essay on blindness

• Collections
• Support PDR

Search The Public Domain Review

Seeking Enlightenment: Denis Diderot’s Letter on the Blind (1749)

Denis Diderot, Diderot's Early Philosophical Works , translated and edited by Margaret Jourdain (Chicago: Open Court, 1916).

Almost two centuries earlier, the Enlightenment philosopher Denis Diderot visited Puiseaux, just south of Paris, to meet a person “of good solid sense” who had been born blind. Arriving at five in the afternoon, he finds the man amid his morning routine. “He had only been up for an hour, for I must tell you the day begins for him when it is ending for us.” Despite the man’s lack of sight and preference for midnight oil, Diderot discovers that the situation is far from “impossible”: they have a conversation about the world of sight and his host exhibits a sophisticated understanding of optics, describing a mirror, for example, as an object that “sets things in relief at a distance from themselves”. Diderot is delighted. “Had Descartes been born blind”, effuses the philosopher, “he might, I think, have hugged himself for such a definition.”

When Diderot wrote his Lettre sur les aveugles (translated into English as Letter on the Blind for the Use of Those Who See ), in which this story appears, blindness had become a topic of philosophical debate. As Mark Paterson notes in Seeing with the Hands , after René Descartes published his essay on optics, La dioptrique (1637), blindness promised to reveal “the relationship between visual clarity and epistemological certainty”. Many treatises on the nature of knowledge, for instance, contemplated those born blind ( l’aveugle-né ), whose vision was restored later in life. In a thought experiment proffered by William Molyneux and later taken up by John Locke in An Essay Concerning Human Understanding (1689), a person born blind learns the tactile difference between a cube and sphere. After sight is magically restored, they encounter the two geometric forms on a table. Without touching the solid objects, would they be able to tell which is which?

If this hypothetical seems fanciful in retrospect, it was important for one of the most controversial debates of the Enlightenment: is knowledge rational or empirical? That is, do we have an implicit, conceptual, and perhaps God-given sense of the world? Or is it derived from raw observation, whether visual or haptic? In this period, blindness also challenged what the intellectual historian Martin Jay calls the scopic regimes of modernity : those layered metaphors, in Western philosophical history, that equate knowledge and vision . Terms like insight and enlightenment preserve the primal scene from Plato’s cave allegory, where truth or “the good” is represented by the sun, toward which we must continually strive. Yet medical progress migrated these questions away from the world of allegory and onto the mid-eighteenth-century operating table. Diderot was writing during an era when, thanks to advances in cataract surgery, these questions could be tested via a scientific method.

Surgeon and assistant performing cataract surgery on a patient and various surgical instruments, Table XXXVIII-XXXIX from A Medicinal Dictionary (1743-45) — Source .

Akin to the epistolary novels that became popular in the 1740s, Diderot’s Letter on the Blind assumes the form of a real letter, penned, it seems, to his occasional lover: Madeleine d'Arsant de Puisieux, author of La femme n'est pas inférieure à l'homme (Woman is not inferior to man), an early feminist treatise. While his correspondent was combating patriarchy, Diderot voiced probing challenges to ableism , by quoting the man from Puiseaux’s response, at length, when asked if would like to have his vision restored:

“If it were not for curiosity,” he replied, “I would just as soon have long arms: it seems to me my hands would tell me more of what goes on in the moon than your eyes or your telescopes. . . I would be as well off if I perfected the organ I possess, as if I obtained the organ which I am deprived of.”

In the spirit of perfecting touch, Diderot segues into an extended discussion of Nicholas Saunderson’s system of “palpable arithmetic”, a precursor to night writing and Braille. Saunderson, who held the Lucasian Professorship of Mathematics at Cambridge, was blinded by smallpox in infancy and remains a largely forgotten though brilliant figure, who astounded students with cutting-edge lectures on light and color, had a love for hunting on horseback, and would supposedly offer detailed commentary on the cloud formations that passed between him and the sun during afternoon turns in the park.

Nicholas Saunderson in a 1752 engraving after an image by J. Vanderbank, 1719 — Source . — Source .

