Adaptation to Low Vision Caused by Age-Related Macular Degeneration: A Case Study.

One in eight Americans aged 65 and older has an eye disease resulting in low vision (National Eye Institute, NEI, 2006), and more women than men are visually impaired, mainly because women live longer (NEI, 2002). Age-related visual impairments are an indicator of a decline in activities of daily living and self-help skills (Travis, Boerner, Reinhardt, & Horowitz, 2004). The top eye conditions that affect older adults are macular degeneration, glaucoma, and diabetic retinopathy. Age-related macular degeneration (AMD) is the leading cause of vision loss in the United States for persons aged 60 and older (NEI, 2007). It adversely affects the ability of an individual to read standard print and can limit a person's independence in preparing meals, using a telephone, taking care of finances, traveling, shopping, taking medications, and washing laundry (Ryan, Anas, Beamer, & Bajorek, 2003). Despite their decreased ability to perform activities of daily living and instrumental activities of daily living (Crews & Campbell, 2001; Heyl & Wahl, 2001; Horowitz, 2004; Raina, Wong, & Massfeller, 2004; Travis et al., 2004), persons with low vision still have the need and desire to perform everyday activities that support their life roles. Given their inability to engage in these activities in the same manner as they once did and their continued desire to do so, persons with low vision usually adapt to the challenges of performing these activities. The purpose of this study was to elucidate how a woman with AMD adapted to the challenges that she faced in performing everyday activities. The research question was "What successful adaptations does a woman with AMD use to address the functional challenges of performing the activities?" LITERATURE REVIEW Although the primary focus of vision rehabilitation needs to include methods to complete everyday activities, the complexity of the visual impairment leaves other needs to be addressed. Simply modifying physical performance does not yield adaptation (Crews & Campbell, 2001; Heyl & Wahl, 2001; Horowitz et al., 1998). Persons with low vision use multiple strategies to address the many difficulties they encounter (Horowitz et al., 1998; Lindo & Nordholm, 1999; Moore, 1999) and use different strategies at different times and in different situations (Lindo & Nordholm, 1999). Strategies for adapting are generally organized into three major areas: "behavioral (overt, observable actions), psychological (cognitions or emotions), and social (involving other individuals)" (Horowitz et al., 1998, p. iii). Behavioral coping strategies include the use of residual vision, adaptive devices, optical devices, other senses or memory, modification of tasks, participation in rehabilitation services, and the restriction of activities (Horowitz et al., 1998). Brennan and Cardinali (2000) found that novel coping strategies led to positive adaptation to age-related vision loss. They determined that novel coping strategies were used most commonly (49%) in the behavioral domain and included seeking low vision services to learn new skills or the use of adaptive or optical devices. Many researchers believe that psychological adjustment is the key to adaptation (Brennan & Cardinali, 2000; Horowitz et al., 1998; Thompson, Goldbaber, Amaral, & Ringering, 1992). Lindo and Nordholm (1999) examined the psychological adjustment and well-being of persons with low vision by using Persson's (1990) model of adaptation, which assumes that a person will adopt several strategies from among six positive adaptation strategies and five negative adaptation strategies. They studied the use of the positive strategies of acceptance (stoicism and revaluation), trust, positive avoidance, minimization, independence, and control, and the negative strategies of denial, resentment, shame, isolation, and helplessness. The participants in their study used the positive strategies of revaluation, minimization, and control less than did the control group, indicating a lower level of adjustment. …