Basic Concepts about Blindness a Diagnosis

Basic Concepts on Blindness and Diagnosing Visual Impairments

The first sign a person begins to realize that they might be going blind comes from an Optometrist or Ophthalmologist. The usual statement is, “I am sorry, but there is nothing more we can do.” When delivered this way, a person feels lost or depressed. However, this is not the case, as it only represents a new beginning.   We will look at several of the general terms that describes sight loss. On a continuum they include blind (no light perception), blind (light perception), legally blind, low vision, and functional blindness.   The easiest term to describe is blindness with no light perception. Probably the best way to describe this is not to stand in a dark place or cover your eyes, but rather think about what you can see directly behind you. Now, do not turn your head, but use your eyes to see directly behind you. That utter sense of darkness where only your other senses describes what is behind you is the closest to no light perception a sighted individual may see. Even if you closed your eyes and stood with a blind fold in utter darkness, your eyes still try to perceive some form of imagery. This represents a significant level of blindness with some residual perception.   Blindness with only light perception has several different forms. However, people often only see light with shadows or shadows with some light. The way one sees in this state depends on the condition of the eye and the cause for the sight loss. IN my case, I would say look through a camera at a light source  with no lens that is very dirty. You can detect the light source, and if anything might be blocking it.   Legal Blindness refers to a term develop to determine cut offs for benefits for sight loss. Legally, it refers to a visual acuity on a Snellen chart of 20/200 corrected with best eye. This means that the size of a sign a normally sighted person sees at 200 feet, a legally blind individual must be 20 feet away. A second classification for legal blindness involves tunnel vision. In this case, a person must have a field of view less than 20 degrees while looking forwards. Basically, look through a paper towel tube. However, even at these levels, one still possesses a fair amount of usable sight, and should be encouraged to use as much of it as possible.    Low Vision is a unique term. This generally hits many individuals with the beginning signs of Macular Degeneration and a host of other conditions. Basically, the visual acuity measures 20/70 or worse in best corrected eye on the Snellen chart. However, I like to look at it in a different manner. This level means that an individual must relinquish their driving privileges in most states, struggle with reading normal printed materials (12 font), and has some difficulties following fine video details on the TV, like a football or basketball in motion. While the Americans with Disabilities Act ensures these individuals receive the same treatment as all other persons with a disability, very few benefits exist. Similarly, the majority of organizations serving the legally blind deny this population access to membership and direct services. However, one may experience the same changes in quality of life, resources (like employment), and barriers like a legally blinded individual.

New to the field of sight loss is the category of functional blindness. This term still has a long way to go before being accepted universally by organizations, providers, insurance companies, and the like, this condition is very real to those who have it. Basically, these individuals possess the sight to pass the standard array of charts, but yet they still struggle to read, tract fine visual detail, struggle in extremely bright or dark settings, and host of other conditions. Causes of functional blindness includes traumatic brain injuries, chemical exposure, strokes, nerve damage, and many other events. In the recent conflicts in Iraq and Afghanistan, the TBI’s sustained opened the doors to learning about such a sight loss. However, this still stands as an emergent field of study, with each passing day bringing forward more information on causes, depth, and treatments.   In terms of the VA, the below chart will help identify the varying levels of sight loss one might receive benefits to service connected disability ratings for. . These are listed within the Code of Federal Regulations (CFR) 38:

First Level of Compensation

  • Light perception or worse in one eye, with legal blindness in other

  Second Level of Compensation

  • 5/200 or less in both eyes
  • Fields of 5 degree or less with both eyes

Third Level of Compensation

  • 5/200 in one eye and light perception or worse in other

Fourth Level of Compensation

  • Light perception only in both eyes
  • 5/200 and factual need for aid and attendance
  • 5/200 and no light perception or worse in other

Fifth Level of Compensation

  • Light perception in one eye and loss of one eye

Highest Level of Compensation

  • Total blindness, with no light perception in both eyes
  • loss of both eyes   .
  • If you know that your claims packet was approved at a different level than your current level, ask your eye doctor to annotate it on your VA electronic medical records.

