Let there be light

Vision depends on light. This may come from either the sun or from an artificial source such as a light bulb. Just as the causes of decreased vision are variable, so the best lighting arrangement for one person may not be best for another. Some people require intense bright light while others require much more subdued levels.

The most important consideration is the direction of the light. It should be aimed at the task at hand, not at the eyes. The light should come over the shoulder of the better eye. Light can be sunlight from a window or artificial light from a lamp. Generally incandescent 75 watt light bulbs at near distances of 1 to 2 feet are satisfactory, but experiment to find out what works best for you. Replacing old and darkened bulbs can also give new light to a room.

Inadequate illumination is a frequent cause of reading failure for people who have adequate magnifiers. So turn on the light and use your vision.

Donald C. Fletcher, M.D. Glendale, California

---

A question I am asked by referring doctors and family members of low vision patients is 'How do I know if an assessment for a video magnifier (CCTV) or other low vision aids is warranted?' I suggest they ask their patient or family member some simple and direct questions that help to reveal whether or not their visual impairment is having a functional impact on their life. Some useful questions might include:

• How are you managing to write checks, pay bills, or balance your accounts?
• How has your vision loss affected your job?
• How has your vision loss affected your leisure-timeactivities?
• Are you able to do any pleasure reading?
• Are you able to read and manage you mail?
• What visual activities do you miss?

A vague question like "How is your vision?" will usually not give the useful information that specific questions such as these can elicit. Vision is useful for more than reading a letter chart, and direct questioning about the functional implications of vision loss is necessary to appropriately treat or refer low vision individuals. Asking specific questions can also demonstrate a sensitivity that will help to open communication lines further.

Donald C. Fletcher, M.D. Glendale, California