Visual Impairment, including Blindness

DISABILITY CATEGORY: Visual Impairment, including Blindness

TYPES: Partially Sighted, Low Vision, Legally Blind, Totally Blind

• “Partially sighted” indicates that some type of visual problem has resulted in a need for special education.

• “Low vision” generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting, the size of print, and, sometimes, braille.

• “Legally blind” indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point);

• “Totally blind” students learn via Braille or other non-visual media.

Visual impairment is the consequence of a functional loss of vision, rather than the eye disorder itself. Eye disorders which can lead to visual impairments can include retinal degeneration, albinism, cataracts, glaucoma, muscular problems that result in visual disturbances, corneal disorders, diabetic retinopathy, congenital disorders, and infection (Source: NICHCY)

DEFINITION: 

Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines visual impairment as follows:

            “…an impairment in vision that, even with correction, adversely affects a child's educational performance.  The term includes both partial sight and blindness.”

[34 Code of Federal Regulations §300.7(c) (13)]

FACTS AND STATS:

• The rate at which visual impairments occur in individuals under the age of 18 is 12.2 per 1,000. Severe visual impairments (legally or totally blind) occur at a rate of .06 per 1,000.

• Globally, in 2002 more than 161 million people were visually impaired, of whom 124 million people had low vision and 37 million were blind. However, refractive error as a cause of visual impairment was not included, which implies that the actual global magnitude of visual impairment is greater.

• Worldwide for each blind person, an average of 3.4 people have low vision, with country and regional variation ranging from 2.4 to 5.5.

• By age: Visual impairment is unequally distributed across age groups. More than 82% of all people who are blind are 50 years of age and older, although they represent only 19% of the world's population. Due to the expected number of years lived in blindness (blind years), childhood blindness remains a significant problem, with an estimated 1.4 million blind children below age 15.

• By gender: Available studies consistently indicate that in every region of the world, and at all ages, females have a significantly higher risk of being visually impaired than males.

• Geographically: Visual impairment is not distributed uniformly throughout the world. More than 90% of the world's visually impaired live in developing countries. (Source: NICHCY; WHO, 2002)

CAUSES: Visual impairments are usually caused by traumatic injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident. Some babies are born with congenital blindness, which means they are visually impaired at birth. Congenital blindness can be inherited or caused by an infection, like measles, that is transmitted from the mother to the developing fetus during pregnancy. 

Amblyopia (pronounced: am-blee-oh-pee-uh) develops in children before age 7. In amblyopia, the two eyes send different messages to the brain. The brain then turns off or suppresses images from the non-dominant eye and vision stops developing normally. Strabismus (misaligned or crossed eyes) is the most common cause of amblyopia.

Diabetic retinopathy (pronounced: reh-ton-ah-pa-thee) occurs when the tiny blood vessels in the retina are damaged due to diabetes. At first, small blood vessels in the retina leak. Later, abnormal blood vessels may grow. Symptoms are not noticeable until damage to the retina is severe, although there may be some blurry vision. Teens who have juvenile diabetes should be sure to get regular eye exams because there are no early warning signs for this condition. Teens with diabetes should also avoid smoking, keep their blood pressure under control, and keep their blood sugar at an even level.

Glaucoma is an increase in pressure inside the eye. The increased pressure impairs vision by damaging the optic nerve. Glaucoma is mostly seen in older adults, although babies may be born with the condition. Teens are most likely to get glaucoma as the result of a head or eye injury.

Macular degeneration (pronounced: mah-kyoo-lur dih-jeh-nuh-ray-shun) is a gradual and progressive deterioration of the macula, the most sensitive region of the retina. The condition leads to progressive loss of central vision. Sometimes macular degeneration is age-related (which means it occurs in older people, especially older than 60). Excessive exposure to sunlight and smoking can increase a person's risk for macular degeneration. Symptoms may include increased difficulty reading or watching television or distorted vision in which straight lines that appear wavy or objects look larger or smaller than normal.