    When receiving an eye exam, it is always wise to ask for an eye exam to determine legal benefits. While many eye exams attempts to obtain information about your best acuity and fields to determine a diagnosis, they often use devices like pin hole tests, inverted contrast charts, encourage straining, and other methods. An exam for legal benefits uses the basic Snellen eye chart, normal corrective lenses, discourages strain, basic glare reduction tactics (like tinted glasses and a hat), and other practices a person may preform outside a clinical setting. The eye exam for legal benefits attempt to measures the individual’s sight as if they are in their natural environment.

    Basic Concepts about Blindness a Diagnosis

    The first sign a person begins to realize that they might be going blind comes from an Optometrist or Ophthalmologist. The usual statement is, “I am sorry, but there is nothing more we can do.” When delivered this way, a person feels lost or depressed. However, this is not the case, as it only represents a new beginning.

     

    We will look at several of the general terms that describes sight loss. On a continuum they include blind (no light perception), blind (light perception), legally blind, low vision, and functional blindness.

     

    The easiest term to describe is blindness with no light perception. Probably the best way to describe this is not to stand in a dark place or cover your eyes, but rather think about what you can see directly behind you. Now, do not turn your head, but use your eyes to see directly behind you. That utter sense of darkness where only your other senses describes what is behind you is the closest to no light perception a sighted individual may see. Even if you closed your eyes and stood with a blind fold in utter darkness, your eyes still try to perceive some form of imagery.

     

    Blindness with only light perception has several different forms. However, people often only see light with shadows or shadows with some light. The way one sees in this state depends on the condition of the eye and the cause for the sight loss. IN my case, I would say look through a camera at a light source  with no lens that is very dirty. You can detect the light source, and if anything might be blocking it.

     

    Legal Blindness refers to a term develop to determine cut offs for benefits for sight loss. Legally, it refers to a visual acuity on a Cnellen chart of 20/200 corrected with best eye. This means that the size of a sign a normally sighted person sees at 200 feet, a legally blind individual must be 20 feet away. A second classification for legal blindness involves tunnel vision. In this case, a person must have a field of view less than 20 degrees while looking forwards. Basically, look through a paper towel tube. However, even at these levels, one still possesses a fair amount of usable sight, and should be encouraged to squeeze as much of it as possible. 

     

    Low Vision is a unique term. This generally hits many individuals with the beginning signs of Macular Degeneration and a host of other conditions. Basically, the visual acuity measures 20/70 or worse in best corrected eye on the Snellen chart. However, I like to look at it in a different manner. This level means that an individual must relinquish their driving privileges in most states, struggle with reading normal printed materials (12 font), and has some difficulties following fine video details on the TV, like a football or basketball in motion. While the Americans with Disabilities Act ensures these individuals receive the same treatment as all other persons with a disability, very few benefits exist. However, sight at this level opens the door to low vision clinics within many optometrists’ and ophthalmologists’ offices.

     

    New to the field of sight loss is the category of functional blindness. This term still has a long way to go before being accepted universally by organizations, providers, insurance companies, and the like, this condition is very real to those who have it. Basically, these individuals possess the sight to pass the standard array of charts, but yet they still struggle to read, tract fine visual detail, struggle in extremely bright or dark settings, and host of other conditions. Causes of functional blindness includes traumatic brain injuries, chemical exposure, strokes, nerve damage, and many other events. In the recent conflicts in Iraq and Afghanistan, the TBI’s sustained opened the doors to learning about such a sight loss. However, this still stands as an emergent field of study, with each passing day bringing forward more information on causes, depth, and treatments.

     

    In terms of the VA, the below chart will help identify the varying levels of sight loss one might receive benefits to service connected disability ratings for. . These are listed within the Code of Federal Regulations (CFR) 38:

     

    First Level of Compensation

    •Light perception or worse in one eye, with legal blindness in other

     

    Second Level of Compensation

    •5/200 or less in both eyes

    •Fields of 5 degree or less with both eyes

     

    Third Level of Compensation

    •5/200 in one eye and light perception or worse in other

     

    Fourth Level of Compensation

    •- Light perception only in both eyes

    •- 5/200 and factual need for aid and attendance

    •- 5/200 and no light perception or worse in other

     

    Fifth Level of Compensation

    •Light perception in one eye and loss of one eye

     

    Highest Level of Compensation

    •Total blindness, with no light perception in both eyes

    •- loss of both eyes

     

    . If you know that your claims packet was approved at a different level than your current level, ask your eye doctor to annotate it on your VA electronic medical records and file a 

    Visually Impaired Veterans by War Era

    Greetings everyone,


    As a way to start off this blog, one needs to first understand the various visual impairments commonly impacting Veterans. In an oversimplified manner to accomplish this mission, this post will describe visual impairments by war era. I do not wish to discredit those Veterans who served either during peacetime or between these major conflicts, but rather identify those eras those outside Veteran communities might understand.

