Visual Skills Workbook
For People with
Age-Related Macular Degeneration
by Leslie Burkhardt, MSLVR
©2007, Leslie Burkhardt
Copying for unpublished, non-profit use is permitted.
Printable PDF version in English or en Español
Also available FREE in large print book form
Adapting to AMD can be challenging. Changes in vision may be disorienting, especially when they first occur. Sometimes learning to better understand and use your vision can be helpful. This booklet presents ways to optimize how you use both your vision and other resources to accomplish daily goals.
If you are reading this book on a computer monitor, you may want to increase or decrease the font size for easier viewing. To do this, press and hold the "Control" key in the lower-left corner of your keyboard. While holding, press the "+" (plus) key to make the print larger, or press the "-" (minus) key to make the print smaller.
PLEASE WRITE A REVIEW: Do you think this booklet might be helpful to you or someone you know who has AMD? If you try these lessons, please write a brief review so that others may be guided by your comments. What was helpful? What was not helpful? Your comments may help others to decide whether or not the book might be useful in their particular circumstances. You may email your comments to me at email@example.com.
Leslie Burkhardt, MSLVR
Los Angeles, California
Who Can Use This Workbook
These lessons help people use their vision better to see objects, to read and to write. They do this by helping people become more aware of ways to use their vision. This workbook is for people who have age-related macular degeneration and:
1) have had a marked change in their ability to read in the past two years,
2) notice that words or parts of words sometimes vanish or dim when reading,
3) can read this print, with or without a magnification device, well enough to finish this page in less than 5 minutes. (A low vision rehabilitation service can help to find the best device for you.)
Age-Related Macular Degeneration (AMD) affects visual abilities. It causes a blank spot (scotoma) in the center of a persons field of view. That center area is normally the area where vision is the sharpest, so even when a very small blank spot occurs in the center, the vision becomes less clear, even when a person wears eyeglasses that focus vision as well as possible. The larger the center blank spot is, the less clear the vision will be. When the blank spot is only in one eye, the person uses the other eye to see as clearly as possible. When the blank spot is in both eyes, the brain usually uses only the eye with the smallest blank spot when it is trying to see something as sharply as possible.
When AMD affects both eyes, nothing can make a persons vision clearer. However, if an object or print is too difficult to see, sometimes it helps if the object can be changed so that it appears larger, bolder and stands out from its background.
AMD particularly affects reading ability. Even with a small central blank spot in the better eye, people will usually have difficulty with long reading tasks like reading a newspaper or magazine article, or a chapter in a book. They are reading much more slowly than they were before AMD, and their eyes get tired much more quickly even when the print is enlarged to the best reading size. This occurs even after people learn to use their vision as well as possible either on their own or using lessons provided by a low vision rehabilitation specialist. If the blank spot gets larger, the print will need to be larger for the person to see it. If the print size needs to be larger, reading speed is slower and peoples eyes get tired faster.
Usually, a person with moderate to severe macular degeneration can still see very large, bold print. However they may use their vision to read only when the task is very important and very short, such as a phone number, an address or a price tag. Even tasks like these are read with great effort. Some people who are able to read large print, still prefer to have someone read their mail to them, because it is much easier and faster. They use audio sources, like recorded books or personal assistance, for longer reading tasks.
How to Use This Workbook
Your eyes may tire using this workbook, so rest often:
Work / Rest / Work / Rest
If you work just 10 15 minutes a day with this book, on and off, you will start to learn new visual habits.
You may also prefer to have a friend or family member read aloud the part of the text that provides learning information, and then view the text yourself only when visual exercises are presented.
Another option is to have your computer read the text to you. Nearly all computers have this option, which can be activated in the "Accessibility" section of your control panel. Other commercial programs are also available that read displayed text aloud. Some are simple-to-use and available for free without trial expiration dates. Check with a low vision rehabilitation specialist for more information.
If you are viewing the printed version of this book, you may want to put it on a reading stand, music stand or clipboard so that it is in front of your face at your best reading distance, and at a good reading angle. Try to sit up straight as you read.
