HOSTORICAL OVERVIEW OF LOW VISION AND

PSYCHOLOGICAL IMPLICATION OF VISUAL

IMPAIRMENT
What is Low vision?
• According to WHO, a person with low vision is one who has
impairment of visual functioning even after treatment and/or
standard refractive correction, and has a visual acuity of less than
6/18 to light perception, or a visual field of less than 10 degree
from the point of fixation, but who uses, or is potentially able to
use, vision for planning and/or execution of a task.
• Lighthouse definition:-
Functional visual impairment is a significant limitation of visual
capability resulting from disease, trauma or congenital condition
which cannot be fully ameliorated by standard refractive correction,
medication or surgery, and is manifested by one or more of the
following:
1. Insufficient visual resolution (worse than 20/60 in the better
eye with best correction of ametropia)
2. Inadequate field of vision (worse than 20° along the widest
meridian in the eye with the more intact central field; or
homonymous hemianopia)
3. Reduced peak contrast sensitivity (<1.7 log CS binocularly)
4. Insufficient visual resolution or peak contrast sensitivity ( see 1
& 3) at high or low luminance's within a range typically
encountered in everyday life
HISTORY
• In 1888, C. F. Prentice, presented the prism diopter to explain the
bending of a light ray through a given strength prism.

• In the early 1900s, the American optical company of Southbridge

and the Bausch and Lomb company manufactured many of the
magnifiers and reading lenses used by individuals at that time and
also, perhaps, by many of the "low vision patients.

• Galileo Galilei (1564-1642) was one of the first to design and

construct a telescope that bears his name.
• Johannes Kepler (1571-1630) developed a two convex-lens telescopic
system that created an inverted image. This telescope, named after
Kepler, is also known as astronomical telescope.

• The first major contribution to the development of telescopic devices for

patient care was made by a Jesuit priest, F. Eschinardi, in 1667.

• The next major development of the telescopic device was made by H.

Dixon in 1785.

• Steinheil and Seidel designed a small Galilean telescope in 1846 that was
composed of an objective lens of crown glass and an ocular of flint glass.

• Giron and Mitaine, in 1840, and Dillenseger, in 1849, designed the

lenses of a Galilean telescope to be adjusted in and out without any
tubular support. This construction was light- weight and somewhat
comfortable to wear, much like theater spectacles.
• Giron and Mitaine, in 1840, and Dillenseger, in 1849, designed the lenses of
a Galilean telescope to be adjusted in and out without any tubular support.
This construction was light- weight and somewhat comfortable to wear,
much like theater spectacles.

• The first telescopic use of a doublet objective and ocular lens was in the
panorthic monacle, designed and man-ufactured by Steinheil's sons in
Germany in the 1870s.

• It was not until 1910 when Dr. M. von Rohr, working for Carl Zeiss
Company of Jena, Germany, developed mathematic formulas (which are
still used today) for telescopic system having different vertex power.
• In 1928, Dr. William Feinbloom ordered a pair of iele. scopic lenses
from the Zeiss Company after studying von Bohr's work on the
development of telescopic spectacles.

• In 1950, Feinbloom attempted to provide normal localization of

distant objects when looking through a Galilean telescope by
producing a meridional magnifying telescope.

• In 1954, Feinbloom designed microscopic spectacles ranging in

power from 2x to 20x for those patients who wanted to read but who
could not use a telescopic system with reading caps.

• In 1936, Tait and Neil designed telescopic spectacles that provided a

combination of magnification at distance and near in the same
spectacle system.
• In an attempt to provide greater magnification for reading, the
closed-circuit television (CCTV), an elec tronic instrument using a
camera and a monitor to pro- vide magnification of printed
material, was first described by Potts, Volk, and West in 1959.

• In 1977, Dr. Feinbloom presented the Camera Lent Tele- scope

(Designs for Vision, Inc., Ronkonkoma, NY), a Kep lerian system
mounted in a spectacle.

• In the hope of providing a spectacle-mounted tele scope with as

large a field as possible. Feinbloom and Brilliant designed and
clinically evaluated the Honey Bee Lens (Designs for Vision, Inc.) in
1980.
• In 1983, Feinbloom designed the Amorphic Lens (Designs for Vision,
Inc.) for patients with reduced peripheral fields.

• In 1989, Dr. Spitzberg developed the Behind-the-Lens telescope

(Optical Designs, Inc., Houston, TX) with cosmesis in mind.

• Pekar and Greene, of Ocutech, Inc. (Chapel Hill, NC), developed the
Horizontal Light Path-Vision Enhancing System (HLP-VES) in 1989.

• In 1995, image-processing technology became available to low vision

patients. A head-mounted video display with electronic manipulation
known as the Low Vision Enhance ment System (LVES) (Visionics
Corporation, Vadnais Heights, MN) came on the market.
BLINDNESS
• Webster's New World Dictionary defines Blindness as "without the
power of sight; sightless: eyeless," whereas Dorland's Medical
Dictionary defines the term as a "lack or loss of ability to see; lack of
perception of visual stimuli, due to disorder of the organs of sight, or
to lesions in certain areas of the brain.

• The federal government has provided a legal definition for official

purposes and has, therefore, defined legal blindness as visual acuity
of 20/200 or worse in the better seeing eye with best conventional
correction (spectacles, contact lenses, or intraocular lenses), or a
visual field of 20 degrees or less in it widest diameter.
 The benefits that may be available to those individuals who are
classified legally blind are as follows:
• An Internal Revenue Service (IRS) income tax exemption.
• Free telephone directory assistance.
• Transportation benefits.
• Free mailing.
• Free library services.
• Vocational rehabilitation services.
• VISUAL IMPAIRMENT

A visual impairment is a reduction in the ability of the eye or visual

system to perform. An example is a patient with macular degeneration
who has reduced visual acuities. This loss of visual acuity is considered
a visual impairment. It does not define how the patient is function
impairmening but rather how the eye or visual system is functioning
form particular task because of his or her impairment, the i.e., loss of
visual acuity).

• VISUAL DISABILITY

When a patient is not able to perform a particular task because of

his/her impairment, the patient is said to have a visual disability. A
visual impairment may not always cause a visual disability.
LEADING CAUSE OF LEGAL BLINDNESS
• Birth to 19 years
 Congenital cataract
 Optic atrophy
 Albinismn
 Retinopathy of prematurity
 Cone-rod dystrophy

• 20-44 years
 Albinismn
 Cone-rod dystrophy
 Optic atrophy
 Myopia
 Retinitis pigmentosa
 Diabetic retinopathy
 Macular degeneration
• 45-64 years
 Diabetic retinopatlıy
 Glaucoma
 Retinitis pigmentosa
 Macular degeneration
 Cataracts

• 65-74 years
 Macular degeneration
 Diabetic retinopatly
 Glaucoma
 Cataracts
 Retinitis pigmentosa

• 75 years and older

 Age-related macular degeneration
 Glaucoma
 Cataract
 Diabetic retinopathy