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Resources for Visually Impaired Patients in the Ambulatory Care Setting

Management of patients in an ambulatory setting almost always requires a level of patient self-management. The tasks that we ask of our patients can vary from monitoring blood glucose levels, to using a blood pressure cuff, or even just taking daily medications. While open communication between the patient and provider can allow these strategies to greatly improve patient outcomes, the tasks can become much more of an obstacle when considering a patient with visual impairment. This post will outline some of the currently available options and techniques that can assist patients in overcoming this obstacle.

Strategies for Diabetes Management:

1. Insulin pens: while more and more patients now use insulin pens over syringes based on ease of use and convenience, this method of insulin delivery is especially helpful for the visually impaired. Insulin pens provide a click with each additional unit(s) dialed, offering a tactile and auditory confirmation of the dose. This strategy does require a certain degree of concentration to ensure an accurate dose but is nonetheless an excellent option for those with visual impairment to inject their insulin independently. Healthcare personnel should take notice that some pen devices deliver 1, 2 or 5-units per click- proper education for patient safety is key.
2. Insulin pumps: Insulin pumps designed for accessibility by those who are blind or with low vision are not currently available. Choosing a model with a larger display and backlight may allow those with low vision to utilize these systems; however, the use of menus for pump use make them nearly impossible for blind users to maintain them independently.
3. Blood glucose monitors for the visually impaired are also available. Some options with integrated digital voice include:
4. Advocate Redi-Code
5. Clever Choice Auto-Code
6. Embrace Talk
7. Fora line of products (includes 2-in-1 blood glucose and blood pressure monitors)
8. Prodigy Voice
9. Prodigy Autocode
10. Other Strategies: Items such as magnifiers can help with everyday management of diabetes, filling syringes and using supplies for those with low vision. A magnified mirror may be utilized to assist in a diabetic patient’s daily foot checks.

Strategies for the Management of Hypertension:

1. Home blood pressure monitors with speech output are available. Upper-arm cuff models available are included below:
2. A&D Medical UA-1030T
3. Maxi-Aids Reizen
4. Fora line of products (includes 2-in-1 blood glucose and blood pressure monitors)

Strategies for General Medication Management:

1. Talking Rx is an available prescription bottle holder that can be pre-programmed to play recorded directions. Audio prescription labels are available at some pharmacies as well.
2. Braille pillboxes are available for the blind. Jumbo pillboxes with large print can be obtained for those with low vision.
3. Patients may ask their pharmacist to fill their prescriptions in different sized bottles to assist with identification.
4. Patients may choose an individual strategy that works best for them. This could include color coding bottles for those with remaining visual function or use of Braille labeling for those who are blind. Patients may find other tactile strategies, such as placing a specific number of rubber bands on each bottle, helpful as well.

Other Available Resources and Assistive Technology:

In addition to the specific devices and strategies listed above, several other options including screen magnifiers, screen reading software, and even cell phone apps are available and continue to be developed. Finding the right strategy for your patient will depend on individual factors and require open conversations about the patient’s needs. Whenever possible, assistance from friends and family can be beneficial in implementing and maintaining self-management strategies. If necessary, options such as home health should be considered as well. The most important thing to keep in mind is that any strategy or device used must be able to be used safely and effectively by the patient in a highly consistent manner.

This post was completed by Ryan Strausbaugh PharmD Candidate 2022, with review and edits by Janee Whitner PharmD, BCACP, BCPS