If you are viewing this book on a computer monitor, you will need to download and print out the worksheets from:
For each lesson, use these tools:
1. THE BEST LIGHTING WITH THE LEAST GLARE
Now lower your chin, so you are looking at the A with the top half of your eyeglasses. Does it get fuzzier? If it helps you to see better, use reading glasses at their best focus distance.
4. THE BEST CONTRAST
5. THE OTHER SENSES
6. MEMORY & LOGIC
7. PERSONAL HELP
People can help you to get things done and learn new skills. There is a difference between dependence and inter-dependence. Think about the difference between these two words. Inter-dependence can be a helpful skill to learn. It is the building block of all great nations.
8. THE BEST EYE POSITION
Look at this book with the different lamps in your home. Move each lamp close to the book and then far away, to the left and then to the right. Look at the book in the sun. Where is the best light for you to read?
Gather any sunglasses and hats that you own. Put them on, in your house, in a market, in bright sun, in shade, and when you ride in a car. What tint do you wear, in what type of light, to see the best? Notice which sunglasses give you better glare protection, and which sunglasses allow you to see more sharply.
Stand across the room from an object like a vase of flowers or a picture. Look at it, then move two steps closer and look again. Keep doing this until you are right next to the object. Where do you stand to see most clearly?
Set your table with different colors of placemats, plates and cups. Add types of food: carrot sticks, potato chips, coffee or milk. What color combinations help you see most clearly?
Sit 3 or 4 feet from a TV. With your eyes closed, change the channel, then listen until you make a picture in your mind of what you hear. Open your eyes and compare the picture you see with the one in your mind. Do this again with 3 more channels.
Call a phone number that you know well. Use only touch to enter the number on the phone keys. Remember that the numbers start at the top:
1 2 3
4 5 6
7 8 9
* 0 #
You can stick a bump on the 5, and find the bump with your middle finger. Your index finger pushes 1, 4, 7. Your middle finger pushes 2, 5, 8. Your ring finger pushes 3, 6, 9. The thumb pushes the bottom row: *, 0, #. Try this many times before you really call. If this is just too much work sometimes, you can push 0 and ask the operator to call the number for you. This is a free service for people with vision problems. Call your phone company for more information.
Pick out an outfit to wear. Then get dressed and groomed. Now ask someone: How do I look? Does anything need fixing?
Go to a market and try to find the food that you need. Can you find ketchup, mustard, mayonnaise and pickle relish at the market? They are all related, so they will be near to each other. Do you remember what part of the store they are in? Can you find them by the color or the shape of the jar? Slowly scan the shelves from top to bottom, and left to right, so you do not miss anything.
Your Toolbox Checklist
Think about and use each of these tools during each lesson. Review this section as you do the lessons to help you remember the information.
Memory & Logic
Lesson 1: Seeing Objects
Find a coffee mug with writing or a picture on it for this first lesson.
1. Place it on a table in front of you, a full arms distance away.
2. Do you need to adjust the lighting, or put a placemat of a different color under the mug so that it does not blend into the background?
3. Cup your hand over the eye with less vision. Does the mug seem more clear? If so, block this eye when you need to see more clearly.
4. Do any blank or dim spots in your field of vision block the mug? The blank spots will move as you move your eye. If you move your gaze up, any spots will also move up.
5. Watch the mug as you move your gaze up, down, to the left and to the right of the mug. Does the mug appear more clear when your eye is in a certain position? You are trying to avoid the blank or dim areas of vision, and find the clearest area.
6. Try to remember where you need to look to see the mug as clearly as possible.
7. Hold the mug about 10 inches from your face and repeat steps 3 - 6 looking through your reading glasses.
Instead of a mug, use a plate of food as your target. Your knife and fork, or your fingers will help guide your line of sight.
Look at a persons face from 4 feet away, then 2 feet away (or look at your own face in a large mirror, 1 foot and 2 feet away from the mirror). Where do you need to look to make the face as clear as possible?
Try to find your best eye position for watching TV. Sit 6 feet away, 4 feet away and 2 feet away. When you sit 2 feet away, sit to the left or right side of the TV. Do you see better sitting on the left or on the right? Sitting to one side also makes moving objects on the TV appear to move less, to decrease the chance of motion sickness when you sit close.
