top of page

Background

Visual impairment or blindness describes when an eye condition affects the visual functions, leading to the loss of or decreased ability in object perception [1,2]. In the blind and visually impaired community, senses like sound, speech, and touch are integral for orientation and communication. Notably, the Braille system, a surface composed of bumps and indentations to represent letters recognized by touch, is a standardized method for education and communication among the blind (Fig. 2 below) [3].

 

“Vision loss” is defined as a visual acuity less than 20/40 with best possible vision correction, and “legal blindness” is defined as visual acuity of less than or equal to 20/200 with the best possible vision correction [4,5]. “Total blindness” is complete loss of light perception, often written in medical notes as “NLP” [5]. The 2017 CDC data shows that about 4 million Americans who have vision loss or blindness are older than 40 years old, and 1 million are younger than 40 [4].  

Health Beliefs

  • When visually impaired patients detect a potential negative perception towards them, they may disengage in medical intervention and further discourage health-seeking behavior [6].

  • People who lose their vision later in life may attempt to conceal it for various personal  reasons, as they have lost a mode of perception used in their daily life; it is thus important for healthcare professionals to look for signs of visual loss or impairment [7].

Implications for Health Practitioners/Health Questions

Guiding: The patient may not be familiar with the healthcare setting; therefore, it is important to ask the patient if they require guidance. If needed, extend your arm to be held just above the elbow. Ensure your pace is not too fast or too slow for the patient. Explain any changes in the ground surface (e.g., stairs, slippery surface) [7].

​​

Greeting: Begin by introducing yourself, and if applicable, those accompanying you in a group setting. Speak in a clear tone while maintaining eye contact. If a physical examination is needed, communicate that it may involve contact. Ensure the patient is aware of his/her surroundings. When concluding the conversation, inform the patient before leaving the room [7].

​​

Because the blind population does not rely heavily on visual cues and gestural communication, it is important to be specific and descriptive about emotions, situations, or directions [8]. 

​

Mental Health: Individuals with visual impairment or blindness are at a higher risk for mental health complications due to the associated economic burden and reduced quality of life [9,10]. The current literature states that one-third of individuals with visual impairment experience mild depressive symptoms [10]. Daily interactions, especially within healthcare settings, can be unwelcoming towards the blind and visually impaired community,  which further prevents communication and help seeking from health professionals [7]. It is thus important to consider the impact of vision-specific distress such as anxiety and social withdrawal, as these might be robust predictors of depressive symptom severity [10]. 

Questions/Education

  • Healthcare challenge:

    • Does anyone in your family have a history of heart problems or diabetes? 

      • Pay special attention to chronic conditions such as hypertension, coronary artery disease/ cardiovascular disease, and diabetes as they are prevalent with visually impaired elderly patients [4,11].

  • Women’s Health:

    • Women are more likely to have conditions that can compromise sight [12].  

    • Does anyone in your family have a history of macular degeneration, cataracts, or glaucoma?

      • Regular comprehensive eye exams starting at age 40 are advised to catch early signs of chronic eye conditions [12].

      • Recommend the use of sunglasses and smoking reduction [12].

Health Challenges

Vision impairment and blindness can affect one’s independence, mobility, and quality of life and, in turn, linked to injuries, worsened cognition, social function, employment, and healthcare and educational attainment [13].

​​

Patients experiencing blindness and visual impairments are more susceptible to comorbidities, which requires more specific health interventions [11]. Visual impairments can create barriers to a healthier lifestyle, making the blind population more vulnerable to conditions like hypertension, coronary heart disease, and diabetes. Moreover, these individuals may have compromised diets, difficulties in exercising, and high levels of isolation and loneliness [11].

​​

As health professionals, it is important to ensure that the blind patients have adequate resources to be compliant with the treatment plan.

Women's Health

  • Women experience a higher prevalence of blindness and visual impairments, possibly explained by the differences in genetics, hormonal, and other biological factors associated with ocular pathology [14].

  • Women made up more than 60% of cases related to age-related macular degeneration, cataracts, and glaucoma [12]. In addition, women are more likely to have autoimmune conditions that can compromise their vision [12]. 

  • Gender specific barriers in eye care services have created a more negative health outcome for women experiencing blindness; furthermore, this extends to other healthcare specialties [15].

Conclusion

  • Individuals experiencing blindness and visual impairments come from various socio-cultural, religious backgrounds, and age groups (but often associated with elderly population).

  • Unwelcoming healthcare settings may discourage blind patients from receiving care. 

  • It is important to be specific and descriptive about emotions, situations, or directions when communicating with blind patients. 

  • Patients with blindness and visual impairments are more susceptible to comorbidities.

  • Women experience a higher prevalence of blindness and visual impairments [12].

(Image: Guiding) [11]

(Image: Braille representation of English alphabet) [16]

Resources for Patients

  • St. Louis Society for the Blind and Visually Impaired

    • Enhance independence, empower individuals, and enrich the lives of people who are visually impaired or blind,

    • Address: 8770 Manchester Rd, St. Louis, MO, United States, Missouri

    • Phone: 314-968-9000 - Mon to Fri: 8 AM - 4 PM

    • Link: https://slsbvi.org/ 

  • Midwestern Braille Volunteers

    • Assist the blind by transcribing a wide variety of materials into Braille

    • Address: 104 W Adams Avenue Saint Louis, MO 63122 

    • Phone: 314-966-5828 - Mon to Fri 8 AM to 1 PM

    • Link: http://www.mbvol.org/

  • Missouri Assistive Technology

    • Increase access to and acquisition of assistive technology and related services.

