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About Low Vision
Vision impairments result from conditions that range from the presence of some usable vision, low vision, to the absence of any vision, total blindness. Low vision is a term that describes a person with a vision impairment that cannot be improved by correction but has some usable vision remaining. Legal blindness is defined as 20/200 or less in the better eye with the best possible correction. Errors of refraction, diseases of the eye, and other vision-related conditions are usually the cause of vision loss. Each of these categories includes more specific disorders, which are described below.
• Common Errors of Refraction
o Myopia (Nearsightedness): Close objects look clear while distant objects appear blurred.
o Hyperopia (Farsightedness): The ability to see objects clearly at a distance while close objects appear blurry.
o Astigmatism: Due to the irregular curvature of the cornea, vision is blurry for both near and far objects.
o Presbyopia: The eye lens becomes less elastic (associated with aging) and produces blurred vision when focusing on near objects.
• Common Diseases of the Eye
o Cataracts: Clouding of the eye’s lens that causes loss of vision.
o Glaucoma: Pressure inside the eye is elevated and can cause damage to the optic nerve, which results in damage to peripheral vision.
o Macular Degeneration: There is a disturbance of blood vessels in the eye resulting in progressive loss of central vision.
o Retinitis Pigmentosa: There is a degeneration of pigment in the eye that is needed to absorb light and create visual images, leading to “tunnel vision” and night blindness.
o Retinopathy (due to Diabetes): Retinopathy typically affects the blood circulation of the retina, which causes blotchy vision.
• Other Vision Related Conditions
o Night Blindness: Night blindness results from pigmentary degeneration of the retina, which leads to difficulty seeing in low light.
o Color Vision Deficiency: A color vision deficiency occurs when cone cells of the retina, which provide daylight and color vision, are affected and there is difficulty distinguishing among colors. Typically this only involves certain hues, for example a red–green deficiency; total color blindness (achromatic vision) is rare.
o Lack of Depth Perception: A lack of depth perception is often caused by the loss of sight in one eye, resulting in difficulty with foreground/background discrimination.
o Floaters: Floaters are small specks or clouds moving in the field of vision.
Low Vision and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Low Vision
People with low vision may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Key Accommodations:
Reading Printed Materials: Individuals with vision impairment may have difficulty accessing printed text. Factors that may influence the readability of printed text include font size, style, color, contrast, and overall text legibility.
- Closed circuit television (CCTV) system, which is sometimes referred to as an electronic or video magnifier
- Hand, stand, or portable magnifier
- Information in large print
- Note: The American Foundation for the Blind (2008c) recommends that the font size be at least 16 point but preferably 18 point.
- Photo copier enlarged paper material
- Color paper, acetate sheet, or overlay to increase color contrast between printed text and document background
- Optical devices such as monoculars or binocular systems, loupes, or prism spectacles
- Smart glasses
- Frequent breaks to rest eyes when fatigue is a factor
Accessing Computer Information: Computer access may be challenging for individuals who have low vision. Photosensitivity may also pose difficulty for when accessing computer information.
- Increased operating system font size with large-size computer monitors
- Note: Computer users can modify their computer display so that text is shown in large print
- Screen magnification software
- Locator dots and/or large print keyboard labels for keyboard navigation
- External computer screen magnifier
- Flicker-free monitor
- Anti-glare guard and computer glasses to reduce glare
- Frequent breaks to rest eyes when fatigue is a factor
Writing Notes and Completing Forms: Individuals with vision impairments may struggle to take written notes or complete forms. When feasible, modifying the way notes are taken or providing a product or service may be helpful.
- Closed circuit television (CCTV) system, which is sometimes referred to as an electronic or video magnifier
- Pens that include a bold felt tip or lighted pen
- Paper with tactile lines, bold print, or low glare
- Form/line guide
- Smart glasses
- Speech dictation software
Accessing a Telephone: Challenges that may arise for individuals with low vision when using a telephone include difficulty seeing displays or buttons, as well as knowing whether a line is active. Smartphones that primarily operate via touchscreen may also pose difficulty.
