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{{Blindness}}
'''For patient information, click [[Blindness (patient information)|here]]'''


 
{{CMG}} {{AE}} {{SME}}
==Overview==
'''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."<ref name="ICO">International Council of Ophthalmology. [http://www.icoph.org/pdf/visualstandardsreport.pdf "International Standards: Visual Standards — Aspects and Ranges of Vision Loss with Emphasis on Population Surveys."] April 2002.</ref> '''Total blindness''' is the complete lack of form and light perception and is clinically recorded as "NLP," an abbreviation for "no light perception."<ref name="ICO"/> ''Blindness'' is frequently used to describe severe [[visual impairment]] with [[wikt:residual|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'''.<ref name="Belote">Belote, Larry. [http://www.larrybelote.com/Files/Low%20Vision%20Education%20and%20Training/Extending%20the%20Boundaries%20of%20Service.DOC "Low Vision Education and Training: Defining the Boundaries of Low Vision Patients."] ''A Personal Guide to the VA Visual Impairment Services Program.'' Retrieved March 31, 2006.</ref> 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 [[degree (angle)|degree]]s (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. [http://www.afb.org/Section.asp?SectionID=26&TopicID=144]
 
By the 10th Revision of the [[World Health Organization|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.[http://www3.who.int/icd/currentversion/fr-icd.htm][http://www.who.int/mediacentre/factsheets/fs282/en/]
 
{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name        = Blindness |
   Name        = Blindness |
   ICD10      = {{ICD10|H|54|0|h|53}}, {{ICD10|H|54|1|h|53}}, {{ICD10|H|54|4|h|53}} |
   ICD10      = {{ICD10|H|54|0|h|53}}, {{ICD10|H|54|1|h|53}}, {{ICD10|H|54|4|h|53}} |
   ICD9        = {{ICD9|369}} |
   ICD9        = {{ICD9|369}} |
   Image          = Millais-Blind Girl.jpg |
   Image          = Millais-Blind Girl.jpg  
   Caption        = The Blind Girl (1856), a painting by [[John Everett Millais]] |
   Caption        = The Blind Girl (1856), a painting by [[John Everett Millais]] |
   ICDO          = |
   ICDO          = |
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   eMedicineTopic = |
   eMedicineTopic = |
}}
}}
==Legal blindness==
==[[Blindness overview|Overview]]==
In 1934, the [[American Medical Association]] adopted the following definition of blindness:
 
:''"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."''<ref name="Koestler">Koestler, F. A., (1976). ''The unseen minority: a social history of blindness in the United States.'' New York: David McKay.</ref>
 
The [[United States Congress]] included this definition as part of the [[Aid to the Blind]] program in the [[Social Security Act]] passed in 1935<ref name="Koestler"/><ref name="Corn">Corn, AL; Spungin, SJ. [http://www.coe.ufl.edu/copsse/docs/IB-10/1/IB-10.pdf "Free and Appropriate Public Education and the Personnel Crisis for Students with Visual Impairments and Blindness."] Center on Personnel Studies in Special Education. April 2003.</ref>. 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[http://www.ssa.gov/history/pdf/80chap12.pdf] which currently states:
 
:''"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."'' <ref>Social Security Act. [http://www.ssa.gov/OP_Home/ssact/title16b/1614.htm "Sec. 1614. Meaning of terms."] Retrieved Feb 17, 2006.</ref>
 
[[Kuwait]] is one of many nations that share the same criteria for legal blindness<ref name="Al-Merjan">Al-Merjan JI, Pandova MG, Al-Ghanim M, Al-Wayel A, Al-Mutairi S. "Registered blindness and low vision in Kuwait." ''Ophthalmic Epidemiol.'' 2005 Aug;12(4):251-7. PMID 16033746.</ref>.
 
