Blind Rehabilitation: Helping Veterans Navigate their New World

Blind people do not always suffer from total loss of sight; it ranges from low vision, such as needing magnifiers, to shadows and light. Blindness covers an array of experiences, and it can start at any point in life. This raises the question, what happens when you have been a member of the seeing world your whole life and then suddenly become blind due to illness, while also being a Veteran. 

 While performing daily functions such as driving, putting on makeup, using your phone, choosing an outfit, and walking across the street, can no longer be performed the ordinary way, that’s when the Veterans Affairs Continuum of Care for vision rehabilitation enters the picture.

This department works in tandem with the Advanced Low Vision Clinic (ALVC) and employs multiple personnel that help Veterans with visual impairment navigate the world.

The Visual Impairment Services Team (VIST) coordinator serves as a case manager and helps schedule and coordinate all services. The Blind Rehabilitation Outpatient Specialist (BROS) helps Veterans with skills in their home, community, environment, including their local VA facility. A Low Vision Secretary helps with communication between Veterans and the clinic.

Low Vision Optometry provides examinations to identify optical corrections and to determine a patient’s capability of benefiting from adaptive vision training and prescriptive low-vision devices.

Beatriz Sanchez-Fields, the BROS specialist at the West Los Angeles VA Medical Center (West LA VA), said, when somebody becomes newly visually impaired, low vision, legally blind, it’s a change, and it registers as a lost. People go through their feelings of being angry, being depressed, not accepting their condition. They become part of my caseload and it’s so enriching to help.

“We can teach basically anything, just as long as the patient is open to it,” said Sanchez-Fields.

Mechanics of Blind Rehabilitation

Ted Zadourian, the Supervisory Blind Rehabilitation Specialist (Section Chief) at West LA VA, said that “There are five major areas of blind rehab. Visual skills are done in the clinic, and it’s mostly centered around the glass magnifiers, reading and distance vision goals like watching TV”.

Zadourian said, if you’re not legally blind, many people believe it ends there and that’s not always the case.

He pointed out that this wasn’t necessarily the case. “If we identify further needs, then we can do more. But if you’re legally blind, then you have more challenges in the other areas, which are called independent living skills, everything around the house from cooking, cleaning, grocery shopping, writing notes to yourself, keeping track of appointments, and medication management.”

According to Zadourian, the third one is orientation and mobility, meaning independent travel skills. “That’s where we introduced long cane and how to use it. If someone has to include that someone’s legally blind, then they’re probably going to need some kind of adaptive tool for walking. We cover that in orientation and mobility”.

“We also cover transportation and help them sign up for access or teach them how to use public transportation. We can teach them how to use Uber if they want. Manual skills are the next discipline that’s working with your hands, which can be chores or crafts. The most popular one is computer assistive technology, or CAT”.

Zadourian added the clinic utilize other technology such as computers, smartphones, and tablets. They incorporate a lot of tech training, utilizing either the built-in accessibility features of devices, or adding additional software to, say, a computer.

With a world class team of experts, Veterans with visual impairments have assets that can help transform their lives.

Veteran’s Diagnosis

Cheri Owen, a United States Airforce veteran who honorably served from 1993-1996, now is a legally blind Veteran due to illness. Her journey is one of sadness, perseverance, and determination and mirrors the journey of being a visually impaired Veteran later in life.

 “I got diagnosed with multiple sclerosis. My vision was shoddy for a long time. It just wasn’t working. It would be blurry and then not and then things started really just going kaput, right? And I was like, Oh, no,” Owen said.

She transferred from the Houston VA to West LA VA due to relocation. During her first visit to West LA VA, she encountered a mix up with her appointment, but thanks to a friendly and diligent doctor, Dr. Xiao Yu, she was able to be connected to a visual aid specialist for low vision and blindness.

The process conjured up numerous feelings for Owen, who thought, “This can’t be happening to me, I cannot be losing my vision. And it was hard. I had a lot of denial, a lot of anger.”

She credits the VA for helping her through this tough time.

“The VA helped me with the acceptance of it [blindness], but without shoving it at you, right? I think everybody has to accept things at a certain time.”

Blind Rehabilitation Center, Long Beach

Due to the severity of her blindness, she went to the Blind Rehabilitation Center at the Long Beach VA.

“It’s inpatient. It’s a facility that we have just for veterans…I don’t think there’s anything in the civilian world that I know of, that you go and all day long, you’re set up with different therapists.”

Owen also learned orientation and mobility, along with manual skills, communication skills, social activities, visual skills, recreational activities, computer access training, and daily living activities.

