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Retinal Implant Restores Sight

Three blind patients have had their sight partly restored after scientists in Germany developed an electronic eye implant. The breakthrough is being hailed as “a significant advance” in retinal prostheses, which could revolutionize the lives of 200,000 people worldwide who (have) retinitis pigmentosa (RP), a degenerative eye disease.

A subretinal implant inserted under the retina of the three patients has allowed them to see shapes and objects. The best results were achieved with Miikka Terhol, a 46-year-old from Finland, who was able to recognize cutlery and a mug on a table, a clock face, and discern seven different shades of grey. He was also able to move around a room independently and read large letters set out before him.

Professor Eberhart Zrenner of Germany’s University of Tuebingen, and colleagues from the private company Retina Implant AG, initially tested the subretinal chip on 11 people. Some noticed no improvement as their condition was too advanced, but most were able to pick up bright objects. It was only when the chip was placed further behind the retina, in the central macula area, that the best results were achieved with three people--two of them having RP and the other a related inherited condition, choroideraemia.

David Head, chief executive at RP Fighting Blindness, welcomed a new report on Dr. Zrenner’s work and said, “This technology is very exciting ... however, these devices are at an early stage of development as this report notes, and it’s important that we recognize that from early trials to a product that is fully proven and generally available can take a long time.”

Follow-up work on the subretinal implant is due to take place in several centres, including Oxford Eye Hospital and the Nuffield Laboratory of Ophthalmology, where a clinical trial of the electronic retina implant is due to take place in 2011-2012.

The research by Professor Zrenner and his colleagues is published in Proceedings of the Royal Society B (November 2010).

RP Fighting Blindness: www.brps.org.uk

Reprinted from NB, Issue 60, December 2010.

When Passions Collide

Editor's Note: Shelley Ann Morris is an AEBC member who lives in Ottawa, Ontario, and works at Volunteer Ottawa as a Recruitment and Referral Services Coordinator

There are two things that I am very passionate about--music and good health.
Although I’m not a musician, I have a deep appreciation for song. I was raised on jazz--classics like Louis, Ella and The Duke. My father is a huge fan, and that provided the soundtrack to my formative years. As I grew, so did my musical tastes. I discovered the jazz that I myself liked--fusion, acid and smooth jazz, which are my mainstays when I am studying or working. One of my favourite uncles was a classical music fan; his legacy includes an appreciation of classical music. We made several trips to the National Arts Centre and excursions to record and CD stores. One of our traditions was to see The Nutcracker at Christmastime.

A look through my iPod or CD collection is like a trip to anywhere! When I’m exercising, it’s straight ahead classic and 80s rock, 90s grunge and today’s alternative. My collection is also filled with plenty of rhythm&blues/soul, electronic/dance and adult urban music. I like my share of pop music, world music, and there are country songs that inspire me too.

Ottawa hosts many music festivals. I feed my musical addiction by volunteering at our Jazz, Blues and Folk Festivals. This allows me to get my fill and not have to spend a fortune on tickets! Volunteering at the festivals has allowed me to see many of my favourite artists and discover new ones. There’s nothing like being outside on a hot summer day, eating junk food and listening to good music. When the warm weather and the positive vibes work their magic, you know that you are living in the best place in the world!

I’ve been involved in an organized fitness program for the last 20 years. In 1990, an aerobics program was initiated at the CNIB in Ottawa. I jumped in enthusiastically and started seeing benefits right away. Unfortunately, our instructor moved to Toronto. Undaunted, I began fitness classes at the Dovercourt Recreation Centre. Along with low-impact aerobics, I added step, spinning, yoga and strength training to my regime. I’m an avid swimmer and feel as at home in the water as I do on dry land. What started out as weekly participation in an exercise class soon developed into a lifestyle that included a love of sports and fitness. I have conquered the CN Tower’s stairs 16 times, and run several 5K races and one 10K race. Recently, I was chosen to be one of 13 blind Canadians who will train for and participate in Won With One--a triathlon program. This is going to challenge me like I have never been challenged before! Being involved in sports and fitness has added life to years. I am 48 years old and never better! Growing up, I was always encouraged to make the most of my abilities regardless of restricted vision.