===Epidemiology===
In 1987, it was estimated that 598,000 people in the United States met the legal definition of blindness<ref name="Kirchner">Kirchner, C., Stephen, G. & Chandu, F. (1987). "Estimated 1987 prevalence of non-institutionalized 'severe visual impairment' by age base on 1977 estimated rates: U. S.", 1987. ''AER Yearbook.''</ref>. Of this number, 58% were over the age of 65<ref name="Kirchner"/>. In 1994-1995, 1.3 million Americans reported legal blindness<ref name="AFB">American Foundation for the Blind. [http://www.afb.org/Section.asp?SectionID=15&DocumentID=1367#prev "Statistics and Sources for Professionals."] Retrieved April 1, 2006.</ref>.
 
In November 2004 article '''Magnitude and causes of visual impairment''', the [[World Health Organization|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. <ref name="WHO">{{cite web
  | last =
  | first =
  | authorlink =
  | coauthors =
  | title = World Health Organization
  | work =
  | publisher = World Health Organization
  | date = 2006
  | url = http://www.who.int/en/
  | format = Web
  | doi =
  | accessdate = December 16, 2006 }}</ref>
 
==Causes of blindness==
Serious visual impairment has a variety of causes:
 
===Diseases===
Most visual impairment is caused by [[disease]] and [[malnutrition]]. According to [[World Health Organization|WHO]] estimates in 2002, the most common causes of blindness around the world are:
*[[cataracts]] (47.8%),
*[[glaucoma]] (12.3%),
*[[uveitis]] (10.2%),
*age-related [[macular degeneration]] (AMD) (8.7%),
*[[trachoma]] (3.6%),
*[[cornea]]l opacity (5.1%), and
*[[diabetic retinopathy]] (4.8%), among other causes.
 
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&mdash;both of which can be treated effectively&mdash;are most often the culprits (see [[Onchocerciasis|River blindness]], for example). Of the estimated 40 million blind people located around the world, 70&ndash;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<ref name="Bunce">Bunce C, Wormald R. [http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=16524463 "Leading Causes of Certification for Blindness and Partial Sight in England & Wales."] ''BMC Public Health.'' 2006 Mar 8;6(1):58 [Epub ahead of print]. PMID 16524463.</ref>.
 
===Abnormalities and injuries===
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 nerve]]s, still be legally or totally blind.
 
===Genetic defects===
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 [[genetic map|mapping]] the [[human genome]] have identified other genetic causes of [[low vision]] or blindness. One such example is [[Bardet-Biedl syndrome]].
 
===Poisoning===
A small portion of all cases of blindness are caused by the intake of certain chemicals. A well-known example is [[methanol]] <ref Name="Methanol">{{cite web
  | title = Methanol
  | work = Symptoms of Methanol Poisoning
  | publisher = Canada Safety Council
  | date = 2005
  | url = http://www.safety-council.org/info/OSH/methanol.htm
  | format = Web
  | doi =
  | accessdate = March 27, 2007 }}</ref>
, found in [[methylated spirits]], which are sometimes used by [[Alcoholism|alcoholics]] as a cheap substitute for regular [[alcoholic beverages]].
 
===Willful actions===
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.
 
==Blindness prevention==
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 [[Egg (food)|eggs]], [[spinach]] and other [[green]] [[vegetables]]) protect against blindness ([[macular degeneration]]), affecting 1.2 million [[United States|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]].<ref>[http://news.yahoo.com/s/nm/20070910/hl_nm/eyesight_nutrients_dc;_ylt=AhJwo077jBEbQvMoRIMIxV2s0NUE  Yahoo.com, Study finds spinach, eggs ward off cause of blindness]</ref>
 
==Adaptive techniques==
[[Image:Banknote feature.JPG|right|thumb|A [[Canadian currency tactile feature|tactile feature]] on a [[Canadian banknotes|Canadian banknote]].]]
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:
 
*Adaptive [[computer software]] that allows people with visual impairments to interact with their computer via audio or screen magnifiers. 
 
