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Guest Editor's Page

It ain't what we don't know that gets us into trouble. It's what we know for sure that just ain't so. --Mark Twain The year 2008 represents a new world for visual impairment in the United States and Canada. The demographics of vision loss have changed radically in the last several decades. Today, the greatest number of people with visual impairments are not children or young adults; rather they are seniors with age-related macular degeneration (AMD), who outnumber younger visually impaired adults and children by wide margins. According to the National Eye Institute, people 80 years of age and older currently make up 8 percent of the population, but account for 69 percent of those with visual impairment and blindness, largely from AMD. Indeed, macular degeneration is the cause of the majority of all visual impairment and blindness in Americans. This matters because much of what we know for sure about visual impairment and vision rehabilitation "just ain't so" with macular degeneration. Why? Two key reasons. DIFFERENT LIFE EXPERIENCE Seniors are a population distinct from all others, including younger and middle-aged adults. Just as children have their own medical specialty--pediatrics--so seniors have theirs--geriatrics. Just as kids are not little adults, seniors are not wrinkled adults. They are unique physiologically, medically, and psychosocially. They require different rehabilitation strategies and approaches, different visual and functional devices, and different teaching approaches and methods for effective rehabilitation. Age-related physiological changes in hearing, balance, agility, recovery time, learning patterns and memory make part of the difference. Seniors often rely on their vision to compensate for these other age-related losses, so that when vision is lost too, they are particularly vulnerable to age-specific functional declines and dangerous falls. This situation does not preclude them from being successful in vision rehabilitation, but it does mean that rehabilitation professionals must understand how to address these conditions and assume the responsibility for doing so, or else partner closely with other health care professionals who can address them. When working with seniors, successful vision rehabilitation professionals may need to modulate the pitch and pacing of their voices, adapt their teaching practices to maximize learning, and take the physiological differences of seniors into account. Clients with low vision may need support canes, rather than long canes, to maintain safe balance when walking. They may need contrasting shower bars, contrasting color mats, and adaptive lighting in order to remain safe in the bathroom. With seniors, these considerations are not side issues but are an integral part of vision rehabilitation practice. Seniors also present with a range of medical conditions that shape vision rehabilitation practice, possibly including a history of minor strokes, diabetes, early-onset Parkinson's, arthritis, hypertension, heart disease, osteoporosis, chronic joint or back problems, reduced range of motion, under- or overdosing on medications, and clinical depression as a result of vision loss. Vision rehabilitation professionals must recognize the symptoms of these conditions, understand their interplay with vision loss in compromising function, and address them as an intrinsic part of vision rehabilitation. Seniors are also at a different life stage, with different skills and resources from younger and middle-aged adults, often with other profound losses in their lives--the loss of a spouses, siblings, jobs, or even homes as they move to retirement or assisted living facilities distant from their familiar neighborhoods. Successful vision rehabilitation requires understanding and incorporating these physical, psychological, and cultural differences that sculpt seniors' experiences of vision loss and influence their approach to rehabilitation. …