Your loved one with vision loss needs to be empowered to do as much as possible independently. Recognize the challenge of vision loss, but don’t take over their tasks. Instead, help identify the adjustments they need to make to maximize their independence.

Vision Rehabilitation
A low vision evaluation and rehabilitation training can help you make the most of your vision. This is available at the Low Vision Aids (LVA) clinic at St Mary’s Hospital.