ALERT LowVision
High-contrast
techniques for
low-contrast vision
by Robin L. Phillips
People living with multiple sclerosis are affected by a spectrum of low-vision issues, but one of
the most common is low-contrast vision acuity.
“When we talk about low-contrast vision, we are
referring to vision in low-light environments, such
as nighttime, as well as the ability to detect edges
of objects,” says Elliot M. Frohman, MD, PhD,
professor of neurology and ophthalmology, and
director of the Multiple Sclerosis and Neuro-immunology Division at the University of Texas
Southwestern Medical Center. “Distinguishing
edges is extremely important, especially for
seeing in three dimensions.” And seeing in three
dimensions is what gives people depth perception,
The “holy grail” of high-contrast
color schemes is dark black
against bright white. But a purely
black-and-white environment
isn’t always practical.
allowing them to judge distances. Without depth
perception, everyday tasks such as driving or
cooking can be risky.
Joyce Cohen, who has lived with MS for 26
years, has become an expert at dealing with her
low-contrast vision, as she uses a wheelchair and
is partially blind. “It impacts everything you do
and every possession you own,” says the 66-year-
old from Omaha, Neb. “You have to learn ways
to make things easier to see clearly, so you don’t
trip over or break them.”
Clarifying the issue
Loss of low-contrast acuity is often caused by bouts
of optic neuritis—a common symptom of MS
whose long-term effects have been underestimated.
“After a bout with optic neuritis, it’s possible to
return to 20/20 vision on high-contrast, black-on-
white letter charts,” explains Dr. Frohman. “But
low-contrast vision can take a devastating hit.”
Dr. Frohman says that people with MS who
experience just one bout of optic neuritis can lose
up to 40 microns of thickness in the retinal nerve
fiber layer, the nerve tissue inside the eye that leads
to the optic nerve. Forty microns is approximately
four times the amount an average person loses
in an entire lifetime. “However, people with
low-contrast deficits can take advantage of their
high-contrast acuity by making as many things as
possible in their environment high-contrast.” He
recommends seeing a specialist first. “A neuro-
ophthalmologist who is experienced with MS can
offer specific recommendations and tools that can
benefit people with low-contrast issues.”
Bright ideas
The “holy grail” of high-contrast color schemes
is dark black against bright white. But a purely
black-and-white environment isn’t always practical.
