Copyright News Limited Oct 14, 2006

Only a fraction of the people with poor eyesight are reaching out for help, despite the improvements in quality of life it can bring. Lynnette Hoffman reports

THE cricket ball hurtled through the air, hit Garry Stinchcombe's leg, and rolled directly into the palm of his hand: the batsman was out.

It wasn't just any game: it was the competition grand final, and the dismissed batsman was the rival team's captain and one of Australia 's best players -- and he hadn't previously been caught out all season.

The catch is one of the highlights of Stinchcombe's cricket career. "I'll dine out on it the rest of my life," he says, his glee still audible.

Considering he represented Australia at a World Cup in India in 1998 and is again joining the team this year, that's saying something.

But Stinchcombe's not your average cricket player and he doesn't play in an ordinary league. A degenerative eye disease left him completely blind from the age of 9. For the last nearly 18 years he's played in Australia 's Blind Cricket Association.

Blind cricket began more than 80 years ago in Melbourne and is played throughout Australia with formal competitions set up in NSW, QLD, VIC and SA. Players range from legally blind, meaning they have less than 10 per cent vision, to vision-impaired. There are variations in between, such as people with "restricted fields" -- for example, people with no peripheral vision. To keep things fair there are limits on how many partially sighted people can be on the field at any given time.

They play with a slightly larger ball that rattles, to help batsmen pinpoint its position. In addition, bowlers bowl underarm so the ball bounces more, creating more noise. Batsmen can also have someone stand behind them to call out whether the ball is straight or off.

For Stinchcombe, playing cricket has provided an outlet for his competitive streak, a way to get more involved in the community, and the opportunity to travel both around Australia and around the globe.

Cricket's not for everyone, of course, and participating in recreation and sport is just one example of the types of challenges people with low vision face in their daily lives. In fact, it's often day-to-day tasks such as reading or getting about that pose the biggest problems.

The phrase "20/20 vision" defines normal eyesight: it means that a person can see the same amount of detail from 20 feet away as a normal person.

Despite its use in common parlance to mean perfect vision, it is possible to have sight better than 20/20, as that simply means normal acuity.

Low vision is defined as 20/70 or worse, meaning that a person needs to be 20 feet away from an object to see the same level of detail that a person with normal vision can see from 70 feet away. This level of impairment cannot be fully corrected with conventional glasses.

Across Australia , more than 20 organisations and services help vision-impaired people adapt and improve their quality of life -- but less than 10 per cent of the 500,000 Australians who are blind or have low vision are actually accessing those services.

Associate Professor Jan Lovie-Kitchin, of the Centre for Health Research at Queensland University of Technology, completed the last comprehensive study on the subject more than 15 years ago. It found that only 3 to 5 per cent of eligible patients were using vision rehabilitation services.

Lovie-Kitchin says that while there's been no follow-up on the data, it seems little has changed, and indeed in 2002 the World Health Organisation estimated less than 10 per cent of people with low vision were accessing available assistance.

The impact of vision loss can be enormous. People with low vision have double the risk of falls and more than four times the risk of hip fractures.

They're twice as likely to be socially dependent, and on average enter nursing homes three years earlier than the rest of the population, according to Vision 2020 Australia , a joint initiative of the World Health Organisation and the International Agency for the Prevention of Blindness.

They're also three times as likely to suffer from depression. Everything from preparing meals to crossing the road can become a problem, and the loss of mobility can lead to social isolation and depression, particularly for people who live alone, Lovie-Kitchin says. Even public transport poses a threat: tasks that seem simple for a person with normal vision, such as seeing the bus numbers or reading the signs to find out what time the next bus is due, can pose a huge challenge.

"The most common thing people seek help with is reading. It's not just books and newspapers, it's much more survival -- reading the labels on the medicine bottles or the bills," she says.

Most people are familiar with seeing eye dog services, but they're just one of a gamut of options available.

A range of adaptive technology is available to help people who are blind or have low vision do everything from reading the newspaper to word processing, and using the internet and email. Among the options are "screen readers" that allow you to use a keyboard to navigate, while the software provides prompts and uses a speech synthesizer to reveal what's happening on the screen.

Other software allows users to magnify the contents on the screen by as much as 16 times. Monitors can also magnify documents and other information.

Other services include talking books and even talking local newspapers in some areas. Courses in orientation and mobility training can also help people who are blind or of low vision regain their independence.

Orientation courses teach people how to use their remaining vision, recognise sounds and use other techniques to move around safely. If someone has some limited vision, they can look for landmarks to find their way around -- even small things such as looking at the corners of steps to see contrast better. Marking door handles and steps with reflective tape can also help someone get around on their own.

Home assessments can help people arrange their living environment to be more accessible and make the best use of available lighting. There are even employment services tailored specifically for vision impaired people.

"People see vision impairment as black and white, but it's not, it's a continuum," Lovie-Kitchin says.

"If you get help early you can adapt and learn to live with it."

So what's holding people back? Experts think a number of factors are to blame.

People over 65 make up more than three-quarters of the total number of people with low vision in Australia , and often they view their vision loss as something that comes with the territory of ageing that they just need to accept.

"Many older people accept that vision loss is an inevitable part of getting older, but of course age is not a disease," Lovie- Kitchin says. Vision loss is always caused by some type of disorder. If it can't be treated medically or surgically, there is still a great deal that can be done to help people function independently, she says.

There may also be a perception that the services available are geared towards people who are completely blind, rather than the broader spectrum of people with vision loss, says Jennifer Gersbeck, CEO of Vision 2020 Australia .

Traditionally services for people with vision loss have had names such as the Royal Blind Society, and many people with impaired vision can't relate to that because they don't think of themselves as being blind, Gersbeck says.

"Many people are aware that organisations that provide these services exist; what they're not aware of is that they exist to help them," she says.

What's more, eye care practitioners and ophthalmologists often aren't aware of the full range of services, or forget to mention them.

Another factor is that having low vision can make applying for and accessing the services a challenge.

"It is a catch-22 -- if they can't see to drive or catch buses, they can't always get to the very services that might be of assistance," Lovie-Kitchin says.


* Eye disease cost Australian taxpayers $1.8 billion in 2004

* The cost to the community has doubled over the past decade

* Direct costs for eye conditions are more than the cost of coronary heart disease, stroke, arthritis or depression

* 75 per cent of blindness and vision loss can be prevented or treated

* Regular eye tests are recommended, especially if there is a family history of eye conditions, you have diabetes, or are over 40