blindness
(medicine) Loss or absence of the ability to perceive visual images. The condition of a person having less than 1/10 (20/200 on the Snellen test) normal vision.
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(medicine) Loss or absence of the ability to perceive visual images. The condition of a person having less than 1/10 (20/200 on the Snellen test) normal vision.
Surprisingly, blindness rarely means total absence of light perception. Most definitions of blindness are based on measurement of visual acuity (the ability to read letters at a certain distance) and assessment of the ability of the person to carry out tasks needing vision. In the UK, the National Assistance Act 1948 states that a person can be certified as blind if they are ‘so blind that they cannot do any work for which eyesight is essential’. This rather circular definition refers to ‘any work’ and not just the person's normal job or one for which he has been specially trained.
Visual acuity is usually tested by asking the patient to read letters of various sizes on a chart viewed from a distance of 6 m or 20 feet (the Snellen method). Acuity is expressed as a fraction, the number on top referring to the distance at which a normal person can read a particular size of letter and the lower number the distance at which the subject being tested can read that size of letter. Hence ‘normal’ visual acuity is 6/6 (European) or 20/20 (American). A person should be certified blind if the visual acuity (while wearing corrective glasses) is 3/60 or below (when a letter that can be recognized from 60 metres by a normal person can be identified only from 3 metres or closer). A person should also be certified blind if their acuity is between 3/60 and 6/60 but they have completely lost the peripheral part of their visual field, hence restricting their vision to the central part of the field. Indeed, if the more useful lower part of the visual field is lost then someone with better than 6/60 acuity can be certified blind.
There is no legal definition of partial sight in the UK, but a person can be certified as partially sighted if they are ‘substantially and permanently handicapped by defective vision caused by congenital defect or illness or injury’. All certification must be done by a consultant ophthalmologist. The help from Social Services should be the same for both legally blind and partially sighted groups but Social Security benefits and tax concessions differ.
Definitions of blindness are not the same around the world and the vast majority depend on measured visual acuity with no allowance for any functional deficits. Consequently comparison of the incidence of blindness world-wide is inexact. The World Health Organisation has proposed categories of visual impairment but these have not yet been widely adopted.
The common causes of blindness vary in different countries according to the general levels of economic and physical health. The high rate of blindness in developing countries is mainly due to malnutrition and infectious diseases, coupled with the scarcity of medical care. Moorfields Eye Hospital was founded in London in 1805 to treat the ‘Egyptian ophthalmia’, a mixture of trachoma and purulent ophthalmitis brought back by British troops from Aboukir after their withdrawal from Egypt in 1803. The disease quickly spread throughout the country when the disbanded soldiers returned to their homes, taking the infection with them. Nowadays the condition is treatable with tetracycline eye ointment and tetracycline taken orally.
Causes of blindness
Lack of vitamin A has a direct effect on the eye, causing clouding and softening of the cornea (keratomalacia), but also increases the risk and severity of infections, so that measles can be a blinding or even fatal disease in children who are deficient in vitamin A. Night-blindness due to lack of vitamin A may occur in famines, and cure of this condition by eating liver, which is rich in vitamin A, has been known for over 3000 years.
Another cause of night-blindness is pigmentary degeneration of the retina (retinitis pigmentosa) which, combined with partial loss of the visual field, eventually contracting down to ‘tunnel vision’, can be most disabling. This condition is mainly inherited as an autosomal recessive condition (showing itself only when both parents carry the mutant gene), but other forms occur. A high proportion of the population of the Atlantic island Tristan da Cunha was recently discovered to be affected when they were evacuated because of volcanic activity. The disorder is progressive and untreatable.
Trachoma, an infectious disease, affects some 500 million people world-wide, of whom 7 million are blind and 10 million visually impaired. The infectious agents are bacteria known as Chlamydia.
River blindness (onchocerciasis) is the next commonest infection, where microfilarial parasites, spread by black flies, which breed in the tropical, sub-Saharan belt across the whole of Africa and at similar latitudes in Mexico, Brazil, and Ecuador, invade the retina and the supporting, vascularized middle layer of the eyeball, the choroid. Treatment was revolutionized in 1987 when ivermectin, already used in veterinary medicine, was registered for human therapy.
From 1976 the total number of people registered blind in Britain has risen, but this rise is limited to those over 75 years old. Fifty per cent of all 75-85-year-olds registered with impaired vision in this country suffer from age-related macular degeneration (ARMD). Cataracts are now second as a cause of blindness, at around 40%, but these are essentially treatable by surgery except in those cases where extraction of the cataract reveals underlying, untreatable ARMD.
