U.S. Commission on Civil Rights

Leading Types and Causes of Blindness and Visual Impairment

Blindness can be partial, with loss of only part of the vision. It can also be complete, in which case there is no perception of light. People with worse than 20/200 vision are considered legally blind, i.e., a person is considered blind if he or she can see at a distance of 20 feet what a person with normal vision can see at a distance of 200 feet.

Not everyone who is blind or vision impaired is the same. Moreover, most blind people have some residual vision, varying in degree from the ability to perceive light to reading normal-sized print with the help of corrective lenses or low vision aids. Only a small percentage of blind persons is totally blind with no light perception.

The reason not all blind and visually impaired people have the same level of vision is because blindness and vision impairment can be caused by a number of different diseases and conditions, as well as by accidents. Some are a result of aging, some are present at birth or before, and some are the result of disease or infection. According to the leading organizations of the blind, there are three major casual categories of blindness:

• Inherited or congenital conditions
• Conditions related to aging
• Other causes

1. Inherited or congenital conditions

Retinitis pigmentosa. Retinitis pigmentosa is an inherited disease caused by a degeneration of the rods and cones of the retina. The disease first affects the rods, which are responsible for peripheral or side vision and vision in low light levels. As the disease progresses, the cones are affected and central vision is lost. Retinitis pigmentosa can include moderate to severe hearing loss, resulting in the person becoming both deaf and blind.

Retinopathy of prematurity. Retinopathy of prematurity is a condition that appears soon after birth, generally in premature infants. With the increased number of surviving premature infants, the incidence of this type of blindness has risen dramatically in recent years. When retinopathy of prematurity occurs, an abnormally high development of blood vessels in the retina occurs that causes the retina to detach and leads to blindness.

Acute glaucoma. Glaucoma is a disease of the eye marked by high intraocular pressure, damaged optic disk, hardening of the eyeball, and partial or total vision loss. Glaucoma can occur in infants when drainage openings are malformed from birth allowing pressure in the canals to buildup.

Albinism. Albinism is the congenital lack of normal pigmentation and can include the lack of normal eye coloring. Individuals affected by a lack of pigment in the eyes often experience vision impairment, including low visual acuity, involuntary spasmodic motion of the eyeball, dimness of vision, and/or an intolerance to light.

2. Conditions related to aging

Glaucoma. Glaucoma is a common vision impairment of the elderly. As individuals age, there may be an increase in the level of pressure within the eye caused by a buildup of fluid due to a partial or complete blockage of the drainage network of the eye. The increased pressure damages the optic nerve, the nerve that carries visual information to the brain, resulting in the gradual loss of vision. Although treatable if detected early, because the onset of the disease is so gradual often the symptoms of glaucoma are not noticed until there has been irreversible damage to the person’s vision.

Macular degeneration. The macula lutea is an area in the eye near the center of the retina at which visual perception is most acute. Macular degeneration, sometimes referred to as age related maculopathy (ARM), results from damage or breakdown in the macula of the eye. ARM is the most common cause of severe vision loss in people over the age of 60 years. Though ARM usually does not result in total blindness, its onset limits the individual’s ability to see clearly or identify visual details.

Cataract. Cataract is opacity of the lens or capsule of the eye causing partial or total blindness. A cataract is a normal part of the aging process, and most older people have some degree of cataract. As individuals age, the lens of the eye that was clear may become cloudy. In advanced cases of cataract, the surgical removal of the cloudy lens is required.

3. Other causes

Diabetic retinopathy. Diabetic retinopathy is an eye condition caused by diabetes. Over a long period of time, diabetes can cause damage to the blood vessels at the back of the eye. This may result in a deterioration of vision.

Trachoma. Trachoma is a contagious viral disease of the conjunctiva of the eye characterized by inflammation, hypertrophy, and granules of adenoid tissue. The damage leads to opacity or cloudiness of the cornea.

Rubella. Rubella is a contagious, eruptive disease caused by a virus and capable of causing congenital defects, such as blindness, in infants born to mothers who are infected during the first 3 months of pregnancy.

Xerophthalmia. Xerophthalmia is an abnormally dry and lusterless condition of the eyeball due to a severe deficiency of vitamin A. The condition is much more common in less developed countries where malnutrition is widespread.

Accidents. Many instances of blindness and vision loss each year are attributable to accidents at work, at home, playing sports and to automobile crashes.

Incidence and Social Characteristics of Blindness and Visual Impairment

Visual impairment¹ can be divided into five categories: (1) functional limitation in seeing print, (2) severe functional limitation in seeing print, (3) severely visually impaired people of working age, (4) legally blind persons, and (5) legally blind persons who are totally blind. Functional limitation in seeing print has two levels: nonsevere, i.e., difficulty in seeing letters in ordinary print even with glasses; and severe, i.e., inability to see letters in ordinary print even with glasses.

