Visual impairment

Visual impairment
SynonymsVision impairment, vision loss
Long cane.jpg
A white cane, the international symbol of blindness
SpecialtyOphthalmology
SymptomsDecreased ability to see[1][2]
CausesUncorrected refractive errors, cataracts, glaucoma[3]
Diagnostic methodEye examination[2]
TreatmentVision rehabilitation, changes in the environment, assistive devices[2]
Frequency940 million / 13% (2015)[4]

Visual impairment, also known as vision impairment or vision loss, is a decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses.[1][2] Some also include those who have a decreased ability to see because they do not have access to glasses or contact lenses.[1] Visual impairment is often defined as a best corrected visual acuity of worse than either 20/40 or 20/60.[5] The term blindness is used for complete or nearly complete vision loss.[5] Visual impairment may cause people difficulties with normal daily activities such as driving, reading, socializing, and walking.[2]

The most common causes of visual impairment globally are uncorrected refractive errors (43%), cataracts (33%), and glaucoma (2%).[3] Refractive errors include near sighted, far sighted, presbyopia, and astigmatism.[3] Cataracts are the most common cause of blindness.[3] Other disorders that may cause visual problems include age related macular degeneration, diabetic retinopathy, corneal clouding, childhood blindness, and a number of infections.[6] Visual impairment can also be caused by problems in the brain due to stroke, premature birth, or trauma among others.[7] These cases are known as cortical visual impairment.[7] Screening for vision problems in children may improve future vision and educational achievement.[8] Screening adults without symptoms is of uncertain benefit.[9] Diagnosis is by an eye exam.[2]

The World Health Organization (WHO) estimates that 80% of visual impairment is either preventable or curable with treatment.[3] This includes cataracts, the infections river blindness and trachoma, glaucoma, diabetic retinopathy, uncorrected refractive errors, and some cases of childhood blindness.[10] Many people with significant visual impairment benefit from vision rehabilitation, changes in their environment, and assistive devices.[2]

As of 2015 there were 940 million people with some degree of vision loss.[4] 246 million had low vision and 39 million were blind.[3] The majority of people with poor vision are in the developing world and are over the age of 50 years.[3] Rates of visual impairment have decreased since the 1990s.[3] Visual impairments have considerable economic costs both directly due to the cost of treatment and indirectly due to decreased ability to work.[11]

Classification

A typical Snellen chart that is frequently used for visual acuity testing.

The definition of visual impairment is reduced vision not corrected by glasses or contact lenses. The World Health Organization uses the following classifications of visual impairment. When the vision in the better eye with best possible glasses correction is:

  • 20/30 to 20/60 : is considered mild vision loss, or near-normal vision
  • 20/70 to 20/160 : is considered moderate visual impairment, or moderate low vision
  • 20/200 to 20/400 : is considered severe visual impairment, or severe low vision
  • 20/500 to 20/1,000 : is considered profound visual impairment, or profound low vision
  • More than 20/1,000 : is considered near-total visual impairment, or near total blindness
  • No light perception : is considered total visual impairment, or total blindness

Blindness is defined by the World Health Organization as vision in a person's best eye with best correction of less than 20/500 or a visual field of less than 10 degrees.[5] This definition was set in 1972, and there is ongoing discussion as to whether it should be altered to officially include uncorrected refractive errors.[1]

United Kingdom

Severely sight impaired

  • Defined as having central visual acuity of less than 3/60 with normal fields of vision, or gross visual field restriction.
  • Unable to see at 3 metres what the normally sighted person sees at 60 m.

Sight impaired

  • Able to see at 3 m, but not at 6 m, what the normally sighted person sees at 60 m
  • Less severe visual impairment is not captured by registration data, and its prevalence is difficult to quantify

Low vision

  • A visual acuity of less than 6/18 but greater than 3/60.
  • Not eligible to drive and may have difficulty recognising faces across a street, watching television, or choosing clean, unstained, co-ordinated clothing.[12]

In the UK, the Certificate of Vision Impairment (CVI) is used to certify patients as severely sight impaired or sight impaired.[13] 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". 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."[14]

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.[14]

  1. Those below 3/60 (equivalent to 20/400 in US notation) Snellen (most people below 3/60 are severely sight impaired).
  2. Those better than 3/60 but below 6/60 Snellen (people who have a very contracted field of vision only).
  3. 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).

The Department of Health also state that a person is more likely to be classified as severely visually impaired if their eyesight has failed recently or if they are an older individual, both groups being perceived as less able to adapt to their vision loss.[14]

United States

In the United States, any person with vision that cannot be corrected to better than 20/200 in the best eye, or who has 20 degrees (diameter) or less of visual field remaining, is considered legally blind or eligible for disability classification and possible inclusion in certain government sponsored programs.

In the United States, the terms partially sighted, low vision, legally blind and totally blind are used by schools, colleges, and other educational institutions to describe students with visual impairments.[15] They are defined as follows:

  • Partially sighted indicates some type of visual problem, with a need of person to receive special education in some cases.
  • 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 or the size of print, and, sometimes, Braille.
    • Myopic – unable to see distant objects clearly, commonly called near-sighted or short-sighted.
    • Hyperopic – unable to see close objects clearly, commonly called far-sighted or long-sighted.
  • Legally blind indicates that a person has less than 20/200 vision in the better eye after best correction (contact lenses or glasses), or a field of vision of less than 20 degrees in the better eye.
  • Totally blind students learn via Braille or other non-visual media.

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.[16]

The United States Congress included this definition as part of the Aid to the Blind program in the Social Security Act passed in 1935.[16][17] 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[18] which 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.[19]

Other

Kuwait is one of many nations that share the 6/60 criteria for legal blindness.[20]

Other Languages
العربية: ضعف البصر
অসমীয়া: অন্ধত্ব
čeština: Oftalmopedie
한국어: 시각 장애
lingála: Mpasi ya miso
Nederlands: Visuele handicap
日本語: 視覚障害者
norsk: Synstap
Patois: Blainis
polski: Wada wzroku
Simple English: Visual impairment
slovenčina: Tyflopédia
svenska: Synfel
Tiếng Việt: Suy giảm thị lực
中文: 視力受損
डोटेली: अन्धोपन