Retinitis pigmentosa describes a group of conditions that affect the retina. Retinitis Pigmentosa is a progressive condition and usually presents in childhood. However, in some cases may not appear until the 30s or 40s. In the early stages, the patient may notice that it takes longer for their eyes to adjust to poor light, such as outdoors at dusk or in a dimly lit room. Known as night blindness.
Patients will also experience a gradual reduction in their peripheral vision. Central vision may be affected first in some cases. Retinitis Pigmentosa is a genetic condition and results in the degeneration of the photoreceptor cells (light-sensitive cells) in the retina resulting in loss of vision and, in severe cases, blindness.
Having correctly structured HTML headings in documents is essential for helping people using accessibility technologies find their way around your webpage. But what are headings, and why are they so important.
Video explaining HTML Headings
What are HTML Headings
HTML has six heading levels labelled <h1>..<h6> with <h1> being the most important heading and <h6> being the least important.
The <h1> heading is only used once per page and represents the main heading of the page. The remaining levels can be used as many times as needed but must be used in order.
When a person uses a screen reader, they have access to none of these navigational clues. Screen readers read text on the screen; they have no way of knowing what is and is not important. So we have to tell them the structure of the document, one of the ways of doing this is by using HTML headings. The screen reader user can then use navigation tools built into their screen reader to move around the page more efficiently.
Using headings correctly will also help search engines to know what is important on the page. There are several tutorials available on YouTube about headings and search engine optimisation.
Common mistakes with headings
Using formatted text instead of headings
In this example, the document on the left appears to use headings; however, the text has been formatted to look like headings. This means to a screen reader, it has no structural information and looks like a mass of text on the right.
Using headings for things that arn’t headings
It’s quite common on web pages for the first paragraph of an article to be in a larger font, and bolder than the rest of the body text. However, in this case, <h2> level heading has been used to achieve this. If you need to format a paragraph, then this should be done with the stylesheet for the web page
Using Headings out of Order
The headings should be in a hierarchical order but in this case, we can see that <h4> comes after <h1>, we’ve got <h2>, but then <h3> is missing.
Age-Related Macular Degeneration or AMD is the leading cause of blindness in people aged 65 or over. AMD Occurs when the Macular, the part of the eye responsible for central vision stops working. This usually happens gradually over time.
Video Simulation of Macular Degeneration
Symptoms of Macular Degeneration include:-
Straight lines such as door frames and lampposts may appear distorted or bent
Vision may become blurry or develop gaps
Objects in front of you may change shape, size, colour or seem to move or disappear
Dark spots, such as a smudge on glasses, could appear in the centre of your vision
Colours can fade
You may find bright light glaring and uncomfortable
You may find it difficult to adapt from dark to light environment
Words might disappear when you are reading
Types of AMD
There are two types of Macular Degeneration, Wet MD and Dry MD. Dry MD causes a gradual deterioration in vision over several years as the cells of the Macular naturally die off but are not replaced. Around 15% of people with Dry MD will go on to develop Wet MD.
In Wet MD abnormal blood vessels grow into the macular and cause scarring. Wet MD can cause a sudden deterioration in vision if these vessels bleed. However, it can be treated if caught quickly.
MD only affects the central vision, so patients will still be able to see using their peripheral or side vision
Charles Bonnet Syndrome is a condition where people with sight loss experience visual hallucinations (seeing things that are not there). In this article, we attempt to answer some questions about this condition.
What sort of Hallucinations do people with sight loss get?
People may see patterns, colours, shapes (simple hallucinations) or distorted faces, objects, animals, landscapes, people in period costume (complex hallucinations).
Hallucinations are often vivid and can be seen in greater detail than the person can see in real life.
The hallucinations may be frightening or benign.
The hallucinations are always visual, they don’t involve taste, touch, smell or hearing things.
People are usually aware that what they are seeing is not real or learn to recognise them as not real, they do not develop delusions.
Charles Bonnet syndrome isn’t a mental illness
Who gets Charles Bonnet Syndrome?
Usually occurs in people with more than 60% sight loss.
Can occur at any age
According to the Macular Society up to half of people with Macular Degeneration experience visual hallucinations (Macular Society, n.d.).
What causes Charles Bonnet Syndrome?
Normally when the eyes are open the brain is constantly receiving visual signals.
Different parts of the brain are responsible for seeing different types of things, such as colour, faces etc.
When a person experiences sight loss, these signals are lost or disrupted.
The brain cells responsible for vision suddenly don’t have enough to do, so start firing spontaneously.
People will experience hallucinations depending on what these areas are responsible for seeing.
The brain gradually gets used to this reduced visual stimulus, so the hallucinations gradually reduce overtime.
