Patients with visual impairment experience barriers to accessing health care
Visual impairment encompasses a wide range of deficits, from reduced visual acuity to visual field deficits to blind-ness. People with visual impairment are more likely to lack a primary care provider, report unmet health needs, and face cost-related barriers to care.1 People who are blind have higher rates of hospital admission and increased mortality than the general population.2,3
Health care providers should introduce themselves and speak directly to the patient with visual impairment
People with sight loss report being treated as incompetent and not being addressed directly by their health care providers. 4 Providers should clearly introduce themselves each time, state their role, and speak directly to the patient — not to the patient’s companion.
Providers should ask before offering help and use descriptive language
Unsolicited assistance can feel intrusive or unsafe. Health care providers should be descriptive during examinations and verbally describe imaging results. When guiding patients to a room or chair, they should offer an arm in a relaxed, bent elbow position rather than grabbing and pulling the patient, and avoid touching canes, guide dogs, or mobility aids. Referral to Vision Loss Rehabilitation Canada can provide orientation and mobility training and assistive technology coaching.
Clinic and hospital spaces should be safe and easy to navigate
Dim lighting, crowded waiting rooms, and small-font sign-age create hazards for people with visual impairment. Keeping walkways clear, maintaining stable furniture placement, using high-contrast tape on carpet edges and other tripping hazards, optimizing natural lighting, and implementing large high-contrast signage will optimize safety. For patients in hospital, frequent verbal reorientation, visual aids (e.g., magnifiers), and simple adaptations (e.g., fluorescent tape on call bells and a larger bedside patient whiteboard or communication board) should be used.
Information should be provided in accessible formats
Many people with low vision struggle to access health information. Large-print materials (e.g., ≥ 18-point, or 14-point bold) on high-contrast backgrounds should be provided; patients may prefer a digital copy, as many are competent at using screen-readers or magnifiers. Digital materials that comply with established accessibility standards (Web Content Accessibility Guidelines 2.0; Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.251872/tab-related-content), which enable assistive technology usability, are preferred.5
Supplementary Information
Footnotes
Competing interests: None declared.
This article has been peer reviewed.
Editor’s note: Kelly Serbu is a legally blind provincial judge whose lived experience informed the recommendations outlined in this article. He is a former criminal defence lawyer who served as vice president of the Nova Scotia Criminal Lawyers Association and president of the Canadian Blind Hockey Association. Anuradha Mishra is an ophthalmologist with expertise in vision rehabilitation. She has extensive experience caring and advocating for patients with visual impairment in Canada. Mostafa Bondok is an ophthalmology resident who works with patients with visual impairment and is involved in community initiatives such as teaching people with low vision to use assistive technologies, and coaching athletes who are blind.
References
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