1. Macular Degeneration and the skill of Eccentric Viewing Presented By: Nancy Parkin-Bashizi, M.A., COMS, CVRT Program Director, Lead Teacher Vision Rehabilitation Services of Georgia nancy@bashizi.com 770-432-7280 nancy@bashizi.com

2. Objectives of the Webinar 1.Understand how Macular Degeneration affects one’s ability to read print 2.Understand how Eccentric Viewing can help improve reading 3.Learn how to locate one’s sweet spot or Preferred Reading Locus 4.Learn how to guide one in improving their ability to see and read using this technique 5.Learn resources available to you to assist in this process.

3. Understanding Macular Degeneration and Eccentric Viewing The Macula is the central part of one’s retina and is responsible for the fine detail seeing and reading we do daily. Once the Macula begins to degenerate – a scotoma or “blind spot” may begin to form in a part or parts of the Macula. Where this scotoma forms and it’s size will affect how much it interferes with your ability to see and read fine print.

4. Overtime, one’s scotoma may grow -- using magnification can help to make things bigger and thus easier to see around the scotoma However, there is usually a point at which reading with our central vision becomes too difficult and frustrating. This is the time when Eccentric Viewing may need to be considered as an option to improve one’s reading efficiency.

5. What is Eccentric Viewing? Eccentric Viewing is basically learning to look around the blind spot to see. It’s the process of finding one’s “sweet spot” for reading using your healthy peripheral vision and learning to read with this. This sweet spot may sometimes be referred to as your “Preferred Reading Locus or PRL.” The sweet spot is different for each person as it depends on the progression of your disease and can even be different in each eye!!

6. Clues to know its time to consider Eccentric Viewing. Reading seems to have become hard, frustrating and tiring. Magnification does not seem to help much. You are using a 4x power magnifier or higher You feel like you have “Lost more vision” or “Had a lot of change to your vision.” Things seem darker and harder to see. You find yourself reading less and less.

7. How do I learn the skills for Eccentric Viewing Eccentric Viewing Training Involves 3 main steps and anyone can learn and practice these on their own. However it may help to have a Vision Rehabilitation Therapist or a Low Vision Therapist help you if you are having difficulty. 1.Locating your Sweet Spot and learning how to “use it when you need it.” 2.Learning and practicing how to identify letters and numbers with your sweet spot. 3.Learning the “hold your eyes still and move the paper” technique. Practice, Practice and more Practice.

8. Locating your Sweet spot for reading – Set Up 1.Choose a good reading location, with desk/ table, good task lighting and your materials ready. 2.Prepare Materials (or see attached documents); bold line pen or sharpie, several pages of blank paper, clipboard. 3.Using dark pen draw a clock face with a star in the middle and the numbers 12, 3, 6, and 9 in their correct location. 4.In print large enough to see, write 2-3 random letters per line on a sheet of paper – approximately 3-4 lines of letters. We will not be using magnification for this exercise.

9. Materials for initial activity

10. Locating your Sweet spot for reading: The technique. Close or cover your “bad” eye and look at the clock you drew. Keeping your eye on the star (for most people the star or parts of it are missing) – note which numbers of the clock are most clear. This gives you a hint of where your sweet spot may be. Your goal is to now move your eye from 12-3-6-9 – pausing at each number to note at which location the star appears most clear. So for example if you slide your eye up towards the 12 – does the star become clearer? Repeat for each number on the clock. There should be 1-2 places where the star appears clearest. Moving your eye in “that direction” is how you find your sweet spot.

11. Locating your Sweet spot for reading: Things to Note 1.Hold the paper with the large letters fairly close 2.If you have reading (non-bifocal) glasses, use these in the process 3.Once you locate your sweet spot, practice “resetting your eyes” and locating it again. You can use large print letters you drew or other objects such as playing cards, dominos or large print flash cards. 4.Think of your scotoma as a curtain – you are sliding it out of the way so that you can see more clearly through your “window.” 5.Re-do with your good eye covered to see where your sweet spot is located in your “bad eye.”

12. Locating your Sweet spot for reading - Common Challenges 1.It’s hard to hold the eye steady Learning to hold one’s sweet spot still and steady takes A LOT of practice. Try to read 3-4 times a day with your large print letters and numbers for about 5 minutes. Once you have mastered this you can move onto reading other large print materials. 2. My sweet spot is different in both eyes This is pretty normal. Most people will naturally adjust to reading with their “good eye.” But this takes time as the brain needs to learn to ignore what it sees from the bad eye. Patching your bad eye while reading will help with this process

13. Locating your Sweet spot for reading - Common Challenges 3. Good eye/ Bad eye It is not uncommon during this time to have sudden vision changes that affect either eye. For many people their former “good eye” is now their “bad eye.” When this happens it is really important to understand that your brain will need a good deal of time to re-learn to pay attention to information coming in from the old bad eye (your new good eye). Patching the new bad eye can help this process. Working daily with reading and seeing tasks will make this process go faster. It is very important to have patience with yourself at this time.

14. Techniques for Identifying Letters/ Numbers Learning to use your sweet spot for reading will take a lot of practice. Short, frequent reading tasks will work best for the first 1-2 months. Ideas of things to read: -Large print letters / numbers on the page -Large print flash cards -Playing cards -Telephone numbers -Shopping lists -Lists of words (animals, plants, cars, flowers, fruit, etc.)

16. “Hold your eyes and move the paper…” Once one has mastered identifying simple letters, short words and numbers it is time to introduce the next technique. In order to increase reading efficiency you will learn to move the paper you want to read, across your sweet spot. Previously you read by moving your eyes across a line of print. Now if you try to read this way your blind spot/ scotoma jumps around, covers letters here and there and makes reading really hard. By moving the paper across your sweet spot you can hold your eye still and identify each letter as it moves through the spot – allowing you to read more efficiently – OVER TIME and with A LOT of PRACTICE

17. “Hold your eyes and move the paper…” For practice materials you will want to have several types of reading material – starting with large print short words / phrases, then moving to material with longer phrases or short sentences. Sample practice materials include: - lists of short words -shopping lists -short phrases /Idioms (blue moon, green thumb, red sky) - nursery rhymes or bible verses Practice 10-15 minutes a day – 3-4 times a day

18. Practice, Practice and more Practice. Once you find yourself easily able to read these materials using these techniques you may consider introducing magnification into the process. Start with a combination of larger print and a lower power (3-4x) magnifier as it has a larger viewing area. Hold your magnifier and eye still and move the paper under the magnifier. Start with easy material then slowly work into reading smaller print Over time you may incorporate the use of a video magnifier/ stronger magnifier to see smaller print.

19. Summary Notes Learning to use Eccentric Viewing to read again is a complex process that requires time, patience and practice. One can approach this activity independently or work together with a Vision Rehabilitation Therapist (see resources to locate one in your area) Reading with Advanced Macular Degeneration is possible and can allow you to maintain your quality of life and independence. Have patience with yourself, go slow and enjoy learning to read again!

20. Resources To locate at Vision Rehabilitation Therapist or Low Vision Therapist in your area go to American Foundation for the Blind’s directory of services on their website: http://www.afb.org/directory.aspx?action=results http://www.afb.org/directory.aspx?action=results Contact a local agency serving individuals with visual impairment and talk to them about Visual Skills Training. Contact Nancy Parkin-Bashizi @ nancy@bashizi.com or 770-432-7280nancy@bashizi.com