Trachoma (pronounced: truh-ko-muh) occurs when a very contagious microorganism called Chlamydia trachomatis causes inflammation in the eye. It's often found in poor rural countries that have overcrowded living conditions and limited access to water and sanitation. The disease is easily spread. For example, children, who often get the condition first, may rub their red, sticky eyes then touch the faces of their mothers and other children - thereby spreading the disease. Flies can also spread the disease. After years of repeated trachoma infections, the inside of the eyelids can become so scarred that they turn inward with the eyelashes rubbing on the eyeballs. Left untreated, this scarring can lead to vision loss and blindness. More than 146 million people need treatment, and trachoma is totally preventable.

(Source: kidshealth.org/teen/diseases_conditions/sight/visual_impairment.html)

Nystagmus refers to rapid involuntary movements of the eyes that may be from side to side (horizontal nystagmus), up and down (vertical nystagmus) or rotary. Depending on the cause, these movements may be in both eyes or in just one eye. The term "dancing eyes" has been used in regional dialect to describe nystagmus. The involuntary eye movements of nystagmus are caused by abnormal function in the areas of the brain that control eye movements. The exact nature of these disorders is poorly understood. Nystagmus may be either congenital (present at birth) or may be acquired (caused by disease or injury later in life). Congenital nystagmus is more common than acquired nystagmus. It is usually mild, does not change in severity, and is not associated with any other disorder. Affected people are not aware of the eye movements, although they may be noticed by a careful observer. If the movements are of large magnitude, visual acuity (sharpness of vision) may be less than 20/20. Surgery may improve visual acuity. A less-common cause of nystagmus is disease or injury of the central nervous system.  There is no therapy for most cases of congenital nystagmus. Availability of treatment for acquired nystagmus will vary with the cause. In most cases, except for those caused by Dilantin or alcohol intoxication, nystagmus is irreversible.

(Source for Nystagmus:  Medline Plus; U. S. Library of Medicine and the National Institutes of Health)

PREVENTION:

Prevention of visual impairment, when possible, is related to the cause. Prevention includes the following:

• Screening for vision problems should be part of a routine checkup by a healthcare provider. All infants and children should be screened. This can help detect a condition called strabismus, or so-called lazy eye, which needs early treatment to prevent blindness. Screening for glaucoma is very important for people who are older than 40, especially those who are black or have a family history of this condition.

• Controlling conditions that can lead to vision impairment. An example of this would be diabetes. Controlling blood sugar levels has been shown to prevent or delay vision problems from this condition. Controlling glaucoma can also help prevent vision loss from this condition.

• It is important to protect the eyes from foreign objects, chemicals, and the sun, by wearing goggles, sunglasses and safety glasses where necessary. Sunlight can also harm the eyes, and people should never look directly at the sun.

• Following directions for proper wearing, cleaning, and storing of the lenses, for those who wear contact lenses. People must also watch for problems that can be caused by the lenses. These may include corneal injuries or corneal infections.

• Providing regular prenatal care for pregnant women to help prevent problems in the developing baby

• Seeking early evaluation and treatment for eye infections (Source: WHO)

CHARACTERISTICS:The effect of visual problems on a child’s development depends on the severity, type of loss, age at which the condition appears, and overall functioning level of the child. Many children who have multiple disabilities may also have visual impairments resulting in motor, cognitive, and/or social developmental delays. A young child with visual impairments has little reason to explore interesting objects in the environment and, thus, may miss opportunities to have experiences and to learn. This lack of exploration may continue until learning becomes motivating or until intervention begins. Because the child cannot see parents or peers, he or she may be unable to imitate social behavior or under- stand nonverbal cues. Visual disabilities can create obstacles to a growing child’s independence (NICHCY).

MEDICAL TREATMENT: There may be ways to improve sight. Glasses and contact lenses are the most common ways to improve vision. Children with a lazy eye may wear an eye patch on one eye, or may use surgery to help with weak eye muscles. Therapists who have been trained in vision problems can suggest exercises that may improve some vision problems. Surgery and medication may also be appropriate, as in glaucoma. Those who have cataracts and some other conditions are "cured" or improved by surgery or medications. If vision cannot be improved, training and special devices may help the person adjust to the impairment.

