DiversityNursing Blog

Best Practices In Caring For Vision Impaired Patients

Posted by Erica Bettencourt

Fri, Jan 03, 2020 @ 12:17 PM

visionimpaireddogVision impaired patients face many challenges when visiting hospitals for treatment. There are different ways staff and hospital design can help assist patients who are struggling.

According to research from JAMA Ophthalmology, vision-impaired Medicare beneficiaries and commercial health insurance patients had significantly higher healthcare utilization and costs during and immediately after hospitalization. This is happening because vision-impaired patients have difficulty following hospital routines and struggle to read discharge orders and medication instructions. The excess costs were estimated at more than $500 million annually.

Hospital staff can play a major role in helping these patients by being actively engaged with them and their families.

Lisa Allen, PhD, MA, Chief Patient Experience Officer at Johns Hopkins Medicine in Baltimore, which includes the Wilmer Eye Institute, says, "The biggest issue is to ask the patient or the patient's family what they need to keep them safe. We need to ask that question to everybody, but that patient engagement question is the most important piece for visually impaired patients. When we assume there is a one-size-fits-all for the visually impaired, we are making a mistake. In other words, if you are not a braille reader, and many blind people are not braille readers, then having braille is not going to help when you are in the hospital."

According to Health leaders media, Johns Hopkins Medicine and Bascom Palmer Eye Institute shared their best practices for caring for vision-impaired patients which included measures designed for discharge and medication management, patient safety, and special accommodations.

Johns Hopkins provides discharge instructions in large font type and has the capability to audio-record instructions for patients. They also provide discharge instructions in a format that can be used with a screen reader.

Johns Hopkins staff are trained to promote safety. After surgery, all Johns Hopkins patients have a staff member with them when they are getting up for the first time and when they are walking the hallways.

The Americans With Disabilities Act (ADA) says, staff should initiate an introduction to a patient who is blind by addressing the patient by name. They should always identify themselves by name and function and the reason they are there.

At the University of Miami Health System's Bascom Palmer Eye Institute, stairwells are designed to lower fall risk for vision-impaired patients. They lengthened the staircase guard rails so they extend beyond the bottom of the stairs.

Johns Hopkins is implementing a Bluetooth way-finding app that can be used from home and while using public transportation. "We made sure when we bought the program that it had voice capability, so it can tell you to go to an elevator, it can tell you that you are at an elevator, it can tell you what floor button to push, and it can guide you throughout the inside of the hospital", said Allen.

If your health system does not have a bluetooth way-finding app, the ADA recommends being verbally specific. When a visually impaired patient wants to independently find their way with a cane or a guide dog, be sure to use right and left as they apply to the person who is blind. What is on your right is on the left of a person facing you. For example indicate the number of blocks, hallways, or doors to the elevator. Let the patients know exactly how far the bathroom is located outside of their room or where their food is closely located to them inside their room and what the food is. Verbal interaction is key.

It is important to offer assistance in a way that is not demeaning to the patient. With more research and input from patients, the future of health system's best practices should improve to provide even better patient care.

New Call-to-action

Topics: blind, blind patients, vision impaired, best practices

'Bionic' Eye Allows Man To See Wife For First Time In A Decade

Posted by Erica Bettencourt

Mon, Mar 02, 2015 @ 01:54 PM

 James McIntosh

senior eye close up resized 600

A blind man is now able to see objects and people again, including his wife and family, for the first time in a decade. How? With the help of a bionic eye implant. 

Affected by a degenerative condition known as retinitis pigmentosa, Allen Zderad was effectively blind, unable to see anything but a bright light. As the condition has no cure, Zderad, from Minneapolis-Saint Paul, MN, was forced to quit his professional career. 

He made adjustments to his lifestyle and was able to continue woodworking through his sense of touch and spatial awareness. However, with the help of his new retinal prosthesis, Zderad is now able to make out the outlines of objects and people, and could even register his reflection in a window.

