Table 2.

(A) Considerations and (B) non-pharmacological approaches tailored to individuals with PCA (adapted from [10••])

(A) Considerations
A key priority is discussion of driving safety; most individuals will not be safe to drive
Occupational and daily routines may be severely impacted by progressive cortical visual loss, despite relatively preserved memory, language and insight
Individuals may have a high risk of becoming lost
Individuals may be eligible to register as severely sight impaired or blind, even despite normal visual acuity
As PCA progresses, most individuals will become functionally blind leading to a high risk of falls

(B) Non-pharmacological approaches
Individuals may benefit from referral to an occupational therapist, ideally with experience in supporting individuals with cortical visual loss, to develop compensatory strategies to support functional status and promote participation in meaningful activities (e.g. utilising voice-activated music listening devices)
Professional recommendations include simplifying the environment (e.g. removing clutter and unused objects). Approaches require sensitivity to the potential emotional impact of inadvertently removing objects relating to an individual’s identity and personhood (e.g. books for a previously avid reader, tools for a former handyman) as well as those acting as visual/orientation cues (see ‘Spatial awareness and mobility’). There is evidence that reading aids reducing visual clutter (by minimising adjacent text) may promote reading function [31•, 32]
There is evidence that strategic use of visual cues and contrast, minimizing lighting variability and shadows may facilitate visually guided navigation and walking [33, 69]. Shared strategies from individuals include brightly coloured stickers to make parts of garments or buttons on gadgets more visually salient and motion-sensor lights or nightlights to support wayfinding to the bathroom
Use of a white cane or sunflower lanyard may be helpful, particularly to encourage awareness of the individual’s support needs amongst others in public places. Many people with PCA may find use of more complex canes (e.g. roller cane) challenging, especially at later stages
Whilst equipment designed for those with low vision might be appropriate beyond the white cane (for example, talking watch, typoscope, audiobooks), careful appreciation of concurrent non-visual symptoms is required. Diminished praxis skills and non-visual spatial awareness subsequently accompanied by declining memory and executive functioning pose substantial challenges to the adoption of generic assistive technology [10••, 38•, 71]