How do these passions collide? Next summer is going to be a challenge. My first triathlon takes place right in the middle of Bluesfest. I’ll be pulled in equally opposite directions. There will be the opportunity to attend great live shows, to meet and volunteer with like-minded people and enjoy some great food. At the same time, there will be the adrenaline rush of building up to race day and the excitement of completion and participating in a brand new adventure with people who, like me, refuse to listen when someone tells them that blind people can’t/shouldn’t do sports. We’ll be showing others that we can, and will give 100% effort. Through the triathlon, I will have the opportunity to be at my best both physically and mentally. There will be a balancing act, as I’ll have to maintain the discipline required to perform well--no binging out on junk food or missing workouts and training sessions. There will be a weekend or two that will take me out of town during my beloved festival season to compete.

Come music festival season, I not only fall right off the health wagon, it usually runs me over! In 2011, sin and salvation will battle for hegemony. Can I keep the balance?

Ready, Aim, Fire!

Editor's Note: Chris Stark is a long-time advocate for increased access, universal design and true inclusion. He is an AEBC member living in Ottawa, Ontario.

It seems to me that the older I get, the harder it is to be independent. While my specialist and hospital clinics communicate with me by email, Health Canada and its agencies do not. Canada Pension Plan will, but I have to call and then wait three weeks. The Ontario government is no better in providing accessible information. I do get pills in bubble packs, paid for by the pharmacy/government, with the packs containing the correct doses of medication for each time of day for a week. This means I can avoid taking the wrong pills in the wrong amounts at the wrong time. Recently, I was asked to monitor my blood glucose level. Here, I outline the research I did on talking blood glucose monitors.

Finding information about products that can be used by persons who are blind is not always easy. As a first step, I spoke with a number of people who are blind, and received a great deal of useful and practical advice. I strongly suggest that others do likewise.

The Canadian Diabetes Care Guide website (http://www.diabetescareguide.com/en/monitoring.html) was helpful in learning about blood-glucose monitoring. While the United States continues to use imperial measurements (milligrams/deciliter), Canada began using millimoles/litre in 1967. Make certain the device you choose can give readings this way.

An article I found particularly useful was "Evaluating Glucose Meters: Talk is Cheap, But Access is Golden" (http://www.nfb.org/images/nfb/Publications/vod/vod_24_1/vodwin0910.htm). Published by the National Federation of the Blind (NFB) in the United States, it says: "The contemporary meters are smaller, faster, and much less expensive than older choices, require only a tiny drop of blood, and are easier to use. However, buyer beware! While these meters are being aggressively marketed to blind and low vision users, only the Prodigy Voice is totally accessible. Despite the hype, you will find that you need sighted assistance to use essential functions such as time and date, and memory review on many of these products." Another NFB article is "The Talking Blood Glucose Monitor Revolution" (http://www.nfb.org/Images/nfb/Publications/vod/vod215/vodwin0707.htm).

Present choices for talking glucose monitors include Prodigy Voice, Prodigy Autocode, Oracle, Advocate, Redi-Code, Companion, Embrace, Clever-Chek, Smartest Smart Talk, and the Accu Check VoiceMate. I have tried the Prodigy Voice and the Oracle.

There are basically three activities involved in monitoring your blood sugar level: pricking the skin with a lancet from an applicator; getting some blood and putting it on the test strip; and having the blood glucose monitor read the result to you. Also, in my case, doctors want to see the record of readings.

Both the Oracle and Prodigy monitors come with manuals in audio format. While I found each manual adequate, the one for the Prodigy contains a chapter on carrying out a blood sugar test as someone who is blind, which I found useful.

Each talking glucose monitor comes with lancets and lancet devices, but it appears that it doesn't matter which ones you use; there are universal lancets available that fit most lancing devices. The test strips used for each monitor, though, are specific to that product. Once you decide on which monitor to use, the correct strips have to be purchased. The talking monitors are usually free or very low cost, but the test strips are fairly expensive. The Prodigy I use requires the Prodigy Voice strips.

