Transcript of Low Vision: High, Low, No Tech Compensatory Strategies Mountain Central Conference November 9, 2014...
- Slide 1
- Low Vision: High, Low, No Tech Compensatory Strategies Mountain
Central Conference November 9, 2014 Debbie Buckingham, OTR, CVE,
CRC, CCM Beth Haerer, MS, Ed, MOTS
- Slide 2
- Learning Objectives Provide an overview of age related vision
loss and the potential impact on occupational performance. Define
the assistive technology (AT) concepts of high tech and low tech.
Identify and describe various AT and environmental modifications
that may be of benefit for individuals with low vision. Provide
information on resources for individuals with vision loss. Note:
Unless otherwise indicated, images are from Google Images
(www.google.com/imghp)
- Slide 3
- Description & Definitions of Low Vision Scheiman: Low
vision can be defined based on either a limitation of visual
acuity, visual field, or visual function. A system of defining low
vision was developed for the primary purpose of administering
financial aid to those who qualify under Title X of the Social
Security Act of 1935. The term legal blindness was developed for
this purpose and is defined as 20/200 or worse in the best
conventionally corrected eye or a visual field diameter of 20 or
less in the better eye.
- Slide 4
- Description & Definitions of Low Vision American Optometric
Association (www.aoa.org)www.aoa.org 20/20 vision is a term used to
express normal visual acuity (the clarity or sharpness of vision)
measured at a distance of 20 ft. If you have 20/20 vision, you can
see clearly at 20 ft. what should normally be seen at that
distance. If you have 20/100 vision, it means that you must be as
close as 20 ft. to see what a person with normal vision can see at
100 ft. National Eye Institute (NEI) a visual impairment that is
not correctable by standard eyeglasses, contact lenses, medication,
or surgery and that interferes with the ability to perform everyday
activities
- Slide 5
- Lighthouse International & CDC A functional definition of
low vision is a vision loss that cannot be corrected and results in
severely reduced visual acuity or contrast sensitivity, a
significantly obstructed field of vision -- or all three
(Lighthouse International, n.d.). In addition to compromising
quality of life by reducing ability to perform self-care and
instrumental activities of daily living, vision loss may contribute
to social isolation (Centers for Disease Control and Prevention
[CDC], n.d.).
- Slide 6
- Normal Visual Changes Associated With Aging Reduced Visual
Acuity Presbyopia Luminance/need for more light Sensitivity to
Glare Difficulty with Light/Dark Adaptation Reduced Sensitivity to
Color Perception & Contrast Reduced Depth Perception Floaters
Dry eyes AFB
- Slide 7
- Reduced Visual Acuity (AFB) Declines to some degree beyond age
50 Reduced visual acuity of 20/30 or 20/40 is typical for person
age 50 or older Presbyopia Condition in which near visual acuity is
decreased because of age related decline in accommodative ability
(Scheiman) Frequently hold reading materials at arms length in
order to get print to focus Gradual loss of ability to see close
objects or small print Some people may begin to experience
headaches or tired eyes while reading or doing other close work
Correctable by bifocals, trifocals, reading glasses or continuous
range eyeglasses Multifocal lens implants post cataract
surgery
- Slide 8
- Luminance/need for more light (AFB) Amount of light reaching
the back of the eye decreases with age Older people receive reduced
light through smaller pupil and increased density or haziness with
aging lens On average, older person requires 4X more light than a
younger person Person age 80 & older requires 10X more light
than the average 25 year old Problem can be remediated with
improved lighting Vision typically good among older people under
conditions of optimal light
- Slide 9
- Sensitivity to Glare (AFB) Caused by bright light reflecting
from shiny surfaces Older person needs brighter light, but too much
light that either shines directly or reflects into the eye can
reduce vision Ability to recover from glare or bright lights
decreases after age 50 due to changes in the lens and retinal
sensitivity Natural environment produces a great deal of glare;
sunlight often a major cause High gloss paper can be hard to read
due to glare
- Slide 10
- Difficulty with Light/Dark Adaptation (AFB) Ability to adapt to
darkness slows significantly with age (secondary to age related
changes in pupil size, amount of light reaching the retina, and
thickening of lens) Eye adapts more quickly from dark to light than
from light to dark Examples: going from brightly lighted lobby into
darkened movie theater, or dimly lit restaurant to outdoor
sunlight.
