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Visual Impairment, Visual Disability, and Legal Blindness:

an American Academy of Ophthalmology publication

 

Over three million people in the United States do not have normal vision even with eyeglasses or corrective lenses. These people are considered visually impaired. Visual impairment may be caused by a number of eye diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and cataracts.

Although many eye diseases can be diagnosed and treated by your ophthalmologist, some may result in unavoidable loss of central (reading) vision, peripheral (side) vision, or both. Accidents or inherited ocular disorders may also produce vision loss which cannot be medically corrected.

Visual impairment can range from mild to severe. Federal regulations define a certain level of visual impairment as "legal blindness," not to be confused with total blindness. Most of the approximately one million Americans defined as "legally blind" retain some useful vision.

How is sight measured?

Central or reading vision is customarily measured using an eye chart. The results are recorded as a pair of numbers called "visual acuity." The first number is the testing distance measured in feet; the second number is the distance from which a normal eye should see the letter clearly. People with a visual acuity of 20/20 can see certain sized letters at a distance of 20 feet. An individual with a visual acuity of 20/60 can only see at 20 feet letters which a normal eye can identify at 60 feet. The larger the second number, the lower your visual acuity.

Side vision--which can be even more important than central or reading vision for many daily activities--can also be measured by an ophthalmologist. Normal eyes can recognize objects over an area measuring at least 140 degrees (almost half a circle). A person with a much narrower range of side vision may have trouble walking or recognizing people in a large room, even when his or her central vision is excellent.

Ophthalmologists can administer tests to measure other aspects of visual function. Tests may include eye movement, color and contrast vision, stereoscopic (three-dimensional) vision, and adjustment to light and dark. These tests allow your ophthalmologist to identify specific visual conditions and describe their severity.

What is legal blindness?

When your best corrected central visual acuity is 20/200 or worse in your better eye, or your side vision is narrowed to 20 degrees or less in your better eye, you are considered legally blind even though you may still have some useful vision. You may qualify for certain government benefits and receive assistance from public and private organizations.

What is visual impairment?

If neither of your eyes can see better than 20/60 without improvement from eyeglasses or corrective lenses, you may be defined as visually impaired. Limitation of side vision, abnormal color vision, double vision, poor night vision, and loss of vision in one eye may also determine visual impairment.

What is a visual disability?

People who are unable to perform certain tasks because of their visual impairment are usually "visually disabled." An exact rating or quantification of the disability is necessary for a person to receive workman's compensation, insurance disability benefits, legal claims, or certain forms of government assistance.

Visual disability is expressed in percentages, which are used by insurers, the courts, and government agencies to determine how much the whole person is disabled by his or her visual handicap. For example, total loss of vision in both eyes is a 100% disability of vision, but only an 85% disability of the whole person.

What can you do about your visual impairment?

 

  • Have your ophthalmologist help you understand the cause and learn whether the impairment is temporary, stable, or likely to progress.

  • Make use of rehabilitation programs, devices, and supportive services. These include counseling, large print and audio publications, optical and electronic magnifiers, mobility training, and non-optical aids such as improved lighting devices, large-face clocks, and special kitchen tools.

  • Join a local support group and a national association for people with similar eye problems.

  • Ask your ophthalmologist to refer you to the appropriate state and local agencies for the visually disabled. These agencies can help you obtain a handicapped parking designation, low-vision services, and possibly Social Security and Department of Veterans Affairs benefits. Federal and state income taxes can be reduced through an extra exemption allowed to "legally blind" individuals. Some communities may offer a reduction in property taxes as well.

  • Continue seeing your ophthalmologist for regular checkups. Your eye disorder may change, so its treatment may also need to be changed. Because eyes can be affected by more than one disease, it is especially important that any new problems be detected and treated promptly in order to preserve your remaining sight.

  • Request the American Academy of Ophthalmology brochure on low vision, and resource list of referral services, large print and recorded reading materials, devices, and support groups



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