Despite his relatively complex and compassionate treatment of the blind, Diderot had an agenda of his own. He interlaced his letter with quiet defenses of atheism, often funneled through quotations from Saunderson, by championing the empirical, scientific method over "religiously tinged rationalism”. The letter concludes with a humorous sigh of defeat, a subtle condemnation of those who claim to know the workings of things in heaven and earth:

Thus we scarce know anything, yet what numbers of books there are whose authors have all pretended to knowledge! I cannot think why the world is not tired of reading so much and learning nothing, unless it be for the very same reason that I have been talking to you for two hours, without being tired and without telling you anything.

A few months after Diderot published the letter anonymously, he was arrested for his godless tone and imprisoned in Vincennes for three months at the age of thirty-five. Shortly after his release, achieved through literary connections, he gained a reputation for co-founding the Encyclopédie , one of the Enlightenment’s pivotal productions. You can browse Diderot’s Letter above, translated by Margaret Jourdain, or purchase Kate E. Tunstall's recent translation here .

• Customs & Culture
• Thought, Reflection & Theory
• Non-fiction
• 18th Century

Jun 24, 2021

If You Liked This…

Get Our Newsletter

Our latest content, your inbox, every fortnight

Prints for Your Walls

Explore our selection of fine art prints, all custom made to the highest standards, framed or unframed, and shipped to your door.

Start Exploring

{{ $localize("payment.title") }}

{{ $localize('payment.no_payment') }}

Pay by Credit Card

Pay with PayPal

{{ $localize('cart.summary') }}

Click for Delivery Estimates

Sorry, we cannot ship to P.O. Boxes.

Friday essay: blind people are often exhausted by daily prejudice – but being blind is ‘inherently creative’

Adjunct Research Fellow, Western Sydney University

Disclosure statement

Amanda Tink does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Western Sydney University provides funding as a member of The Conversation AU.

View all partners

Andrew Leland was in his thirties when he had to stop driving at night – and then stop driving at all. Next, he had to start using a cane in public. As the cycle of decreasing vision became familiar, each absent sliver of vision required more adjustment to how he navigated the world.

He moves through the same steps in the same sequence each time, but each loss is unique, and uniquely stressful. And he can still see the disdain of sighted people, which makes him long to lose all his vision at once:

I thought about my periodic desire for the eye disease to just get it over with, and take the rest of my sight. I wanted to be relieved of seeing the way people look at blindness: the scorn, the condescension, the entitled, almost sexual leer. Skepticism, pity, revulsion, curiosity. I know I’ve looked at blind people this way too […] But I was a different person then: I didn’t really think of myself as blind.

Blindness, creativity and memoir

Responding to the idea that James Joyce’s blindness influenced his writing of Finnegans Wake , his biographer Richard Ellmann asserted:

The theory that Joyce wrote his book for the ear because he could not see is not only an insult to the creative imagination, but an error of fact. Joyce could see; to be for periods half-blind is not at all the same thing as to be permanently blind.

What Ellmann presents as a fact is actually a common myth. 85% of permanently blind people have sight . (I am one of the 15% of blind people who is totally blind, and the even smaller minority born this way.) And the line between blind and sighted is not straightforward. The results of a number of tests, and other factors, are taken into account.

Ellmann sounds like he is uncomfortable with thinking of Joyce as blind, and thinking of blind people as creative.

By contrast, during the writing of Finnegans Wake, Joyce himself was relaxed about the losses and gains of his situation. Responding to a letter from a friend on this topic, he wrote: “What the eyes bring is nothing. I have a hundred worlds to create, I am losing only one of them.”

Review: The Country of the Blind: A Memoir at the End of Sight – Andrew Leland (Penguin Press), Life Unseen: A Story of Blindness – Selina Mills (Bloomsbury Academic)

These tensions of identity and creativity between those who are sighted and those who are blind existed long before Joyce, and are still prevalent a century later. They are explored with candour and thoughtfulness in two recent memoirs, by Selina Mills and Leland .

Like Joyce, their versions of blindness mean they have sight that gradually decreases over decades. And they are writers – both are journalists.

While their memoirs are obviously written from personal vantage points, Mills and Leland detail much more than their own stories. Interwoven with their experiences of becoming blind are the experiences of blind writers, performers, teachers, activists, inventors and so on.

