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. Total blindness is the complete lack of form and visual light perception and is clinically recorded as NLP, an abbreviation for "no light perception." Blindness is frequently used to describe severe visual impairment with residual vision. Those described as having only light perception have no more sight than the ability to tell light from dark and 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 . 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 (6.1 m) from an object to see it—with corrective lenses—with the same degree of clarity as a normally sighted person could from 200 feet (61 m). In many areas, people with average acuity who nonetheless have a visual field of less than 20 degrees (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.
By the 10th Revision of the WHO International Statistical Classification of Diseases, Injuries and Causes of Death, low vision is defined as visual acuity of less than 6/18 (20/60), but equal to or better than 3/60 (20/400), 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 (20/400), or corresponding visual field loss to less than 10 degrees, in the better eye with best possible correction.
It should be noted that blind people with undamaged eyes may still register light non-visually for the purpose of circadian entrainment to the 24-hour light/dark cycle. Light signals for this purpose travel through the retinohypothalamic tract, so a damaged optic nerve beyond where the retinohypothalamic tract exits it is no hindrance.
Classification
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.
The United States Congress included this definition as part of the Aid to the Blind program in the Social Security Act passed in 1935. 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 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.
In the US, legal blindness due to acuity loss is most often measured by a regular eye doctor with an eye chart.
Legal blindness due to visual field being less than 20 degrees is measured by a visual field test using a number IV target size. If the doctor or facility performing the test is approved by the Social Security Administration, this is the official US determination for legal blindness due to field loss in conditions like retinitis pigmentosa.
Kuwait is one of many nations that share the same criteria for legal blindness.
Causes
Serious visual impairment has a variety of causes:
Diseases
Most visual impairment is caused by disease and malnutrition. According to WHO estimates in 2002, the most common causes of blindness around the world are:
- cataracts (47.9%),
- glaucoma (12.3%),
- age-related macular degeneration (8.7%),
- corneal opacity (5.1%), and
- diabetic retinopathy (4.8%), among other causes.
- Amaurosis fugax is a sudden blindness from decreased blood supply via the ophthalmic artery
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.
In developing countries, wherein people have shorter life expectancies, cataracts and water-borne parasites—both of which can be treated effectively—are most often the culprits (see river blindness, for example). Of the estimated 40 million blind people located around the world, 70–80% 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.
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 nerves, 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 mapping of the human genome have identified other genetic causes of low vision or blindness. One such example is Bardet-Biedl syndrome.
Poisoning
Rarely, blindness is caused by the intake of certain chemicals. A well-known example is methanol, which is only mildly toxic and minimally intoxicating, but when not competing with ethanol for metabolism, methanol breaks down into the substances formaldehyde and formic acid which in turn can cause blindness, an array of other health complications, and death. Methanol is commonly found in methylated spirits, denatured ethyl alcohol, to avoid paying taxes on selling ethanol intended for human consumption. Methylated spirits are sometimes used by alcoholics as a desperate and cheap substitute for regular ethanol 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.
In 2003, a Pakistani man named Mohammad Sajid was sentenced to be blinded under Islamic Qisas law, for blinding his fiancee after her parents called off the engagement. The same sentence was given in 2009 for the man who blinded Ameneh Bahrami.
Management
A 2008 study published in the New England Journal of Medicine tested the effect of using gene therapy to help restore the sight of patients with a rare form of inherited blindness, known as Leber Congenital Amaurosis or LCA. Leber Congenital Amaurosis damages the light receptors in the retina and usually begins affecting sight in early childhood, with worsening vision until complete blindness around the age of 30.
The study used a common cold virus to deliver a normal version of the gene called RPE65 directly into the eyes of affected patients. Remarkably all
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