Functional Limitation in Seeing Print

Nationwide it is estimated that 9.7 million adults have a significant functional limitation in seeing print. This is 4 percent of the adult population, or 4 of every 100 adults. Moreover, of these 9.7 million adults, 1.6 million individuals have “severe” functional limitations in seeing print. This is 0.6 percent of the adult population, or 6 of every 1,000 adults.²  There are high rates of visual impairment in the adult population of Illinois. It is estimated that 40,000 of the State’s 6 million adults, 6.7 percent, have a significant functional limitation in seeing print.³

Legal Blindness

In the United States there are 1.1 million legally blind persons, i.e., clinical visual acuity of 20/200 in the better eye with best correction or a visual field of 20 degrees or less. This is a rate of 4.5 individuals per 1,000. Of those individuals considered legally blind, 220,000 have no useful vision, i.e., their vision is limited to light perception or less. Of those individuals who have no useful vision, 110,000 are totally blind, i.e., they have no light perception.

Incidence of Blindness/Visual Impairment

Every year approximately 200,000 persons in the United States acquire some form of visual impairment that is a severe functional limitation in seeing, an incidence rate of 1 per 1,000. In addition, there are 80,000 annual new cases of legal blindness, an incidence rate of 33 per 100,000.⁴

Age-related Blindness/Visual Impairment

The elderly, those aged 65 or older, are those most affected by vision loss; two out of three persons who are blind or visually impaired in the United States are over the age of 65. In 1990 the number of elderly affected by blindness or visual impairment was 2,700,000. Prevent Blindness America reports the leading causes of blindness will double their impact in the coming years as the Nation’s 76 million baby boomers reach older adulthood. By the year 2020, twice as many people will be blind as are today. Macular degeneration will continue to be the leading cause of blindness, and there will be a near doubling of the total cases of glaucoma.

A special problem borne by some individuals is the incidence of the dual disability, deaf-blindness. The dual disability is not as rare an occurrence as perceived by the general public. The number of children, i.e., individuals 21 years of age or younger, in the United States who are both deaf and blind is estimated at 10,000, an incidence rate of 1.2 per 1,000 children.⁵

Employment and Social Characteristics

Individuals who are visually impaired are disproportionately outside the labor force and not working. The labor force is considered to include all individuals between the ages of 16 and 64 who are either employed or unemployed yet seeking work. Nationwide, 67.3 percent of all adults are in the labor force. Among adults who are blind with a severe visual impairment, just 26 percent are in the labor force. This means that for adults who have sight, 67 of 100 are either working or actively looking for work; among those with a severe visual impairment, only 26 of 100 are either working or actively looking for work.

It is a common perception among the public that persons who are blind read Braille. Most persons who are legally blind do not use Braille as a reading medium. This includes students in educational programs below college and adults. Among legally blind students registered as such by the American Printing House for the Blind, only 10 percent use Braille as their primary reading medium. It is estimated that 8 percent of all legally blind adults are able to use Braille.⁶
 

Conference on Civil Rights Issues Facing the Blind and Visually Impaired

The Americans with Disabilities Act of 1990

The Americans with Disabilities Act (ADA)⁷ gives civil rights protections to individuals who are blind similar to other individuals with disabilities. The act guarantees equal opportunity for the blind and visually impaired in public accommodation, employment, transportation, State and local government services, and telecommunications. In passing the Americans with Disabilities Act, Congress found that historically society has tended to isolate and segregate individuals with disabilities. In addition, section 504 of the Vocational Rehabilitation Act⁸ makes discrimination against individuals with disabilities illegal for all entities receiving Federal assistance.

Despite some improvements in equal opportunity for disabled individuals, discrimination in employment, public accommodation, transportation, and access to public services continues to be a serious and pervasive social problem. Some forms of discrimination against individuals with disabilities include outright exclusion, the discriminatory effects of architectural and transportation barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities.⁹

Title I of the ADA prohibits discrimination against qualified individuals on the basis of blindness in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. Additionally, employers are obligated to make reasonable accommodations for the blind if such accommodations do not impose an “undue hardship” on the operation of the employer’s business. In this respect, the ADA applies to private employers with 15 or more employees, State and local governments, employment agencies, and labor unions. The Equal Employment Opportunity Commission is the Federal agency charged with enforcing Title I of the ADA.¹⁰

Title II of the ADA prohibits discrimination against persons who are blind in all programs, activities, and services of public entities. It applies to all State and local governments, their departments and agencies, and any other instrumentalities or special purpose districts of State or local governments and requires that all government facilities, services, and communications be accessible to the blind. Title II also clarifies the requirements of section 504 of the Rehabilitation Act of 1973 for public transportation systems that receive Federal financial assistance and extends coverage to all public entities that provide public transportation, whether or not they receive Federal financial assistance, establishing standards for the operation of public transit systems, including commuter and intercity rail (AMTRAK).