"I would like to say I think he's a remarkable man, when you consider what he's overcome in dealing with his visual disability," says Dr. Raymond Iezzi Jr., an ophthalmologist from the Mayo Clinic. "To be able to have offered him the retinal prosthesis to enhance what he can already do was a great honor for me." 

Retinitis pigmentosa is an inherited condition that causes the degeneration of specific cells in the retina called photoreceptors. The disease can cause some people to lose their entire vision. Mr. Zderad's grandson has the disease in its early stages and, after seeing him, Dr. Iezzi asked if he could meet his grandfather.

The eye implant that Zderad now has works by bypassing the damaged retina and sending light wave signals directly to the optic nerve. A small chip was attached to the back of the eye with multiple electrodes offering 60 points of stimulation.

'Not like any form of vision that he's had before'

Wires from the device on the retinal surface connect to a pair of glasses worn by Mr. Zderad. The glasses have a camera at the bridge of the nose that relay images to a small computer worn in a belt pack. These images are then processed and transmitted as visual information to the implant which in turn interprets them, passing them on to the retina and eventually the brain. 

"Mr. Zderad is experiencing what we call artificial vision," explains Dr. Iezzi. "It's not like any form of vision that he's had before. He's receiving pulses of electrical signal that are going on to his retina and those are producing small flashes of light called electro-phosphenes. These small flashes of light are sort of like the points of light on a scoreboard at a baseball game."

There are only 60 of these flashes of light, but it is enough for Zderad to reconstruct scenes and objects. Although he will not be able to see the details of faces or read, Mr. Zderad will now be able to navigate through crowded environments without the use of a cane, significantly improving his quality of life.

Dr. Iezzi would like to see the technology expanded to patients who have lost the use of their eyes, such as wounded soldiers or people with advanced diabetes or glaucoma.

"In addition, while Mr. Zderad has 60 points of stimulation, if we were able to increase that number to several hundred points of stimulation, I think we could extend the technology so that patients could recognize faces and perhaps even read," he concludes. 

"It's crude, but it's significant," said Zderad happily, as he first used the device. "It'll work."

Zderad will now be able to see his family again, including his 10 grandchildren and his wife, Carmen. And how does he distinguish her, having not seen her for a decade? "It's easy," says Zderad, "she's the most beautiful one in the room."

At the end of last year, Medical News Today reported on the story of a woman with quadriplegia who is now able to use her mind to move a robotic arm, demonstrating "10° brain control" of the prosthetic.

Source: www.medicalnewstoday.com

Topics: medical technology, clinic, technology, health, healthcare, hospital, patient, blind, bionic eye, retinitis pigmentosa, ophthalmologist, implant, senior, nerve, optic nerve

After 30 Years, Blind Patient Can See With 'Bionic Eye'

Posted by Erica Bettencourt

Wed, Oct 08, 2014 @ 11:30 AM

By Linda Carroll

4570884 16x9 700x394 resized 600

For years Larry Hester lived in darkness, his sight stolen by a disease that destroyed the photoreceptor cells in his retinas. But last week, through the help of a “bionic eye,” Hester got a chance to once again glimpse a bit of the world around him.

Hester is the seventh patient to receive an FDA-approved device that translates video signals into data the optic nerve can process. The images Hester and others “see” will be far from full sight, but experts hope it will be enough to give a little more autonomy to those who had previously been completely blind.

Hester’s doctors at Duke University Eye Center believe that as time goes on the 66-year-old tire salesman from Raleigh, N.C., will be able to “see” more and more. After only five days, there has been remarkable progress.

“I hope that [after some practice] he will be able to do things he can’t do today: maybe walk around a little more independently, see doorways or the straight line of a curb. We don’t expect him to be able to make out figures on TV. But we hope he’ll be more visually connected.” said Dr. Paul Hahn, an assistant professor of ophthalmology at the university in Durham.

