Articles: Medical Topics
Vision Changes and the Elderly: Is Your Law Firm an Accident
Waiting to Happen?
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 “Come
quick! A woman fell in the hallway!” When
your secretary bursts into your office, your heart sinks.
Are people at risk for injuring themselves at your law firm?
Have you made the necessary changes needed to accommodate
the visual changes of the workers and clients who walk up
your stairs, come through your doors, or use your bathrooms?
Have you considered the coming epidemic of visual loss associated
with the aging of the population?
Age
related macular degeneration (AMD) is the number one cause
of vision loss and legal blindness in adults over 60 in
the U.S. As our population ages, and the baby boomers advance
into their 50s and 60s, we will see a virtual epidemic of
AMD. Perhaps 14-24% of the U.S. population aged 65-74 years
and 35% of people aged 75 years or more have the disease.
Although it rarely causes total blindness, age-related macular
degeneration robs those affected of their sharp central
vision and can dim contrast sensitivity and color perception.
It destroys the clear, “straight ahead” central
vision necessary for reading, driving, identifying faces,
watching television, doing fine detailed work, safely navigating
stairs and performing other daily tasks we take for granted.
Peripheral vision may not be affected, and it is possible
to see “out of the corner of your eye”.
The
impact of developing AMD can be devastating to those who
were independent and active prior to the onset of this cruel
impairment. Their visual world gradually diminishes into
a vague blur, making ordinary daily activities challenging.
[1] Cataracts, glaucoma, diabetic retinopathy, stroke, and
retinal tears also impact vision. Any of these conditions
may be present in the elderly with whom you interact.
Up until
about six years ago, there was no treatment for AMD. It
is currently treated with vitamins, argon laser, light sensitive
laser, or injections into the eye. The vitamins are specific
to eye health, and include beta-carotene, Vitamin C, Vitamin
E, zinc and copper. Argon laser cauterizes abnormal blood
vessels and lesions close to the optic nerve. This treatment
may provide only temporary improvement or may worsen vision
by creating an area of scar tissue. Light sensitive laser,
or photodynamic therapy, is performed five minutes after
a dye is injected intravenously. The patient remains sensitive
to light for five days, and is unable to be outside, sit
near a window, or be under a halogen light. This is a serious
restriction—third degree burns will result from exposure
to bright lights.
The
concept of intravitreal injections into the eye sends shivers
up most people’s spines. Kenalog and Avastin are both
being used off label for this purpose, and Lucentis, which
was approved for use in June 2006, is also employed. Kenalog
injections are associated with major risks, including infection,
steroid induced glaucoma, and retinal detachment if the
needle is put in the wrong spot. Avastin injections cost
about $50 per dose compared to $1950 per dose for Lucentis.
Lucentis must be injected every 4 weeks for 4 months, and
then quarterly. [2] Macugen has been approved for treatment
and is injected into the eye every 6 weeks. Given the expense,
complexity, and low success rates for treatment of AMD,
the best method is prevention of eye damage.
Walk
around your law firm viewing it as if your next visitor
had impaired vision. What do you see?
Are
the hallways highly polished, creating a glaring surface?
Carpeting or nonglare finishes are safer. Is there extra
lighting in the hallway and stairwell?
Is the
furniture in the waiting room beige, pink or gray, making
it difficult for the older eye to see? Bright contrasting
colors—red, orange and yellow—are easier to
distinguish.
Are
there redwells on the floor in the way of traffic?
Do the
stairs lack hand railings?
Are
there large picture windows open to the view outside, but
allowing glare to overwhelm the scene? Better, keep the
shades or blinds closed.
Are
the forms you frequently hand to people to read printed
in a small (10 or 12) font or do you have a large print
version available? Are magnifying glasses available?
Are
the doorways of the rooms painted in the same color as the
wall, or are they in a contrasting color to make them easier
to see?
Do your
lamps have glare? Do you have small lamps that can be focused
on paper that you want your client to be able to read?
Do you
have a dimmer switch attached to overhead lights that permits
an increase in light or use bulbs that have three settings?
Is the
switch plate the same color as the wall, or is it a contrasting
color or have a light built into the switch?
Do you
serve coffee or tea to older clients in cups with contrasting
rims?
Med
League offers aging simulations and sensitivity training
for law firm staff in select geographical areas. Your staff
will have an opportunity to experience the changes in senses
associated with aging. Med League provides expert
witnesses and medical
record summaries for cases involving injuries to the
elderly, as well as plain English explanations of medical
issues. Contact Pat Iyer for details.
References
1. www.amd.org
2. L. Samorski, "Emergent Therapies in Macular Degeneration",
National Gerontological Nurses Association Annual Conference,
October 6, 2006.
Tips
for attorneys: What you can do to protect your eyesight:
1. Stop smoking. Tobacco seems to interfere with the absorption
of lutein, an antioxidant that protects the eyes from ultraviolet
light.
2. Wear sunglasses when exposed to blue light or sunlight
and use caps with brims to protect the eyes, even on cloudy
days.
3. Control blood pressure. The link between high blood pressure
and AMD has been the subject of much research.
4. Eat a healthy diet low in saturated fats and high in
fruits and vegetables.
5. Keep your blood glucose under optimum control if you
are diabetic.
New
Resources for Cases involving the Elderly:
Patricia Iyer (Editor) Nursing
Home Litigation: Investigation & Case Preparation,
2006,
University
of Maryland School of Medicine videocassettes and DVDs that
may be purchased or rented concerning elder care: www.videopress.org.
Thesaurus
of Aging Terminology, available for $10.00 from AARP, provides
terms useful for searching the AgeLine Database of AARP.
Contact ageline@aarp.org
for information.
Barbara
Acello, The Long Term Care Legal Desk Reference: Understanding
and Minimizing Risk for Nursing Home Managers, 2006, HCPro,
www.hcpro.com, search
for Acello.
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