Mills, who is from the UK, researched blind women throughout European history. The few famous blind women she mentions are from outside Europe (which demonstrates the need for her research). One of them is American activist and author Helen Keller (1880-1968). Another is Tilly Aston (1873-1947), also known as “Australia’s blind poet.”

As Mills’ own sight decreased, she felt surrounded by sighted people’s stereotypes of blindness. She was compelled to research the real members of her community, for herself and her readers. As she writes:

so much of our knowledge of blind people has relied on how sighted people have interpreted blindness. […] We fear it, we punish with it, we find it powerful and alluring all at the same moment and have done so for centuries. Principally, we rarely hear the voices of blind people themselves. Why not? Who were these blind people who lived and died, who were not just heroes or burdens of the sighted world?

Similarly Leland, who lives in the US, concentrates on the recent and present US blind community in order to encourage both himself and his audience to develop a more nuanced understanding of what it means to be blind:

I met people who said that their blindness meant nothing to them – that it was a mere attribute, like hair color – and others whose blindness utterly defined and upended their lives. […] I sympathized with all of these positions, even as I wondered which attitudes I would adopt for my own life. I tried to understand how blindness was changing my identity as a reader and a writer, as a husband and a father, as a citizen and an otherwise privileged white guy.

Read more: The amateur’s age of unriddling: Finnegans Wake on stage

What blind people have in common

I was drawn to both books by their exploration of historical and philosophical questions. But as I read, Leland and Mills’ experiences of being blind with some sight also became compelling for how universal they are.

I have talked with many people losing sight as they transition to blindness, and am well aware of the shape of the sight-loss journey. Yet these books emphasised to me the significant number of experiences blind people have in common, regardless of how much sight we have, or where we live, or when we were born.

Mills and Leland have both been losing sight for two decades now. But they began at different levels of sight and the cause was different for each of them.

Leland’s sight loss began as night blindness when he was a teenager. His research on the early internet suggested the cause was retinitis pigmentosa (RP), a degenerative condition where night blindness is followed by peripheral vision loss, then central vision loss, sometimes ending in total blindness. After his first year of college, he went to an eye clinic where his self-diagnosis was confirmed.

Read more: Happy birthday, Braille: how writing you can touch is still helping blind people to read and learn

Leland’s interest in understanding blindness as an identity develops another dimension when he learns his retinitis pigmentosa is part of his Ashkenazi Jewish heritage. He discovers that throughout history, blind people and Jewish people were often denigrated in similar ways.

Medieval literature and disability studies researcher Edward Wheatley points out, for example, that both groups were branded as greedy, lazy, and dishonest. And both groups were said to be responsible for their marginalisation by Christian society – Jewish people for refusing to convert, and blind people for sinfulness.

Significantly, both blind people and Jewish people were early and constant victims of the Nazis. And the threat multiplied if you belonged to both groups.

Read more: Disabled people were Holocaust victims, too: they were excluded from German society and murdered by Nazi programs

The borderlands between blind and sighted

Mills’ sight began to decrease in her early thirties. However, she was already accustomed to living in the borderlands between blind and sighted: she was born with no sight in one eye.

Growing up, she attended mainstream schools. Her childhood, though, had many experiences in common with other blind children. Teachers incorrectly assumed that she had learning difficulties when she was six and she got a prosthetic eye when she was ten. She was left to drift rather than being supported throughout her schooling and she finished school without having been taught braille or how to use a cane.

Having only spent time with sighted people, she was used to thinking of herself as similar to them, even though she was often exhausted and they were not.

In her twenties, she became a journalist and travelled throughout Europe. She only sometimes carried a cane, just as a precaution. Mills was in her early thirties when bus numbers and step edges became difficult to see. This prompted her to go to an ophthalmologist, who discovered she had an inoperable cataract.

Other people’s prejudice

Mills and Leland have to manage a range of emotions that accompany losing sight, as well as the reactions of their families and friends. But the most difficult aspect of being blind, they discover, is other people’s prejudice.

