Activity 8 - Visual impairment and aids?

Any feedback from advisers who have some specialism in assisting clients with VI would be very welcome.

What kind of aids would be available to somebody to assist them with the Activity 8 activities (reading and understanding written information)?

Our client has software that enables him to read emails (I think it enlarges the text). I am pretty comfortable in arguing that as he cannot use this software to read printed information or outdoors he cannot use it reliably.

What other aids might be considered for more everyday use? Client states that he has particular problems reading correspondence in standard print (the smallest he can read is 18pt) and with reading signs/maps/bus numbers outdoors. I’ve had some elderly clients who use a magnifying glass to read letters which might work for my client but I still would be arguing that it is not practical for him to be able to use it to read a sign in a building for example. Do people think that by using a magnifying glass a claimant can be treated as being able to read basic sentences in enough situations to class as being able to do this activity reliably? Client already uses a special contact lens in his left eye to try and improve his sight a little.

Client needs 4 points from the activity - he cannot prepare a simple meal (although he can use a microwave to cook it) but states that is independent with the other activities. Are there any particular aspects of these other activities that someone with VI might struggle with that I might not have asked client about?

Client’s last CVI has him as no sight right eye, 6/60 left eye, extensive loss of visual field and primary loss of periphial vision. Visually impaired since early childhood.

Thanks!!

Starting point would be… what is the VI? VI is usually thought of in terms of “So how far CAN you see?” when our eyes do much more than distance e.g. light, colour, movement and field. Pet hate of mine but I will repeat it ad nauseum…

The post above says “he can’t see far and he can’t see wide” but it’s a more complex than that. To what extent is his condition impacted by light for example? Is there a difference between day and night? What about colour? Huge issues around movement too.

Saying he can read 18 point is meaningless if what he means is that’s the first size with which he’s not straining rather than the first he can get into focus. Having less field of vision doesn’t necessarily mean you see less. Turning your head often solves that but what it can mean is that when you want to see something you have less visual field into which to fit the light AND the object you want to see. Some people have conditions where light behind them solves this. Others need direct light but if they have it in a smaller visual field than the norm it can often blind them to the thing they want to see. So, you need to be a lot more precise about what your clients issues are. That’s more of an observation than a critique.

Anyway, the range of aids is huge but will depend very much on the VI, the person and their circumstances. There is simply no one size fits all. You can get a great idea of what’s out there by looking at stuff the RNIB or AbilityNet sell but also by searching on “assistive technology” or “low vision aids” but what works for one may not work for someone else.

You need to know more about what your client does use and why and the extent to which they have been assessed. Have they been registered? I know you say they have a CVI but that’s not the same. Could they be (not as straight forward as it looks) and have they had things like a low vision assessment, which looks specifically at aids?

I wouldn’t, with due respect, be so comfy on the software front in terms of portability. We are 14 years into the 21st century and most things which exist on a PC are replicated in some form on smartphones or less functional devices specifically for people with VIs.

Rather than you decide what might work for him it might be better for him to have an up to date low vision assessment where they can run through options and he wil then be better able to articulate what doesn’t work. I use a monocular for bus numbers. Mine has a variable focus. I know of people with the same eye condition who could never contemplate using a monocular and others who do but who need a fixed focus. Each of them could articulate why. That’s the level of detail needed IMO.

In terms of other activities I would guess your client won’t have 3D vision although they may not recognise that as it won’t necessarily be something that’s top of their list given their other issues.

So, just how accurate are they getting food onto utensils and then into their mouth? They may think themselves no more clumsy than anyone else. Discussion with family members may reveal otherwise.

How good are they at monitoring their own eye health? When they are tired etc.? Does someone else have to do it for them?

I’m sure physically they may perceive no issue with personal hygiene but how exactly does a person with vision in one eye and a restricted field of vision look in the mirror to wash and shave accurately? You can’t do it by touch alone and you certainly can’t do anything requiring precision.

Toileting falls into the same category. Being blunt, ever tried shaking yourself dry if you can’t see where things are flying! You may think your personal hygiene is good but can you see the drips you’ve just left on yourself or the toilet seat or the floor? I appreciate we’re heading into alien territory for most WR advisers here but the range of impacts of VIs are hugely underestimated if all you think of it is in terms of distance.

Slips and trips that are often dismissed as clumsiness or carelessness can also be specifically down to lack of 3D vision and the inability to fully track the movement of objects across a full field of vision. The latter severely impacts on the ability to judge the speed of any moving object from a rolling pencil to a car.