Damage to the retina caused by glaucoma (increased pressure in the eyeball) and by diabetes (diabetic retinopathy) make up almost all the remaining causes of blindness. Glaucoma is insidious in onset: acuity in the central visual field is not seriously affected and a diagnosis may not be made until much of the peripheral retina has been destroyed. Diabetic retinopathy is most prevalent and severe in long-standing insulin-dependent diabetes. This emphasizes the importance of striving for optimal diabetic control. Routine screening checks for both glaucoma and diabetic retinopathy are essential, but manpower and economic considerations have led to much of this work being transferred to orthoptists and optometrists. Retinal detachment (separation of the retina from the pigment epithelium behind it) is a rarer cause of blindness.
There is a long history of visual upsets from staring directly at the sun. The high energy optically concentrated at the central part of the retina for only seconds can produce prolonged after-images and even permanent loss of central vision. This is an occupational hazard for astronomers, and for members of the public who sun-gaze in a misguided attempt to strengthen their eyes or when under the influence of hallucinogenic drugs. There is a particular hazard during solar eclipses because the reduced total amount of light makes it easier to hold fixation on the sun, but the intensity on the remaining illuminated part of the retina is just as high (and just as damaging) as when there is no eclipse: hence the term ‘eclipse blindness’.
Possibilities for treatment
Given the immense social importance of vision, there is intense effort to develop new treatments for blinding conditions. These are focusing not only on the conventional approach of developing new vaccines to prevent infection and new drugs to treat specific conditions, but also on more innovative approaches. For instance, attempts have been made to implant an array of electrodes over the surface of the visual cortex, coupled to a video camera or an optical letter reader, in the hope of bypassing the eye and providing visual sensation by direct stimulation of the cortex. Unfortunately, such stimulation produces only the sensation of tiny pin-points of light, which appear to move with movements of the eyes. A more promising approach is the implantation of a thin sheet of light-sensitive electrodes into the retina, to take the place of degenerated receptors and provide direct stimulation to the fibres of the optic nerve.
Cortical blindness
Damage to the visual cortex in the occipital lobe of the cerebral hemispheres can also cause blindness — cortical blindness. When fixation is maintained on a point in space, a particular region of the visual field is blind (a ‘scotoma’) whether either eye is open, or both (because the cortex receives signals from corresponding regions of the two retinae). Cortical blindness can occur, for example, after a stroke affecting the posterior cerebral artery, which supplies blood to that part of the brain. If extensive damage occurs in one hemisphere, the opposite side of the visual field becomes blind (hemianopia). Often, a small region around the fixation point is spared. This ‘macular sparing’ is thought to be due to the fact that so much of the visual cortex is devoted to the central part of the retina that some part of this region has a high chance of surviving. Interestingly, even when the occipital visual cortex is bilaterally destroyed, resulting in total blindness with no light perception, the patient does not feel enveloped in darkness: rather, the outside world simply does not exist visually (as for the world behind our heads). This contrasts with blindness resulting from retinal damage (for instance from total bilateral retinal detachment), when the patient complains of being in complete darkness. Indeed, the cortically blind patients are subjectively unaware of their disability — blind to their blindness.
When damage is restricted to the primary visual cortex (not extending into the surrounding cortical areas) some patients are still able to detect certain forms of visual stimulation (especially moving objects and sudden changes in brightness) in the ‘blind’ part of the visual field. Amazingly, if the stimulus is not very intense or rapidly moving, they are often unaware of their residual visual capacity, but can reliably ‘guess’ whether, for instance, the stimulus has moved, and even in which direction. This bizarre dissociation of vision from consciousness is known as ‘blindsight’. Recent research even suggests that the facial expression of faces ‘seen’ in the blind part of the field can be recognized. Blindsight is not magic! Even when the primary visual cortex is damaged, information from the eyes still reaches parts of the midbrain and other visual parts of the cerebral cortex. These secondary pathways presumably mediate the impoverished visual performance.
If a stroke or injury leaves the primary visual cortex intact but destroys visual areas further forward in the occipital lobe of the cerebral hemispheres, remarkable disorders of visual perception, without frank blindness, can occur. These include the inability to see movement, even though stationary objects are quite normally perceived (akinetopsia), and a lack of perceived colour, despite normal perception of shape and movement (achromatopsia). These observations are entirely compatible with evidence from experiments in animals in which the activity of nerve cells has been recorded with microelectrodes, as well as with studies using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) to detect activity in the normal human brain caused by different forms of visual stimulation. These experimental approaches have shown that the primary visual cortex is surrounded by a patchwork of other areas in which neurons are devoted to the analysis of one aspect or another of the visual image — motion in some areas, colour in others, etc.