Echoing the experiences of the blind people whose lives they explore, they are exhausted by the frequency and variety of prejudice they have to manage in their daily lives.

Sometimes it is overt: being denied education or work, being told to not have sex or have children, being refused entry to a venue if not accompanied by a sighted person. Sometimes it is questions disguised as concern – about whether you can cook, or how you are sure you have performed a work task properly, or whether you actually need to learn braille.

It always contains the message that being sighted is superior to being blind, and blind people should feel envious of sighted people and ashamed of who we are.

I suspect it was this prejudice Joyce was reacting to when he said, “What the eyes bring is nothing.” I don’t think he meant he had no use at all for the tiny amount of sight he had. I think he was exasperated by so many people continuing to insist it must be more difficult for him to write as a blind person. Certainly, he felt sight was not a prerequisite for creativity and that blindness had enhanced his writing.

This prejudice even extends to sighted people believing they have the knowledge to distinguish between blind and sighted strangers within seconds of seeing them. And they believe they are entitled to call out anyone they are convinced is faking it.

This happens to Mills at a train ticket barrier when the guard asks her for her ticket, then for her disabled person’s travel card. Like most blind people, she keeps the card in a specific place in her wallet, ready for these occasions. But the guard associates blindness with slowness and incompetence, so takes her organisation as evidence she is faking blindness:

“How did you get that then?” “Get what?” “Your disability travel card? – I mean, you can see all right, can’t you?” Having learnt to be patient with other non-believers, I was calm. “Oh, I know, but I have only got about 20 per cent vision on a good day. The doctors tested me.” Unconvinced, the guard continued: “You think you can get your card, and just get away with it. I saw you walking down the platform, bright and breezy. You are faking it!” He was quite proud of his little diatribe and seemed unkeen to let me through unless I confessed to my high crimes and misdemeanours.

Fortunately she has an irrefutable piece of evidence – her prosthetic eye, which she removes and presents to the guard:

“ The queue gasped. I was shaking with fury. You really think I had my real eye plucked out and went through the pain of having a false eye made, just to get a discount on my f*king train ticket?

Blind people are harassed in this way regardless of our level of sight. As a totally blind person, I have many similar anecdotes. However, these experiences can have a particularly devastating effect on someone adjusting to blindness.

Both Mills and Leland discuss how incidents like this make them reluctant to use a cane. "Sometimes I left the cane behind, just to have a day off from the reactions, but the falling over and bashing into lampposts is not always worth it,” writes Mills. “The more I need to use my cane to find curbs and doorways, the more patronizing and intrusive (and sometimes hostile) strangers become,” echoes Leland.

Read more: Henry Lawson and Judith Wright were deaf – but they’re rarely acknowledged as disabled writers. Why does that matter?

Blind women from history

Connecting with other blind people helps both Leland and Mills not just accept, but value their blindness. The blind people they encounter show them how to minimise the effect of sighted prejudice on their identity, and to understand that being blind is inherently creative.

Mills connects with blind women from history who deserve to be better known. And it is thrilling to learn about them with her, and to know that details of their lives are finally more publicly accessible.

They include Saint Odile of Alsace (an area now occupied by France and Germany), born in 660 AD, who travelled throughout Europe and founded two monasteries. Therese-Adele Husson , born in 1803, was a French writer of children’s books and romantic fiction. And Maria Theresia von Paradis , born in 1759 in Austria, was a talented pianist from a young age.

As an adult, Maria Theresia’s life was divided between being subjected to one horrific so-called cure after another and performing throughout Europe. She was friends with Haydn, as well as Mozart – who composed a piano concerto for her. She was a composer herself, of more than five operas and more than 30 sonatas, and in Vienna she established one of the first schools for blind musicians.

As Mills points out, “unlike Mozart and Haydn and a few other known women composers, who died penniless or unpublished, she had what few musicians had in the age – a successful profession and an income.”

Developing a blind identity

Leland feels connected to a number of 20th-century blind writers, such as James Joyce, and to many current blind writers, as well as advocates, engineers and artists.

Many blind people devoted years of their lives to argue for the rights of all disabled people to have equal access to public spaces, education, employment and more.