Both the Oracle and Prodigy come with software to install on a computer to record readings. Each has an internal memory to keep track of about 400-plus readings. While the Oracle software is not accessible without using a mouse, the Prodigy software is supposed to be accessible, though it was being updated at the time of this writing. The company did acknowledge that the software would be reviewed by people who are blind to make sure it continues to be usable.

I personally find the Prodigy more user friendly than the Oracle. It is easier to get blood onto the strips and get a reading, and the review and settings functions are totally accessible. While I can control the Prodigy independently, sighted help is required to alter the Oracle's settings and read the history of results. The downside of all of this is that neither device is available in my province and test strips have yet to be approved for use. Therefore, you have to order the devices from a supplier.

The Prodigy can be ordered from several U.S. places, which ship it as "Medical Supplies for the Blind." They go right through customs, but you should check on regulations (Canada Customs: English: 1-800-461-9999; French: 1-800-959-2036). Future Aids/The Braille Superstore is a Canadian company that sells the Prodigy in provinces where the device has been approved for use (Toll Free: 1-800-987-1231; Email: sales@FutureAids.com; Website: www.braillebookstore.com).

As a newbie, I found it challenging to tell if I had punctured the skin to get enough blood to test. But as the Prodigy manual says, "Don't give up, keep trying and practice, practice, practice." And though I shouldn't be, I'm appalled at the lack of locally available, useful information. Diabetic organizations and most pharmacies had no information for people who are blind. The only device they knew about, and could get, was ten-year-old technology, the Accu-Check VoiceMate, in which the audio is an add-on. It is the most expensive of them all, costing $400-$500.

Compared to when I was younger, the same old problems persist--lack of resources and lack of accessible information, not to mention people who know nothing about blindness except perhaps pity. This has motivated me to outline my impressions and experiences as a new user, hoping to help others who find themselves in a similar situation.

Project Takes Eye Health to the People

Snuneymuwx First Nation, British Columbia--How long does it take for a Mobile TeleOphthalmology Project to go from dream to reality, asked Norman Lewsey, executive director of the Inter Tribal Health Authority (ITHA) on Vancouver Island. Five long years, he said. Not so surprising then that the launch of the project would be turned into a big event, complete with feast and speeches from some of the people who had devoted considerable energy to seeing the dream come to fruition. The celebration included the blessing of the teleophthalmology mobile units and traditional First Nations drumming and singing.

Gathered at Snuneymuwx near Nanaimo on April 16 were health representatives full of the hope that their project would bring some equity to First Nations in the area of health services. Vancouver Island residents living in 51 rural and remote First Nations communities at high risk of developing diseases of the retina related to diabetes would soon benefit from a new mobile retinal screening service. The technicians were trained, nurses hired, and two highly motivated doctors were standing by in Victoria ready to make assessments.

Rural and isolated patients have trouble accessing the same levels of health care as other people in British Columbia. Some can't afford to travel to urban centres. Others refuse to leave home. The danger of not getting tested is that diseases that could be treated are left undetected. Patients with diabetes are particularly prone to eye disease that can lead to blindness, and there are more incidences of the occurrence of diabetes in the Aboriginal community than there are in the mainstream population across Canada. The British Columbia First Nations Health Plan estimates that prevalence of diabetes among First Nations people is up to 40 percent higher than for other British Columbians.

Dr. Stanley Shortt, one of the retinal specialists on the teleophthalmology project team, said people born within the past 10 years have a one in three chance of developing diabetes. Worldwide, by the year 2030, 438 million people will (have) the condition. Diabetes is the leading cause of blindness in people ages 21 to 74. Getting tested allows doctors to treat issues before they become problems.

The mobile teleophthalmology units will travel to the patients and send the images of their eyes via a secure link to retinal specialists who will examine, investigate, monitor and treat any problems long-distance. Nanoose First Nation Chief David Bob is the ITHA co-chair. He explained that the units didn't test for vision but for disease and urged everyone to take advantage of this technology when the units are in the communities.

About two million Canadians have diabetes mellitus, one-third without knowing it. Uncontrolled blood sugar levels can cause many health problems, including coronary heart disease and renal failure, retinal damage or retinopathy. People with diabetic retinopathy are 29 times more likely than the general population to become blind.

