How “Blind” Are You?

Eye

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:

Seeing Through Clouded Eyes, But with Clarity/

The Ayes and the Eyes Have It

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.[11]

  • 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),

See Low Vision and Legal Blindness Terms and Descriptions.

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!)

This is how the world looks to someone with cataracts.

This is how the world looks to someone with cataracts.

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.

This is what the world looks like for someone with glaucoma.

This is what the world looks like for someone with glaucoma.

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.

This is what the world looks like for someone who is totally blind.

This is what the world looks like for someone who is totally blind.

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.

This is what the world looks like for a person with macular degeneration.

This is what the world looks like for a person with macular degeneration.

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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About DogDharma

Dog Dharma is written by a human who loves dogs and who believes dogs have attained enlightenment. The human behind Dog Dharma came from humble origins, has faced many trials, enjoyed many adventures, and taken a path less traveled. He claims no special privilege or expertise, and remains humble. Dog Dharma‘s author has learned a few things along the way, and has much yet to learn. He has been told by many people that he has a talent for writing, and aspires to write a book, but is a little too lazy and disorganized, so his blog will suffice for now. He opens a window into his life in the hope that some of his words may be of comfort, some may be a beacon or warning, and perhaps he will connect with like-minded souls. Everything shared comes from a place of openness and honesty, but with no claim that he possesses the Truth. People and places mentioned should be taken as pseudonyms. In many cases, details may be an amalgamation of actual events disguised to protect the “innocent.” Nothing written is to be taken as actual fact, but as the author of Dharma Dog‘s limited understanding. From the mouths of the Beatles: In the end, the love you take is equal to the love you make
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18 Responses to How “Blind” Are You?

  1. Thanks for this post. Very interesting and educational. 🙂

    Liked by 1 person

    • DogDharma says:

      Thank you, nftbrf! I tried to make it interesting, and inject a little humor. I hope it gently educates people so that they are not afraid to approach persons with vision deficits. 🙂

      Like

  2. mandy says:

    Terry, this is a most valuable post that I’m saving!! You’ve just educated me about so many things that I should spend more time thinking about. My dad’s side of the family (10 kids) all had various serious vision problems since childhood. He was legally blind from glaucoma by his 40’s. I’ve got beginning stage glaucoma–not yet using drops–but all of this info really makes me see the importance of staying on top of it.

    I can hardly believe (but I do!) all you’ve endured with your vision problems. Your incredible spirit would never let on. Maybe I overlooked this in your post here, but with the vision problems, how do you write, read, research so much? Do you use any sort of tool like the auto read/write things? I’m just so amazed and impressed by YOU.

    I hope so much your surgery in December is successful! ♥

    Liked by 1 person

  3. DogDharma says:

    Mandy, THANK YOU!! First of all, if you are at the beginning stages of glaucoma, be sure to have the recommended regular exams so you know if / when you need the eye drops.

    Secondly, the vision in my left eye is completely clouded over so that all I have is light perception. But the vision in my right eye is more like what’s shown in the “glaucoma” photo. In what remains of my central vision in my right eye, I have roughly 20/100 acuity. 20/200 is the yardstick for “legal blindness” on the acuity measure, but I have lost so much of my visual field that I “qualify” as legally blind.

    However, what remains of the acuity of vision in my right “good” eye is sufficient for me to do most things, even if I have to use a magnifying glass. I just have to tilt my head so that what I’m looking at lines up with my remaining central vision. Which has then given me repetitive strain injury in my neck… But I have a large screen computer monitor, and I’ve learned to use CTRL-+ to make web pages larger. iPads are wonderful for anyone who has a vision impairment, also. I don’t use anything special beyond that. Well, my magnifier, and my monocular (a “binocular” for one eye for stuff in the distance).

    I can read normal-sized print if the lighting is good — but not the tiny print like we used to see in telephone books (who uses those anymore?) and not the list of ingredients on food and medicine products. For smaller print, I use my magnifier. (I had to do that to read the little manual when I adjusted the time on my watch last week.)

    One thing that happens when you have a vision deficit is you learn to make good guesses. Sometimes when I’m out walking, I will see a dark spot on the sidewalk and not know if it is a shadow, a step, or a fallen limb. Educated guesses from long experience get me by.

    My only complaint is not being able to drive, which is part of what keeps me isolated. But then I’d complain about parking, auto insurance, and people who cut me off. 🙂 Thanks for asking. 🙂

    Like

  4. mandy says:

    That’s a LOT of coping you do, Terry, and in the most positive, graceful way. My heart hurts at your goodness! I suppose, since you started dealing with vision problems almost as far back as you an remember, you’ve learned to cope with the obstacles–jumping over (falling over) them as they arise. I’m a baby about sight and have complained my entire life about not being able to see well, even though I wore glasses, got Lasik, etc. I’ have severe dry eye syndrome that nothing helps and that distorts vision a lot.Many abrasions from falling asleep without eye gel! I’m going to appreciate what I do have a little better now. I feel bad because I have a car, I CAN drive, but have a fear of being in vehicles, so I drive very little. I REALLY regret writing out that insurance payment 🙂 and I isolate because of it.
    Oh, I can tell you one thing: Parking sucks, lol! 🙂

    Like

    • DogDharma says:

      Mandy, I have severe dry eyes, too, so we have that in common. If you use artificial tears, be sure to get the ones packaged in individual vials even though they are more expensive. The type in little bottles contain preservatives and other chemicals that actually make the dryness worse. Also, a hot compress over the eyes for 5 minutes every day can do wonders. Then, there’s Restasis… I have a high tolerance for pain, and I *know* how painful dry eyes can be. {{{hugs}}} for that.

