Introduction
The word "blindness" may create an image of people who have no sight at all. But medically, a person is blind if he or she has visual acuity of 20/200 or less in the better eye. There are many other misperceptions about people who are blind.
People who are blind often face challenges in getting around their community, in using computers, in reading, and in gathering information in a visually-oriented world. Up to 80 percent of what we learn in early life is information gained through sight. Interacting with other people can also be more difficult for people with vision loss, because there are many subtle, non-verbal clues which contribute to communication. But none of these challenges are insurmountable.
Technology and early intervention are rapidly filling in the gaps. An increasing number of alternative technologies are being developed, for everything from mobility to computer use. Parents of children who are blind or have vision loss can and do learn to use language to convey information other babies absorb through vision. And advances in medical research are steadily reducing the number of people who experience vision loss.
The most difficult challenge for people who are blind or have vision loss is the beliefs and attitudes of the people who surround them. When people with vision loss are perceived to be less than capable, it has a crippling impact on their lives, socially and economically. Unemployment rates for people who are blind are remarkably high--up to 70 percent by some estimates.
Overcoming those perceptions of disability is the major obstacle faced by people who are blind, and it is an obstacle that must be recognized and addressed by our entire society. Disregarding the talents and resources of an entire group of people has economic and social consequences for sighted people as well. The human race is not so affluent that we can afford to overlook the potential of any group labeled "disabled," whether they have vision loss, are physically-challenged, deaf or hard of hearing.
Who is Blind?
According to reports from professional organizations, a loss of vision affects 50,000 new people in the United States every year. It is most often associated with aging; half of all people who are blind are over 65.
The National Aging and Vision Network estimates that there are more than four million people in the U.S. who are 55 or older and experiencing severe vision loss. Only 30 years ago that number was just two million; the number is expected to double again by 2030. Vision loss will eventually affect almost everyone. "By age 85, 1 in 4 older people cannot read a newspaper with best corrected vision," the National Aging and Vision Network reported to the U.S. Congress in 1997. "Loss of vision dramatically affects the older person's ability to do other everyday tasks as well."
Vision loss also affects a significant number of children and young adults. The American Foundation for the Blind explains that although 24,877 children with vision loss are reported by the U.S. Department of Education, this figure falls far short of the actual number, perhaps by as much as 80 percent. This figure usually only includes students who are legally blind, overlooking those who have serious visual disabilities but do not meet the criteria for legal blindness. In some cases, children with vision loss are not counted because they have other conditions reported in federally-defined categories, such as "mental retardation" or "multiple disabilities."
Causes of Blindness
Accidents, disease and birth defects are among the many causes of blindness. The Prevent Blindness America website reports that there are about 290,000 eye injuries treated each year in emergency rooms, and children under five account for about 10 percent of those injuries. According to the American Academy of Ophthalmologists, there are about 2,000 eye injuries from fireworks alone, and up to 25 percent of those accidents result in permanent blindness or vision loss.
One major cause of blindness is cataracts, which is a condition causing opacities and clouding of the eyes' lenses. When cataracts form, they block the passage of light through the eye. Some people may be born with cataracts, but they are more likely to occur as we age. If they are large enough to cause serious visual problems, they can be surgically removed.
Blindness can also occur as a side-effect of diabetes. With treatment, diabetics enjoy a much longer lifespan; this length of time unfortunately sometimes leads to the development of diabetic retinopathy. The tiny blood vessels of the retina change, some may burst, and the retina may even break loose from the back of the eye. Early treatment can sometimes prevent blindness. Not every diabetic experiences vision loss.
One in every seven or eight cases of blindness is caused by glaucoma. This disorder prevents the transparent fluid inside the forward part of the eye from draining properly, and pressure builds up inside the eye. If the pressure is not controlled, the eye is damaged, and blurred vision, a narrowed field of sight and eventually total blindness can be the result.
Macular degeneration is the leading cause of legal blindness among Americans older than age 65, according to the Mayo Clinic Health Oasis website. The retina of the eye functions somewhat like the film in a camera, capturing light. The macula is the part of the retina that forms the sharpest image. With increased age or other conditions, the retina or macula may degenerate or break down, and central vision is lost, although peripheral vision may remain good. Laser surgery can sometimes help.