Meanwhile, so much technology in everyday use over the last century has been created or enhanced by blind people, from long-play records to internet chat forums. And every step of the way, many blind people generously shared their knowledge to help others who were still developing their skills.

One of the people who shared their knowledge with Leland was American activist and teacher Barbara Loos. Leland met Loos at a blindness convention. She encouraged him to attend the residential training course that later accelerates Leland’s cane skills and confidence.

She then pinpoints the problems with how he’d been taught to read braille. This sets him on the path to reestablishing and reinvigorating his identity as a reader by learning to read braille correctly and obtaining a braille display – a device that connects to a computer and displays the screen one line at a time.

once I’d finished my last course, I brought it [the braille display] out again, and fell in love. Reading on the braille display was a palliative against my anxiety about going blind. The more facility I gained with it, the more I could imagine a rich life for myself as a blind reader.

Reading these books, and the lives and work they explore, I feel extremely proud of my community.

• James Joyce
• Finnegans Wake
• Disability coverage

Research Fellow

Senior Research Fellow - Women's Health Services

Lecturer / Senior Lecturer - Marketing

Assistant Editor - 1 year cadetship

Executive Dean, Faculty of Health

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health; Welp A, Woodbury RB, McCoy MA, et al., editors. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington (DC): National Academies Press (US); 2016 Sep 15.

Making Eye Health a Population Health Imperative: Vision for Tomorrow.

• Hardcopy Version at National Academies Press

3 The Impact of Vision Loss

Vision loss has a significant impact on the lives of those who experience it as well as on their families, their friends, and society. The complete loss or the deterioration of existing eyesight can feel frightening and overwhelming, leaving those affected to wonder about their ability to maintain their independence, pay for needed medical care, retain employment, and provide for themselves and their families. The health consequences associated with vision loss extend well beyond the eye and visual system. Vision loss can affect one's quality of life (QOL), independence, and mobility and has been linked to falls, injury, and worsened status in domains spanning mental health, cognition, social function, employment, and educational attainment. Although confounding factors likely contribute to some of the harms that have been associated with vision impairment, testimony from visually impaired persons speaks to the significant role that vision plays in health, vocation, and social well-being.

The economic impact of vision loss is also substantial. One national study commissioned by Prevent Blindness found that direct medical expenses, other direct expenses, loss of productivity, and other indirect costs for visual disorders across all age groups were approximately $139 billion in 2013 dollars ( Wittenborn and Rein, 2013 ), with direct costs for the under-40 population reaching $14.5 billion dollars ( Wittenborn et al., 2013 ). These costs affect not only national health care expenditures, but also related expenses and the resources of individuals and their families. For example, Köberlein and colleagues (2013) found that the time spent by caregivers increases substantially as vision decreases.

This chapter explores the impact of chronic vision loss in the United States—both in terms of its financial costs and its effects on QOL. The first two sections of the chapter details the consequences of vision impairment and the relationship between chronic vision impairment and other chronic conditions. The third section of this chapter provides an overview of the economic impact of vision loss on individuals, insurers, and society, including estimates of direct and indirect costs, and life years lost. The final section discusses the state of cost-effectiveness research for clinical eye and vision care.

• CONSEQUENCES OF VISION IMPAIRMENT

Quality of Life

Vision impairment is associated with a reduced QOL, which is a “complex trait that encompasses vision functioning , symptoms, emotional well-being, social relationships, concerns, and convenience as they are affected by vision” ( Lamoureux and Pesudovs, 2011, p. 195 ). Numerous studies have shown that vision impairment is often associated with various negative health outcomes and poor QOL ( Chia et al., 2006 ; Langelaan et al., 2007 ). A recent study using Behavioral Risk Factor Surveillance System (BRFSS) data from 22 states examined unadjusted health-related QOL among individuals ages 40 to 64 years by visual impairment status and found that the percentage of individuals reporting life dissatisfaction, fair or poor reported health, physical and mental unhealthy days, and days of limited activity increased as the self-reported severity of vision impairment increased ( Crews et al., 2016b ) (see Table 3-1 ). An earlier study found similar results among people ages 65 and older ( Crews et al., 2014 ). Based on a variety of measurement instruments, reduced QOL has been related to the severity of disease in glaucoma, cataract, age-related macular degeneration, and strabismus ( Chai et al., 2009 ; Chatziralli et al., 2012 ; Cheng et al., 2015 ; Freedman et al., 2014 ; Hassell et al., 2006 ; Orta et al., 2015 ). Although greater emphasis is traditionally placed on the better-seeing eye's role in visual function, one study concluded that the worse-seeing eye contributes importantly to patients' estimates of vision-related QOL, particularly when the underlying eye disease affects peripheral vision (e.g., in the case of glaucoma) ( Hirneiss, 2014 ).