    • Address: 1501 NW Jefferson St. Blue Springs, MO 64015

    • Phone:  816-655-6700

    • Link: https://at.mo.gov/

  • Wolfner Talking Book and Braille Library

    • A free library service for Missourians of all ages who are unable to read standard print materials due to visual impairment, blindness, physical disability or reading disability, either temporary or permanent.

    • Address: 600 W Main St, Jefferson City, MO 65101 

    • Phone: 573-751-8720

    • E-Mail: wolfner@sos.mo.gov

    • Link: https://www.sos.mo.gov/wolfner 

  • American Foundation for the Blind (AFB)

    • An American non-profit organization for people with vision loss

    • Toll free phone: 800-232-5463

    • Link: https://www.afb.org/ 

    • Best Practices Guide for Hospitals Interacting with People Who Are Blind or Visually Impaired

    • Training materials can be found in this link. 

This information was collected and organized by our team. As of this time, we have not yet been able to connect with any individuals in this community that could review this article. If you are interested in reviewing this article, please contact kaitlynn.borik@health.slu.edu

References

(1) Getnet, M., Akalu, Y., Dagnew, B., Gela, Y. Y., Belsti, Y., Diress, M., Fekadu, S. A., & Seid, M. A. (2021). Visual impairment and its associated factors among medical and health sciences students at the University of Gondar, Northwest Ethiopia. PloS one, 16(8), e0255369. https://doi.org/10.1371/journal.pone.0255369

(2) Blindness and vision impairment. (2023, August 10). World Health Organization. Retrieved March 20, 2024, from https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment

(3) Deshpande, S., Rajpurohit, L., & Kokka, V. V. (2017). Effectiveness of braille and audio-tactile performance technique for improving oral hygiene status of visually impaired adolescents. Journal of Indian Society of Periodontology, 21(1), 27–31. https://doi.org/10.4103/jisp.jisp_149_17 

(4) Centers for Disease Control and Prevention. (2022, July). Prevalence Estimates – Vision Loss and Blindness. Retrieved March 20, 2024, from Centers for Disease Control and Prevention.

(5)American Foundation for the Blind. (2018, May 15). Low Vision and Legal Blindness Terms and Descriptions. Retrieved March 20, 2024, from https://www.afb.org/blindness-and-low-vision/eye-conditions/low-vision-and-legal-blindness-terms-and-descriptions

(6) Heydarian, N., Morera, O., & Frankowski, S. (2020). Developing a measure of blind patients' interactions with their healthcare providers. Disability and health journal, 13(3), 100906. https://doi.org/10.1016/j.dhjo.2020.100906 

(7)  Cupples, M. E., Hart, P. M., Johnston, A., & Jackson, A. J. (2012). Improving healthcare access for people with visual impairment and blindness. BMJ (Clinical research ed.), 344, e542. https://doi.org/10.1136/bmj.e542 

(8) Wagner, L. (2021, September 3). 6 Tips to Communicate with a Blind or Visually Impaired Person. 6 Tips to Communicate with a Blind or Visually Impaired Person. Retrieved March 9, 2024, from https://www.inclusivecitymaker.com/6-tips-communicate-blind-visually-impaired-person/

(9)  Koberlein, J., Beifus, K., Schaffert, C., Finger, R. P. (2013, November 6). The economic burden of visual impairment and blindness: a systemic review. British Medical Journal Open. Retrieved March 20, 2024, from PubMed Central.

(10)  Demmin, D. L., & Silverstein, S. M. (2020). Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clinical ophthalmology (Auckland, N.Z.), 14, 4229–4251. https://doi.org/10.2147/OPTH.S258783

(11)  Welp A, Woodbury RB, McCoy MA, et al., editors.; (2016, September 15). Making Eye Health a Population Health Imperative: Vision for Tomorrow.  Retrieved March 20, 2024, from Centers for Disease Control and Prevention. Retrieved March 9, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK402367/

(12)Women Face Higher Risk of Blindness Than Men. (2017, April 24). American Academy of Ophthalmology. Retrieved March 20, 2024, from https://www.aao.org/newsroom/news-releases/detail/women-face-higher-risk-of-blindness-than-men

(13) Court, H., McLean, G., Guthrie, B., Mercer, S. W., & Smith, D. J. (2014). Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC medicine, 12, 181. https://doi.org/10.1186/s12916-014-0181-7 

(14) Ulldemolins, A. R., Lansingh, V. C., Valencia, L. G., Carter, M. J., & Eckert, K. A. (2012). Social inequalities in blindness and visual impairment: a review of social determinants. Indian journal of ophthalmology, 60(5), 368–375. https://doi.org/10.4103/0301-4738.100529 

(15) Courtright, P., & Bassett, K. (2003). Gender and blindness: eye disease and the use of eye care services. Community eye health, 16(45), 11–12.

(16) K V, S., B, K., B, M., Shree, P., & K G, A. (2020). Design and Implementation of Digital Braille System for The Visually Impaired. In International Journal of Computer Trends and Technology (Vol. 68, Issue 3, pp. 80–83). Seventh Sense Research Group Journals. https://doi.org/10.14445/22312803/ijctt-v68i3p116 

bottom of page