It was at Duke three decades ago that Hester learned that something was seriously wrong with his eyes. After a battery of tests, doctors delivered the disheartening news: Hester had retinitis pigmentosa, a disease that would inexorably chip away at the rods and cones in his retinas, eventually leaving him blind.

“It was a pretty devastating blow, frankly,” Hester said. “I was 33 at the time.”

But Larry Hester wasn’t the sort of guy to sit around feeling sorry for himself. With the support of family, friends and a devoted wife, he found a way to live his life as normally as possible, depending on his memory to help him navigate around his home and his workplace.

One day his wife, Jerry, saw a story about a device that might help Larry. The FDA had just approved it for use in people who suffer from the same condition as Larry —some 50,000 to 100,000 in the U.S.  

Larry was just the kind of patient that Hahn was looking for to try out the Argus II Retinal Prosthesis system, and he became the first to get the device at Duke.

Argus was designed to bypass damaged photoreceptors and send signals directly to the next layer of retinal cells, which are on the pathway to the optic nerve.

A miniature video camera seated in a pair of glasses captures what the patient is “looking” at and sends the video through a thin cable to a small external computer that transforms the images into signals that can be understood by that second layer of retinal cells. Those data are then sent back to the glasses, which transmit the information through a small antenna to an array of 60 tiny electrodes that implanted up against the patient’s retina.

The electrodes emit small pulses of electricity that make their way up the undamaged retinal cells to the optic nerves, creating the perception of patterns of light. The hope is that patients will learn to interpret those patterns as images.

Last week with the new glasses perched on his nose, Larry sat in a chair at Duke surrounded by medical staff and his family — all waiting for Hahn to turn on the device. Directly in front of Larry was a brightly lit screen.

“At the count of three, we’re going to hit the start button and we’ll see what happens,” Hahn said.

At three, a smile started to play on Larry’s lips.

“Yes,” he said and the smile broadened across his face. “Oh my goodness!”

Jerry looked at him and exclaimed, “Can you see, Larry?”

After giving her husband a kiss, she asked again, “Can you really see?”

“Yes. Flashing. Big time flashing.”

Experts see the new device as the start of something big.

“It’s a fairly limited device, but it’s an amazing leap forward,” said Dr. Colin McCannel, a retinal expert at the Jules Stein Eye Institute at the University of California, Los Angeles. “It’s not the vision you or I are used to. But for someone who has been in complete darkness it must be amazing to see again. I think it’s absolutely phenomenal.”

Dr. Neil Bressler turns to the space program for an analogy.

“It’s like the first rocket ship that went up and down, or when John Glenn went into orbit,” said Bressler, a professor of ophthalmology and chief of the retina division at Johns Hopkins Medicine. “If you asked can we put a man on the moon the next day the answer would be no. It was the first of many steps to achieve the objective of putting a man on the moon.”

While the device isn’t even close to giving Larry back the vision he was born with, he can see contrasts, which allows him, for example, to distinguish between a white wall and a darkened doorway.

If you’ve lived in darkness for decades, that little bit of new-found vision can be a huge gift.

“The other night I was sitting on a dark leather chair,” Jerry said. “He was able to scan over and see my face because it was lighter. And he reached out and touched my face. That is the first time he had done that in a long time. It was a sweet and precious moment.”

Linda Carroll is a regular contributor to NBCNews.com and TODAY.com. She is co-author of "The Concussion Crisis: Anatomy of a Silent Epidemic” and the recently published “Duel for the Crown: Affirmed, Alydar, and Racing’s Greatest Rivalry.”

Source: www.today.com

Topics: FDA, device, technology, medical, patient, blind, bionic eye, vision

Recent Jobs

Article or Blog Submissions

If you are interested in submitting content for our Blog, please ensure it fits the criteria below:
  • Relevant information for Nurses
  • Does NOT promote a product
  • Informative about Diversity, Inclusion & Cultural Competence

Agreement to publish on our DiversityNursing.com Blog is at our sole discretion.

Thank you

Subscribe to Email our eNewsletter

Recent Posts

Posts by Topic

see all