She developed various skills, including how to audibly use her iPhone with a program called VoiceOver, which all iPhones have.

“I can’t see, I just see shadows. And I have light perception. And that’s it. And so, I use swiping things on my phone, and it talks to me.”

She also had to take some of the same tests again to ascertain her level of blindness.

Her process was daunting and the need to accept her impairment was curated by the staff. She was in denial about her vision during a vision test.

“Because in reality, what I saw, it would be like standing in front of the Eiffel Tower and saying I can see a building. I couldn’t see anything. I was completely blind, right.”

It was the staff’s humility that helped Owen.

“Instead of saying, ‘Oh, my gosh, this is terrible.’ The therapist’s said, ‘Yeah, yeah, that’s good. That’s good.’ And the therapist was okay, let’s go now and just taught me audibly. She didn’t bring it up. We didn’t have to have a long discussion about it. You got through that today, we’ll start tomorrow.”

Owen appreciates the VA for presenting her with options and teaching her resilience in the face of adversity.

“They were smart enough, and they were empathetic enough and understanding enough to understand that, hey, let’s not tell this veteran what she can’t do. Let’s show this veteran what she’s capable of. Because that’s what veterans do, right? We all have that in us. It’s what motivates that.”

Owen met Lisa Mitchell, an instructor for the blind, on her journey to acceptance and agency. Their journey started in the Long Beach Blind Rehabilitation Center and transitioned to West LA, which is one of the 13 programs available across the country.

Mitchell stated, “Ms. Owen came just for a one-day visit. And she was really freaked out, just starting to deal with the application. My chief came to me and said, ‘Hey, there’s somebody here who we think could really benefit, but she’s terrified and we don’t see that she’s going to connect. We think that she’s just going to go back home and be at home and really probably suffer.’”

Mitchell asked her chief if she could be Owen last visit of the day. She ended up connecting with her.

“I said, ‘Miss Owen, there is support here that can help you. Will you trust me? Will you put yourself in my care? If you come back, I’m going to ask my chief to let me be in charge of your program. You need to be here, and it will change your life.’”

Mitchell was able to see the Owen’s progression from inpatient treatment not only as her blind instructor at Long Beach, but also as her Vision Impairment Services Team coordinator at West LA VA.

“After a while, that woman was soaring, because the sort of things that they learned.”

True Companion

After concluding her training at Long Beach, she went through weeks of Orientation and Mobility training. She was then approved due to her VA training to get a guide dog and went to the Guide Dogs for the Blind in San Rafael, CA and stayed there for two weeks working with instructors.

“I had to learn how to use the long cane first with orientation and mobility, and once I was a well-trained cane user, I was able to apply to get a guide dog. It's also awesome that the VA, through the prosthetics department, pays for all of Martinez's care through the Trupanion program. It covers vet costs because Martinez is my guide dog.”

With Martinez in her world, he adds additional confidence to her mobility. Her guide dog is so special to her because he is an amazing worker and an unconditional friend. 

Advanced Low Vision Clinic (ALVC)-West LA VA

The continuation of any new process starts with cultivation of alternatives, which is one way that the team at ALVC helps Veterans.

Owen talks about a time when an orientation and mobility specialist helped her find the location of her class and understand the layout of the campus.

“When I called and said, ‘Hey, I’m taking this one class at SBCC,’ which is Santa Barbara City College, they’re immediately said okay, we’re sending Adriana. I said yes because I don’t know what I’m doing.

“‘Okay, we’re sending you somebody,’ and she drove up here, she picked me up, she took me to the school, and she showed me, ‘Okay, this is how this is, where your class is going to be. This is this.’ And even though I had an aide there, it’s different because, then I know the landmarks, a landmark is something that isn’t going to move. The VA was there in a heartbeat.”

Despite her initial reluctance, it was her acceptance of help that changed her trajectory.

This coincides with Zadourian’s sentiment for Veteran’s: “We do a lot of education, even just learning what glaucoma means, or what macular degeneration means. Those are the two most common conditions and how it affects your vision. Even just learning that, even if you turn down all the devices we offer, which rarely anyone does, [helps].”

His sentiment highlights the yearning of the staff and the hospital to help Veterans.

See what’s offered. Give it a try. And if you’re still not interested, fine, but I’m pretty sure you will be. It’s only information that can help a person understand their options and we are here to help them understand and navigate their disability, Zadourian said.

It’s with diligent VA staff, amazing family, and wonderful friends that patients can live fulfilling and engaging lives despite their disability. This community fortifies and nurtures this new way of life.