- Slide 11
- Reduced Sensitivity to Color Perception & Contrast (AFB)
Greater the difference in contrast between an object & its
background, the easier it is to see. Increasingly sharper contrasts
& sharper edges around an object to differentiate it from its
background is needed. Recognizing faces & objects involves
ability to see contrast, textures & patterns. Need high
contrast printed material- sharp, crisp black lettering on a white
or pale yellow page Ability to identify color diminishes with
age
- Slide 12
- Reduced Depth Perception (AFB) Difficult to determine how near
or far away or how high or low something is. Loss of depth
perception makes steps or street curbs difficult to manage.
Floaters (AFB) Tiny specks that float across the field of vision
Generally most aware of them in well-lit rooms or outdoors on a
bright day Often normal but sometimes indicate an eye problem.
Floaters accompanied by light flashes could mean that the retina is
detached, which requires immediate medical attention.
- Slide 13
- Dry eyes (AFB) Occur when tear glands dont produce enough
lubricating fluid Can be uncomfortable, causing itching, burning,
scratchy sensation, or even some loss of vision. Eye Dr. may
suggest using a humidifier in the home and/or eye drops that
compensate for the lack of natural lubrication.
- Slide 14
- Conditions That Result In Low Vision Four major causes of low
vision are directly related to the aging process: Diabetic
retinopathy Age related macular degeneration Glaucoma Cataracts
(Warren, NEI, & AFB; AMD.org. Kaldenberg)
- Slide 15
- Diabetic Retinopathy (DR) Diabetes is the leading cause of
adult blindness in the US At 20 years after the onset of diabetes,
up to 99% of persons with Type 1 diabetes & 60% with Type 2
diabetes have DR to some degree. Affects entire retina & can
cause any level of vision loss, including total blindness
- Slide 16
- Diabetic Retinopathy (DR) Involves a continuum of pathology
beginning with non- proliferative form or background diabetic
neuropathy Only common eye disease that can cause varying patterns
of vision loss because it affects the blood vessels that support
the entire retina. Scattered spotty areas of vision loss, called
scotomas May have decreased contrast sensitivity & color
discrimination, poor night vision & fluctuations in vision May
experience diplopia from neuropathy that affects the 3 rd or 6 th
cranial nerves (usual resolves spontaneously) (Warren, NEI, &
AFB; AMD.org. Kaldenberg)
- Slide 17
- Age related macular degeneration (AMD) Leading cause of visual
impairment among adults in US; Often causes low vision but not
complete blindness. Two types "wet" and "dry." Dry is most common.
In the dry form, there is a breakdown or thinning of the layer of
retinal pigment epithelial cells (RPE) in the macula. Wet AMD
occurs when blood vessels growing up from beneath the retina leak
blood. Leaked blood pushes on the light receptor cells resulting in
damage to the retina.
- Slide 18
- Age related macular degeneration (AMD) Affects central visual
field; does not destroy peripheral vision A vision problem of the
retina. Yellowish deposits (drusen) form, resulting in distortion
and gradual blurring of vision. In advanced cases, blind spots
develop that grow larger as the disease progresses. Causes a
clearly demarcated central blind spot (scotoma). Even early loss of
central vision causes significant functional problems (Warren, NEI,
& AFB; AMD.org. Kaldenberg)
- Slide 19
- Glaucoma Warren: Group of eye diseases in which the pressure
inside the eye is too high for the health of the eye and causes
damage to the optic nerve. Increased pressure gradually damages the
delicate optic nerve fibers and causes vision loss. Distinctive
pattern of vision loss. Begins by reducing vision in the
mid-peripheral visual field and then progresses toward the center
and the periphery, reducing or eliminating the vision. (Warren,
NEI, & AFB; AMD.org. Kaldenberg)
- Slide 20
- Glaucoma If untreated can leave affected eye with only a narrow
tunnel of vision or, in some cases without any vision. Because if
affects central vision only in late stages, can be advanced in the
presence of near normal acuity on a vision chart. Restricted field
can severely affect mobility. No symptoms, persons older than 40
should have eye exams every 2-3 years for early diagnosis (Warren,
NEI, & AFB; AMD.org. Kaldenberg)
- Slide 21
- Cataracts Opacification of cloudiness of the lens of the eye
Typically develop slowly; commonly occurs with advanced aging May
occur congenitally in newborns; result from hereditary causes in
young adult or from trauma Dulls colors & blurs visual detail;
eventually compromises distance & near vision (Warren, NEI,
& AFB; AMD.org. Kaldenberg)
- Slide 22
- Charles Bonnet Syndrome Syndrome characterized by visual
disturbances usually occurring in people who have experienced
visual impairment or sight loss later in life. May see a wide range
of images, from simple patterns to people, animals, &
buildings. Visual disturbances associated with this syndrome are
not signs of mental illness, & people realize that the images
they are seeing are not real. No cure for Charles Bonnet Syndrome.
