FAQs

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Reading and writing can be accomplished in many different ways. If you have some remaining vision, it’s recommended that you first make an appointment with a low vision specialist, either an optometrist or ophthalmologist with additional training in this area, and discuss the ways that low vision optical devices and non-optical devices, such as magnifiers, small telescopes, improved lighting, or closed circuit televisions and video magnifiers can supplement your reading needs. You can also make adaptations on your computer, use large print, or learn more about braille. In this section, you will discover that there are many options for continuing to read and write if you are blind or have low vision.

Available Resources:

• Traumatic Brain Injury and Low Vision
• All About Braille
• Using Screen Readers

Braille is a tactual reading system that was invented in France in the mid-1800s and is named for its inventor, Louis Braille. Braille enables children who are unable to read print to become literate, and helps adults who lose the ability to read, due to blindness or low vision, to continue enjoying books, newspapers, and magazines. The Braille alphabet is based upon a "cell" that is composed of 6 dots, arranged in two columns of 3 dots each. Each Braille letter of the alphabet or other symbol, such as a comma, is formed by using one or more of the 6 dots that are contained in the Braille cell.

Types of Braille: Braille has codes for writing text, music, and even technical material for math and science. Text or literary Braille has two forms - uncontracted or alphabetical Braille and contracted Braille for saving space:

Alphabetic Braille, formerly called Grade One, writes out each letter and word exactly as it is spelled out in print. For example, in Alphabetic Braille the word "can" is written by using three separate braille cells — one cell for each of the three letters in the word "can." If you're interested primarily in writing shopping lists, keeping telephone numbers, or writing labels or brief notes, Alphabetic Braille may meet your needs.

Literary Braille, formerly called Grade Two, is also called "contracted" braille. For example, in Literary (or contracted) Braille the word "can" is written in a highly condensed or contracted form, using only one braille cell to represent the entire word. The majority of books and magazines are written in Literary Braille because it requires much less space than does Alphabetic Braille. If you want to read novels, magazines, or newspapers in braille, it is recommended that you learn to read and write Literary Braille.

Web Eyes is a patented screen magnification software program that makes the web more comfortable for individuals with low vision. Web Eyes will increase the size of the text to any size that's comfortable for you and the type stays crisp and sharp. It also increases the size of boxes and forms, as well as web-based email.

Screen Reading Software: If you have been dependent on your computer but can no longer distinguish information on the computer screen, even using the accessibility features of Windows VISTA or XP or the MAC Leopard, you may be feeling very lost. It would be advisable to locate a vision rehabilitation agency in your area where you can take advantage of a thorough Technology Evaluation. Specially trained AT (Assistive Technology) professionals will be able to help you determine which adaptive devices and software will best meet your computer usage needs. Thanks to major advances in screen reading software, it has become much more possible and far easier to access all aspects of computer usage via synthesized speech. Some of the more popular speech software programs (screen readers or speech synthesizers) on the market today include:

• JAWS — from Freedom Scientific
• WindowEyes — from GW Micro
• Hal — from Dolphin Computer Access
• ZoomText with NeoSpeech from AI Squared

In the United States, and increasingly throughout the world, JAWS for Windows is taking a significant part of this market. For this reason, you may find it easier to locate potential trainers for this software as opposed to other alternatives. The downsides to these types of programs are their relatively high price and their complexity, which can make the learning process rather time consuming. However, all of these products offer free demonstration copies, which you can either request on a CD-Rom or download directly from their websites. These demonstration copies will come with certain restrictions, but do provide you with the opportunity to try them out and get used to listening to synthesized speech. By the way, do not get discouraged if you are unable to easily understand everything you hear. With practice, you will get much faster and you will quickly forget you are listening to computer-generated speech.

A. Low Vision Therapists - typically certified in low vision therapy. They provide training and assistance in your optical aids for near and distance viewing tasks. They teach a veteran how to use the optical devices safely, how to clean and maintain them, and evaluate different optical devices. They instruct veterans to use their remaining vision effectively based upon the recommendations from the eye care specialist

B. Orientation and Mobility - a Certified Mobility Specialist has been trained to instruct the visually impaired in safe travel in a variety of settings. They begin with basic cane instruction to more advanced concepts such as 5-point intersections to escalators and airports. They must be certified.