It is possible to live a nearly normal lifestyle with most visual impairments. Many people use eyeglasses or magnifiers so they can still perform certain activities. To function safely, affected people may, however, need to rely on signals other than sight. For example, some lighted signals at a crosswalk also make beeping sounds to indicate when it is safe to cross the street. People who have severe vision problems or are blind can benefit from special devices and training. A white cane and a guide dog are familiar aids for helping blind people function on their own. Computers are now able to recognize speech and can talk to the person. Keyboards with Braille symbols, Braille books, and books on audio tape are also available (Source:WHO).

PROGNOSIS: The prognosis generally relates to the severity of the impairment and the ability of the aids to correct it. A good low vision exam is important to be aware of the latest low vision aids. (Source: Health A to Z)

EDUCATIONAL IMPLICATIONS:

Children and youth with low vision have unique educational needs. Research documents that these students often require direct instruction by a teacher for students with visual impairments in areas that are not typically addressed for other students. All students who meet the criteria for visual impairment within their state should have a document that addresses their individual needs. This document, called an Individualized Education Plan (IEP), is used to place a child in the most appropriate educational setting. A thorough assessment for students with visual impairments is the key in creating an adequate IEP. And the assessment process is an essential component in developing appropriate goals and objectives for the student.

Parents may learn that their child has VI much earlier than do parents of children with other disabilities. Children with visual impairments should be assessed early in order to benefit from early intervention programs, when applicable. Technology in the form of computers and low-vision optical and video aids enable many partially sighted, low vision, and blind children to participate in regular class activities. Large print materials, books on tape, and Braille books are available. Students with visual impairments may need additional help with special equipment and modifications in the regular curriculum to emphasize listening skills, communication, orientation and mobility, vocation/career options, and daily living skills. Students with low vision or those who are legally blind may need help in using their residual vision more efficiently and in working with special aids and materials. Students who have visual impairments combined with other types of disabilities have a greater need for an interdisciplinary approach and may require greater emphasis on self care and daily living skills. (Sources: American Foundation for the Blind; NICHCY)

MUSIC AND VISUAL IMPAIRMENT: Resources for Helping Visually Impaired Music Students

http://www.nfb.org/fr/fr2/frsp9905.htm

An overview of the music Braille system is provided for the music educator in search of music programs and resources for visually impaired students. Braille music aids students in learning to read and play music, enabling the student to read music independently, participate in ensemble groups, or perform as a soloist to the extent that his or her musical ability allows. A list of organizations, information for college bound individuals and transcription resources are available on this site.

Music Technology Scanning, Transcription, and Translation Programs

http://www.rnib.org/xpedio/groups/public/documents/PublicWebsite/public_rnib003030.hcsp

This site highlights three main music technology programs for the blind and visually impaired. Among these are:

SharpEye is a music scanning and recognition program, which can produce MIDI, NIFF and SharpEye’s own output files.

Toccata is a Braille music transcription program with its own integrated music editor making it possible to view both the music editor and a translated Braille file through a split screen option.

Goodfeel is a Braille music translator program produced by Dancing Dots, which converts MIDI and Lime files into Braille music.

Sigma Alpha Iota International Music Fraternity Inc.

http://www.sai-national.org

This organization sponsors projects for the blind and visually impaired such as the Bold Note Project and Braille Transcription Project. The Braille transcription project educates Braille transcribers in literary and music Braille for the completion of projects for the Library of Service for the Blind and Physically Handicapped. The Bold Note project assists those with partial vision by creating musical scores with enlarged print.

ORGANIZATIONS:

American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
800.232.5463 (Hotline)
For publications call: 800.232.3044
http://www.afb.org

The American Foundation for the Blind (AFB) is a national nonprofit that expands possibilities for people with vision loss. AFB's priorities include broadening access to technology; elevating the quality of information and tools for professionals who serve people with vision loss; and promoting independent and healthy living for people with vision loss by providing them and their families with relevant and timely resources. AFB's work in these areas is supported by the strong presence the organization maintains in Washington, DC, ensuring the rights and interests of people with vision loss are represented in our nation's public policies.