A hereditary condition known as retinitis pigmentosa causes degeneration of the retina and the choroid, a related vascular area. Although the progression of the disease is different for everyone, it usually begins around age 10 to 12 with some difficulty seeing at night and in poorly-lighted areas. The vision may begin to narrow, causing what is sometimes called "tunnel vision." By young adulthood, the person is usually legally blind, and progressively loses any remaining vision. There is no known treatment.
There are many other conditions which cause vision loss, including stroke and HIV. If you experience any difficulty with your vision, see an eye specialist as soon as possible.
Low Vision
Low vision means that a person's vision cannot be fully corrected by ordinary prescription lenses, medical treatment or surgery, but there is still some usable vision. It affects both children and adults. Low vision may be the result of cataracts, macular degeneration, glaucoma, and diabetic retinopathy, or stroke. While changes in vision are a normal part of aging, these changes are usually correctable with glasses or contact lenses. If they are not, a low vision specialist should be consulted.
Low vision specialists can provide a low vision evaluation and prescribe special adaptive devices to help maximize the remaining vision. They might include hand-held magnifiers, high-intensity lamps, pocket-sized telescopes for distance vision, or closed-circuit television, which magnifies and projects printed materials onto a television screen to make reading easier.
People with low vision can also benefit from rehabilitation services provided for people who are blind. These services teach people with vision loss alternative strategies for performing daily activities, and may also include training in how to get around safely, within the house and in the community.
Early Intervention
Children who are blind or who have low vision can enjoy a high-quality of life, just like any other child. It takes special skills on the part of the parent, and special services from professionals, to make sure this happens.
Most of what we learn in the first few years of life we pick up by seeing. This incidental learning is how we discover that the sky is above us (spatial concepts); that the grass is green; that people usually wear shoes to work; that balls roll away but don't disappear forever. Parents must be trained to make this kind of incidental learning intentional; there are training programs available in every state, mandated by federal law. This special training should begin as soon as vision loss is detected.
Mobility is another important issue in the first years of life. Children who are blind have little incentive to learn to move, because they cannot see that fascinating toy just beyond their reach, or a parent beckoning for them to crawl. It is hard for parents to encourage mobility too, because of a natural fear that the child will get hurt.
But it is crucial that children who are blind be encouraged to move. The Institute for Innovative Blind Navigation says that, "Blind children must lay down a neural 'movement' map in their brains to replace undeveloped visual pathways. The more movement (the more training and practice), the richer the neuronal pathways laid down in the brain." An Orientation and Mobility teacher can help parents teach these skills to their children.
While being blind or having low vision can be difficult, learning alternative strategies for coping can greatly reduce the frustration and lead to a higher quality of life.
Braille
People who are blind or have vision loss need an alternate method of reading and writing that does not depend on sight. A young blind man in France in the early 19th century, Louis Braille, invented a system when he was fifteen. He based his tactile system on the "Ecriture Nocturne" (night writing) code invented by Charles Barbier for sending military messages that could be read on the battlefield at night, without light.
Braille is essentially a code made up of raised dots which can be felt with the fingertips. People with sight can read Braille with their eyes. The code is formed within units of space called Braille cells. Each cell has up to six raised dots arranged in two parallel rows. Each different arrangement of the dots represents a letter of the alphabet, a number, a punctuation mark or sometimes an entire word. There are 64 possible combinations of the dots within a single cell.
There are different levels of complexity within the Braille code. If every letter of every word is expressed in Braille, it is called grade one Braille. Since this type of Braille takes up quite a bit of space, it is rarely used for books or other reading material. People who are newly-blinded, however, might find grade one Braille a good system for labeling items around the house.
In grade two Braille, cells are used by themselves or in combination with others to create a number of contractions or whole words. A single letter might be used to represent an entire word. For example, the word "you" is represented simply by the Braille letter "y". This cuts down on the amount of space needed to write Braille. Most Braille books are two to three times larger than their printed counterparts, even when they are transcribed into grade two Braille.