Unadjusted Health-Related Quality of Life Among Those Ages 40 to 60 by Visual Impairment Status in 22 States, 2006 to 2010, United States.

A study by Rein and colleagues (2007) found that the QOL begins to slowly decline with the onset of vision loss, and then decreases more precipitously as measures of visual field defects increase. A systematic literature review of studies that reported QOL in patients with central vision loss or peripheral vision loss, and found that both types of vision loss were associated with similar degrees of detriment to QOL, although “different domains were affected” which “might be a function of the pathology of diseases” ( Evans et al., 2009, p. 433 ). A recent Korean study, using the EQ-5D instrument 1 examined QOL scores based on whether participants were visually impaired 2 and whether they had 1 of 14 chronic conditions. The authors found that QOL scores in persons with each of the 14 chronic conditions, excepting coronary artery disease, were lower among individuals with that condition alone than individuals who also had any co-existing vision impairment ( Park et al., 2015 ). The impact of vision impairment on people with chronic conditions is explored further later in this chapter.

Two studies indicated that the QOL impact of vision loss may be perceived differently by health care providers than by the patients themselves. One study administered time-trade-off utilities to Canadian medical students and patients for different levels of vision loss (anchors were death = 0 and perfect vision = 1.0); the study found that medical students tended to underestimate the impact of vision loss ( Chaudry et al., 2015 ). In a similar study in China, utility values for mild glaucoma and severe glaucoma were obtained from glaucoma patients and ophthalmologists; the ophthalmologists' utility ratings for mild glaucoma were significantly higher than the patients', suggesting that physicians may underestimate the impact of mild glaucoma on QOL ( Zhang et al., 2015 ).

Loss of vision affects patients' ability to work or care for themselves (or others), and it affects numerous casual activities such as reading, socializing, and pursuing hobbies ( Brown et al., 2014 ). Vision impairment makes it more difficult to perform the basic self-care activities of daily living such as eating and dressing as well as instrumental activities of daily living such as shopping, financial management, medication management, and driving ( Brown et al., 2014 ; Haymes et al., 2002 ; Whitson et al., 2007 , 2014 ). Most studies have found that vision loss has a greater impact on dependency in instrumental activities of daily living than in basic activities of daily living. The instrumental activities of daily living are critical to one's ability to function in modern society. In particular, the loss of near vision affects one's ability to perform a variety of tasks that involve reading (e.g., getting information from medication labels, balancing bank statements, or following recipes), recognizing faces and images (e.g., socializing, playing cards, using a smartphone), or manipulating small objects (e.g., sewing, replacing batteries). One cross-sectional study found that individuals with visual impairment, defined as a best-corrected binocular presenting visual acuity of 20/30 or worse, had greater disability across functional measures, such as task performance, walking speeds, and driving when compared to people with normal vision and even uncorrected refractive error 3 ( Zebardast et al., 2015 ). Visual field deficits affect one's ability to perform tasks that require ambulation in challenging settings (e.g., moving along crowded city streets, negotiating stairwells) or the use of peripheral vision (e.g., driving).

Due to the challenges that vision impairment imposes for independent living, older adults with vision impairment may be more likely to require long-term care. In the Australian Blue Mountains Eye Study, with each line of reduction in presenting visual acuity at baseline, there was a 7 percent increased risk of subsequent nursing home placement ( Wang et al., 2003 ). For participants in the Beaver Dam Eye Study, the odds ratio for nursing home placement was 4.23 (95% confidence interval [CI] = 2.34, 7.64) for low best-corrected visual acuity in the better eye, 5.00 (95% CI = 2.28, 10.94) for poor near vision, and 2.40 (95% CI = 1.46, 3.92) for poor contrast sensitivity, after adjustment for age, sex, self-rated health, and arthritis ( Klein et al., 2003 ).