Diabetic prevalence among the 35,000 First Nations people living within the Vancouver Island Health Authority region is estimated to be 2,200. This population is geographically distributed among some of the health authority's most isolated communities. Health Canada's First Nations and Inuit Health Branch and Canada Health Infoway jointly funded the $1 million teleophthalmology project, contributing $404,000 and $636,000 respectively.

"Improving the health status of Aboriginal people on Vancouver Island is one of VIHA's key priorities, as identified in our five-year strategic plan," said Jac Kreut, Vancouver Island Health Authority board chair. "We are delighted to be a part of this innovative project that gives residents living in remote and rural Vancouver Island communities who are at risk of developing diseases of the retina the same access to retinal screening services that are available to people living in urban centres."

Four primary screening clinics are located on Vancouver Island in Sooke, Nanaimo, Port Alberni and Alert Bay. The screening equipment used in the clinics is portable, and will be taken to remote and rural First Nations communities where needed.

Said Snuneymuwx Elder Bill Seward, he was pleased to have witnessed the launch of the technology in his community. "It's good for our people. It's good for our children."

© Windspeaker. May 1, 2010. All rights reserved.

Canada's Programs for Disabled Too Complex, Says OECD

Canadians with disabilities or health (issues) are caught in a complex web of federal and provincial programs that make it almost impossible for them to join or remain in the workforce, says a new OECD report. Few programs lift the disabled out of poverty and many seem to work at cross-purposes, says the report by the Paris-based Organization for Economic Cooperation and Development, which looked at the major disability benefits and services offered by Ottawa and the provinces.

To improve programs and make it easier for the disabled to get help, the report recommends better federal-provincial coordination and "one-stop shopping" offices.

The 85-page report comes on the eve of a promised Ontario review of social assistance and mirrors many of the recommendations of a provincial expert panel that called for more coordination of federal and provincial programs for vulnerable working-age people.

"Even with better coordination, there is considerable room for streamlining by making provinces fully responsible for all employment measures and programming," says the OECD report, released this week.

Like many OECD countries, the report notes Canada's benefits and services are focused on what the sick and disabled cannot do rather than on what meaningful work they are able to do. Before the recession, just 60 per cent of Canadians with health (issues) or disabilities were in the workforce and their unemployment rate of more than 16 percent was twice as high as the general population, the report says.

A spokesperson for federal Human Resources Minister Diane Finley said the Harper government has taken "unprecedented action to support Canadians with disabilities" including the new Registered Disability Savings Program, Employment Insurance sickness benefits for the self-employed, and the Working Income Tax Benefit.

Mary Marrone, of Ontario's Income Security Advocacy Centre, welcomed the report's recommendation that Canada and other countries need to focus on people's abilities, not their disabilities. But she is concerned about the report's suggestion that countries should tie disability benefits to a person's efforts to work, even part-time. "We need to be providing real opportunities for people to work through employment support and accommodation and not make work an obligation for people with disabilities," she said in an interview.

Michael Mendelson of the Caledon Institute of Social Policy said Canada would be unwise to adopt one-stop shopping for the disabled before reforming the various federal and provincial programs. "Creating an integrated service as a Band-Aid over a dis-integrated system would just create one more layer of bureaucracy," he said. "The issue is the coordination of programs," said Mendelson. "We need to try to develop our income security system as a whole."

Reprinted from The Toronto Star, October 3, 2010, courtesy of Torstar Syndication Services.

Climate Change and Disability: A Burning Issue

Known for his work in the Disability Studies field, academic Dr. Tom Shakespeare is also interested in the environment. This month he has come across recently written papers on where the two areas collide. Scenes in New Orleans post Hurricane Katrina.

I've just spent 30 minutes on the phone, arranging wheelchair assistance for one of my frequent visits to Geneva. This time it was more complicated, because I am travelling by train, and my meagre French was tested to the limit trying to book help on French and Swiss railways. But minimizing extra flights seems the least I can do to contribute to avoiding global warming. Amidst all the dire warnings, I had heard nothing so far about the impact of climate change on disabled people, until I read a recent essay by my friends Leslie Swartz and Kumanan Rasanathan. They argue that climate change is a health and disability issue. Given that global warming will disproportionately affect the world's poor, and that the world's poor are disproportionately likely to be disabled people, they conclude logically that our disabled brothers and sisters in the developing world will bear the brunt of the impact.

