How easy is it for low vision patients to navigate their way around your office? As an experiment, put on a pair of trial glasses that blur your vision to 20/200 and imagine that you are visiting your building for the first time—it could be an eye-opener.
The good news is that you don’t have to break the budget to make your office more low vision–friendly. Some changes can be made this week; others can be implemented, at little extra cost, when you next renovate your office.
And once you have made those changes, will everybody assume that you have become a rehabilitation specialist? No—patients with normal or near-normal vision are unlikely to realize the significance of your practice’s new look; but your visually impaired patients will be much more at ease when visiting your office.
Though different disabilities affect vision in different ways, the recommendations that are described below will help most visually impaired patients.
Doors, Stairs and Hallways
Even if your building wasn’t built with low vision in mind, there is much you can do to accommodate the needs of your visually impaired patients.
Building’s entrance. Doorways are easier to find when they are offset from the wall, rather than flush with it. And while you might not be able to change your building’s architecture, you can use color to the same effect. Suppose, for instance, the front of your building is made up of glass panels. A color trim around the doorway makes it a lot easier to find the glass panel that is the door. It is also a good idea to put bold printing or graphics at eye level on glass doors—particularly sliding doors.
Stairs. A bad fall can have devastating, long-term consequences, and this makes changes in the floor surface one of the greatest fears of the visually impaired. A flight of stairs should have a handrail, be well-illuminated and have minimal glare. Put a contrasting strip on the leading edge of each step; without that, the stairs can look like a ramp to a person with low vision. If you have concrete steps outside your building, this contrasting strip can simply be painted on.
Hallways. The next time you recarpet your hallways, put a six-inch-wide, contrasting strip of carpet along the walls to define the path. If you break this strip at the doorways, it will help cue patients to where the door openings are. Similarly, when you paint the baseboards and door frames, select a color that contrasts with the color of the walls. And when you paint those walls, select a matte finish—gloss and semigloss reflect too much light.
Signage. When it comes to your “Exit” and “Restroom” signs, one-inch letters aren’t very helpful. In addition to size, the boldness and font style of the letters is important, as is the contrast between the color of the letters and the background color.
Your Reception Area
For patients, a trip to a physician’s office can be a worrisome experience. And for low vision patients, the challenge of navigating an unfamiliar office is an additional source of anxiety. Your practice can eliminate some of that stress if 1) staff members are sensitive to the patients’ visual needs and 2) the design of your reception area addresses the following issues:
Color scheme. If a carpet, chair and wall are all the same tone, patients with blurred vision will be hard-pressed to tell where one stops and the next begins. You should therefore choose strong, contrasting colors with minimal pattern.
Furniture. Does your furniture have chrome legs? These are often thin and they reflect the color of the carpet—and if patients don’t see them, they may catch their canes or walkers on them. Glass-topped tables might also be invisible to your low vision patients. Tabletops and the reception desk’s countertop should have a matte finish, because it reflects less light than a gloss finish. When selecting chairs, opt for ones with sturdy arms. Patients often use those arms to orient themselves, so they can rotate themselves into the correct position for sitting down. Also, many elderly patients use the arms of a chair when getting up.
Lighting. It is not uncommon for low vision patients to bring along their own large-print reading materials. But if they can’t read them because of inadequate illumination, they won’t be in the best of moods when they enter your exam room. People who are in their 60s may need three to 10 times as much illumination as they did when they were 20 years old—so you should make sure that there is good lighting throughout the reception area.
Your Exam Room
Staff members who escort patients from the reception area to your exam room should be trained in guiding the visually impaired (see “Additional Resources”). In conducting the exam, consider the following issues:
The exam chair. When asking a patient to sit down, be specific with your directions. “Have a seat over there” may not be much help to a visually impaired patient; instead say, “Have a seat in the exam chair that is three feet directly in front of you.” And watch for clutter—the patient should have a clear path from the door to the exam chair. Put the exam chair in its lowest position, and make sure the footrest is up against the chair. This allows patients to get their feet right against the chair, which gives them more control when they lower themselves into a sitting position.
Educational materials. Three-dimensional models can help the patient build up a mental image of the eye’s structure. You can, for instance, take the patient’s hand and show them where the lens is in relation to the rest of the eye.
Medications. Before patients leave the exam room, it is a good idea to ask about their medications. If they have more than one type of eyedrop, then you need to make sure that they have a strategy for telling them apart. They shouldn’t be relying on a friend or family member to identify each bottle because they can’t assume that somebody will always be there to help out.
Your Printed Materials
Many low vision patients prefer text that is in large print, but some larger organizations, particularly academic ones, have design standards that require a certain-sized font. And if you use a billing house, billing statements with large print might not be one of their options. If you can’t print your materials in large print, how do you meet the needs of your low vision patients?
Forms. If your forms use a standard-sized font, you can offer to read the form to your visually impaired patients; you can use a highlighter or a black marker to indicate where they need to sign; you can provide a low-power magnifier; and you can offer them use of a signature guide, which is a plastic square that has a rectangular hole and can be placed where they need to sign.
Billing statements. People with low vision don’t get more junk mail than anybody else, but they have a harder time separating the wheat from the chaff. What can you do to help them recognize your mailings? If it isn’t feasible to print the billing statements of your low vision patients in large print, the next best option is to include a cover letter that uses large print. Another option would be to add an easily recognizable insignia to the top of your letters and billing statements. This could be a color or a logo, and it should be distinctive but not complex.
Business Cards. Some practices have “supersized” some of their business cards to three inches by five inches. But if you don’t want two different sets of business cards, you can have one card that is printed on both sides (on one side, you would have all your information in standard-sized print; on the other, just your name and phone number in large print).
Sue Mussatt, RN, CLVT, is coordinator of low vision services at the University of Missouri.
Use SmartSight materials to assist low vision patients. Not all ophthalmologists have the time or inclination to offer comprehensive low vision services, so the Academy’s SmartSight initiative provides resources for four levels of service. These resources include a patient handout (also in French and Spanish), physician materials and suggestions for further reading. For more information, go to www.aao.org/patiented and click “SmartSight.”
Learn the appropriate technique for guiding low vision patients. If you contact your state’s commission for the blind, you should be able to arrange instruction in sighted guide technique. There is typically no fee.
Help patients find local resources. The Academy has partnered with VisionConnection, a part of Lighthouse International, to provide an online database of resources. Go to www.visionconnection.org and select “Help Near You.” If you provide vision rehabilitation services, you can add your practice to this database by filling out an online form at www.visionconnection.org/hnyform.org.
Know your legal obligations. The Americans With Disabilities Act requires that you provide certain accommodations for blind and low vision patients. You can download the Title III Technical Assistance Manual, Title III Highlights and yearly supplements from www.ada.gov/publicat.htm.
Sign up for a listserv. To register for the Academy vision rehabilitation listserv, visit www.aao.org/member/visionrehab.