For persons with vision loss who desire to be a part of the workforce, vision impairment often poses barriers to employment opportunities ( O'Day, 1999 ). Unfortunately, employment statistics pertaining to Americans with vision loss are lacking because available nationally representative data sources, such as the U.S. Census, group persons with vision impairment with all people who have sensory impairments or with people with sensory or communication impairments ( U.S. Census Bureau, 2014 ).

Mobility and Falls

In a person with intact eyesight, the primary sense used to navigate three-dimensional space is vision. Mobility is therefore greatly affected by vision loss, whether resulting from changes in visual acuity, visual fields, depth perception, or contrast sensitivity ( Bibby et al., 2007 ; Lord and Dayhew, 2001 ; Marron and Bailey, 1982 ). In the Salisbury Eye Evaluation (SEE) project, vision impairment (defined by visual acuity or visual field deficit) was significantly associated with self-reported difficulty with walking or going up or down steps ( Swenor et al., 2013 ). Also in the SEE project, visual field deficits—but not visual acuity or contrast sensitivity deficits—were predictive of a slower-than-usual gait speed while navigating an obstacle course ( Patel et al., 2006 ). A study from the United Kingdom found that 46 percent of frail elderly individuals admitted for hip fracture in two hospital districts had visual impairment, most frequently untreated cataract (49 percent) and macular degeneration (21 percent), but also uncorrected refractive error (17 percent); the visually impaired hip fracture patients were less likely than those without vision impairment to be under an eye provider's care and more likely to live in areas of social deprivation ( Cox et al., 2005 ). In the Low Vision Rehabilitation Outcomes Study, 16.3 percent of participants referred to vision rehabilitation at 28 U.S. centers indicated that one of their chief vision-related problems was mobility ( Brown et al., 2014 ).

Multiple peer-reviewed studies have documented a relationship between vision impairment and falls ( Crews et al., 2016a ; Lord, 2006 ). A 2016 study by Crews and colleagues that used 2014 BRFSS data to analyze the state-specific annual prevalence of falls among persons aged 65 years or older found that 46.7 percent of persons with severe vision impairment (state prevalence range 30.8–59.1 percent) and 27.7 percent of older adults without such impairment (state prevalence range 20.4–32.4 percent) reported having fallen during the previous year ( Crews et al., 2016a ). The visual parameters that have been strongly and consistently associated with falls include poor contrast sensitivity, reduced depth perception, and visual field loss ( de Boer et al., 2004 ; Ivers et al., 1998 ; Klein et al., 2003 ; Lord and Dayhew, 2001 ; Lord et al., 1991 , 1994 ; Nevitt et al., 1989 ). A review of studies that reported the univariate relationship between visual deficits (defined variously) and falls found that the relative risk ratios across studies was 2.5 (CI = 1.6, 3.5) ( Rubenstein and Josephson, 2002 ).

Evidence is limited or conflicting on the need for vision assessment and specific interventions to reduce falls among visually impaired populations. The U.S. Preventive Services Task Force determined that vision correction was among several potential interventions that “lack[ed] sufficient evidence for or against use in prevention of falls in community-dwelling older adults” ( Moyer, 2012, p. 200 ; see also, Schneider et al., 2012 ). Unfortunately, the visual deficits most strongly linked to fall risk (contrast sensitivity, depth perception, and visual field deficits) are generally less amenable to remediation than visual acuity. Other factors such as weakness, other chronic conditions, and the use of medications are also associated with falls, suggesting that successful interventions to reduce falls in visually impaired populations will require a multi-pronged approach ( Steinman et al., 2011 ). Evidence is needed to determine which training aspects, equipment, and environmental modifications are most effective at reducing falls and improving mobility. However, it is the committee's assessment that there remains a role for vision rehabilitation in mitigating fall risk associated with vision loss.

