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.

The World Health Organization (WHO) estimates that 80% of visual impairment is either preventable
or curable with treatment.[5] This includes cataracts, the infections river blindness and trachoma,
glaucoma, diabetic retinopathy, uncorrected refractive errors, and some cases of childhood
blindness.[12] 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. [6] 246 million had low
vision and 39 million were blind.[5] The majority of people with poor vision are in the developing
world and are over the age of 50 years.[5] Rates of visual impairment have decreased since the
1990s.[5] Visual impairments have considerable economic costs both directly due to the cost of
treatment and indirectly due to decreased ability to work.[13]

Classification
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 (NLP) : 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.[7] This definition was set in
1972, and there is ongoing discussion as to whether it should be altered to officially include
uncorrected refractive errors

Associated problems
Blindness can occur in combination with such conditions as intellectual disability, autism spectrum
disorders, cerebral palsy, hearing impairments, and epilepsy.[25][26] Blindness in combination with
hearing loss is known as deafblindness.
It has been estimated that over half of completely blind people have non-24-hour sleep–wake
disorder, a condition in which a person's circadian rhythm, normally slightly longer than 24 hours, is
not entrained (synchronized) to the light–dark cycle.

There are many causes that may lead to loss of vision or lead to impairment of vision.

Common causes that lead to vision loss or visual impairment include injury to the eye,
inherited conditions, infections and so forth. (1-4)
CAUSES
Injury to the eyes
Injury to the eyes while playing or at work or due to accidents may result in vision loss
and impairment.

Particularly injuries to the cornea are the commonest cause of vision loss.

Inherited conditions of blindness and vision

impairment
Retinitis pigmentosa is the most common cause of inherited blindness.

Infections of the eyes

Sometimes if the mother has had a viral infection like German measles that is
transmitted from the mother to the developing fetus during pregnancy the baby may be
born with blindness or visual impairment.

Trachoma of the eyes caused by contagious microorganism called Chlamydia

trachomatis may also damge eye sight. This is seen in the developing and
underdeveloped countries with poor water and sanitation facilities.

Amblyopia
This is basically impaired vision in one eye due to lack of its use in early childhood.

This is seen in squint or “lazy eye” since both the eyes project differently and send in
different messages to the brain the brain may then turn off or suppress images from the
weaker eye.

This stops development of the weaker eye leading to amblyopia in that eye.

Cataract
Clouding of part or the entire lens of the eye.
Normally, the lens is clear to let in the light that focuses on the retina. Cataracts prevent
light from easily passing through the lens, and this causes loss of vision.

This condition usually affects the elderly. Symptoms include cloudy or blurry vision,
difficulty in seeing in dimly lit areas and bright lights, colors appear faded, double vision
etc.

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Cataract affects 20.5 million (1 in 6) Americans age 40 and older. By 80 years of age,
more than one half of Americans have cataract.

Cataract is the leading cause of blindness in the world (47.8%) compared to other eye
disorders.

Diabetic retinopathy
Diabetes affects the small blood vessels in the retina. When damaged this leads to
impairment of vision.

This is the commonest cause of blindness and visual impairment in the United States.

An estimated 23.6 million people in the U.S. have diabetes.

Of those, 5.7 million are undiagnosed. Currently, 1 in 10 individuals has diabetes.

Between 40% to 45% of all people with diabetes have diabetic retinopathy.

Glaucoma
This condition results due to raised pressure within the eyes. The increased pressure
impairs vision by damaging the optic nerve.
This may be seen in older adults and in some babies as well who are born with the
condition.

Approximately 2.3 million Americans (1.9%) age 40 and older, have glaucoma.

African-Americans (age 40 and over) are 4 to 5 times more likely than any other ethnic
group to have glaucoma

Age related Macular degeneration

Age related Macular degeneration or AMD that is a progressive loss of the visual acuity
due to damage to the macula that is the most sensitive part of the retina.

AMD affects more than 1.75 million individuals in the U.S. This number is expected to
increase to almost 3 million by 2020 due to the rapid rise in the aging of the U.S.
population.

The center of the visual field appears blurry or opaque. The patient is unable to focus
clearly. This mainly occurs in the elderly.

The risk of AMD rises in those exposed to excess sunlight and those who smoke
excessively.

AIDS related visual impairment

This is usually caused by viral infections of the eyes called Cytomegalovirus or CMV
retinitis.