Dressing and undressing should be obvious enough. Can they do a tie in a mirror? Do their socks match (and remember matching socks is not just about colour. You can have 2 black socks from 2 completely different pairs.). They’ll tell you they can do lots of things by feel e.g. zips and buttons. You’ll often find that’s what they think they’re doing but in reality they instinctively try to use their vision and the results are not great. They may have a long history of button 3 to hole 4 and so on.

Verbal communication is less obvious but there are still issues. Understanding a simple process described verbally is often harder if you lack the visual cues. Same applies to the reading activity already discussed. You need to make the client articulate what they can see as opposed to what they can deduce using visual cues. People often say they can read a specific font size when what they really mean is that’s the size they can see some of the words and deduce the rest through context. Guessing is not the same as reading regularly

Mike thanks so much for your detailed reply.

I’ve already suggested to client that he contact London Action for Blind People who have a welfare rights team. He has been round the houses a bit and was impatient just to get advice from someone. ESA and PIP claims are now up and running so in the light of your response I might repeat my previous advice - this is clearly a specialist area.

If he just wants to go ahead with me I’m sure your reply will be extremely valuable in helping me complete the PIP2 form.

Couple of particular queries:
- re the computer aid, I was more referring to its range of uses (i.e. it only reads emails) rather than portability. Is the technology now advanced enough that there are smart phone apps that can use text recognition software to read printed text or signs?
- does shaving/grooming count for the washing and bathing activity? More from a MH perspective I have a few clients that manage to maintain a basic level of personal hygiene but struggle to manage beard, hair, nails etc

Hi Sam,

I have very mixed feelings about VI being perceived as a specialist area. I don’t think it is. I think it’s more that because services don’t really think about access for people with sensory impairments they don’t get to see so many as they might with physical disability or mental ill health. I am utterly bewildered that mentail health is still seen as a hidden thing in comparison to stuff like sensory impairments.

As far as computer aids are concerned then yes there is tech out there on smartphones and other devices that can enable the reading of signs and the translation of that into speech. I’m not sure there’s anyrhing integrated though. It usually takes one app to read the sign and another to translatw that to speech. Most people either need magnification or someone to help them though. Someone with a restricted visual field may have difficulty looking up at signs though whether because of a physical restriction or because of the light.

Can’t remember on personal hygiene. I was using it more as an example of how people often miss the obvious. I could look it up but I’m on a bus at present and doing well to type anything.

Incidentally, I forgot to mention maps and journey planning. Paper maps are pretty much out of the equation for a lot of people. That could be because of size, colour or clutter. Maps on devices are highly variable but generally better. Sat Nav on your phone with a VI is useful but lots of people struggle to use it. Maps can be more useful because you can often subtract unwanted detail and pinch to zoom. On the other hand some people react badly to backlit stuff because they have issues with light; some struggle with scrolling and some can’t locate their current location to begin with.

Sadly you also have to factor in that many people with a sensory impairment feel extremely vulnerable when out and about and a device that draws attention to them might be a no no even if it otherwise works brilliantly. Hand held monoculars can be very discreet but you still have to put them to your eye and the attention can often be very unpleasant so what looks reasonable on paper may not be at al if the client has previously been abused/assaulted or otherwise challenged.

Inability to read 16 point print meets support group criteria in ESA, so there may be an argument that the PIP descriptor should apply if he cant even read 18 point??

Just a thought

There is official guidance on the interpretation of activity 8 in the PIP Assessment Providers’ Guide (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/368122/pip-assessment-guide.pdf):

“This activity considers the capability to read and understand written or printed information in the person’s native language.

To be considered able to read, claimants must be able to see the information. If the claimant cannot read, this must be as a direct result of their health condition or impairment e.g. visual impairment, cognitive impairment or learning difficulties. Illiteracy or lack of familiarity with written English are not health conditions.

Basic information is signs, symbols or dates. Complex information is more than one sentence of written or printed standard size text – e.g. for example, text found in utility bills and bank statements.

An example of simple information would be a green exit sign on a door in a public building.

An example of complex information: “Your home may be at risk if you do not keep up repayments on your mortgage or any other debt secured on it. Subject to terms and conditions.”