      Are you afraid of being in vehicles even if you are not the driver? There was a period of about a year when I was in my 20’s that I could drive with special telescopic glasses. My vision was better then and I had use of both eyes. So I know *how* to drive, and even a stick shift. I *loved* driving and will occasionally have dreams about it, but oddly, in the dreams, it’s always a tiny child-sized car. Must be something Freudian in that? 🙂

      Liked by 1 person

      • mandy says:

        The eye drops/meds have been a frustrating roller-coaster. So far they all evaporate almost instantly and it feels more dry. The Restasis was cost-prohibitive and the eye doctor told me they didn’t have a high success rate with it. Oh well!

        My fear of being in cars–and probably more so as a passenger–but I have a dreadful fear of other drivers (wonder why?). It comes from my childhood. A mentally ill stepfather who terrorized the family with maniacal car rides. And then being with someone who enjoyed swerving to hit animals.

        I have had lots of driving dreams, too! That must have been incredible for the brief period you drove. I can see why you’d still dream about it. 🙂

        Like

  5. krisalex333 says:

    Having lost more than 50% of my hearing (cochlear loss, genetical) and wearing two hearing aids, I SO understand the social isolation and lack of understanding of people. One of our HR policies still refer to “people who suffer from disability” – the only thing I suffer from, is insensitivity of people. It is a constant battle to educate them. My partner has been know to tell people that I am hearing disabled, but there is nothing wrong with my brain, as they tend to address her and not me. To be part of two minority groups (the trans* and disabled groups), I (and I am sure you too) have had my share of wishing I could just evaporate from this planet and appear on a different one where everybody looks different and are accepted, but instead, I think I will just book a flight on air Gen’Italia. 😀 All the best with the surgery and I’ll hold thumbs for a positive outcome. Let us know how it went. Take care.
    Kris

    Liked by 1 person

    • DogDharma says:

      Kris, I *so* understand! There have been many times when people would talk to my partner (or whoever I was with) rather than me! I *think* my brain is just fine, some might question! I wish you’d write a post similar to mine. Educating people will open a few minds.

      I need to put on my “to write” list a post about the intersection of being in the “blind community” and the GLBT community. When I was younger, like a teenager, and my vision was better, it seemed that the twain did not meet. I could “pass” as having normal vision, and I felt like I had to choose which group to affiliate with because the two groups didn’t mix well. Since I perceived myself to be a lesbian at the time, I chose to affiliate with the GLBT group. But that meant that I didn’t get much peer support as a kid growing up with a vision loss.

      PS for you and kind Mandy: The surgery is not a definite yet. The first visit is a consult to see if my left eye is healthy enough to endure the surgery and the aftermath. So please keep holding those thumbs!

      Also, can you book me a flight on Air Gen’Italia, too? 😉

      Like

      • krisalex333 says:

        Terry (?), I am considering that post, just need to get more ammunition. 😉

        I unfortunately find that there is as much “in-fighting” in the disabled community as in any other group – so “belonging” is a concept I still struggle with. I have however found the blogging trans community’s ‘company’ a big support.

        Will hold those thumbs!

        Your place is booked next to me on that flight – we can chat about a myriad of things! Btw, the more abnormal your mind and humour, the better we will get along! 😉

        Liked by 1 person

  6. DogDharma says:

    Mandy, do try the individual vials — they still evaporate, but they don’t so much leave the eyes feeling more dry than when you use the other artificial tears. Restasis is cost-prohibitive for me as well, so I use it sparingly. I found it did help, but mainly when used consistently.

    OMG — the things these psychopaths do to animals and the children who love them. 😦 My drunken stepfather who my mother married when I was a teenager, once went into the back yard chasing my dogs with a knife to slit their throats. Luckily, he was too drunk to catch them, but … the memories and fears we are left with… I’m so sorry these things happened to us. 😦

    But we’re moving forward, eh? I liked your “Bill of Rights” post. Grow, learn, strengthen, share, educate, and retain our sense of self and be a part of the Goodness in this world.

    PS: I mentioned to Kris above — the surgery for my eye is not a definite yet. First the initial consult to see if my left eye is healthy enough for the surgery. Thanks for the good wishes, though — I need them!

    Liked by 1 person

  7. DogDharma says:

    Kris, yes, it’s Terry. I’m normally abnormal and abnormally normal, so I imagine we’ll get along. 😉

    I see you put those tell-tale U’s in your words — are you Brit or Aussie? 🙂

    Like

    • krisalex333 says:

      Nice meeting ya, Terry! Yeah, sounds like we will get along splendidly! I’m neither Brit nor Aussie, but South African – from German European immigrants in the 1600’s or so, but who really cares. 🙂

      Liked by 1 person

      • DogDharma says:

        Doggone it, you’re getting our summer while we get your winter! Not fair. I’m American with German roots from immigrants in the 1800’s and Italian from 1905 immigrants. Being 1/2 Italian (and working on getting an Italian passport), I should be able to get us a discount on Air Gen’Italia. 😉 Splendid meeting you, too, Kris!

        Liked by 1 person

  8. krisalex333 says:

    Terry, I’d like to contact you by email if it is possible – want to hear what assistive devices you use to aid with reading and writing. Lemme know if it is ok? My email is kris dot alexandersa at gmail dot com

    Liked by 1 person

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