The estimated proportion of persons with AIDS who will develop CMV retinitis ranges
from 20 to 40%.

Cancer of the eyes

Retinoblastoma is the most common eye cancer of children. There are between 300
and 400 new cases diagnosed annually.
Tests for visual impairment
The tests that are used to diagnose visual acuity and visual impairment include the
Snellen test, visual field test and so forth. (1-4)

Snellen test
The Snellen test is also known as the visual acuity test.

Usually a chart called the Snellen’s chart is used. It contains progressively shortening
random letters and numbers and is placed 6 meters away from the patient.

The patient is asked to read the letters with each eye separately and both together.
Ability to read the letters at each size determines the visual acuity.

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After the test a score is obtained. It is made up of two numbers.

The first number represent how far away from the chart the patient was when he or she
was able to successfully read the letters on the chart.

The second number represents how far away a person with healthy vision should be
able to read the chart.

Healthy vision scores 6/6. If the score is 6/60, it means that the patient can only read
something 6 metres away what a person with healthy eyesight can read 60 metres
away.
Being partially sighted, or sight impaired means if level of sight loss is moderate and
blindness, or severe sight impairment means when level of vision loss is so severe that
a person is unable to complete any activities that require eyesight.

Partial sight or sight impairment is defined as 3/60 to 6/60 vision or having a

combination of moderate visual acuity (up to 6/24) and a reduced field of vision.

Blindness is defined as having poor visual acuity (less than 3/60) but having a full field
of vision or having poor visual acuity (between 3/60 and 6/60) and a severe reduction in
the vision field or having average visual acuity (6/60 or above) and an severely reduced
field of vision.

Visual field test

Visual field is the range of vision that a person can see without tilting or turning one’s
head. This measures the peripheral vision of the eyes.

The test uses a device strapped over the patient’s eyes. Lights are flashed on and off in
the patient’s peripheral vision.

He or she is then asked to press a button every time they see a light. Any gap of field of
vision is detected.

Tonometry test
This test uses specialized instruments to determine fluid pressure inside the eye to
evaluate for glaucoma.

Ocular Motility Assessment

This tests if there is squint of other problems in the movement of the eyeballs.

Other tests
Other tests like Visually evoked potential (VEP), Electroretinogram (ERG), Electro-
oculogram (EOG) are sometimes prescribed to test if the signals from the eye are
travelling adequately to the brain.

These may help if the patient is very young and clinical examination is difficult or if there
are multiple handicaps that make diagnosis difficult.

Common Visual Impairments

By: Carmen Willings
teachingvisuallyimpaired.com

A visual impairment is the loss of vision that cannot be corrected by refraction (glasses). There
are a number of eye disorders that can lead to visual impairments. Visual impairment can also
be caused by trauma and brain and nerve disorders. Visual impairments affect people
differently. It is important to understand each student's visual impairment in order to understand
the potential impact on the student's vision and prognosis. 
A visual diagnosis will not affect two people in the same way. Each student is unique and will
have individual characteristics based on intellectual ability, developmental rate, social
competence as well as other factors including educational opportunities. Even when students
have identical acuities and visual diagnosis, their use of vision can be very different. Eye
specialists use a variety of diagnostic procedures and tests to assess the integrity, health and
function of the eye. As part of the evaluation process, the doctor will use a combination of the
child's history as well as the evaluation of the eye in determining the type and extent of visual
impairments. It is common for eye reports to change from year to year in the report of the visual
diagnosis. Doctors may drop diagnosis or change their impressions of the visual diagnosis. For
this reason, it is best to retain copies of previous reports as it will help paint a picture of the child
and understand current and previous therapies and recommendations.

Amblyopia
(am-blee-OH-pee-uh) Amblyopia is sometimes called “Lazy eye.”  It is a functional defect
characterized by decreased vision in one or both eyes without detectable anatomic damage to
the retina or visual pathways.  If the eyes are not straight (strabismus), the student may
suppress the vision in the turning eye to avoid seeing double. In all cases of amblyopia, the
brain "shuts off" one eye to favor the eye with better vision. Amblyopia may be treated by
patching the good eye, by surgery or with corrective lenses.

 “Crossed eyes”, a patch over an eye or high refractive corrective lenses may cause
social adjustment problems. 
 Depth perception may be affected. Students may need familiarization to help anticipate
distances and heights. 