Following up their piece, I came across the Human Impact Report on "Climate Change--The Anatomy of a Silent Crisis", published by the Global Humanitarian Forum here in Geneva. It is as alarming as it is glossy, showing that while 235 million people are currently directly affected by climate change, this will rise to 660 million by 2030.

From the projections in the report, it seems that many factors will cause problems for disabled people in particular. For example, we can expect more heat waves. Increased heat contributes to worsening health, due to things like asthma and strokes. The 2003 heat wave in Europe killed 35,000 people in five countries, and it was older people and disabled people who were the worst affected. Higher temperatures also mean that diseases such as malaria will become more widespread. It is estimated that climate change related deaths will increase to 500,000 by 2030.

Drought and famine will have a big impact. Already, 1.3 billion people in the world suffer water scarcity. Global warming is projected to cause a 50% reduction in food yield by 2020. Already, drought reduced food yield in Uganda by 30% in some areas in 2008. Currently, 40% of child deaths in Uganda are caused by malnutrition, and 38% of children under 5 are stunted because of lack of food.

By contrast, in Indonesia too much rainfall also affects food yield: in some regions, 50% of children are stunted. It is well known that food shortages, and particularly lack of micronutrients, cause physical and mental impairments.

A third example is the increase in climate-related disasters, such as hurricanes and flooding. According to the insurer Munich Re, there has been a 40% increase in weather related disasters since 1980. There are currently 400 weather related disasters per year.

It is well known that disabled and older people are more vulnerable in emergencies. For example, 60% of the deaths caused by Hurricane Katrina were in people aged 65 or older. By 2030, 350 million people worldwide will be affected by natural disasters. More awareness is needed of the particular needs of disabled people in emergencies.

Finally, the problems of food and water scarcity, plus natural disasters, plus rise in sea level, will generate more displaced people. Already, there are 26 million climate- displaced people in the world, and each year, another 1m are displaced due to climate related disasters. These figures are projected to triple by 2030, with low-lying islands and countries like Bangladesh particularly vulnerable.

Migration is more complex for disabled people, who will face access and transport barriers, and are not likely to be a priority when it comes to resettlement.

To summarize, the message from these projections seems to be that because of global warming, more people might become disabled; more disabled people are likely to become sick or die; and that disabled people will be more affected by factors such as famine, weather disaster and consequent migration. The obvious conclusion is that climate change is a disability rights issue.

Faced by the reality documented in this and other global reports on global warming, my individual decisions to use the train rather than fly, or use my manual chair rather than the power chair, can only be trivial acts of conscience. But perhaps together, when the millions of disabled people in the world add their voices to the campaign for climate action, we can help make a difference.

Reprinted from BBC Ouch, October 23, 2009.

Photo: Tom Shakespeare, a Research Fellow at Newcastle University. His non-fiction books include Genetics Politics: from Eugenics to Genome and The Sexual Politics of Disability

Hope for Future Cancer Patients

I was born in 1952 and was a healthy baby. When I was about six months old, however, my mother began to notice I was having difficulty focusing when looking at something, and before long that I could no longer see her when she stood in my bedroom doorway. Although our family physician in the small northern Ontario town where we lived did not think that anything was amiss, he eventually referred us to a specialist in Kirkland Lake, the city closest to our home. It was there that my mother learned I had bilateral retinoblastoma, a rare form of cancer of the eyes that, if not treated, would be fatal. My parents had never heard of it before.

Retinoblastoma (RB) occurs in children from the time they are in the womb up to the age of five years, and accounts for about three percent of pediatric cancers in those under the age of 15. Approximately 60% of cases are unilateral (affecting one eye), with the remaining 40% being bilateral (affecting both eyes). While RB is curable if caught early, 87% of affected children worldwide die, mostly in developing countries. In developed countries, 97% of those who do live have moderate to severe vision impairment.