*Adaptive [[mobile phones]] that allows people with visual impairments to interact with their phones via audio or screen magnifiers. These mobile phones uses software called Mobile Speak a screen reader from Code Factory http://www.codefactory.es. It provides audio feedback to every functionality on the phone.
*Adaptations of [[banknote]]s so that the value can be determined by touch. For example:
** In some currencies, such as the [[euro]], and [[pound sterling]], the size of a note increases with its value.
** Many [[banknotes]] from around the world have a tactile feature to indicate denomination in the upper right corner. This [[Canadian currency tactile feature|tactile feature]] is a series of raised dots, but it is not standard [[Braille]] [http://www.bankofcanada.ca/en/banknotes/accessibility.html].
** It is also possible to fold notes in different ways to assist recognition.
*Labeling and tagging clothing and other personal items
*Placing different types of food at different positions on a dinner plate
*Marking controls of household appliances
 
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]].
 
==Tools==
[[Image:Watch for the blind2.jpg|thumb|300px|Watch for the blind]]
Designers, both visually impaired and sighted, have developed a number of tools for use by blind people.
 
===Mobility===
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 symbols|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 [[Traffic#Priority .28right of way.29|right-of-way]] be given to users of white canes or [[guide dog]]s.
 
A small number of people employ [[guide dog]]s. 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.


===Reading and magnification===
==[[Blindness historical perspective|Historical Perspective]]==
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 glass]]es, 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 machine]]s.  They use computers with special hardware such as scanners and [[refreshable Braille display]]s as well as software written specifically for the blind, like optical character recognition applications and screen reading software.
==[[Blindness classification|Classification]]==


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 [[Royal National Institute for the Blind|RNIB]] in the United Kingdom.
==[[Blindness pathophysiology|Pathophysiology]]==


[[Closed-circuit television]]s, equipment that enlarges and contrasts textual items, are a more [[high-tech]] alternative to traditional magnification devices. So too are modern [[web browser]]s, which can increase the size of text on some web pages through browser controls or through user-controlled [[style sheet]]s.
==[[Blindness causes|Causes]]==


===Computers===
==[[Blindness differential diagnosis|Differentiating Blindness from other Diseases]]==
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 [[Internet]] access. This bleak outlook is changing, however, as availability of assistive technology increases, accompanied by concerted efforts to ensure the accessibility of information technology to all potential users, including the blind. [[Linux]] distributions (as [[Live CD]]s) for the blind include [[Oralux]] and [[Adriane Knoppix]], the latter developed in part by [[Klaus Knopper|Adriane Knopper]] who has a visual impairment. The Macintosh OS also comes with a built-in screen reader, called [[VoiceOver]]. Later versions of [[Microsoft Windows]] include an Accessibility Wizard & Magnifier for those with partial vision.


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.
==[[Blindness epidemiology and demographics|Epidemiology and Demographics]]==


Experimental approaches in [[sensory substitution]] are beginning to provide access to arbitrary live views from a [[camera]].
==[[Blindness risk factors|Risk Factors]]==


===Other aids===
==[[Blindness natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
People may use talking [[thermometer]]s, enlarged or marked oven dials, talking watches, talking clocks, talking [[weighing scale|scales]], talking [[calculator]]s, talking [[compass]]es and other talking equipment.


==Social attitudes towards blindness==
==[[Blindness cultural aspect|Cultural Aspect]]==
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.
==Diagnosis==
[[Blindness history and symptoms|History and Symptoms]] | [[Blindness physical examination|Physical Examination]] | [[Blindness other imaging findings|Other Imaging Findings]] | [[Blindness other diagnostic studies|Other Diagnostic Studies]]


The [[Moche]] people of ancient [[Peru]] depicted the blind in their ceramics. <ref>Berrin, Katherine & Larco Museum. ''The Spirit of Ancient Peru:Treasures from the [[Larco Museum|Museo Arqueológico Rafael Larco Herrera]].'' New York: [[Thames and Hudson]], 1997.</ref>
==Treatment==
[[Blindness adaptive tools and techniques|Adaptive Tools and Techniques]] | [[Blindness medical therapy|Medical Therapy]] | [[Blindness surgery|Surgery]] | [[Blindness primary prevention|Primary Prevention]] | [[Blindness cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Blindness future or investigational therapies|Future or Investigational Therapies]]


==Young mammals==
== Case Studies ==
Statements that this or that species of [[mammal]]s 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]].
[[Encopresis case study one|Case #1]]