Aniridia
(an-uh-RID-ee-uh) Aniridia is a congenital anomaly.  It is characterized by the incomplete
formation of the iris.  Associated with glaucoma, nystagmus, sensitivity to light, and poor vision.
Normal reactions (adaptations and responses) are impossible.

 Corrective lenses may be prescribed, usually tinted to help reduce photophobia.

 The student will typically have problems relating to illumination and glare.
 The student may function best in reduced lighting. 
 The student may experience eye fatigue when reading for extended periods of time.

Anophthalmos
Anophthalmos or Anophthalmia is the absence of a true eyeball. The student may have a
prosthetic eye.

 Students may have problems associated with wearing a prosthesis. Teachers and/or

attending adults become involved in this care and routine. Frequently cleansing and
placing the prosthesis, and care of the orbit are part of the training required during the
school day.

Aphakia
The absence of the lens of the eye usually is due to surgery for cataract. In rare cases it is a
part of the abnormally small eye (microphthalmos). Convex lenses are worn to provide refractive
power lost because of the absence of the lens. Plus lenses of high power make the eyes look
larger when worn in spectacles.

Achromatopsia
(ay-kroh-muh-TAHP-see-uh) Achromatopsia is a congenital defect.  It is characterized by the
rare inability to distinguish colors due to cone malformation and partial or total absence of
cones). It is a hereditary condition that is non-progressive.  People with achromatopsia also
commonly experience some vision loss, especially in bright light, to which they are extremely
sensitive.  The severity of achromatopsia varies.

 Bright light and glare should be avoided. Some students may be so negatively impacted
that they will need to be instructed in cane skills in order to travel independently on bright
days or when there is a lot of glare.
 Student's typically prefer reduced illumination when reading. The student may benefit
from task lighting from behind directed on the book/paper so long as the light does not
reflect off of a high sheen surface.
 Student's may need high contrast, tinted lenses, and/or sunglasses both indoors and
outdoors.
 The student may not be able to discriminate colors (may need to teach the student
alternative techniques for identifying colors. For example the position of the red and
green lights in a traffic signal, using color identification tags on clothing).

Albinism
(AL-bin-izm) Albinism is a congenital defect.  It is characterized by a lack of pigment in eyes,
hair and skin.  Usually associated with decreased visual acuity, nystagmus (rhythmic side-to-
side eye movements) and photophobia (light sensitivity). It is non-progressive.

Ocular albinism:  lack of pigment in iris and choroids; results in reddish pupils and iris (from
choroidal vessels seen through overlying retina).  Usually accompanied by poor vision, light
sensitivity (photophobia), and involuntary oscillating eye movements (nystagmus). Complete-
Glare is more troublesome than illumination. Tinted lenses may be prescribed.

 The student may function best in reduced illumination but glare is the critical concern. 
The student may be adventitiously blinded throughout the day depending upon lighting
and glare conditions.  Adjust illumination to conditions and individual (i.e., control glare
via seating and/or tinted lenses; use sunglasses and/or hat with visor outdoors).
 There may be concern over personal appearance. The student may be more resistive to
using any accommodations because they may not want to stand out more.
 Classroom seating should be appropriate to the corrected refractive error and
photophobia. 
 The student may benefit from high contrast line markers for reading.

Astigmatism
(uh-STIG-muh-tiz-um) Astigmatism is a refractive error characterized by the inability of an eye to
focus sharply (at any distance), usually resulting from a spoon-like (toric) shape of the normally
spherical corneal surface.  Instead of being uniformly refracted by all corneal meridians, light
rays entering the eye are bent unequally, which prevents formation of a sharp focus on the
retina.  Slight uncorrected astigmatism may not cause symptoms, but a large amount may result
in significant blurring.  Corrected by a cylindrical (toric) eyeglass or contact lens, or refractive
surgery.

Cataract
(KAT-uh-rakt) Cataracts are a pathologic condition.  It is characterized by opacity or cloudiness
of the crystalline lens, which may prevent a clear image from forming on the retina.  Surgical
removal of the lens may be necessary if visual loss becomes significant. A cataract may be
congenital or caused by trauma, disease, or age.

 Glare should be avoided.

 Restriction of physical contact sports may be necessary if there is a danger of retinal
detachment. 
 Social and emotional problems may result if the lens are noticeably opaque or if the
glasses lenses are very thick.  