Damage further forward, in the lower part of the temporal lobe, can precipitate even more curious failures of perceptual interpretation, generally known as visual agnosias (from the Greek for lack of knowledge). Not uncommon, especially after damage on the right side, is prosopagnosia — an inability to recognize faces, sometimes even of family members, although other aspects of object identification (even knowing that a face is a face) are intact. In extreme cases, the poor patient has great difficulty in recognizing a wide variety of everyday objects (until he or she touches them), even though all basic aspects of vision (acuity, colour vision, detection of movement, etc.) are unaffected.
Injury to the rear part of the corpus callosum — the great cable of millions of nerve fibres that links the two hemispheres — or to regions at the junction of the occipital and temporal lobes can cause specific disorders of visual integration (associational disturbances), such as word blindness (alexia).
Provision for the visually disabled
The reaction of the public to handicapped and disabled people remains capricious, and often prejudiced. The deaf have long been figures of fun: they are often ignored and easily retreat into solitude. However, the blind generally receive more sympathy, even admiration. Social Services for the blind unfortunately are not uniformly good throughout the UK. However, some national organizations such as the Royal National Institute for the Blind and Guide Dogs for the Blind give great help and provide funds for research into blindness as well. In 1835 Louis Braille introduced his system of raised writing, where projecting dots represent a letter or number and are interpreted by touch, but it took 30 years to gain acceptance. In this electronic age there are many devices which can make an enormous difference to the blind person's quality of life. One is a computer that reads out text audibly as it appears on screen. This can be set to speeds as fast as the subject can comprehend the speech. A braille printer and labelling machine help, for example, to identify foodstuffs in the kitchen or deep-freeze, or to catalogue a CD library. Microwave units can respond to and speak instructions and will defrost different foods correctly once they have been weighed. For contact with the outside world there are talking newspapers, which can be sent by compressed e-mail, or put on to the Internet. A CD-ROM of all British daily newspapers is available weekly. Never has so much been available for blind people who can afford it.
— Peter Fells, Colin Blakemore
Bibliography
See also blind spot; eyes; optometry; orthoptics; vision.
For more information on blindness, visit Britannica.com.
A major cause of congenital blindness in the United States, ophthalmia neonatorum, which is caused by gonorrhea organisms in the maternal birth canal, is now prevented by placing silver nitrate solution in all newborn infants' eyes. Retinitis pigmentosis, a hereditary and degenerative eye disease, affects 100,000 people in the United States. An early sign is night blindness which progresses to total blindness. Color blindness, an hereditary problem, is an inability to distinguish colors, most commonly red and green. Snow blindness is a temporary condition resulting from a burn of the cornea caused by the reflection of sunlight on snow. Night blindness results from a deficiency of vitamin A. See eye.
Lack or loss of ability to see. Diagnosed in an animal on the absence of a menace reflex, walking into obstructions and failure to indicate awareness of a soundless movement in its visual field, e.g. a falling cotton ball or feather.
Quotes:
"In the country of the blind, the one-eyed man is King."
- Michael Apostolius
"Blindness hatred is blind, as well as love."
- Thomas Fuller
"But who would rush at a benighted man, and give him two black eyes for being blind?"
- Thomas Hood
"There is a condition worse than blindness, and that is, seeing something that isn't there."
- L. Ron Hubbard
"We may remark in passing that to be blind and beloved may, in this world where nothing is perfect, be among the most strangely exquisite forms of happiness. The supreme happiness in life is the assurance of being loved; of being loved for oneself, even in spite of oneself; and this assurance the blind man possesses. In his affliction, to be served is to be caressed. Does he lack anything? no. Possessing love he is not deprived of light. A love, moreover, that is wholly pure. There can be no blindness where there is this certainty."
- Victor Hugo
"What a blind person needs is not a teacher but another self."
- Helen Keller
See more famous quotes about Blindness
Blindness is the condition of lacking visual perception due to physiological or neurological factors.
Various scales have been developed to describe the extent of vision loss and define "blindness."[1] Total blindness is the complete lack of form and light perception and is clinically recorded as "NLP," an abbreviation for "no light perception."[1] Blindness is frequently used to describe severe visual impairment with residual vision. Those described as having only "light perception" can see no more than the ability to tell light from dark. A person with only "light projection" can tell the general direction of a light source.