Numerous Federal agencies are charged with enforcing title II, including the Office of Civil Rights, U.S. Department of Transportation; Office of Civil Rights, Federal Highway Administration; the Office of Civil Rights, Federal Railroad Administration; Office of Civil Rights, Federal Transit Authority; the Office of Civil Rights, U.S. Department of Commerce; Architectural and Transportation Compliance Board; and the Civil Rights Division, U.S. Department of Justice.¹¹

Title III of the ADA prohibits discrimination against the blind by any private entity that owns, operates, leases, or leases to a place of public accommodation. Places of public accommodation include a wide range of entities, such as restaurants, hotels, theaters, doctors’ offices, pharmacies, retail stores, museums, libraries, parks, private schools, and day care centers. Private clubs and religious organizations are exempt from the ADA’s title III requirements for public accommodation.¹²  Federal agencies charged with enforcing title II of the ADA also are charged with enforcing title III.

Authority of the U.S. Commission on Civil Rights and Purpose of the Illinois Advisory Committee Conference

The U.S. Commission on Civil Rights is charged with the duty to study and collect information on legal developments constituting discrimination or a denial of equal protection of the laws under the Constitution because of disability. The Commission is also to appraise Federal laws and policies with respect to discrimination or a denial of equal protection of the laws under the Constitution because of disability.

An Advisory Committee to the U.S. Commission on Civil Rights has been established in each of the 50 States and the District of Columbia. Advisory Committees are to advise the Commission of all relevant information concerning their respective States on matters within the jurisdiction of the Commission, and receive reports, suggestions, and recommendations from individuals, public and private organizations, and public officials upon matters pertinent to inquiries conducted by the State Advisory Committee.

The Illinois Advisory Committee is composed of 13 members. It includes representation from both political parties as well as the different geographic regions of the State. The Illinois Advisory Committee is also independent of any National, State, or local administration or policy group.

The purpose of the Advisory Committee conference on “Civil Rights Issues Facing the Blind in Illinois” is to examine and publicize major civil rights issues in order to ascertain the extent of and promote the elimination of any continuing unfair and illegal forms of discrimination against the blind and visually impaired, the existence of which denies such individuals the opportunity to compete on an equal basis, full participation, and economic self-sufficiency.

This is the first report by any State Advisory Committee or the U.S. Commission on Civil Rights in its 40-year history focusing on the issue of blindness and visual impairment. It is not the first time, however, for the Illinois Advisory Committee to direct its attention to a specific disability civil rights issue. In October 1990 the Illinois Committee released a report, Rights of the Hearing Impaired,¹³ which examined civil rights legislation as it affects the hearing impaired.

On May 29, 1998, the Advisory Committee held a public conference on “Civil Rights Issues Facing the Blind in Illinois.” Invitations were extended to all known prominent advocacy organizations of and for the blind, service providers to the blind and visually impaired, and government agencies charged with serving the blind and visually impaired or enforcing the civil rights of the blind and visually impaired. Statements received from such individuals and organizations are included in this report. In section 6 of the report, the Advisory Committee sets out its observations and recommendations regarding the civil rights of the blind and visually impaired in Illinois.

Endnotes 

¹ Information in this part, unless otherwise noted, is from the American Foundation for the Blind, presented by Paul Schroeder to the Illinois Advisory Committee, conference on “Civil Rights Issues Facing the Blind and Visually Impaired in Illinois,” Chicago, IL, May 29, 1998.

² American Foundation for the Blind, from Census Bureau Survey of Income and Program Participation.

³ 1990 U.S. census.

⁴ American Foundation for the Blind, from Census Bureau Survey of Income and Program Participation.

⁵ Ibid.

⁶  Ibid.

⁷ 42 U.S.C. 1201–12213 (1998).

⁸  29 U.S.C. 794 (Supp. 1994).

⁹ Ibid., sec. 2 (a).

¹⁰ Ibid., title I.

¹¹  Ibid., title II.

¹² Ibid., title III.

¹³ See report of the Illinois Advisory Committee to the U.S. Commission on Civil Rights, Rights of the Hearing Impaired, October 1990.