Introduction

Welcome to this newsletter, rather delayed, I’m afraid, by a back injury which I shall try not to mention too often.

The theme of this issue carries on from the last newsletter. Whereas the causes and types of vision loss were described before, here the emphasis will be on what we can do if we have any degree of vision loss. It may still be useful and reassuring to read even if you do not suffer any vision loss as a result of uvetits. It is also worth noting that it does not necessarily follow that if you have uveitis you will, at some point, have visual problems.

This newsletter also introduces a section of commonly asked questions about uveitis. This has been written by Prof. Lightman from Moorfields Eye Hospital in London and is based on what she is often asked in a busy uveitis clinic.

It is planned to expand this in the future, so the group should be a useful way of channeling questions through to leading uveitis specialists who have kindly offered to contribute in this way.

I receive quite a few questions from people who contact the group and I would always welcome more. The questions may be quite specific but, of course, any response will be of a general nature and not case specific.

The more questions received by the group the more we can pass them on to the specialists to answer.

Low Vision: What can I do about it?

In the last newsletter, low vision was defined, and the different types of low vision were described and how it can be measured. As was emphasised in that article, vision may be affected in many different ways and by widely varying degrees. Fortunately, many people will not experience visual impairment or it will only be mild and able to be stopped from getting worse in the future. However to balance things, it must be said that we must be aware of the potential danger to vision and be vigilant and report any suspected signs of visual problems or discomfort in our eyes to our Ophthalmologists

Probably the most important thing to remember about dealing with any loss of our vision is:

People with ‘perfect’ eye sight do not usually use their sight to its full potential. If the vision becomes impaired then the potential for using our vision more effectively is enormous. To illustrate this, consider 2 people out for a walk. One sees a rabbit running across the hillside. They can not see any detail to tell it is a rabbit, but a combination of memory, being observant and maybe being used to having poor vision, tells them it is a rabbit. If the person next to them hasn’t spotted the rabbit, then who in this case has the better vision?

There are many ways of maximising low vision. Some involve the use of all sorts of visual aids including sophisticated computer systems. These can be extremely useful and will be covered later in this article.

However there is a principle that applies to a lot of things and is especially relevant to dealing with low vision. It goes something like: “Out of all the possible solutions to a problem, the most likely to be the best one is the simplest.”

At some stage, and certainly before trying any of the specific vision aids, a professional assessment of low vision should be made by a specially trained Optometrist. This, again is something which will be covered later in this article.

Apart from seeking professional advice or working out what vision aids will be useful then it is just as important to work out the many simple ways that can make all the difference in doing the things we need or want to do.

It may sound too easy to just say how important a positive attitude is, but it can help us adapt to vision problems. For example: When first affected by poor vision one might look at a task like chopping an onion with a sharp knife and think it is something that can’t be done because the onion and knife can’t be seen clearly. However ‘the brain’ still possesses the ability to do the task and knows where your hands are and so the task can be done perfectly well; it just feels a bit funny at first because you can’t see for certain that the onion is all nicely chopped up. After a while you know that the onion is chopped up just fine and so you don’t even think about it. It is also unlikely that you will need to lose a few fingers in the learning process because it is likely that more care is taken because the vision is not great.

This way of adapting can be applied to many situations and as long as it is given the chance and ‘pushed a bit’ the brain has an amazing capacity to adapt.

This is a greatly underestimated means of maximising vision. Trying various types of lighting from different directions and of varying brightness can make all the difference between being able to read a newspaper or book, or not. The reflector type of ‘desk lamps’ are very useful and not expensive. Some rearranging of furniture etc. is often all it takes to establish a few positions around the house or work where you can get straight down to reading, knitting etc. etc. Experimenting and persisting is well worth while as attention to a bit of detail can make all the difference between ‘nearly’ being able to read that newspaper and actually being able to.

The type of lighting required will depend on the type of vision problem. Some people with uveitis will need brighter lights (e.g. macula oedema, certain vitreous opacities), whilst someone with active anterior uveitis or who has a cataract may require the lighting to be more subdued if bright light aggravates their symptoms. One member of the group found that a ‘rose’ coloured bulb helped when anterior uveitis was active. Any suggestions from readers who have found any useful tips would be welcomed and will be passed on in future.

One of the most obvious ways to make our vision better is to enlarge whatever it is we are trying to see.

There are simple ways of doing this like using broad black felt tips to write labels, addresses and recipes etc. or to sit at the very front row of the pictures.