In order to determine which people may need special assistance because of their visual disabilities, various governmental jurisdictions have formulated more complex definitions referred to as legal blindness.[2] In North America and most of Europe, legal blindness is defined as visual acuity (vision) of 20/200 (6/60) or less in the better eye with best correction possible. This means that a legally blind individual would have to stand 20 feet (6 m) from an object to see it with the same degree of clarity as a normally sighted person could from 200 feet (60 m). In many areas, people with average acuity who nonetheless have a visual field of less than 20 degrees (the norm being 180 degrees) are also classified as being legally blind. Approximately ten percent of those deemed legally blind, by any measure, have no vision. The rest have some vision, from light perception alone to relatively good acuity. Low vision is sometimes used to describe visual acuities from 20/70 to 20/200. [1]
By the 10th Revision of the WHO International Statistical Classification of Diseases, Injuries and Causes of Death, low vision is defined as visual acuity of less than 6/18, but equal to or better than 3/60, or corresponding visual field loss to less than 20 degrees, in the better eye with best possible correction. Blindness is defined as visual acuity of less than 3/60, or corresponding visual field loss to less than 10 degrees, in the better eye with best possible correction.[2][3]
| The Blind Girl (1856), a painting by John Everett Millais | |
| ICD-10 | H54.0, H54.1, H54.4 |
| ICD-9 | 369 |
In 1934, the American Medical Association adopted the following definition of blindness:
The United States Congress included this definition as part of the Aid to the Blind program in the Social Security Act passed in 1935[3][4]. In 1972, the Aid to the Blind program and two others combined under Title XVI of the Social Security Act to form the Supplemental Security Income program[4] which currently states:
Kuwait is one of many nations that share the same criteria for legal blindness[6].
In 1987, it was estimated that 598,000 people in the United States met the legal definition of blindness[7]. Of this number, 58% were over the age of 65[7]. In 1994-1995, 1.3 million Americans reported legal blindness[8].
In November 2004 article Magnitude and causes of visual impairment, the WHO estimated that in 2002 there were 161 million (about 2.6% of the world population) visually impaired people in the world, of whom 124 million (about 2%) had low vision and 37 million (about 0.6%) were blind. [9]
Serious visual impairment has a variety of causes:
Most visual impairment is caused by disease and malnutrition. According to WHO estimates in 2002, the most common causes of blindness around the world are:
People in developing countries are significantly more likely to experience visual impairment as a consequence of treatable or preventable conditions than are their counterparts in the developed world. While vision impairment is most common in people over age 60 across all regions, children in poorer communities are more likely to be affected by blinding diseases than are their more affluent peers.
The link between poverty and treatable visual impairment is most obvious when conducting regional comparisons of cause. Most adult visual impairment in North America and Western Europe is related to age-related macular degeneration and diabetic retinopathy. While both of these conditions are subject to treatment, neither can be cured. Another common cause is retinopathy of prematurity.
In developing countries, wherein people have shorter life expectancies, cataracts and water-borne parasites—both of which can be treated effectively—are most often the culprits (see River blindness, for example). Of the estimated 40 million blind people located around the world, 70–80% can have some or all of their sight restored through treatment.
In developed countries where parasitic diseases are less common and cataract surgery is more available, age-related macular degeneration, glaucoma, and diabetic retinopathy are usually the leading causes of blindness[10].
Eye injuries, most often occurring in people under 30, are the leading cause of monocular blindness (vision loss in one eye) throughout the United States. Injuries and cataracts affect the eye itself, while abnormalities such as optic nerve hypoplasia affect the nerve bundle that sends signals from the eye to the back of the brain, which can lead to decreased visual acuity.
People with injuries to the occipital lobe of the brain can, despite having undamaged eyes and optic nerves, still be legally or totally blind.
People with albinism often suffer from visual impairment to the extent that many are legally blind, though few of them actually cannot see. Leber's congenital amaurosis can cause total blindness or severe sight loss from birth or early childhood.
Recent advances in mapping the human genome have identified other genetic causes of low vision or blindness. One such example is Bardet-Biedl syndrome.
A small portion of all cases of blindness are caused by the intake of certain chemicals. A well-known example is methanol [11] , found in methylated spirits, which are sometimes used by alcoholics as a cheap substitute for regular alcoholic beverages.
Blinding has been used as an act of vengeance and torture in some instances, to deprive a person of a major sense by which they can navigate or interact within the world, act fully independently, and be aware of events surrounding them. An example from the classical realm is Oedipus, who gouges out his own eyes after realizing that he fulfilled the awful prophecy spoken of him.