Coloboma
(kah-luh-BOH-muh) Colobomas are a congenital anomaly.  It is characterized by a cleft or
defect in normal continuity of a part of the eye, e.g., absence of lower segment of optic nerve
head, choroids, ciliary body, iris, lens or eyelid.  It is caused by improper fusion of fetal fissure
during gestation.  It may be associated with other abnormalities, including a small eye
(microphthalmia).
  Educational needs and lighting requirements and other accommodations are dependent
upon the severity of the condition and the part of the eye affected.

Color Blindness
If the student is color blind, they may encounter difficulty with tasks involving color discrimination

 The student may not be able to discriminate colors (may need to teach the student
alternative techniques for identifying colors. For example the position of the red and
green lights in a traffic signal, using color identification tags on clothing).

Glaucoma
(glaw-KOH-muh) Glaucoma is a pathologic condition characterized by increased intraocular
pressure resulting in damage to the optic nerve and retinal nerve fibers. Characterized by typical
visual field defects and increased size of optic cup.  A common cause of preventable vision
loss.  May be treated by prescription drugs or surgery.

 Generally, high levels of illumination are needed with control of glare even though the
student may be sensitive to light.
 Difficulty in adapting to various changes of light may be present. 
 Physical activities as well may be curtailed.  Peripheral field loss may restrict mobility
and sports activities.
 Large print materials are generally not recommended due to peripheral field loss.  If
there is only a reduction of vision, large print may be used but the number of words seen
will be reduced. 

Hemianopsia
Hemianopsia (half vision) is a result of a malfunction along the optic pathway sometimes as a
result of pressure from a tumor. The result will be related to the amount of pressure and
location. Field loss can be the same in both eyes or opposite, involving half fields or quadrants
or affect the uppor or lower fields. 

Hyperopia (Farsightedness)
(hi-pur-OH-pee-uh) Hyperopia is a refractive error sometimes called farsightedness.  It is a
focusing defect created by an underpowered eye, one that is too short for its optical power. 
Light rays from a distant object enter the eye and strike the retina before they are fully focused
(true focus would be“behind the retina”).  Farsighted people can see clearly in the distance but
only if they use more focusing effort (accommodation) than those who have normally powered
eyes; close-up vision may be blurred because it requires even more focusing effort.  Corrected
with additional optical power, supplied by a plus lens (spectacle or contact) or refractive surgery.

Lebers Congenital Amaurosis 

(am-uh-ROH-sis) Lebers is a congenital defect.  It typically involves blindness or near-blindness
in both eyes.  There is typically marked reduction in retinal function seen on an
electroretinogram. 
Macular Degeneration
Macular Degeneration is a pathologic condition.  It is characterized by deterioration of the
macula, resulting in loss of sharp central vision. Loss of central vision affects acuity, color vision,
and may also cause light sensitivity.. There are two types: juvenile or senile. The most common
form of inherited macular degeneration in Stargardt's Disease.

 Student may need average or dim lighting

 Student may need high contrast line markers for reading

Myopia (Nearsightedness)
(mi-OH-pee-uh) Myopia is a refractive error sometimes called nearsightedness.  It is a focusing
defect created by an overpowered eye, one that has too much optical power for its length.  Light
rays coming from a distant object are brought to a focus before reaching the retina. Nearsighted
people see close-up objects clearly but distance vision is blurry.  Corrected with a minus lens
(spectacle or contact) or refractive surgery to “weaken” the eye optically and permit clear
distance vision. For students with simple myopia, usually corrective lenses will correct the visual
disorder mechanically. Headaches from eye strain are common for uncorrected myopia. 
Further, corrective lenses are able to mechanically restore distance vision such that images are
not blurred.  Degenerative myopia is different in that it usually can not be corrected with
corrective lenses.  The high refraction required will mechanically reduce the peripheral fields. 

 Children with Myopia will frequently hold their reading material very close to the eyes
which is acceptable since it tends to increase the visual size of the print nor will it hurt
their eyes.
 The severe myopic student may develop an interest in activities requiring close visual
work as opposed to those activities requiring distance vision such as sports. 
 Restrictions may be placed on physical activities due to the possibility of retinal
detachment. 

Nystagmus
(ni-STAG-mus) Nystagmus is a functional defect characterized by involuntary, rhythmic side-to-
side or up and down (oscillating) eye movements that are faster in one direction than the other.
The inability to maintain a steady visual fixation causes low visual acuity. 