American Council of the Blind
155 15th St. N.W., Suite 1004
Washington, D.C. 20005
202.467.5081; 800.424.8666
http://info@acb.org
http://www.acb.org

The American Council of the Blind is the nation's leading membership organization of blind and visually impaired people. It was founded in 1961 and incorporated in the District of Columbia. The Council's membership numbers in the tens of thousands. The majority of its members belong to one or more of its 71 affiliated organizations. There are also members-at-large. Membership is not limited to blind or visually impaired individuals. There are many sighted members. Legal blindness, however, is a requirement to serve on the ACB Board of Directors

American Nystagmus Network (ANN)
http://www.nystagmus.org/entry.html

The American Nystagmus Network, Inc. is a nonprofit organization founded in 1999 to serve the needs and interests of those affected by nystagmus. ANN seeks to provide technical and experiential information about nystagmus and its manifestations, but not medical advice. Information relates to a wide range of concerns including without limit, diagnosis, type, visual effects,  non-visual effects, tests and available treatment. It  also covers heredity, research, and known statistical data on nystagmus. ANN also seeks to provide help in coping with nystagmus through the exchange of information and ideas, guidance and counseling. ANN not only seeks to serve those affected by nystagmus, but also to provide useful information to persons with a professional or personal interest as well. These include health care providers, educators, researchers, and other relevant private and public institutional personnel.

Blind Children’s Center
4120 Marathon Street
Los Angeles, CA 90029-0159
323.664.2153; 800.222.3566
http://www.blindchildrenscenter.org

The Blind Children’s Center is a family-centered agency which serves children with visual impairments from birth to school-age. The center-based and home-based programs and services help the children acquire skills and build their independence. The Center utilizes its expertise and experience to serve families and professionals worldwide through support services, education, and research.  The organization was founded to serve children from birth to school-age who are blind or severely visually impaired. The Center’s goal is to provide a comprehensive program of specialized education and training which will optimize the blind or visually impaired child’s development and consequent opportunities to lead a meaningful and productive life.

National Association for Parents of the Visually Impaired, Inc.
P.O. Box 317
Watertown, MA 02472-0317
617.972.7441; 800.562.6265
http://www.napvi.org

The National Association for Parents of Children with Visual Impairments (NAPVI) is a non-profit organization of, by and for parents committed to providing support to the parents of children who have visual impairments. NAPVI is a national organization that enables parents to find information and resources for their children who are blind or visually impaired, including those with additional disabilities. NAPVI provides leadership, support, and training to assist parents in helping children reach their potential. NAPVI is dedicated to: giving emotional support; initiating outreach programs; networking; advocating for the educational needs of children who are blind or visually impaired.

National Association for Visually Handicapped
22 West 21st Street, 6th Floor
New York, NY 10010
212.889.3141
http://www.navh.org

NAVH is the only non-profit health agency in the world solely dedicated to providing assistance to those with partial vision loss or, as we say, the "HARD OF SEEING"®. The organization does receive federal subsidies or United Way funds, but rather, rely upon the contributions of Members and Friends. Its purpose is to work with the visually impaired so that those affected can live with as little disruption as possible. No one is ever denied services of any kind if they are unable to make a donation.

National Braille Association, Inc. (NBA)
3 Townline Circle
Rochester, NY 14623-2513
585.427.8260
http://www.nationalbraille.org

The mission of the National Braille Association, Inc. is to provide continuing education to those who prepare Braille, and to provide Braille materials to persons who are visually impaired. Among its resources is a link which is a gateway many useful websites for Braille.

Prevent Blindness America
500 E. Remington Road
Schaumburg, IL 60173
847.843.2020; 800.221.3004
http://www.preventblindness.org

Founded in 1908, Prevent Blindness America is the nation's leading volunteer eye health and safety organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision care, Prevent Blindness America touches the lives of millions of people each year. The organization carries out important roles such as screening, providing educational programs, advocacy, research, and training for screening instructors.