The other main way of enlarging things is to use magnifiers of varying kinds. Using them may sound simple enough but there are many different kinds and, a bit like the lighting situation, a good deal of experimentation and attention to detail pays dividends.

There is help at hand for tasks close up such as reading or detailed work with various magnifying glasses and also for distant tasks such as watching TV or looking for street signs etc. using special monocular telescopes or binoculars.

Close up / Magnifying lenses.

The strength of the different magnifiers is expressed as a power. X1.5 is about the weakest and X8 is powerful for close up work. There are some ‘golden rules’ which are worth remembering so that the best use of these aids are made.

In general, it is best to use the weakest strength of magnifier possible. This usually means that you can see more of anything you are looking at, whether it be more words on a page or more of a picture etc. This probably especially applies to reading. If we try to read the smallest print we can just about manage we will tend to adapt well to that and the result is we can manage to read more things without magnification or need less magnification. Again it is sometimes worth ‘pushing’ a bit to let our brains adapt to something new.

Another general rule is that the lower the magnification power of an aid the larger it will be physically. For example a more powerful X8 magnifier will always tend to be a small lens, whereas a X2 lens could be quite large and wide. This leads onto another rule. The larger the power or strength a lens has then the smaller the field of view.

This is an important rule to understand and is one to consider when choosing a magnifier with a low vision specialist. At X8 power then a word on a page will appear very large and may be able to be seen easily.

The problem is that only one word may be visible. If a X4 is used then the words will be smaller and more difficult to see but more words can be seen.

NB These are not in scale, but just diagrams.

This may make the actual reading process much easier because we can ‘scan’ across the page and take in the meaning of the text instead of struggling to put a lot of individual words together. This, again, is one of these things that can make all the difference between comfortably being able to read a book or not. This is one area where it is essential to get good advice from the low vision service.

Close up types of magnifiers may be hand held, on stands or even set on to a spectacle frame. Having a variety of aids is usually needed to be able to deal with different situations, eg a small hand held for a pocket for travelling, shopping etc. and a larger stand mounted lens for desk work. With practice and enough types of lenses then most tasks can be covered and, once used to them, their use becomes almost ‘unconscious’ and the ‘eye problem’ can almost be forgotten. I know my only problem now with magnifiers is the time I spend looking for the things.

These can be very useful for watching TV and theatre and can also solve a lot of the problems traveling around by making signs readable and they are great for just appreciating the surrounding scenery. They often work best as a small monocular which easily fits in a pocket. Using these automatically, as a matter of habit can, again, hopefully reduce the ‘self consciousness’ that sometimes may be felt with low vision. Apart from the hand held variety monoculars can be made to fit a spectacle frame which is more suited to watching TV.

A major point that is overlooked with all visual aids is that often it is not the vision side of the aid that may be a problem but the ergonomic side. That is to say, you may now be seeing the book you are reading nice and clearly but your arm is dropping off holding up the book close enough to the light etc. This just goes to emphasise that different aids and different furniture/lighting combinations must be explored.

A final point on magnification worth making is: Using magnification and looking at books, lenses or screens will NOT damage the eyes. It may be that the eyes (or the arms) get more tired using aids and rests are needed but no damage will be done.

There are far too many practical tips to mention here and there are many resources which can help (listed at the end of this article). Often the best ones are the ones we discover for ourselves. Tips may range from the simple things like keeping a good supply of black felt tip pens around to use routinely, to making enlargements of maps, directions and recipes etc. using photocopiers or computers. It is worth pursuing these solutions, for example, who has a photocopier? - local library? Soc. for the Blind? friendly school or business? Once a problem has been solved then it just becomes a routine and it ceases to seem like a problem at all.

Depending on the level of vision, there are an increasing number of hi-tech aids. These are worth considering when their use allows much more to be achieved than by using simpler methods. As emphasised before, there are many simple solutions which work well because they can be very versatile and transportable. When the benefits of a hi-tech device obviously outweigh the drawbacks of cost, lack of transportability etc. then they can be excellent tools.

It is not the aim of this article to go into lots of detail about the various types but to cover the sorts of possibilities. Anyone who would like more detailed information should contact the UIG, and more info and other contacts can be passed on.