In the 1950s, when I was diagnosed with RB, there were very few treatment options. Radiation therapy was available in New York, but my mother was told that it created a great deal of facial scarring, and often didn’t work. The second option was radical surgery to the affected eyes, which could result in blindness. My ophthalmologist at Toronto’s Sick Children’s Hospital, where I was taken in the winter of 1955, felt my condition had progressed beyond the point where radiation would help, and so in order to save my life my mother signed a consent form to have both of my eyes removed and replaced with prosthetic ones. About two months before my third birthday, I entered the hospital with enough vision to remember seeing my mother standing just outside my room talking to a nurse. When I left the hospital, I saw nothing, and all I really remember is a feeling of extreme confusion at people being able to see me but I couldn’t see them.

But I adapted to my situation, and for the most part I had a happy childhood. I was a curious and adventurous child, and I taught myself to do just about everything my sighted friends did. I grew up, obtained a university degree, and after a few other jobs began working at Statistics Canada.

As far back as I can remember, I wanted to have children. For me, becoming a mother was more important than anything else at that time. When I learned at the age of 23 that the retinoblastoma that had caused my blindness was 50% hereditary, I was devastated. Between the ages of 23 and 30, I struggled with the numerous ethical issues this raised. Friends and family regularly voiced their opinions about people with hereditary conditions starting families, with one individual even saying that it would be “socially irresponsible” for me to have children. At the age of 30, however, I was married, and my husband and I decided to start a family.

Unlike my parents before me, and thanks to modern advances in genetic research and treatment options, my husband and I were able to inform ourselves about retinoblastoma before we had children. I contacted the National Cancer Institute of Canada during my first pregnancy and was provided with a great deal of literature on this particular form of pediatric eye cancer, as well as the name of a doctor at Sick Children’s Hospital who specialized in this condition. Under her guidance, every possible step was taken to ensure that, if the condition existed in any of our children, measures to arrest the progress of the disease would be taken as soon as possible.

We had two children--Philip in 1984 and Alena in 1987. Philip was monitored regularly from birth until he was two years old to make sure he was clear, and a later blood test showed that he does not carry the RB gene. Alena, however, was found to have two tiny tumours on one eye and three on the other when she was four months old. From then on, we travelled once a month from our home in Ottawa to Toronto, then every two months, every three months, etc. Lazar and cryo (freezing) therapies--treatments that were not available during the 1950s--were used to arrest the growth of the tumours. By the time Alena was two years old, the tumours had faded into scars that seemed to have had no effect on her vision. In April of 1990, Alena’s doctor said, “Yes, I would say this child is cured.” We then visited the hospital every year till she was 14 and every two years till she was 18. Since the scars have remained quiet and she has passed the age when any retinal tumours might occur, Alena can now make annual visits to a local retinoblastoma specialist.

Thanks to the great strides in cancer research, my daughter has full vision in both eyes and is a healthy young woman. We are fortunate in Canada to have access to world leaders in the diagnosis, treatment and genetic analysis of retinoblastoma. Consequently, the survival rate in Canada is now about 96%.

For further information, visit the Canadian Retinoblastoma Society’s website at http://www.rbsociety.ca or Retinoblastoma International at http://www.retinoblastoma.net.

Adapted from the March 2007 edition of @StatCan, the newsletter of Statistics Canada.

Vision Loss: Signs and Prevention

Editor's Note: Sara Bennett is an AEBC member and Associate Editor of this magazine. She is a freelance writer and holds Certification as a Vision Rehabilitation Therapist.

The four main causes of blindness and partial sight in Canada are age-related macular degeneration (AMD), glaucoma, diabetic retinopathy and cataracts. While two major risk factors for each are age and a family history of the eye condition, neither of which can be changed, there are steps you can take at any stage of life to help minimize, or even prevent, vision impairment caused by these diseases. Taking precautions, staying alert to vision changes and having routine eye exams, even when your vision is stable, are all crucial.

