U.S. veteran James Nakamoto's vision has slowly worsened over the last few years.

He recently retired as an architect and simply wants to maintain a high quality of life, do more cooking for his wife and be more socially responsible when in public.

"In the last years, I can't take notes in a legible fashion," he said.

Life has gotten harder for Nakamoto. But that is likely to change quickly.

Nakamoto is a new client in the Blind Rehab Program at the Veterans Affairs Hospital at American Lake in Lakewood, where veterans learn to cope or better understand their visual impairments. There are approximately 157,000 veterans in the U.S. who are legally blind; more than one million have low vision that causes a loss of ability to perform necessary daily activities, according to the U.S. Department of Veterans Affairs website (www.va.gov).

The hospital at American Lake is one of 13 VA facilities across the country that in 2008 implemented a progressive plan to expand vision and blind rehabilitation to veterans and eligible active-duty Servicemembers with visual impairments, ranging from early vision loss to total blindness.

The program may not be a place of physical healing, but it does serve as a confidence booster or a place that teaches self-reliance, according to Robert Mower, a retired Airman and district director for the Blinded Veterans Association. Although he completed the program seven years ago, he still returns and serves as an advocate to other graduates.

He felt broken upon entering the program, he said.

"What the blind rehab program does is it reinvents that can-do attitude."

Though legally blind, the 78-year-old Spanaway resident is able to do just about anything he wants to do, he said, include turn wood on a lathe.

The Blind Rehab program at American Lake works with about 120 people per year. That number has remained constant, despite anticipation that the figure will climb due to Korea and Vietnam-era veterans developing vision loss from age-related diseases. Patients who enter the program are 73 years old on average. The youngest person currently in the program is 43. Veterans from all over the Pacific Northwest come to the VA hospital for blind rehab services.

"We are dealing with what cannot be improved medically," said program director Tim Sniffen, adding that the eye clinic next door serves as more of a hospital while the blind rehab program functions more as a place for education. "We find teaching methodologies that will stick, discerning the best ways to learn new information."

Last week, Nakamoto was working with a staff member on finishing his introductory assessment and identifying his areas of need, such as cooking, cleaning, taking notes and other duties around the house.

Each patient in the program receives one-on-one treatment, making the quality of care target specific.

The program can last from two weeks up to about three months, Sniffen said.  The staff treats inpatients and began conducting outpatient treatment in 1994.

Last week, staff and supporters celebrated the graduation of two people who recently finished the program. "It has been a really good program in every way," said one.