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Health Literacy, Prescriptions and the Blind and
Vision-Impaired by John Dobbins When one thinks of the Blind they usually have a preconceived notion
that they are dealing with someone who is totally devoid of sight and needs assistants
with ADL. This could not be further from the
truth. Many of our patients that are legally
blind can use our services as pharmacists to remain independent and function just like
anyone with normal vision. When doing an
intake history, we should include the question about vision-impaired or blindness. Reasons for vision-impairment include trauma or
infection, congenital problems, Age Related Macular Degeneration, Glaucoma, Cataracts and
Diabetes. It should be noted that the number of Blind and vision-impaired is estimated to
be 12-14 million. Legally blind diabetics
represent about 10% of the legally blind population. Any
further discussion on the types and reasons for blindness are beyond the scope of this
article. The definition of legally blind in most states is 20/200 or less in
the best-corrected eye or a narrowing of the visual field by 20 degrees. Physicians are by law required to report any
patient who is legally blind to the appropriate state agency for follow-up services.
Services for the legally blind vary from state to state and may provide some instruction
in medication management by a rehabilitation councilor.
This is where the pharmacist can help tailor therapy to best fit the
patient. There are any number of low-tech
devices that we have available at little or no cost to the patient. These include: (1) Marking Rx vials with large print letters (AM/PM) (2) Rubber bands (# of times per day) (3) Color-coding (yellow for AM, blue for PM) (4) Bumper dots (# of times per day) (5) Large-print medication logs/calendars (6) Bubble-packing prescriptions or pre-packaging by manufacturer (7) Medication organizers You should not put Rx tape on prescription containers. This causes glare and can make reading difficult.
Items such as handheld magnifiers and better lighting with contrast should be considered
for the counseling area. For those that need more help, there are a number of different talking
products. These include: (1) Talking glucometers a.
Accu-Chek Voicemate b.
Lifescan One Touch II or Profile series with voice
synthesizer (2) Talking blood pressure meters – various types (3) Talking digital thermometers – various types (4) Talking Rx containers a.
Talking Rx b.
Aloud c.
Script Talk (5) Insulin measuring devices a.
Count-a-dose, both
Hi and Lo-dose b.
Loadmatic c.
InnoLet Most pharmacists were never taught in school how to counsel a patient
who is vision-impaired. I would like to
include some tips that you might want to consider for your practice. Here are some Courtesy Rules of the Blind that you may want to include
in your practice. THE COURTESY RULES OF THE BLIND When you meet me don’t be ill at ease. It will help both of us if you remember these
simple points of courtesy: (1)
I’m an ordinary person, just
blind. You don’t need to raise your voice
or address me as if I were a child. Don’t
ask my spouse what I want or how I take my medication – ask me. (2)
I may use a long white cane or a guide
dog to walk independently: or I may ask to
take your arm. Let me decide, and please
don’t grab my arm; let me take yours. I’ll
keep a half-step behind to anticipate curbs and steps. (3)
I want to know who’s in the room
with me. Speak when you enter. Introduce me to others. (4)
The door to a room or cabinet or to a
car left partially open is a hazard to me. Similarly, always keep the isle of your store
completely clear of boxes and display items. (5)
Typesetting of 14 point or larger
complies with federal standards for printing of material for the visually impaired. This should be helpful for you as practitioners
when providing written material. 16 or 18
point is even better. Remember to change your
printer cartridge as well. (6)
Don’t avoid words like
“see”. I use them, too. I’m always glad to see you. (7)
I don’t want pity. But don’t talk about the “wonderful
compensations” of blindness. My sense of
smell, touch or hearing did not improve when I became blind.
I rely on them more and therefore, may get more information through those
senses than you do – that’s all. (8)
If I’m your customer, show me
around your store. I like to know where things
are. (9)
I’ll discuss blindness with you
if you’re curious, but it’s an old story to me.
I have as many other interests as you do. (10)Don’t think of me as just a blind person. I’m just a person who happens to be blind. (11)You don’t need to remember some “politically
correct” term, “visually impaired”, “sight challenged” etc. Keep it simple and honest, just say blind. In all 50 states the law requires to yield to the right of way in
cross walks, when they see an individual with an extended white can. Only the blind may carry white canes. You see more blind persons today walking alone, not
because there are more of them, but because they have learned to make their own way. I hope these pearls will help you in your practice and feel free to
contact with any additional suggestions or comments.
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