What should you be looking for? Any of the eye conditions listed above can progress to an advanced stage before symptoms appear; however, some signs of vision loss you might notice include:

Age-Related Macular Degeneration

  • The "dry" form progresses slowly and the "wet" form very quickly
  • Decreased central/fine-detail vision; needing more light or magnification when reading/sewing
  • Decreased colour perception, contrast sensitivity; difficulty matching clothes
  • Straight lines appear wavy, like the sides of buildings or telephone poles
  • Blurry/dark spot in centre of vision
  • Turning/tilting your head to use peripheral vision

Glaucoma

  • The "open-angle" form progresses slowly and the "closed-angle" form very quickly
  • Reduced peripheral vision; bumping into things, difficulty seeing in the dark
  • Reduced depth perception; stumbling on stairs, difficulty in sports
  • Reduced distance vision; missing street signs when driving
  • Turning your head to view things straight on

Diabetic Retinopathy

  • Blurry spots, floaters and/or flashing lights
  • Trouble adjusting to changes in light; going from a dim building into sunshine outside, or vice versa
  • Sensitivity to glare; difficulty reading a glossy magazine
  • Reduced night vision

Cataracts

  • Cloudy vision, like looking through a dirty window
  • Frequent changes to your eyeglass prescription
  • Double vision in one eye
  • Sensitivity to light and glare (see Diabetic Retinopathy above)

Now that you are aware of possible signs of vision impairment, here is a list of strategies to help minimize further vision loss, or even prevent it in the first place:

Avoid Eye Injuries

  • Hard blows, punctures, cuts, extreme heat or chemical burns can cause cataracts, retinal detachments, corneal scarring and more
  • Protect eyes, such as by wearing safety goggles, during sports, home repairs and other possibly "dangerous" activities
  • If working with chemicals, make sure the area is well ventillated

Reduce Sunlight Exposure

  • Protects retina and reduces risk of cataracts and AMD
  • Wear sunglasses with 100% UV protection, even in the winter

Quit Smoking

  • Lighting up is a risk factor for AMD
  • Quitting or even reducing the amount of smoking decreases the chance of developing cataracts and, if you're a diabetic, diabetic retinopathy

Limit Alcohol Use

  • Heavy drinking increases risk of cataracts

Improve Diet/Maintain A Healthy Weight

  • Reduces risk of developing diabetes
  • To reduce risk of AMD, avoid foods rich in unsaturated fats, highly processed or refined foods, and increase intake of whole grains, foods high in omega-3s, fresh fruits and dark green leafy vegetables

Reduce Risk/Manage Diabetes

  • Diabetes increases risk of many vision conditions, like retinopathy
  • If you already have diabetes, managing it reduces risk of getting diabetic retinopathy

Visit the Eye Doctor

  • Routine eye exams, even when your vision appears fine, can detect early stages of eye conditions
  • Early detection is essential for treating eye disease and minimizing vision loss
  • Some eye conditions, if caught early enough, can be corrected/treated with glasses, medication or surgery
  • Visiting the eye doctor regularly is also vital because vision changes may indicate the presence of another, possibly more serious health condition

While the possibility, or reality, of vision impairment might seem overwhelming and even scary, you can be proactive in preventing or minimizing it. You can also take steps to inform yourself about the many resources and services that are available to ease the transition and assist you in continuing to live your life--as someone with limited sight. The good news is that you, or someone you know with restricted vision, can work, play, socialize and achieve as much as you did before--just a bit differently.

While I've tried to concentrate on the most prevalent eye conditions, symptoms and preventative strategies here, space did not permit a more thorough look at any, or at conditions specific to children, for example. I encourage readers to check out the resources below for further information.

Resources

Insight eNewsletter: http://www.cnib.ca/en/about/publications/newsletters/insight/default.aspx#contentstartshere

Your Eyes: http://cnibsecure.cnib.ca/site/R?i=DUL0yXhsDTIoihA7hSgQfQ

AMD Alliance International: http://www.amdalliance.org/

Foundation Fighting Blindness: http://www.ffb.ca/index.html

Glaucoma Research Foundation: http://www.glaucoma.org

Canadian Association of Optometrists: http://www.opto.ca/en/public/site_map.asp

Canadian Ophthalmological Society: http://www.eyesite.ca/english/public- information/index.htm

The Prodigy Voice Speaks

Editor's Note: Ruth Hogue is a member of AEBC and lives in Winnipeg, Manitoba. She is a passionate advocate for blind and low vision diabetics to be able to access talking meters, etc. and control their diabetes so they can live well with diabetes.