However, the symptoms often stop on their own. Should consult with
an eye care specialist because treatment for underlying vision
disorders may help. (Warren, NEI, & AFB; AMD.org.
Kaldenberg)
- Slide 23
- Projections As noted by the National Eye Institute (NEI),
millions of Americans lose some of their sight every year;
furthermore, the condition is most common for those over age 65
(NEI, n.d.). Given population aging trends and the chronic nature
of age related vision loss, occupational therapists will be
increasingly likely to encounter clients with low vision in a
variety of practice settings (McGrath and Rudman).
www.nei.nih.gov
- Slide 24
- Impact of Low Vision Older adults with vision loss compared to
older adults without vision loss bathing: 27.5% versus 11.7%
dressing: 16.6% versus 7.4% preparing meals: 20.1% versus 6.7%
managing money: 15% versus 4.2% performing light housework: 18.3%
versus 7.6% (Kaldenberg & Berger reference to Crews &
Campbell, 2001)
- Slide 25
- OT Role: In order to provide quality, well informed, evidenced
based services for this population, it is important for
occupational therapy practitioners to understand the impact of low
vision on occupational performance and be able to provide simple
adaptations or strategies to maximize participation, safety and
quality of life (Weisser-Pike and Kaldenberg).
- Slide 26
- High, Low, No Tech Intervention Assistive Technology Device any
item, piece of equipment, or product system, whether acquired
commercially, modified, or customized, that is used to increase,
maintain, or improve functional capabilities of individuals with
disabilities. (Assistive Technology Act of 2004)
- Slide 27
- Classifying technology Low Technology: (Low Tech) Simple
technology, with generalized systems or devices Minimum of capital
investment Comprehended easily Requires increased level of clinical
reasoning and creativity High Technology (High Tech) Technologies
involving highly advanced, specialized systems or devices Large
capital investment More advanced training may be required Clinical
reasoning driven by systems and protocols (Rakoski &
Ferguson)
- Slide 28
- Low & high technology Distinction between the two is
imprecise Low Tech = inexpensive devices that are simple to make
and easy to obtain High Tech = expensive, more difficult to make
and harder to obtain (Cook, A. & Polgar, J.)
- Slide 29
- No Tech Environmental modifications Modification - a change in
something (such as a system or style) Adaptive strategies
Strategies: a careful plan or method for achieving a particular
goal www.merriam-webster.com
- Slide 30
- General considerations for compensation Eight key elements in
the home environment that can be utilized and adjusted to enhance
the functioning of people with vision loss: lighting; glare; color
contrast; labels lettering & marking; organization; use of
texture & touch; environmental cues and techniques such as
sound and smells; safety issues (Orr & Rogers) Many of the
examples included in this presentation fit in several categories
and/or overlap. Suggestions and material presented is intended to
provide some examples and is by no means exhaustive.