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.
==Related Chapters==
 
==See also==
*[[Accessibility]]
*[[Accessibility]]
*[[Amaurosis]]
*[[Amaurosis]]
*[[Blind musicians]]
*Blind musicians
*[[Blindness and education]]
*[[Blindness and education]]
*[[Braille]]
*[[Braille]]
Line 185: Line 63:
*[[Web accessibility]]
*[[Web accessibility]]


==External links==
==External Links==
*[http://www.accesswatch.info Access Watch: Blind users review accessibility of mainstream software]
*[http://www.thechicagolighthouse.org The Chicago Lighthouse for People Who Are Blind or Visually Impaired]
*[http://www.afb.org/accessworld AccessWorld] Technology and People Who Are Blind or Visually Impaired
*[http://www.acb.org American Council of the Blind]
*[http://www.acb.org American Council of the Blind]
*[http://www.afb.org American Foundation for the Blind]
*[http://www.blindaccessjournal.com Blind Access Journal: Visual impairment in the real world]
*[http://www.cbm.org  Christian Blind Mission]
*[http://www.v2020.org VISION 2020: The Right to Sight]
*[http://www.v2020.org VISION 2020: The Right to Sight]
*[http://www.iapb.org International Agency for the Prevention of Blindness (IAPB)]
*[http://www.iapb.org International Agency for the Prevention of Blindness (IAPB)]
*[http://www.braille.org International Braille Research Center]
*[http://www.afb.org/jvib Journal of Visual Impairment & Blindness]
*[http://www.growingstrong.org/bvi/resource.html Literature Bibliography and Resources List]
*[http://www.nbp.org National Braille Press]
*[http://www.nfb.org National Federation of the Blind: Civil rights and consumer advocacy]
*[http://www.nfb.org National Federation of the Blind: Civil rights and consumer advocacy]
*[http://www.nlb-online.org/ National Library for the Blind]
*[http://www.loc.gov/nls National Library Service for the Blind and Physically Handicapped]
*[http://www.loc.gov/nls National Library Service for the Blind and Physically Handicapped]
*[http://www.rfbd.org Recording for the Blind and Dyslexic]
*[http://www.rnib.org.uk/xpedio/groups/public/documents/code/InternetHome.hcsp Royal National Institute for the Blind]
*[http://www.ssc.mhie.ac.uk/ Scottish Sensory Centre]
*[http://www.derbay.org/visionlinks.html SMCCB Vision Links]
*[http://www.who.int/mediacentre/factsheets/fs282/en/ WHO Fact Sheet on Visual Impairment]
*[http://www.who.int/mediacentre/factsheets/fs282/en/ WHO Fact Sheet on Visual Impairment]


{{Eye pathology}}
{{Eye pathology}}
 
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==References==
{{WikiDoc Sources}}
{{Reflist|2}}


[[Category:Blindness]]
[[Category:Blindness]]
[[Category:Primary care]]
[[zh-min-nan:Chheⁿ-mê]]
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[[de:Blindheit]]
[[es:Ceguera]]
[[eo:Blindeco]]
[[eu:Itsutasun]]
[[fr:Cécité]]
[[gl:Cegueira]]
[[hi:अन्धापन]]
[[hr:Sljepoća]]
[[ia:Cecitate]]
[[it:Cecità]]
[[he:עיוורון]]
[[nl:Blindheid]]
[[ja:失明]]
[[no:Blindhet]]
[[pl:Ślepota]]
[[pt:Cegueira]]
[[qu:Ñawsa kay]]
[[ru:Слепота]]
[[simple:Blindness]]
[[sl:Slepota]]
[[sh:Sljepilo]]
[[fi:Sokeus]]
[[sv:Blindhet]]
[[th:ตาบอด]]
[[yi:בלינדקייט]]
[[zh:失明]]
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Latest revision as of 20:38, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saumya Easaw, M.B.B.S.[2] Template:DiseaseDisorder infobox

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Blindness from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

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Diagnosis

History and Symptoms | Physical Examination | Other Imaging Findings | Other Diagnostic Studies

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