There exist a number of organizations, such as International Agency for the Prevention of Blindness, ORBIS International, and Seva Foundation, who have developed programs aimed at preventing blindness.
On September 10, 2007, in a 6-year study, researchers, led by John Paul SanGiovanni of the National Eye Institute, Maryland found that Lutein and zeaxanthin (nutrients in eggs, spinach and other green vegetables) protect against blindness (macular degeneration), affecting 1.2 million Americans, mostly after age 65. Lutein and zeaxanthin reduce the risk of AMD (journal Archives of Ophthalmology). Foods considered good sources of the nutrients also include kale, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, garden peas and Brussels sprouts.[12]
Visually impaired and blind people have devised a number of techniques that allow them to complete daily activities using their remaining senses. These might include the following:
Most people, once they have been visually impaired for long enough, devise their own adaptive strategies in all areas of personal and professional management.
For corrective surgery of blindness, see acquired vision.
Designers, both visually impaired and sighted, have developed a number of tools for use by blind people.
Many people with serious visual impairments can travel independently assisted by tactile paving and/or using a white cane with a red tip - the international symbol of blindness.
A long cane is used to extend the user's range of touch sensation, swung in a low sweeping motion across the intended path of travel to detect obstacles. However, some visually impaired persons do not carry these kinds of canes, opting instead for the shorter, lighter identification (ID) cane. Still others require a support cane. The choice depends on the individual's vision, motivation, and other factors.
Each of these is painted white for maximum visibility, and to denote visual impairment on the part of the user. In addition to making rules about who can and cannot use a cane, some governments mandate the right-of-way be given to users of white canes or guide dogs.
A small number of people employ guide dogs. Although the dogs can be trained to navigate various obstacles, they are not capable of interpreting street signs. The human half of the guide dog team does the directing, based upon skills acquired through previous mobility training. The handler might be likened to an aircraft's navigator, who must know how to get from one place to another, and the dog is the pilot, who gets them there safely.
Orientation and Mobility Specialist are professionals who are specifically trained to teach people with visual impairments how to travel safely, confidently, and independently in the home and the community.
Most blind and visually impaired people read print, either of a regular size or enlarged through the use of magnification devices. A variety of magnifying glasses, some of which are handheld, and some of which rest on desktops, can make reading easier for those with decreased visual acuity.
The rest read Braille (or the infrequently used Moon type), or rely on talking books and readers or reading machines. They use computers with special hardware such as scanners and refreshable Braille displays as well as software written specifically for the blind, like optical character recognition applications and screen reading software.
Some people access these materials through agencies for the blind, such as the National Library Service for the Blind and Physically Handicapped in the United States, the National Library for the Blind or the RNIB in the United Kingdom.
Closed-circuit televisions, equipment that enlarges and contrasts textual items, are a more high-tech alternative to traditional magnification devices. So too are modern web browsers, which can increase the size of text on some web pages through browser controls or through user-controlled style sheets.
Access technology such as Freedom Scientific's JAWS for Windows screen reading software enable the blind to
use mainstream computer applications. Most legally blind people (70% of them across all ages, according to the Seattle Lighthouse for the Blind) do not use computers. Only a small fraction of this
population, when compared to the sighted community, have
The movement towards greater web accessibility is opening a far wider number of websites to adaptive technology, making the web a more inviting place for visually impaired surfers.
Experimental approaches in sensory substitution are beginning to provide access to arbitrary live views from a camera.
People may use talking thermometers, enlarged or marked oven dials, talking watches, talking clocks, talking scales, talking calculators, talking compasses and other talking equipment.
The story of the Blind Men and an Elephant uses blindness as a symbol of limited perception and perspective. Stories such as The Cricket on the Hearth by Charles Dickens provided yet another view of blindness, wherein those affected by it were ignorant of their surroundings and easily deceived. H. G. Wells' story The Country of the Blind explores what would happen if a sighted man found himself trapped in a country of blind people to emphasise societies atttitude to blind people by turning the situation on its head.
The authors of modern educational materials (see: blindness and education for further reading on that subject), as well as those treating blindness in literature, have worked to paint a different picture of blind people as three-dimensional individuals with a range of abilities, talents, and even character flaws.
The Moche people of ancient Peru depicted the blind in their ceramics. [13]
Statements that this or that species of mammals are "born blind" refers to them being born with their eyes closed and their eyelids fused together; the eyes open later. One example is the rabbit.
In humans the eyelids are fused for a while before birth, but open again before the normal birth time, but very premature babies are sometimes born with their eyes fused shut, and opening later.
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