C. Certified Visual Rehabilitation Teacher - typically a certified instructor who was trained in teaching activities of daily living skills to the visually impaired. This can include audible devices, Braille, cooking, labeling, writing skills, and home organization

D. Computer Access Trainer (CATS) - typically a blind rehabilitation specialist who has training and experience in teaching the visually imparied computer skills. There are specific software programs which they are familiar with teaching, such as Zoom Text, Guide, or JAWS

E. Visual Impairment Services Team (VIST) Coordinator - is a case manager who has major responsibility for the coordination of services for visually impaired veterans, service members, and their families. They are often the entry point into the continuum of care for visually impaired veterans.

F. Blind Rehabilitation Outpatient Specialist (BROS) - A person with a degree in blind rehabilitation that typically teaches blind rehabilitation skills in the veterans' home community. VISN 23 only has a poly-traume BROS for the inpatient Poly-trauma Rehabilitation Center in Minneapolis.

General Optometry with Basic Low Vision - Comprehensive ocular health evaluation and basic glasses are the focus. Limited higher power reading glasses, hand magnifiers, and special sun filters are provided to help thos with minor difficulties that have resulted in decreased vision. The typical exam time for these are about 30-40 minutes in length. Minimal training is provided as the best candidates for this type of care are high functioning patients with only minor visual impairment.

Comprehensive Low Vision Evaluation - A detailed personal history has specific focus on the multiple aspects of each patient's daily life annd how their vision affects their ability to performa particular tasks. This includes a meticulous refraction, eccentric viewing training, an in-depth reading evaluation, and trials and specific training on numerous handheld optical aids. We also provide more advanced technologies for those with profound visual loss that is unable to be remediated using traditional optical devices. A fully comprehensive evaluation may take up to 3 hours initially, with several follow ups and additional training sessions by a low vision therapist and/or low vision optometrist. The candidates for this type of program often have significant visual impairment and are frequently affected by multiple medical issues that make it difficult for them to adjust rapidly or learn quickly, a new way of viewing things.

Consultation is the set of specialized clinical services that are provided when the patient requires involvement of others beyond the primary care team to meet the agreed upon plan of care.

Care Coordination is the overarching goal of the Patient Aligned Care Teams (PACT) whereby all participants in the delivery of health services work cooperatively as a cohesive unit, facilitating access to care and improving each patient's health by providing the right care in the right place at the right time. It is a shared responsibility of all involved to engage the patient in shared decision-making and the cooperative exchange of information, expertise, and data to ensure smooth transitions and prevent that burden from being placed solely on the patient.

Care Management is a systemic approach to the implementation and facilitation of Care Coordination so that patients are linked with needed services, resources, and opportunities. This encompasses care across the continuum, connecting all services throughout the varied points of care for each veteran in their primary care panel (VA and non-VA services).

Case Management is a specialized services provided by designated clinicians who have unique training and skills to assist with highly complex situations requiring coordination of care that goes beyond the level normally offered by the primary care core team. It is a collaborative process under the population health continuum which assesses, advocates, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's and family's health needs through communication and available resources to promote quality, cost-effective outcomes.

DVIEVR is a joint initiative between the Departments of Defense and Veterans Affairs’ vision care communities to manage an ocular care clinical data repository. It is a location for both DoD and VA’s eye care community including clinical providers, researchers and academia to review and research data collected on eye care diagnosis, surgical intervention, operative procedures, visual acuity, and treatment for our service members and veterans injured in battle.

With DVEIVR, eye care providers can review longitudinal eye care data for our service members and veterans. DVEIVR captures and shares data on treatment from the point of injury through follow on care, including VA. This aggregate of data helps the vision care community make improvements to eye care enhances, enhance how eye care treatment improvements are made, guides eye care research, and helps to improve or enhance clinical practice guidelines.

The DoD and VA’s vision community identified the same need, which is the need to view longitudinal data on eye care provided to their patients to improve patient outcomes. The singular focus on patient outcomes allowed the vision community to be specific with the IT developers when it came to defining their requirements. The community continues to stay involved and vested in the development of the IT solution reviews. The result is a one of a kind IT innovation based on meeting the requirements of the functional community.

DVEIVR is a government owned system leveraging a Service Oriented Architecture (SOA) that is standardized, reusable, and independent. Therefore, the DVEIVR is a viable product that can be used by other communities of interest.

Taking the community of interest approach in building requirements, along with an agile project management methodology for system development contributed significantly to the success of the DVEIVR. The work with DVEIVR is with a specific community, the vision care community, as opposed to the multiple specialties that come with big medicine. The vision community knew what they needed their data to do and the DVEIVR system was built to those requirements. This approach allowed for the customer’s requirements to be heard and a solution geared towards exactly what they needed.