People who are blind can write in Braille using several different methods. The oldest and simplest method is using a slate and stylus. The slate is a sort of template, with evenly spaced indentions for the Braille cells. Paper is placed in the slate, and the stylus is used to press the appropriate dots onto the paper. The paper bulges on its reverse side, and tactile dots are formed. Slates are portable and don't break down, so they are the best form of written communication for students and others who need to take notes. People using slates learn to write their sentences backwards, since the impressions appear on the reverse side of the paper.
Braille can also be created using a machine called a Braille Writer. While a typewriter has more than fifty keys, a Braille Writer has only six keys and a space bar. The keys are numbered to correspond to the six dots of a Braille cell. All or any of the keys can be depressed at the same time, making the appropriate number of raised dots appear within the cell.
The computer industry has made revolutionary changes in the lives of Braille users. Portable Braille notetakers and software programs allow people to save and edit their writing, review it either by hearing it read back to them or reading it in Braille, and then have a hard copy printed out from a desktop Braille embosser. There is also Braille display technology which displays the information on a computer screen in Braille. Many more advances make Braille an effective means of communication for people who are blind or have vision loss.
Braille is a crucial skill for people with vision loss. Print surrounds us, every day, in the workplace, at home and during our leisure time. Braille makes it possible for people who are blind or who have low vision to be literate, and literacy plays a very big role in achieving employment and in developing a better quality of life. Skilled Braille teachers are in short supply, but organizations like AIDB and the American Foundation for the Blind are working diligently to make Braille literacy possible for the majority of people who are blind or have vision loss.
Alabama students who are blind can have Braille or large print textbooks and learning materials provided at no cost through the Alabama Instructional Resource Center. There are other services available to make movies and television available for people with vision loss, and the National Library Service/Library for the Blind and Physically Handicapped provides books on tape. Click here to learn more.
Orientation & Mobility
If you have ever played a game of blind man's bluff, or any game requiring a blindfold, then you should instantly recognize one of the primary challenges facing people with vision loww. Moving through space without knowing what pitfalls are in front of you, beside you or behind you is a daunting task.
Teaching people who are blind how to get around is the purpose of Orientation and Mobility training. People who are blind must learn alternate methods of crossing a street safely, and how to stay oriented so they can travel alone to the store, or a friend's home, without having to wait for someone to escort them.
People with low vision need to learn how to cross streets even when they can't see the traffic signals, how to travel using whatever vision they have, and how to remain oriented in every environment, indoors and out.
The most familiar mobility tool is the long white cane. Used properly, it can help people detect objects in their path, or find steps, curbs and other drop-offs. Learning how to use it well takes many months of work, but the rewards are enormous. It is a low-tech tool with a variety of uses.
Orientation and Mobility specialists may also work with people who are blind in sensory awareness training. It involves stimulating residual vision and non-visual senses, and teaching students how to locate and discriminate between sounds and other stimuli which might help them navigate safely. For example, at a street crossing, students might be taught how to use their residual senses, what to focus on, how to listen for oncoming traffic, and how to make safe and efficient decisions based on this sensory input.
A growing number of advanced technologies exist to help make navigating in the community even easier for people who are blind or who have low vision. Sophisticated navigational tools using sonar and laser light are available now, according to the Institute for Innovative Blind Navigation. Satellite navigation is a very real possibility in the near future. Even smart computers are being developed that can recognize faces and emotions, so small they can be built right into our clothing to unobtrusively tell us who we're talking to and how they're responding nonverbally.
Orientation and Mobility training may also include learning how to control the space around you to enhance the potential for vision. People with vision loss can learn to manipulate lighting and their surroundings to produce high contrast and better illumination.
Advanced mobility skills can be taught to some students. This would include learning the skills to successfully travel to a totally unfamiliar location successfully. The advanced student can question others to gain knowledge that is relevant to his or her mobility needs. Advanced students are also proficient at reading Braille maps, able to handle complex transportation depots, and savvy about the violence in the world today. They have strategies for dealing with intrusion.