- Large print/color labels or tactile markings on telephone to identify keys and lines
- Hand/stand magnifier or optical magnifier
Working with Money: Accommodation may be needed to assist employees in identifying bills and coins when working with money.
- Hand/stand magnifier or optical magnifier
- Task lighting or headlamp
- Smart glasses
Reading from Instrument or Control Board: Individuals may need to access a variety of equipment in the workplace. Following instructions or prompts that are displayed visually may require accommodation.
- Hand/stand magnifier or optical magnifier
- Large print/color labels or tactile markings on telephone to identify keys and lines
- Task lighting
- Smart glasses
- Glare reduction
Repairing, Constructing, Assembling Pieces/Parts: Identifying and differentiating pieces or parts, as well as assembling or repairing appropriately, can pose unique challenges. Individuals with color vision deficiency may also struggle to work with color-coded assembly materials.
- Hand/stand magnifier or optical magnifier
- Task lighting
- Smart glasses
- CCTV
- Color identifying apps or devices
- Color vision correcting lenses
Mobility: Accommodations for workplace navigation, as well as necessary work travel, should be considered for individuals with low vision. Limitations may include difficulty reading signage or noticing obstacles that may be in one’s path.
- Service animal and/or mobility aid (e.g., cane, electronic aid)
- Mobility and orientation training
- Detectable warning surfaces
- Colored and/or textured edges on stairs
- Improved area lighting
- Traveling/evacuation partner
- Tactile map of evacuation and common routes
- Talking landmark or global positioning system
Driving: Commuting to and from work, as well as work-related travel, may require accommodation for employees who have driving limitations due to vision impairment. Note that while employers are not obligated to provide transportation to and from work unless they do so for other employees as a benefit of employment, they must consider other accommodations related to the commute if needed due to a disability.
- Shift change to daylight hours
- Driver (e.g., hired driver, volunteer, coworker)
- Public transportation or carpool
- Modified or flexible work schedule to meet public transportation needs
- Reassignment
- Telework
Other Accommodation Considerations:
- Training materials or company correspondence in alternate format (e.g., large print, Braille, CD-ROM, audiotape)
- Time off for training on adaptive technology, mobility training, and/or service animal training
- Additional training beyond what is typically given to others
- Accessible versions of employee related Web sites or Intranet material
- Note: See JAN's Tips for Designing Accessible Web Pages
Accommodation Ideas:
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A freezer operator with low vision had difficulty reading visual notifications, both electronic and in print.
The employee was accommodated with handheld portable magnifiers.
A buyer for a department store has low vision.
A buyer for a department store has low vision and was accommodated with a CCTV magnification device for reading paper documents and screen magnification software for her computer.
A claims representative for an insurance agency was having difficulty reading files due to a vision impairment caused by multiple sclerosis.
His employer purchased a stand magnifier and added task lighting to his workstation.
A technician/educator with a school system had low vision and was having difficulty viewing information from a computer screen.
Because the employee benefited from magnification, an inexpensive screen magnification software package was purchased.
A computer programmer with Addison's disease was dealing with progressive vision loss.
He was accommodated with magnification and software to enlarge his computer screen.
A paralegal with Marfan syndrome was experiencing fluctuating vision, therefore she was having trouble viewing her computer screen.
The employer noticed her having a hard time and purchased screen reading software which allowed her to continue performing her computer tasks.
A custodian with low vision in a public school setting was having difficulty viewing the carpeted area he was vacuuming.
A lighting system was mounted on the custodian's industrial vacuum cleaner and the custodian was provided a headlamp.
A data entry clerk with diabetes was having problems with vision.
Her employer installed additional lighting in the file room and purchased a glare filter for her computer monitor to reduce eyestrain.
A typist with low vision was having some difficulty distinguishing among certain character keys.
She was provided with a glare guard for the computer monitor and large print keyboard labels, which significantly enhanced accuracy.