- Slide 31
- No Tech (AFB; AOTA; Bergman; Caves; DeBrakeleer; Orr &
Rogers; Steelman)
- Slide 32
- Lighting Overhead lighting to help eliminate shadows and keep
rooms evenly lit Room should have more than one light source so
that lighting is dispersed Light should be aimed at the work not at
the eyes Maintain good lighting in the hallways walkway stairwells
etc. Use nightlights, flashlight or hall or room lighting if you
get up at night Install extra lights in the bedroom closet and
other frequently used closets and other rooms Improve task lighting
with easily adjustable gooseneck lamps Replace burned-out light
bulbs regularly Use adjustable blinds, sheer curtains or draperies
to allow adjustment of natural light Note: Home Environment
Lighting Assessment (HELA)
- Slide 33
- Glare Place mirrors so that light doesnt reflect off them
Reduce glare by covering windows with shades, mini-blinds or
honeycomb blinds If wax floors, use non-glossy wax Avoid using
glossy finish paper Position computer monitor away from ambient
light sources
- Slide 34
- Color & contrast (solid colors typically work better than
patterns) Bathmat (nonskid) and towels contrast with floor and wall
Replaced toilet seat with one contrasting color Place colored tape
on edges of stair risers; paint thresholds with a highly
contrasting color Use white sheets with dark comforter and pillows
Use contrast for place setting or place the plate on a nonskid
contrasting surface such as piece of cloth or shelf liner Use a
dark colored or striped toothpaste to contrast with white
toothbrush bristles or vice versa Avoid using clear glasses with
water or clear liquid Drape a contrasting color towel around the
shoulders to make the head and hair more visible while grooming;
alternately install a high towel bar across from the mirror in the
bathroom and hang a contrasting towel
- Slide 35
- Labels, lettering, & marking Use rubber band to distinguish
items such as shampoo & conditioner or use separate pump
dispensers Ask pharmacist for large print labels Mark each pill
bottle in a distinctive way for easier identification Use large
print pillboxes (and contrasting colors) Use large print check
registers; banks required to make statements available in large
print if requested Large print for other common items such as
calendars, magazines, books Large print games such as Monopoly,
& Scrabble Fonts that have an equal amount of space allocated
for each letters such as Courier
- Slide 36
- Organization Remove clutter Use organizational strategies &
devices such as shower caddy, drawer organizers Use tray dividers
to hold items like cosmetics and small tools Organize bills &
other important papers in different colored trays or folders
Establish a place to put essential small items such as keys,
eyeglasses, etc. & keep them in the same easy-to-access
location Hang clothes by color Make a list according to where the
items are in the grocery aisles Use wall-mounted pegboard to hang
frequently used kitchen items (choose safe location)
- Slide 37
- Use of textures & touch Bathmat that has a different feel
than the floor or tub Apply makeup or shaving using facial features
such as the nose and chin as landmarks Use clothing tags or sew
different shaped buttons to mark clothing Distinguish similar
clothes with safety pins Use a multiple compartment wallet and/or
system for identifying paper money (e.g. $1 bills unfolded and
extended flat, $5 bills folded in half with the short ends
together, fold $10 bills in half lengthwise with the long sides
together, fold $20 bills in half and then fold in half again)
- Slide 38
- Environmental cues &/or alternate techniques Place
furniture & appliance in traffic patterns to feel comfortable
to use; move furniture from the middle of a room to a wall to
create an open pathway Shop online or use stores that offer
delivery Avoid moving quickly from a dark room to a lighted area
and vice versa Pay bills and track accounts online (enlarge font)
Use a magnifying mirror for application of make up; hair grooming
Try detergent tablets/ premeasured tablets Help to locate items in
the room using the clock method Rooms that have color contrast
between the walls & furniture may be easier to navigate
- Slide 39
- Environmental cues &/or alternate techniques Family &
friends learn & use sighted guide techniques Use audible
medication reminder Install doorknobs of contrasting color with the
door or hanging a brightly colored ribbon on the doorknob Avoid
upholstery with patterns & patterned carpeting Subscribe for
radio reading and news line services NFB news Include video
description of TV programs and films & movies Use clock method
for locating food on plate Use an electric razor for shaving
- Slide 40
- Safety issues Note how far you have to rotate faucets to turn
the temperature to what you want. Turn on cold water first then add
hot turn off hot water first Remove clutter, cords and throw rugs
Use the microwave if you feel unsafe using the stove Do not wear
long sleeves while cooking Use trailing and protective techniques
Use nonskid surfaces in the tub or shower Remind others to close
doors and drawers completely Remove flammable or combustible items
