I wanted to write a post about blindness. It’s an aspect of my life I haven’t mentioned a great deal, except in passing. I have written about things to do with transitioning from female to male and GLBTQ* matters. I’ve written about relationships and psychopathy. I’ve shared many personal details of my life, included some of my favorite music and my art work. Posts focused on healing and my groan-eliciting sense of humor. A potpourri of spirituality and politics and philosophy and linguistics (especially the differences between American English and Britspeak).
My two previous posts related to blindness have been:
The eyes are intricate organs, and many things can affect them: accidents and injury; inherited diseases; environmental factors; aging; and simple near-sightedness and far-sightedness. Each factor impacts what a person can and can’t see in a different way.
From Wikipedia (my go-to source in a pinch):
As of 2012 there were 285 million visually impaired people in the world, of which 246 million had low vision and 39 million were blind. The majority of people with poor vision are in the developing world and are over the age of 50 years.
In the United States, from the American Medical Association, blindness is:
“Central visual acuity of 20/200 or less in the better eye with corrective glasses or central visual acuity of more than 20/200 if there is a visual field defect in which the peripheral field is contracted to such an extent that the widest diameter of the visual field subtends an angular distance no greater than 20 degrees in the better eye.”
Per the United States Congress under the Title XVI of the Social Security Act, blindness is this:
“An individual shall be considered to be blind for purposes of this title if he has central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes of the first sentence of this subsection as having a central visual acuity of 20/200 or less. An individual shall also be considered to be blind for purposes of this title if he is blind as defined under a State plan approved under title X or XVI as in effect for October 1972 and received aid under such plan (on the basis of blindness) for December 1973, so long as he is continuously blind as so defined.”
In the United Kingdom, blindness is this:
In the UK, the Certificate of Vision Impairment (CVI) is used to certify patients as severely sight impaired or sight impaired. The accompanying guidance for clinical staff states: “The National Assistance Act 1948 states that a person can be certified as severely sight impaired if they are “so blind as to be unable to perform any work for which eye sight is essential” (National Assistance Act Section 64(1)). The test is whether a person cannot do any work for which eyesight is essential, not just his or her normal job or one particular job.”
In practice, the definition depends on individuals’ visual acuity and the extent to which their field of vision is restricted. The Department of Health identifies three groups of people who may be classified as severely visually impaired.
- Those below 3/60 (equivalent to 20/400 in US notation) Snellen (most people below 3/60 are severely sight impaired),
- Those better than 3/60 but below 6/60 Snellen (people who have a very contracted field of vision only),
- Those 6/60 Snellen or above (people in this group who have a contracted field of vision especially if the contraction is in the lower part of the field),
In the United States, I am “legally blind.” In the United Kingdom, I am “severely sight impaired.” My eye problems started at birth with congenital cataracts (not genital) I hear that Italy is changing the official name of its airline to Gen’Italia! warned you many times about my humor!)) inherited from my father. From there, I developed secondary glaucoma as a teenager. And as a result of some 20+ eye surgeries, I had damaged corneas, with two failed corneal transplants. And many other complications… By now, I’ve earned an MD in ophthalmology for my particular eye conditions! (And I learned how to spell “ophthalmology” without auto-correct!)
Cataracts are a clouding of the lenses of the eyes. As the cataracts progress, the cloudiness becomes worse and worse until it seems the person is maneuvering in the densest fog imaginable, with nothing but light perception. The only cure is to surgically remove the clouded lens from the eye. My cataract surgery was performed when I was 5 years old, in 1961, before the advent of artificial lens implants. My eyes are too damaged now for the artificial lens implants. Imagine a camera with no lens. That’s my world. Hence, I either have to wear expensive, hideously thick glasses with strong magnification, or a combination of contact lenses and “regular” glasses for a little extra clarity and up-close reading. But my corneas are also too damaged now for the contact lenses, so it’s Coke-bottle glasses for me now. I’m working on solutions….
Corneal disease is somewhat similar to cataracts, except it’s the cornea rather than the lens of the eye that is clouded. The impact on vision is similar, though. And the main “cure” is a cornea transplant from cadaver tissue, or more recently, a synthetic corneal transplant. This is what I’m hoping for when I go to the Wilmer Eye Institute at Johns Hopkins in Baltimore in December.
Glaucoma is a disease where the natural, nourishing fluid of the eye is produced faster than it can be drained through the fine meshwork. There are various types and causes of glaucoma. The build-up of excess fluid slowly kills the optic never (in the most common type of glaucoma). The optic nerve is damaged from the outer edges inward, so that the person gradually loses peripheral vision. It’s like looking through a straw that gets thinner and thinner over time. Eye drops and medications are prescribed to reduce the build-up of the fluid, but if they don’t work, the solution is surgical. A hole is surgically made in the eye so that the fluid can drain properly. This is where things went wrong for me. The medications didn’t work, and so I had countless surgeries of various types to make the drainage opening. But I was young, and each time, the hole created by surgeons healed closed, just like if you have pierced ears but don’t wear your earrings. I now have a plastic shunt implanted in my left eye. It worked great for decades, but it seems that something more may soon need to be done.
Both cataracts and glaucoma are diseases that usually come with old age and are easily solved these days. Everyone should be careful to get their eyes checked for glaucoma as they age, because the loss of visual field is so slow, one may not notice the loss of visual field until too much vision is irretrievably gone, resulting in total blindness.
These are the eye conditions I’m familiar with through extensive personal experience, but there are many, many others that I’m not familiar with.
I do not have macular degeneration, so I can’t speak about it. But from the photograph, it appears that the affect on vision is the opposite of glaucoma. Central, rather than peripheral, visual field is lost.
What Can You Do?
- Understand that vision deficits manifest in various forms.
- Know that blind and vision-impaired people are human beings with hopes and dreams and talents and capabilities.
- Help when you can, but don’t patronize.
- The vision problems are real with real impact on function. Don’t say, “I know a totally blind person who can do XYZ just fine…”
- You’d be surprised at how creative blind and vision-impaired people can be at solving their own problems.
- If you have a friend who is blind or with vision impairment, educate yourself.
Here are a few short tips for treading kindly with someone who has limited vision:
- If we’re in a social situation, many of us can’t see through eye contact when you are talking to us unless we’re sitting next to your nose, so say our names or give some cue that you are speaking directly to us.
- Don’t assume someone is snobby if they don’t wave back at you from a distance.
- If you encounter us at the grocery store or on the sidewalk and say hello, tell us your name. We can’t remember every voice.
- If we are out shopping or walking together, don’t wander off without telling us. Can’t tell you how many times I kept talking to someone (and appeared to be insane rather than blind) who had veered down an aisle to look at a new display of towels in Target.
- If we go to see a movie, try to be willing to sit near the front of a theater. Don’t invite us to see a movie with subtitles.
Know that we may have been bullied when we were children, and hence, we may have “emotional issues” (like everyone else) that detract from what we can and can’t do. That’s one reason why it is very rude to say, “I know a totally blind person who can do XYZ…”
Blindness doesn’t discriminate and neither should you. We come in all flavors — gay / straight / transgendered; Christian / Jew / Muslim / Buddhist; Democrat / Republican / independent / anarchist; rich / poor; kind and decent / psychopaths, etc.
The hardest part of being blind or having a vision impairment is not the vision deficit itself. It’s social isolation and lack of understanding. Be kind, be love, and educate yourself.
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