Chapter 5
Understanding Low Vision Rehabilitation
A review of the various ways we can intervene to help you see. It’s not just about making things bigger.
How to use this site: This page is a chapter in an online book. If you’ve arrived here without reading the previous chapters first, it might not make much sense. I strongly recommend you start at the beginning. Click here to go to the beginning.
Now that we have a solid understanding of the eye, how vision works, and exactly how vision can become impaired, let’s turn now to what exactly we can do about it.
But first, a short diversion into… gardening.
Understanding Gardening
Wait, what? Isn’t this supposed to be about vision impairment?
Trust me, all will become clear.
I was a terrible gardener. I’m still not great. But I’ve learnt that growing plants isn’t as simple as just watering them and watching them thrive. There’s much more to it than that. For a plant to grow, it needs many things, and if any single one of them is wrong then your plant won’t grow properly. To be a good gardener, you should understand all the things your plants might need, and you need to be able to recognise when they are missing something.
Gardening
What do Plants Need?
Water
Plants all need enough water. But beware — too much can be bad for some plants, so you can damage a plant by over-watering too.
Sunlight
All plants need light, but different plants need different amounts of light. Again, you’ve got to get the amount right — too much can be bad for some plants.
The right soil
The soil has to have all the nutrients the plant needs — enough nitrogen, phosphorus, selenium, and so on. If any are missing, your plant won’t grow right. But again, sometimes too much can be a problem too.
Safety
If your plant is being eaten by caterpillars, snails, aphids or goats, or your garden gets frosts and your plant is tropical, clearly it won’t grow well.
Gardening
Principles of Gardening
So, what do you do if your plant isn’t growing? Something must be wrong. What can you do to get it growing again?
Here are some principles you should keep in mind.
Fix the right thing
If you’ve got a plant dying from lack of sunlight, don’t expect to fix it by watering it more. There’s no point trying to fix a different problem. Identify and fix the actual problem.
Fix all the things
If you’ve got a plant that’s dying because it’s in the dark and because of lack of water, you can’t fix it by just putting it in the sun but leaving it dry. Nor can you fix it by just watering it but leaving it in the dark. If you want to save your plant, you need to put it in the sun and water it.
For a plant to survive, all of the factors must be within the survival range. If even one of those factors is outside of that range, the plant will die.
Helping a plant flourish is harder than just helping it survive.
For me, having a plant survive is definitely a win. But good gardeners want better than that. They don’t want their plants to just survive, they want them to thrive.
How? It’s basically the same as above, but with a narrower range. Plants have an optimal level of watering that they love, and an optimal level of sunlight that they love, and so on. If (if!) you can keep every parameter within those narrower ranges, the plant will not just survive, it will flourish.
Sometimes, just survival is the best anyone can achieve.
You might give your plant the perfect amount of water, nutrients and light. But we can’t control everything. For instance, what if your local climate is just too cold, and the plant’s not frost resistant?
We’re gardeners, not magicians. Sometimes just keeping our plant alive is the best anyone can do. We might find it frustrating that we can’t make it flourish, but remember that just keeping it alive is still a win.
You can cheat…
Have a think about what you’re trying to achieve. If what you’re after is a spot of lush green to brighten the place up, but it’s in a spot where it’s impossible to grow a plant, perhaps consider an artificial plant? Sure, it’s not the same as a real plant, but perhaps it’s better than nothing?
Low Vision
Principles of Low Vision Rehabilitation
Okay, after that little sojourn into gardening, let’s get back to vision. As you’ve probably guessed, I’m using gardening as an instructive analogy. We need to think about low vision rehabilitation in a similar way to gardening.
Similar, but not quite the same. Let’s look at the ways it’s similar.
Fix the right thing
If the print (or whatever) is too small, make it bigger.
If the light is too dim, make it brighter.
If the print is too pale, increase the contrast.
If there’s something in the way, move it.
Fix all the things
If the print is too small, and it’s too dark, then don’t expect that just magnifying it or just bringing in some extra light will do the trick — do them both.
Seeing comfortably is harder to achieve than just barely seeing.
Don’t have just barely enough light — have a good amount. Don’t make the print just barely large enough to read — make it bigger than that.
Note: This distinction between threshold and optimal conditions is going to be super-important when we get around to considering how to achieve fluent and comfortable reading.
Sometimes, just seeing is the best anyone can achieve.
We’re not magicians. Sometimes there’s a task that there’s just no solution for. The main thing is to understand your options well enough that you can be sure there isn’t a solution out there you haven’t thought of.
You can cheat…
Perhaps you can’t read a book fluently and comfortably like you used to. Would you consider listening to that book as an audiobook?
Maybe you can’t read the newspaper anymore. Would you consider keeping up with what’s happening by listening to the local radio news?
Maybe you can’t see subtle colours well enough to paint realistic flowers like you once did. Maybe you could develop a new style, with bold colours on a larger canvas?
You don’t have to do things just the way you’ve always done them in the past. You yourself can grow, and learn to do old things in new ways.
I’m still a poor gardener, but I’m a very experienced low vision optometrist.
In the next sections of this website, we’ll have an in-depth look at a range of interventions we can make, and in what situations they might be most effective.
If you don’t get this, you should watch Ingmar Bergman’s The Seventh Seal (1957) — or at least Bill and Ted’s Bogus Journey (1991).