If you are a diabetic, you know the importance of blood glucose monitoring. If you are in the process of losing, or have already lost, your sight due to diabetic retinopathy, a complication of the disease, then what? Monitoring becomes a difficult task, as there are so few talking blood glucose metres on the market today. In the past, talking metres were bulky and expensive, but you had to bite the bullet, as the risk of further complications made blood glucose testing all the more important. Now, there is a talking blood glucose metre called the Prodigy Voice coming to Canada (approval for sale here is pending) that will address these issues.

The third generation of talking blood glucose metres, the Prodigy Voice, is the genius of Diagnostic Devices Inc. of Charlotte, North Carolina, and has received awards for accessibility and affordability from both the National Federation of the Blind and the American Foundation for the Blind in the United States. This praise is hardly surprising, given that the process of developing the product and its manual, as well as training technical support staff, included input from the blind and partially sighted community.

So what's so special about the Prodigy Voice? It's 3.78 inches long (95 mm), 1.7 inches wide (55 mm), 0.71 inch in height (18 mm), and weighs only 2.4 ounces (68 grams)--all of which make it very portable for a pocket or purse. It has raised buttons with contrasting colours, as well as an indent to indicate where to insert the test strip, but its most important feature is that it speaks and guides the user through all the steps of testing, in the setting mode, and in the memory storage of 450 previous tests which other meters on the market do not do. In addition, it has a repeat button, an ear jack, and a standard USB port to easily connect to your computer. A printed and audible CD manual comes with the metre, but it can also be obtained in braille or a Word document upon request. And for users wishing to test on other areas such as the palm, forearm, thigh or calf, the Voice metre offers alternate site testing. Finally, if you need help, technical support staff has been trained with the assistance of blind and partially sighted people, so they can understand problems from an unsighted person's perspective.

As a 44-year-old living with type 1 diabetes for 35 years, I have been blind for 21 years, and I have seen talking blood glucose metres come and go. Although I had to purchase my metre from the U.S. for $85 (American), I felt my health was worth the cost. I have used the Prodigy Voice for two years now, and it has given me the independence I was looking for. I was able to cancel the visits from the health-care professionals, and I know I can check my blood glucose readings, even in the middle of the night, when experiencing a hypoglycemic episode; my husband, who has retinitis pigmentosa (RP), no longer has to struggle to help me read the result. I also find it useful to be able to re-check my blood sugar reading using the memory function, if I was distracted before measuring my insulin. I can also use the repeat button to repeat either instructions or the last test result, if I missed it. I have heard the Prodigy Voice referred to as the "Cadillac of talking blood glucose metres" by other blind and partially sighted users. As a fellow consumer, I would definitely agree with this assessment.

For more information on the Prodigy Voice, contact Diagnostic Devices Inc., by calling toll-free 1-800-366-5901, emailing intlsales@prodigymeter.com or visiting their website at http://www.prodigymeter.com.

Listening to The Oracle

Editor's Note: Gerry Nelson is a Social Service Worker with CNIB, and volunteers with a variety of service, health- and disability-related charities.

I have been a type 1 diabetic since childhood, almost 40 years ago, and lost my eyesight totally from diabetic retinopathy when I was 25. About two months ago, I was introduced to a wonderful new piece of technology from E Z Health called the Oracle, a talking blood glucometer.

Up until now, glucose monitoring technology was outdated, cumbersome to use, and also very expensive, so when my local pharmacist called to inform me of this new piece of equipment, I was extremely excited. For years, my diabetes had suffered as a result of poor and outdated technology. And the best news I could have heard was my pharmacist telling me the Oracle was now available, and free when I purchased a box of test strips.

The Oracle is small and compact, goes anywhere, and is so simple to use! For any diabetic, blind or sighted, the most important part of good diabetes management is well-controlled blood sugar and testing often. With my new Oracle, I can test as often as I want, or as is required. The Oracle's clear, definitive voice walks me through each step, and gives me my results in only five seconds. It is a must for any diabetic with limited vision!

For more information about the Oracle, contact Tremblay Harrison Inc., by calling toll-free 1-866-829-7926, emailing info@oraclediabetes.com, or visiting their website at http://www.oraclediabetes.com.

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