By Laila Gaasbeek and Ann-José van Rossum
In the past, only people who were considered visually impaired according to the World Health Organization (WHO) were allowed to register with an organization for the blind and visually impaired, such as Bartiméus or Visio. A person is considered visually impaired if their visual acuity (ability to perceive detail) with optimal correction (glasses) is less than 30% (0.3) and/or their visual field (the area you can see when looking at a single point) is less than 30 degrees. As a result, clients with a functional loss of visual acuity in one eye were not eligible for support or assistance. Yet they still experienced difficulties.”
Psychological consequences
In addition to the grief over the loss of one eye and coming to terms with the illness that caused it, the client is often worried about the other eye. He or she may then feel the need to talk to a professional about this fear and grief. A sense of reduced self-confidence and insecurity can also lead to isolation. In the case of children, it is often the parents who need help.
Functional consequences
In addition, the sudden loss of vision in one eye can cause functional problems such as: balance issues, headaches (either more frequent or less frequent than before), falling or stumbling on steps, missing or reaching for objects incorrectly, knocking things over, pouring liquid off the mark, (ball) sports, having trouble writing on the line or losing the line, being bothered by shiny surfaces, having difficulty seeing in low light (poor lighting), being startled when someone enters from the wrong side, maintaining an overview (e.g., a large map), difficulty navigating or bumping into things in crowded environments, such as in a city; judging speeds (of oncoming cars); cycling while looking back to check for oncoming traffic; and accommodation (the lens becoming more curved), for example, when reading.
Monocular Vision Program (PMK)
PMK focuses on quickly and effectively addressing visual functioning following the loss of one eye. We also offer support in coping with the loss of an eye or dealing with anxiety regarding the remaining healthy eye. One of the clients who completed the program said: “At Visio, they helped me with advice on driving and on lighting at home and at the office. There were some useful tips among them. I took those to heart, and that’s how I was able to get back to my work and my life, through trial and error.” With the PMK, we work together with the client to address their specific needs and find a solution. As you can see, the program is tailored to the client’s individual needs. Not everyone experiences the same challenges. Through the PMK, we aim to work together with the client to find a solution.
What is the procedure?
Clients can register with Visio. A referral from an ophthalmologist is required. We will then contact the client to schedule an intake (by phone), after which a decision will be made regarding which tests will be performed. In general, clients do not undergo a visual function assessment unless there are indications that the other eye also has a condition or abnormality. Clients may opt for a social work assessment and/or an evaluation by our occupational therapist (rehabilitation therapist). For social work assessments, “standard” interviews are conducted, as is already the practice at Visio.
The occupational therapist conducts a targeted interview and observes the activities with which the client reports having difficulty. Recommendations are then provided. These recommendations may include performing eye-hand coordination exercises, applying a visual strategy, or optimizing lighting and contrast. If necessary, a treatment plan with multiple (sub)goals is developed.
The recommendations provided focus on: learning more efficient eye movements to improve mobility and general daily living skills. In addition, attention is given to eye-hand coordination, with an emphasis on body awareness (knowing where something is through your body). Lighting makes a big difference in perceiving “depth.” In most homes, lighting is not optimal. However, in workplaces, it can be adequately adjusted if necessary. With the right lighting, it is often easier—and therefore more sustainable—to perform certain tasks. For participating in traffic, additional modifications to a car and/or bicycle may be recommended. For example, extra mirrors and/or indicators in the mirrors or on the dashboard so that the driver can clearly see if someone is driving behind or next to the vehicle. But here, too, efficient eye movements can provide clear added value.
A few examples
A nurse was observed attaching a needle to a syringe. The woman does not perform this in a single fluid, coordinated motion; she focuses intently on the task. With some effort, she is able to complete it within an acceptable amount of time. It is recommended that, during eye-hand coordination tasks (e.g., attaching a needle to a syringe), she compensate by making symmetrical contact with both little fingers and the bases of her hands, and then precisely attaching the needle to the syringe. She has been given exercises to help her become more skilled at this.
A clinical chemistry and hematology analyst had significant difficulty perceiving depth while pipetting, transferring blood tubes, and pouring a specific amount of liquid into a measuring cup. It is recommended to use a solid, matte, contrasting background while pipetting and while reading the volume of liquid in a measuring cup so that the scale markings are more visible.
Once the counseling sessions are over, an evaluation follows. Is there anything left unresolved? Are things going as you’d like? Are any updates needed? The client mentioned earlier now says: “Considering the circumstances, I’m doing remarkably well. Over the course of four years, I’ve gotten very used to living with one eye. I can drive again and navigate traffic on my own. I also feel confident enough to go to the theater alone and go out on my own again.”
That is what PMK and Visio stand for: “Making participation possible (as soon as possible).”