The most obvious ’hi-tech’ aid, I suppose, is the personal computer (PC). They are useful in a number of ways for anyone with any visual problem. Firstly, with low vision, it is often the case that typed text is easier to read than hand-writing. The size and type of font (this is written in Arial 14) can also make a big difference. When using a personal computer the magnification of anything on the screen can be easily rearranged without any special programmes/software. This advantage of the computer may be combined with the vast amount of information on the internet and CD roms to make it a very powerful tool for people with low vision. The ‘ergonomic’ problem concerning handling large books and searching for things in magazines or catalogues can be made easy when a computer is set up to handle all these things. Indeed it has been said that the internet is one of the greatest steps forward for the visually impaired since braille.

If the standard set up of the PC is not sufficient to overcome the visual problems then there are various specialised magnification programmes or ’speech back’ options available. As said before these are more specialised and for more info or advice please contact us.

Another specific solution is the closed circuit television. (CCTV). This consists of a small TV camera under which a book or papers are placed. They are then viewed on a TV screen or monitor. These vary in their transportability and cost but are very useful with practice.

The RNIB have a large and very useful website to find a number of resources. Below are some links to specific areas of their site that deal with low vision. RNIB can also be contacted on 0345-66 99 99 (UK). 

RNIB Home page:                      RNIB Home Page 

To find a low vision service near you: go to

                                                        RNIB low vision services 

• Find practical aids;

such as large print kitchen accessories, lighting and all sorts of aids that you may not of thought of as being available. The RNIB may be contacted for a catalogue, by phone or from their website. You can also ask them to direct you to a nearby voluntary society that would have items on sale. Conact: RNIB Resource Centre, 224 Great Portland Street, London W1N 6AA. Telephone: 0171-388 1266.

Contact the UIG for further advice or help with the above  

Low vision is obviously a large topic and it will affect people in different ways. The ability to adapt and to think how to solve each problem as it crops up can be of great benefit. When it comes to finding out which type of aids may be useful for a certain individual then contacting a low vision specialist is strongly recommended. The type of aid can be tailored specially to suit and this, as mentioned before, can make all the difference between being able to do a task or not.

A Patient's View  by Adonica Anderson

My 1st Uveitis attack.......

Dec 1999, Sumatra, Indonesia. I was relaxing reading on the veranda awaiting the arrival of my partner & friends. We were to spend Xmas & New Year together. My partner & I then planned to have a final month traveling before returning to England, having spent the last two years away. Whilst reading, I noticed my vision seemed blurred. I decided to test my eyesight, and on doing so discovered my left eye had blind spots or ‘floaters’ in the centre. I could not read and words were broken up on the page. To say the next few days were a nightmare is an understatement that I am sure readers will have a high level of empathy with. Of course it was made all the worse due to my location and circumstances. It was hard finding a Dr/Eye Specialist in Indonesia, and by the third specialist, I found I was extremely weary. My third specialist put me at ease though and seemed to know what he was talking about. I had had four crazy taxi journeys, sharing my seating with chickens and breaking records for how many people you could fit into a hackney style cab. Seemingly endless waits outside and inside surgeries, clinics & hospitals - most of them the kind of places you’d be afraid to take your cat! The blood test centre had the most concentration of mosquitos I had ever seen. I was extremely relieved to be attending a modern city hospital in Medan -finally I had a specialist I felt relaxed with. He prescribed steroids, drops, vitamin C and eye pressure tablets - told me to relax and get back to England as soon as I could. He couldn’t give me an explanation for the blindness, but said maybe I’d had a bang on the head. I headed back to my accommodation and awaited the arrival of my partner, who turned up the following day having had all his money stolen by customs officials in a small Indonesian port. We spent Xmas day with friends and started our 5 day journey across to Bangkok, Thailand. We arrived back in England on 30.12.99 - ready to celebrate the New Year with family!

The thoughts of my 1st Uveitis attack in Indonesia bring back the very emotional feelings I experienced and, at the same time remind me of how strong I can be in a crisis. Although the thought of my sight becoming further damaged frightens me, I also know that no matter what, I will have the strength to get through it and carry on striving for a happy and good life. My return to England brought a clearer diagnosis (Punctate Inner Choroidopathy) and despite my experience, my desire is to one day to go back and spend a less stressful Xmas and new year in a wonderful country – Indonesia.

Adonica Anderson

I know people benefit from hearing other's experiences. Please consider writing a few lines for this section to pass on any useful ways to deal with any aspect of uveitis.

Uveitis Information Group is a charity registered in Scotland, no. SCO28439