Optic Nerve Atrophy (ONA)

Optic Nerve Atrophy is a dysfunction of the optic nerve resulting in the inability to conduct
electrical impulses to the brain causing loss of vision. The optic disc becomes pale and there is
a loss of pupillary reaction.

 The needs of the student will be dependent upon the characteristics of the disease and
the involvement. 
 Since blind spots can be central or in the peripheral areas, the type of reading material
will be determined by the particular characteristics of the disease. 
 High levels of illumination are usually needed.
Optic Nerve Hypoplasia (ONH)
(hi-poh-PLAY-zhuh) Optic Nerve Hypoplasia is a congenital, non-progressive,  abnormality
characterized by small optic disc; sometimes surrounded by a double ring (scleral halo) and
often a pigment epithelium halo.

Presbyopia
Presbyopia is when the lens becomes less flexible and less able than previously to
accommodate for near viewing. Presbyopia occurs as a natural part of aging and typically
around the age of 40 so school age students will not be affected by this, however, this could
compound the student's vision when they get older. 

Retinal Detachment
Retinal detachment is a pathological condition.  It is characterized by separation of the retina
from the underlying pigment epithelium. It is almost always caused by a leaking retinal tear,
which allows fluid to pass from the vitreous into the sub-retinal space.  It disrupts visual cell
structure and thus markedly disturbs vision; often requires immediate surgical repair. The
foremost recommendation is that a student with a detached retina or a student with conditions
associated with retinal detachments such as high myopia, be restricted for physical activities. 
Even a mild blow to the head can result in a detachment.

Retinitis Pigmentosa 
Retinitis Pigmentosa is a pathologic, hereditary condition that is characterized by progressive
retinal degeneration in both eyes.  Students experience night blindness, that may be followed by
loss of peripheral vision (initially as ring-shaped defect), progressing over many years to tunnel
vision and finally blindness.

 Students typically need high illumination.

 Students may experience visual fatigue.

Retinoblastoma
(ret-in-noh-blas-TOH-muh). Retinoblastoma is a pathologic, hereiditary condition.  It is
characterized by a malignant intraocular tumor that develops from retinal visual cells. If
untreated, seedling nodules produce secondary tumors that gradually fill the eye and extend
along the optic nerve to the brain, ending in death.  It is the most common childhood ocular
malignancy. 

Retinopathy of Prematurity
(ret-in-AHP-uh-thee) Retinopathy of Prematurity is a pathologic condition.  It is characterized by
a series of destructive retinal changes that may develop after prolonged life-sustaining oxygen
therapy is given to premature infants.  Sometimes it regresses but other times a peripheral
fibrous scar forms that detaches the retina, resulting in vision loss or blindness. Other possible
complications include glaucoma, cataracts, myopia (nearsightedness), sunken eyes, eye
misalignment. 
  Due to the possibility of retinal detachment, physical activities may need to be restricted. 
 Services and accommodations will be dictated by the limitations and severity of the
visual loss. 

Strabismus
(struh-BIZ-mus) Functional defect.  Strabismus is a defect of the eye-muscle system. Eye
misalignment or eyes that do not move normally, caused by extraocular muscle imbalance. 
One fovea is not directed at the same object as the other. Strabismus causes either "tropias" or
"phorias." Tropias deviations that can't be controlled as the one eye is turned when trying to look
at an object which makes binocular vision impossible. 

 Esotropia is the turning of one or both eyes toward the nose;

 Exotropia is the turning of one or both eyes away from the nose (toward the temploral
side of the face);
 Hypertropia is the deviation of the eye upward; and
 Hypotropia is the deviation of the eye downward.

Other Causes of Visual Impairments

Infections
An infection is a pathologic condition.  Invasion of disease-producing microorganisms, resulting
in localized cell injury, toxin secretion, or antigen-antibody reaction. Several infections may
affect the visual system.  There are several infections that may be contracted in utero or during
birth.  They are often known by the acronym TORCH, for toxoplasmosis, rubella,
cytomegalovirus, and herpes.

Trauma
Trauma may be incurred by amniocentesis (rarely) or by forceps delivery.  Globe perforation
can occur from amniocentesis, leading to corneal scarring, possible cataract, retinal
detachment, and retinal or vitreous hemorrhage. Maternal drug abuse is another cause of
trauma.