Try moving your gaze from object to object in your living room.
Try moving your gaze to find and follow a walking person, a car or a low-flying airplane or helicopter.
Lesson 2: Reading
Use the word in the center of the grid as your target.
6. Read each word on this next grid. Where do you look to see each word the best?
Excerpts from Rhyme and Reason
from The Phantom Tollbooth
© 1961 by Norton Juster
"It has been a long trip," said Milo, climbing onto the couch where the princesses sat; "but we would have been here much sooner if I hadn't made so many mistakes. I'm afraid it's all my fault."
"You must never feel badly about making mistakes," explained Reason quietly, "as long as you take the trouble to learn from them. For you often learn more by being wrong for the right reasons than you do by being right for the wrong reasons."
READING EASY WORDS
More from The Phantom Tollbooth
© 1961 by Norman Juster
"You may not see it now, said the
Princess of Pure Reason, looking
knowingly at Milo's puzzled face,
"but whatever we learn has a purpose
and whatever we do affects everything
and everyone else, if even in the
tiniest way. Why, when a housefly
flaps his wings, a breeze goes round
the world; when a speck of dust falls
to the ground, the entire planet weighs
a little more; and when you stamp
the earth moves slightly off
its course. Whenever you laugh,
gladness spreads like the ripples in a
pond; and whenever you're sad,
no one anywhere can be really happy.
And it's much the same thing
with knowledge, for whenever you
learn something new, the whole world
becomes that much richer.
READING HARD WORDS
TIP: Most print is not large print. A low vision rehabilitation service can help you find a magnification device that will help you read print that is this size:
Lesson 3: Writing
Writing is a very useful skill. Also, because the sense of touch works with vision when writing, each sense helps the other work. This lesson has drills to help improve writing skills.
As you do the drills, use a pen that has a bold line. When writing large print, use something similar to a Sanford brand 20/20 or Sharpie pen. These make a thick, black line. If you use a Sharpie, a blank page under the writing page will blot the ink. When you need a thinner line, use a medium-point, nylon-tip pen.
If you see better when you are up close, put pillows or phone books below your writing surface, to raise it nearer to your face, or use a clip board or music stand to raise your task up to your face.
If you get bored with Xs, try to draw a happy, sad or wow face. On the facing page, you may want to try using a pen with a thinner line, along with a magnification device or CCTV. Examples:
TIP: Visit a low vision rehabilitation service to select the best magnification device, and to learn how to use it.
Drill 2: Draw Zig-Zag Lines Between the Lines
On the next page, you may want to try using a pen with a thinner line, and a magnification device or CCTV. Example:
TIP: Bold-line paper and writing guides are available from companies that sell products for people with vision impairments.
Drill 3: Practice Writing B-I-G
If you have written one size and style most of your life, you will need to practice writing big. Block printing can be hard for someone who likes to write in script, but it is often easier to read. Use a pen with a thick line for this next drill. Copy this on the second line:
You have more room to write big if you turn the paper sideways. Write a note to yourself:
Drill 4: Practice Math Problems
Here are some sample math problems. Make up some of your own on the next page:
Drill 5: Practice Your Signature
When you sign your name, it should be:
1. On or near the signature line.
2. Not easy for someone to copy.
3. The same each time.
4. Able to be done fast.
Practice writing your signature again and again. You may want to use a writing guide or the edge of a credit card above or below your writing to guide you. If your signature has changed a lot since your vision has changed, give your bank a new copy of your signature.
Charles Bonnet Syndrome
This note is included, because people with AMD or any vision problem can have something called Charles Bonnet Syndrome (CBS). A person will see a visual image that the person usually knows is not real. Some people may not want to tell anyone that they are seeing strange visions out of fear that people might think they have a mental disorder. CBS occurs in about twenty percent of people who have vision loss. Though no accepted theory explains why this occurs, it is known to be related to vision loss, and not to a mental disorder. The images are only visual, uncontrollable, and vary as to how long and often they occur.
Reported images include highly colored flowers, shapes or patterns, landscapes, animals, walls of brick, uniformed people and elves! If you have questions about CBS, take this booklet to your eye doctor, who can discuss it with you.