Consideration needs to be given to whether the claimant can read and understand information both indoors and outdoors. In doing so consideration should also be given to whether the claimant uses or could reasonably be expected to use aids or appliances, such as a blue screen to read text when indoors and a portable magnifying glass to do so when outdoors. If despite aids the claimant cannot read both indoors and outdoors, a descriptor may apply.

For the purpose of this activity, accessing information via Braille is not considered as reading, as the claimant must be able to see the information.”

I would argue that being able to read written information includes being able to see that the information exists at a specific location, before you even get to the stage of actually attempting to read it. And somebody with extensive loss of visual field may not be able to see that a sign is present, unless they are prompted as to its location.

The guidance gives the example of an exit sign, and another salient example would be the words/symbols identifying the doors of public toilets. These tend to be smaller than “exit” signs. Many people with visual impairment would need to have these pointed out to them. If someone has to stand right in front of a doorway and use careful scrutiny to be able to read the signage on it (either with or without a magnifier) then they risk being hit by the door if someone opens it from the other side.

Regarding the issue of shaving, unfortunately that is very unlikely to be taken into account for PIP. It doesn’t seem to come within the scope of Activity 4 as that just covers washing, bathing and getting in and out of the bath or shower. Other aspects of personal appearance which are important to many people (such as putting on make up and brushing or styling hair) are not covered either.

Thanks for that Emma. I thought that stuff was indeed excluded but couldn’t be bothered opening 2 (Safari) tabs whilst on a bus as it starts to slam my battery power.

I think the reading stuff is interesting because again we end up focusing on reading whilst forgetting the phrase “read and understand”. There is an often missed argument around this which is to do with time to see. A Snellen test tells you your visual acuity indoors, in perfect conditions, under no pressure to see quickly and in daylight. It doesn’t say anything about other situations which are far more prevalent at all, which is why it’s so frustrating it still plays a part in registration…

Anyway, “time to see” is a critical element of understanding. If you can locate the fire exit and eventually read the sign but it takes you several minutes to do so then does that really constitute understanding? If understanding is not timely then how can it be relevant?

The new PIP assessment guide now says about not being able to read both in AND outdoors, whilst the previous one was OR so accounted for the different conditions.
But I think the exit sign example is completely wrong because the interpretation in the regulations for both basic and complex written information refers to ‘print in standard size text’ and therefore comparable with the 16 point text of ESA.

Yes indeeed. The guidance says that the assessor is supposed to look at whether the claimant can complete each activity “In a reasonable time period – no more than twice as long as the maximum period that a non-disabled person would normally take to complete that activity.”

Another thing to consider would be that written information is not always stationary, and if something is moving it could be a lot harder to read. Eg you may need to read a bus number on a moving bus as it approaches the bus stop. Or a name badge worn by a shop assistant who is walking around the shop floor (If you can’t see and read a shop assistant’s badge or logo, you probably can’t distinguish them from other members of the public.)

It will be interesting to find out to what extent decision makers and tribunals take all these factors into account.

Emma,

I think there’s plenty of evidence they simply don’t get it at all. It would never occur to them and, whilst that is understandable to some extent, it’s also immensely frustrating because they will rely on misleading information like Snellen or (lack of) registration etc. It’s the harsh reality of the sensorily impaired having neither access to advice or to the process for understanding and challenging decisions.

An additional element to the whole “time to see” business is that when it’s longer than for another person it takes more effort to get to the point where something can be read and understood and the consequence of this is tiredness and stress, which in turn impact the ability to read further. There are a significant number of eye conditions which are negatively impacted by the simple effort to see and which therefore need to be described carefully because what a person can see once they may not be able to then check to ensure that have understood correctly.

You may have a case for Washing and Bathing for VI if the client cannot see properly getting in the bath and shower (risk factor), also for someone who cant see shampoo bottles, shower gel bottles etc and could pick up bath cleaner instead (don’t know how far you would get with that one, but I did get 3 points for a VI client getting in and out bath/shower safely)

There’s always a risk factor but what really matters is the extent to which a person adapts. Older people with a newly acquired VI may not adapt as well to the need to organise themselves or use visual cues as a younger person. That’s a sweeping generalisation though and it really does come down to understanding what an individual can or cannot do. It simply wouldn’t occur to some people to use visual cues and, sadly, and contrary to the approach of the average decision maker, you don’t magically become organised merely through acquiring a VI.

Other factors again kick in on risk though. What time of day does a person bathe? What’s the light like? How small, confined or cluttered is the relevant area, and so on.