Employment
People who are blind can be just about anything they desire. The American Foundation for the Blind lists these professions just as a starting point: astronomer, attorney, chemist, clergy, college professor, computer analyst and programmer, electrical engineer, elementary and high school teacher, farmer, food service worker, investment broker, journalist, marketing professional, mechanic, medical transcriptionist, musician, nurse, physical therapist, physicist, psychologist, radio and television personality, real estate professional, rehabilitation counselor, restaurant owner, social worker, statistician, website designer.
Unfortunately, many people with vision loss are unemployed or underemployed. The U.S. Census Bureau provides the best statistics on this issue. Although they were published for 1991-92, they are still relatively accurate.
For people who described themselves as having "functional limitation in seeing" (they have difficulty seeing words and letters in ordinary newsprint, even with glasses or contact lenses), the estimated employment rate was 35 percentage points lower than the employment rate of people with no disabilities. For people with a severe functional limitation in seeing (not able to see words and letters in ordinary newsprint at all), the estimated employment rate was 55 percentage points lower than the employment rate of people with no disabilities.
Earnings were also substantially lower for people with vision loss. The mean monthly earnings of workers with functional limitations in seeing were about 20 percent lower than workers without disabilities. Workers with severe limitations in seeing earned about 37 percent less. These differences in earning probably have a strong relationship to educational levels achieved; people with disabilities generally do not attend school as long as people without disabilities.
There are many possible explanations for high unemployment among people with vision loss. Getting to and from the workplace, navigating space within the workplace, and communicating at work all require alternative strategies. Learning Braille makes it easier for people who are blind to attend school, and later, to gain employment. Adequate orientation and mobility training can make getting to work possible for people who are blind.
Many people who are blind feel like the primary obstacle to gainful employment is the attitudes and stereotypes sighted people have about people who are blind. There are very few tasks which absolutely require vision. If sighted people, including lawmakers and public officials, are committed to making the most of every citizen's talents, unemployment discrepancies should shrink dramatically. Making public transportation safe and available and workplaces accessible is an important first step.
Signs of Vision Loss in Adults
If an adult has difficulty in the following areas, it may be a sign of vision loss. If you suspect vision loss, consult an eyecare professional immediately. Many conditions can be treated successfully if they are diagnosed soon enough. Every older adult should have regular eye exams, even if no problems are suspected.
- changes in the way he or she watches television, drives, walks or engages in hobbies
- squints or holds head to the side to get object in focus
- has trouble identifying faces or objects
- frequently cannot locate personal objects, even in a familiar environment
- acts uncertain when reaching out for objects
- has trouble identifying colors and chooses clothing in unusual color combinations
- no longer reads the mail or newspaper
- holds reading material close to the face or at an angle
- writing becomes less legible
- finds lighting inadequate for reading or other activities
- brushes against the wall while walking or constantly bumps into objects
- travels up and down stairs slowly, even though there are no other physical limitations
- has difficulty getting food on a fork, cutting food or serving food
- spills foods off the plate while eating, or spills drinks from cups
Signs of Vision Loss in Children
If you notice any of the following behaviors in your child, it may be a sign of vision problems. Young children should have regular eye exams; check with your doctor about establishing a schedule to ensure good vision for a lifetime.
- rubs eyes excessively
- shuts or covers one eye
- tilts or thrusts head forward
- has trouble reading or with close-up work
- holds objects close to eyes
- blinks more than usual or is irritable when doing close-up work
- is unable to see distant things clearly
- squints eyelids together or frowns
- eyes are crossed or misaligned
- eyelids red-rimmed, encrusted or swollen
- eyes are inflamed or watery
- recurring eye infections
- color photos of eyes show white reflection instead of typical red or no reflection
- eyes itch, burn or feel scratchy
- complains that cannot see well
- dizziness, headaches or nausea following close-up work
- blurred or double vision
Selected Sources
American Academy of Ophthalmologists- January 21, 2005
American Foundation for the Blind
Blind Net
The Institute for Innovative Blind Navigation
Lions World Services for the Blind
The National Aging and Vision Network