A customer service representative for a financial institution had long-term blurry vision from a stroke and could no longer read his computer screen.
The employer provided screen reading software for his computer so that information present on the screen and information inputted into the system would be read back to him.
An assistant for a disability program had complete loss of vision in one eye and low vision in the other.
The assistant was having problems reading printed paper copies. A portable magnifier and a CCTV were used to magnify materials.
An investigator was having problems balancing between reading text and his computer screen due to diabetic retinopathy.
Accommodations were made so he could use task lighting, a glare filter for computer monitor, and closed circuit television with a split screen to view text and the computer monitor at same time.
An assistant manager for a nonprofit had complete loss of vision in one eye and low vision in the other due to a stroke.
The individual was having problems reading printed paper copies and emails. A portable magnifier, stand magnifier, and a closed-circuit television (CCTV) were used to magnify materials.
An employee working as a law office clerk was having trouble reading the text on the memos she has being given by the lawyers in her office.
She disclosed that she had low vision due to albinism and requested that the memos be provided in large print. The employer made a policy that memos must be written in a minimum of 18 point font and also provided a stand up magnifier to assist in reading hand-written items.
A worker in a manufacturing plant had color vision deficiency and used corrective lenses that helped her to distinguish color during day-to-day tasks.
Unfortunately, they did not fit well under the safety goggles that she was required to wear at work. She requested that her employer provide prescription eye goggles with the same type of lenses for use at work. The employer provided her with customized prescription goggles to wear at work.
A social worker with Type 2 diabetes was experiencing vision loss. The individual requested a reduced workload.
The employer contacted JAN looking for alternatives to lowering productivity standards. JAN suggested stand magnification equipment for reading print materials and screen magnification software for reading from the computer screen.
A preschool teacher needed to read books aloud to students during circle time.
She had difficulty describing and talking about the pictures in the books because of her color vision deficiency. She wanted to be able to describe the pictures accurately in order to help the children learn their colors. She was sometimes able to get help from a teaching assistant, but wanted a more independent solution. A JAN consultant discussed free and low-cost apps for identifying colors and suggested that she use an app to familiarize herself with the colors used on various pages in advance. The teacher also made index cards with notes about the pictures that she wanted to describe and taped them to the back cover of each book while reading.
A dental office hired a receptionist with a vision impairment to work in the front office.
The new employee had acquired a service animal, but did not yet have accrued vacation time that could be used for service animal training. The employer allowed the receptionist to take unpaid leave to attend service animal training.
An engineer with color vision deficiency needed to work on multiple projects.
The engineering firm where he worked printed materials related to each project on a different color of paper in order to help everyone stay organized. The engineer was not able to distinguish colors, and did not find the system useful. A consultant from JAN discussed numerous accommodation ideas including organizing the paperwork differently, handwriting the color or first letter of the color in the upper right corner of the master copy so that it would be there on all photocopies, and providing a handheld color identifier to the engineer so that he could use it identify the color of each paper on his own. The employer provided a high-end handheld color identifier.
A health care worker with lupus had low vision.
She was having difficulty viewing her computer screen and paper copies. The individual was accommodated with a large monitor, screen magnification software, hand/stand magnifier for paper copies, and a closed circuit television system.
A maintenance director at a residential building had color vision deficiency and needed to repaint and touch up the paint in various rooms.
He had particular difficulty distinguishing between white paint and light green paint. As a result, he sometimes found it hard to choose the correct shade of paint for touchups and noticing when he had missed a spot while painting. A JAN consultant provided information about handheld color identifiers and apps for smart phones that could help with color identification. The consultant also discussed that a coworker might be able to help the maintenance director identify the correct can of paint before starting a task and could also help with checking for spots that he may have missed. The employer chose to restructure the maintenance director's job to reduce the amount of painting for which he was responsible, and also allowed him to seek assistance from a coworker to ensure use of the correct shade of paint and to check for missed spots.