from around the cooking area Be sure the light switches can be
reached from the entrances to each room and from the bed Halogen
light is very hot and focused and can cause fire burns; it is not
recommended for close up tasks
- Slide 41
- Low Tech (AFB; AOTA; Bergman; Caves; DeBrakeleer; Orr &
Rogers; Steelman)
- Slide 42
- Lighting Under counter lighting to highlight meal prep area
Glare Anti-glare computer screen Color & contrast Large letter
computer keyboards, with bright contrast Contrast cutting boards
Organization Use of personal digital assistant
- Slide 43
- Labels, lettering, & marking Pens with a light &/or
enhanced visual contrast E-books & newspapers (allow contrast
variation & increased font size) Accessible cell phones &
tablets Software packages for screen/print enlargement (also can be
high tech) Large print heating and air conditioning thermostat
- Slide 44
- Labels, lettering, & marking Book share (www.bookshare.org
) Once registered (nominal fee), can download up to 100 books per
month. Books can be read on a computer with screen enlargement
software or a screen reader software program (which book share
provides for free) or can be downloaded into a portable device that
stores the books and electronically converts them into synthetic
speech.)www.bookshare.org US Library of Congress (www.loc.gov/nls),
for free, sends audiobooks and magazines to registered
users.www.loc.gov/nls
- Slide 45
- Use of textures & touch &/or auditory cues Writing
guides for checks, signatures, letters and envelopes Various shapes
for game pieces such as checkers, poker chips Liquid level
indicator Beeping &/or musical balls Talking thermometer,
glucometer, blood pressure machine, weight scale Tactile bump dots
for marking appliances, etc. Boil alert disc Audio books Auditory
color ID Voice label scanners that can describe products such as
contents of cans
- Slide 46
- Environmental cues &/or alternate techniques Word
prediction & spellcheck utilities Utensils such as a rocker
knife and plate guard Talking calculators, electronic bill
identifiers, watches, clocks, etc. Use of needle threader; eye drop
device Place pot on burner before turning it on Use double spatula
to avoid spills when turning food Universal remote control panel
with large buttons & speech recognition Handheld or stand
magnifiers (non electronic) Note: Rather than attempting to buy any
kind of optical device off the shelf, it is better to consult with
a low vision specialist to determine what type of magnification if
any would be useful for the types of tasks the person wishes to
undertake.
- Slide 47
- Environmental cues &/or alternate techniques Accessibility
features on operating systems of computers (e.g. increasing print
and pointer size, modifying print and background color, voice
input, & Flickr reductions; note: Fonts such as the serif Times
Roman and sans serif Arial have features that are more easily
distinguishable )
- Slide 48
- Safety issues Long oven mitts Grab bars in bathroom
(contrasting colors) Syringe magnifiers Install smoke alarms,
carbon monoxide detectors, and fire extinguishers Remote controls
on-off switches
- Slide 49
- High Tech: (AFB; AOTA; Bergman; Caves; DeBrakeleer; Orr &
Rogers; Steelman)
- Slide 50
- High Tech Home automation & emergency alert systems Keyless
entries Script readers (e.g. script talk station - uses
radiofrequency identification & text-to-speech technologies)
Electronic mobility aids (software uses global positioning
satellite) Voice recognition software Refreshable braille
displays
- Slide 51
- High Tech Electronic portable magnifiers (may have capacity to
freeze an image; change color contrast) Screen reader software (for
computer and/or portable devices) Combined screen magnifiers and
readers CCTV, video magnifiers (illuminate and magnify images and
words on a screen) Optical character recognition (software that
analyzes video data and converts for speech output)
- Slide 52
- Low to High Tech Variety of mobile apps (AOTA; AFB are
resources) Examples: Tap TapSee (Free) Designed to help the blind
and visually impaired identify objects they encounter in their
daily lives Magnify (Free) Turns a phone into a magnifying glass
with flashlight. Brighter and Bigger (Free) Turns your device into
a magnification device that will make reading material bigger,
brighter, and high contrast. Med Helper (Free) Tracks prescription
medication, treatment, and appointment schedules. Alarm reminders
and a log of past doses. My Med Schedule (Free) Web-based
application that sends text alarms as reminders for taking
medications. Read2Go ($19.99) Allows user to browse, search,
download, and read books directly from Bookshare and other DAISY
book sources.
- Slide 53
- Note: AFB access world magazine: provides some product
evaluations & guides. Example: a comparative review of iPhone
magnifier apps
- Slide 54
- AFB: Center on Vision Loss Student researchers (Haerer &
Tuttle) initiated contact with 33 participants who completed a
visitor survey after touring the Center for Vision at AFB in Dallas
and were successful in obtaining responses from 25 participants.
The 6 question follow-up survey included information on low vision
strategies implemented by participants after touring the Center.