     

    Overview:

    The Blinded Veterans Association reports from Department of Veterans Affairs statistics that over 158,000 visually impaired Veterans live amongst us. The rate these increase each year is around 7,000 Veterans.

     

    Operation Enduring and Iraqi Freedom, and Operation New Dawn:

    From the recent conflicts in Iraq and Afghanistan, roughly 17% of injured Service Members incurred a visual impairment. 36,000 have received visual impairments related to Traumatic Brain injuries. The VA’s Public Health Services reports a much larger number, 118,150 Veterans, as incurring some form of optical injury. All of these differing conditions are directly related to penetrating or concussive/blast injuries from Improvised Explosive Devices (IED), shrapnel, gunshot wounds, and environmental incidents. These injuries creates a range of injuries from losing an eye, low vision, legal blindness, to complete blindness.


    There are still many more unreported cases of these recent Veterans with functional sight impairments that range from issues with glare, headaches, blind spots, reading difficulties, and numerous other conditions. Research has only recently started to examine functional blindness, and many doctors, case managers, and organizations still question the legitimacy of these claims. However, these conditions are real, especially to those Veterans and Service Members living with them.

    http://www.visionaware.org/section.aspx?FolderID=8&SectionID=115&TopicID=538

     

    Vietnam Era Veterans

    The fastest growing segment of Veterans developing visual impairments includes those who served either in Southeast Asia or during that era. With research showing high correlations between Agent Orange and many troubling health conditions, more than direct physical injuries to the optical systems can receive service connection for sight loss. Most notably are those secondary impacts from Diabetes. Alternatively, many of our Vietnam Era Veterans continue to reach the age when various age related conditions arise like macular degeneration. For these individuals, there is no reason why with proper resources they should discontinue any of those activities they most enjoy.


    Looking at the Department of Veterans Affairs eligibility for compensation, here are a few thoughts. For those Veterans who lost an eye during their military service, they can qualify for an increase in their disability compensation should the remaining eye begins to deteriorate. This stems from the VA’s policy on paired organs, like Eyes, hearing, kidneys, and lungs. Any loss or functioning of the remaining paired organ will be considered as service connected as it is the only remaining organ of its kind. On a different note, some Veterans have received compensation for sight loss from diabetes retinopathy, since Agent Orange exposure caused their diabetes. While this is a grey area matter, one should consult a certified Veteran Service Officer.

    http://www.lawyers4veterans.com/VA-Disability-Compensation/Types-of-VA-Disability-Claims/Agent-Orange-Related-Conditions.aspx

    http://www.law.cornell.edu/cfr/text/38/3.383


    World War II and Korean War Veterans:

    For those Veterans who served during these eras, a combination of service related andage related conditions take a heavy toll on sight impairments and independent living. Both of these generations reached the ages when Age Related Macular Degeneration or glaucoma increases exponentially. Some estimates show that over 20% of those 80 years of older develop these forms of sight loss. In many cases, a co-occurring hearing impairment adds to their limitations. This places a very heavy burden on both the Veteran and their support systems. 

    http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

     

    Department of Veterans Affairs Services

    One should not give up hope, as the VA offers an array of Blind Rehabilitation Services that can occur anywhere from home based interventions to extended training within the Blind Rehab Centers. It matters not if the Veteran incurred their sight loss from war or developed a naturally occurring condition, VA Blind Rehab Services provides training and even equipment to all Veterans. Many Veterans qualify for these services at no cost. Entry point into these programs requires one to contact their Visual Impairment Services Team (VIST) or visit the below website.

    http://www.va.gov/blindrehab/