However, another deterioration vision may cause the Hallucinations to return
Infection such as urine or chest infections may also cause the Hallucinations to return.
How do you diagnose Charles Bonnet Syndrome?
There is no one test to diagnose Charles Bonnet Syndrome
A diagnosis is made by talking to the patient and ruling out other medical conditions that could be causing Visual Hallucinations
“If a person has vision loss and they’re experiencing simple or complex hallucinations and don’t have signs of dementia or mental illness, they probably have Charles Bonnet syndrome”. (NHS, 2018)
How do you treat Charles Bonnet Syndrome?
There is currently no cure for Charles Bonnet Syndrome
Gaining reassurance that the Hallucinations are caused by sight loss and not a mental illness can help people cope better.
Talking about CBS with family/friends, GP or Ophthalmologists can help.
CBS isn’t a mental illness but professionals working in mental health have experience in helping people cope with hallucinations.
Esme’s Umbrella recommends the following self-help techniques (Potts, n.d.)
if sitting, try standing up and walking round the room. If standing, try sitting.
Walk into another room or another part of the room.
Turn your head slowly to one side and then the other. Dip your head to each shoulder in turn.
Stare straight at the hallucination.
Change whatever it is you are doing at that moment – turn off/turn on the television/radio/music.
Other strategies target the brain regions involved in hallucinations. These include:
Changing light level in the room. It might be the dim light that is causing the hallucinations. If so, turn on a brighter light – or vice versa.
Blink your eyes once or twice.
A specific eye-movement exercise. When the hallucination starts, look from left to right about once every second for 15 seconds without moving your head. If the hallucination continues, have a rest for a few seconds and then repeat the eye movements. You may need four or five repeats of the eye movements to have an effect but there is no point in continuing beyond this if there is no benefit.
Shine a torch upwards in front of the eyes – NOT INTO THE EYES – and the light stimulates the cone cells, so the brain switches off the hallucination.
Some medications used to treat Epilepsy, Dementia and Parkinson’s Disease have been effective for some people, but these may also come with serious side effects.
As of the 1 August 2020, the BBC scrapped free TV licences for the over 75s unless they receive pension credit. However, you may be able to apply for the Blind Persons TV Licence Concession.
What reductions are available?
You can get a Free TV licence if:-
You are over 75 and get pension credit
You are over 75, and regardless of if you get pension credit you live in a care home that has an ARC (Accommodation for Residential Care Licence), you need to speak to the care home administrator to see if this applies to you.
You can get a 50% reduction in the cost of a TV Licence if
You or someone you live with is Blind/Severely sight impaired regardless of their age.
You don’t need a TV licence if:-
You receive TV signals by a digital receiver that can only play sound and not display a picture.
Blind Persons TV Licence Concession
You are eligible for a 50% reduction in the cost of your TV Licence, If you or someone you live with is registered Blind or Severely Sight Impaired. For a Colour TV that’s £78.75 and for a Black and White TV it is £26.50 (as 5 August 2020).
When you first apply for the Blind person concession, you will need to provide proof that you are Blind or Severely Sight Impaired, this can be either a copy of:-
Your CVI (Certificate of Visual Impairment) or BD8 Certificate
A certificate or document issued by a Local Authority that shows you are registered as blind (severely sight impaired)
certificate from an Ophthalmologist (eye surgeon), stating that you are blind (severely sight impaired
Sight airedale is unable to provide you with proof of your visual impairment. Your GP (they may charge for this) or Hospital should be able to provide you with evidence of your visual status.
If the Blind Person is not the licence payer.
If the Blind person is not the licence payer, you will need to transfer the TV licence into their name, assuming they are over 18 for more information on how to do this visit the TV Licensing website or call them on 0300 790 6130. You will need to have your current TV licence number available.
How to get a refund
If you are currently paying for a full TV licence, you can apply for a refund from the date that you became registered Blind or April 2000 which is when the scheme started. You will need to be able to show that you were registered blind at the time you purchased the licence.
You can now support sight airedale through amazon smile by using the amazon app on your iPhone or android phone.
Load the Amazon shopping app
Choose the main menu
Choose Amazon smile
Follow the on-screen prompts
If you’re not already giving to us via amazon.smile visit https://www.smile.amazon.co.uk/ch/1080245-0 When you shop at smile.amazon.co.uk 0.5% of your purchase will go to support sight airedale. If you forget, Amazon will remind you.
We hope you are all staying safe during this time, we’re both working from home, so the office is closed to callers, but we are still answering the phones. Our helpline hours remain the same from 9.30 am to 12.30 pm Monday to Thursday.