Regarding low vision strategies implemented, participants mentioned
both low tech and high tech strategies. Suggested/additional
resources mentioned that would be helpful: Support groups,
transportation, reading, technology, opportunities to donate
- Slide 55
- AFB Center on Vision Loss Results RESULTS
- Slide 56
- Evidence to support OT intervention Sampling of evidence
articles included in reference list Kaldenberg, J. &
Smallfield, S. Brunnstrom, Sorensen & Alsterstad Eklund &
Ivanoff Smallfield, Clem, & Myers Fok, Polgar, Shaw & Jutai
Occupational therapy practice guidelines for older adults with low
vision (2013, AOTA press)
- Slide 57
- I wish I might be taken just as a normal person, and my
accomplishment treated simply as illustrations of how much more
others can do if they only use their five senses with thought and
perseverance. Helen Keller
- Slide 58
- Resource List (separate)
- Slide 59
- References AFB (2000). To love this life; Quotations by Helen
Keller, AFB Press, New York, NY. American Foundation for the Blind.
http://afb.org/http://afb.org/ American Occupational Therapy
Association: Occupational therapy practice framework: Domain &
process, 3 rd ed. (2014) American Occupational Therapy Association:
Tips for living life to its fullest: Living with low vision,
(2013). American Optometric Association. www.aoa.orgwww.aoa.org
Bergman, L. (2012) Out of sight, not out of mind: Personal and
professional perspectives on age related macular degeneration. AFB
press, New York, NY. Brunnstrom, G., Sorensen, S., and Alsterstad,
K. Quality of light and quality of life the effect of lighting
adaptation among people with low vision in OPthal. PHysiol. OPT,
2004 274-280 Centers for Disease Control and Prevention. (n.d.) The
state of vision, aging, and public health in America. Atlanta: U.S.
Department of Health and Human Services Center on Vision Loss -
American Foundation for the Blind. (2013). Retrieved from
http://www.afb.org/info/programs-
and-services/center-on-vision-loss/12
http://www.afb.org/info/programs-
and-services/center-on-vision-loss/12 Cook, A. M., Polgar, J. M.
(2008). Cook & Hussey's assistive technologies: Principles and
practice. St. Louis, Mo: Mosby Elsevier. Eklund, K & Ivanoff,
S. (2006) Health education for people with macular degeneration:
Learning experiences and the effect on daily occupations. Canadian
Journal of occupational therapy
- Slide 60
- References Kaldenberg, J. & Berger, S. (April, 2008).
Essential skills for working with older adults with low vision.
Presented at the AOTA annual conference in Long Beach, CA.
Kaldenberg, J. & Smallfield, S. (2013). Occupational therapy
practice guidelines for older adults with low vision. AOTA press
Lighthouse International. (n.d) All about low vision.
http://lighthouse.org/about-low-vision-blindness/all-about-low-vision/
http://lighthouse.org/about-low-vision-blindness/all-about-low-vision/
McGrath, C., & Rudman, L. (2013). Factors that influence the
occupational engagement of older adults with low vision: A scoping
view. British Journal of Occupational Therapy, 76(5). National Eye
Institute. (n.d.) Low vision: What you should know.
http://www.nei.nih.gov/lowvision/content/know.asp
http://www.nei.nih.gov/lowvision/content/know.asp Olson, D. &
DeRuyter, F. (2002) Clinicians guide to assistive technology.
Mosby, St. Louis, MO Radomski, M. & Latham, C. (2104).
Occupational therapy for physical dysfunction, 7 th ed. Lipponcott,
Williams, & Wilkins, Philadelphia, PA Rakoski, D. &
Ferguson, R. (2013). The virtual context of occupation: Integrating
everyday technology into everyday practice. OT Practice, 18(9),
CE-8 Scheiman, M. (2011) Understanding and managing vision
deficits: A guide for occupational therapists, 3 rd. ed. Slack
Inc., Thorofare, NJ. Smallfield, S., Clem, K. & Myers, A.
(2013) Occupational therapy interventions to improve the reading
ability of older adults with low vision: A systematic review. The
American Journal of occupational therapy, Vol 67, #3. Warren, M.,
& Barstow, D. (2011). Low vision: Occupational therapy
evaluation and intervention with older adults. Bethesda: American
Occupational Therapy Association Weisser-Pike, O. & Kaldenberg,
J. (2010). Occupational therapy approaches to facilitate productive
aging for individuals with low vision. OT Practice, 15(3),
CE1-8.