RESOURCES:

National Library Service for the Blind and Physically Handicapped (NLS)
Library of Congress
Washington, DC 20542
1-800-424-8567 Toll-Free
(202) 707-0712 FAX
http://www.loc.gov/nls/index.html

A free national library program of braille and recorded materials for blind and physically handicapped persons is administered by the National Library Service for the Blind and Physically Handicapped (NLS), Library of Congress. Under a special provision of the U.S. copyright law and with the permission of authors and publishers of works not covered by the provision, NLS selects and produces full-length books and magazines in braille and recorded formats. Reading materials are distributed to a cooperating network of regional and subregional (local) libraries where they are circulated to eligible borrowers. Reading materials and playback machines are sent to borrowers and returned to libraries by postage-free mail. Braille books, magazines, and music materials are also made available on the Internet through Web-Braille. Established by an act of Congress in 1931 to serve blind adults, the program was expanded in 1952 to include children, in 1962 to provide music materials, and again in 1966 to include individuals with other physical impairments that prevent the reading of standard print.

Music section: The special music collection consists of more than 30,000 braille and large-print music scores, texts, and instructional recordings about music and musicians on cassette. Persons interested in music materials may receive them directly from the Music Section of NLS. The collection consists of scores in braille and large print; textbooks and books about music in braille and large print; music appreciation cassettes, including interviews and opera lectures; and self-instructional cassettes for voice, piano, organ, electronic keyboard, guitar, recorder, accordion, banjo, harmonica, and other instruments. Braille scores and books are also available on the Internet.

National Eye Institute
http://www.nei.nih.gov/health/resourceAlpha.asp

This site is a database of resources for the blind and visually impaired. It lists organizations whose primary purposes are to provide those having visual impairments with educational programs, financial assistance, healthcare information, and employment options. News concerning the blind and visually impaired community are also available, so is information on current research, legislation, and conventions.

Recording for the Blind and Dyslexic
20 Roszel Road
Princeton, NJ 08540
609-452-0606
http://www.rfbd.org/

Recording for the Blind & Dyslexic, a nonprofit volunteer organization, is the nation's educational library serving people who cannot effectively read standard print because of visual impairment, dyslexia, or other physical disability. Our mission is to create opportunities for individual success by providing, and promoting the effective use of, accessible educational materials. Our vision is for all people to have equal access to the printed word.

Resource Guide for Individuals with Visual Difficulties and Impairments
About Visual Difficulties and Impairments
http://www.microsoft.com/enable/guides/vision.aspx

Highlighted here are some of the many options available for individuals with vision difficulties to modify their computer displays and appearance so it is more legible, or receive information through sound or touch. Those who are visually impaired cannot use a computer monitor and but have the option to receive information from their computers through hearing or touch offered through screen readers and Braille displays. Assistive technology products compatible with Microsoft® Windows® operating systems, made by independent assistive technology manufacturers, are included in the assistive technology catalog.

Council for Exceptional Children: DVI Quarterly
http://www.ed.arizona.edu/dvi/dviq/Spring05/pix/DVI%20Logo.jpg

This site discusses the work of the Division on Visual Impairments at the University of Arizona. The Division has a membership coming from residential public and private school programs, state departments of education, teacher education, and related fields. Division activity currently shows concern for federal, state, and local issues and policies related to education of infants, children and youths with Visual Impairments. The site addresses areas such as curriculum development, parent counseling, development and selection of appropriate materials, research needs, teacher preparation, career education and vocational preparation of infants, children and youths with Visual Impairments.

The Office of Special Education (Visual Impaired)-University of Virginiahttp://curry.edschool.virginia.edu/sped/projects/ose/categories/vi.html

This site provides general resources for organizations for the blind, general resources for the visual impaired as well as Braille resources. The Curry School of education at the University of Virginia provides these resources.

Disability Resources
http://www.disabilityresources.org/AT-BLIND.html

This site provides technological resources for individuals who are blind and visually impaired. The resources include links to specific technological equipment such as screen magnifiers and voice access for the visually impaired. Information on web browsers is available to persons having special needs. Detailed instructions are given to assist the user with customizing web browsers (i.e. setting a larger font) according to personal preferences. This site also provides blind persons with links to Braille technology and synthetic speech systems.

Visual Impairment Guide
 http://www.viguide.com

The visual impairment guide is a resource for parents who may need educational and technological resources for children who are visually impaired. This site contains information on Braille, orientation and mobility, educational therapies used to improve the quality of life for visually impaired students, and assistive technology. Interestingly, this site also gives parents legal information that may impact the lives of the visually impaired such as federal and state laws.

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