Vision impairment has been shown to be associated with an increased risk of fractures in multiple studies. In the Framingham Eye Study, which included a subset of participants from the Framingham Study Cohort, those participants with visual acuity worse than 20/100 were more than twice as likely to have had hip fractures than participants with visual acuity of 20/25 or better (relative risk [RR] = 2.17; 95% CI = 1.24, 3.80) ( Felson et al., 1989 ). In the EPIDOS Prospective Study, among a prospective cohort of 7,575 French women, those with visual acuity of 2/10 (using the decimal Snellen fraction, thus equivalent to 20/100) or worse had a RR of 4.3 (95% CI = 3.1, 6.1) of hip fracture compared to those with visual acuity better than 7/10 (roughly equivalent to 20/30) (RR = 1.0) ( Dargent-Molina et al., 1996 ). Various other aspects of visual impairment besides poor visual acuity have been shown to be associated with an increased fracture risk. In the Study of Osteoporotic Fractures, white women in the lowest quartile of depth perception measures were estimated to have a 40 percent increased risk of fractures compared with women in the other three quartiles (RR = 1.4; 95% CI = 1.0, 1.9), and the risk of fractures increased by 20 percent for each standard deviation decrease in low-frequency contrast sensitivity (RR = 1.2; 95% CI = 1.0, 1.5) ( Cummings et al., 1995 ). Furthermore, in the same cohort, women with mild, moderate, or severe binocular visual field loss had an increased risk of hip fractures when compared with women without binocular visual field loss, and women with moderate or severe visual field loss had an increased risk of non-hip and non-spine fractures compared with women without binocular visual field loss ( Coleman et al., 2009 ).

Studies have suggested that reversing vision impairment from cataract may be protective against fractures. A randomized controlled trial that evaluated expedited versus routinely scheduled cataract surgery in 306 women found that women with expedited cataract surgery had a 67 percent lower risk of fractures within 1 year after surgery than women with routinely scheduled surgery (RR = 0.33; 95% CI = 0.1, 1.0) ( Harwood et al., 2005 ). A large study of more than 1.1 million men and women with cataract in the national U.S. Medicare database found that compared to patients with cataract who did not undergo surgery, patients with cataract surgery had a 16 percent lower risk of hip fracture (odds ratio [OR] = 0.84; 95% CI = 0.81, 0.87) and a 5 percent lower risk of any fracture (OR = 0.95; 95% CI = 0.93, 0.97). Furthermore, this protective association was modified by the effects of age and systemic disease burden, and the apparent protective relationship between surgery and fracture, based on having a high Charlson Comorbidity Index score, was even stronger among participants who were elderly or ill ( Tseng et al., 2012 ).

The protective association between cataract surgery and fractures may extend beyond a reduction in fracture risk. In a recent study of the same large population of Medicare beneficiaries with cataract, those who had cataract surgery experienced 27 percent decreased risk in long-term mortality compared with those without cataract surgery (hazards ratio [HR] = 0.73; 95% CI = 0.72, 0.74) ( Tseng et al., 2016 ). Similar to what was seen in the study of cataract surgery and fractures, the protective association between cataract surgery and mortality was modified by the effects of age and systemic disease burden, where patients who were elderly or who had a moderate burden of systemic disease experienced even stronger protective effects than the overall population. Although this study did not examine the mechanisms of the protective effect between cataract surgery and mortality and the study design does not permit conclusions about causation, the reduction in the risk of fractures and accidents was proposed as a contributing factor in the reduced risk of death. The protective association between cataract surgery and mortality in this study was supported by additional data from two earlier studies in the Blue Mountains region, west of Sydney, Australia, both of which demonstrated that patients with vision improvement after cataract surgery had decreased mortality risk compared with patients with vision impairment due to cataract who had not undergone surgery or those with persistent vision impairment after cataract surgery ( Fong et al., 2013 , 2014 ).

Subsequent Injury

People with vision loss are at higher risk for several types of injury. Of these, the link between vision loss and fall-related injuries has been most clearly documented. In a population-based cohort of Latinos in California, a greater risk of injurious falls was reported in those with both central vision impairment (OR = 2.76; 95% CI = 1.10, 7.02) and peripheral vision impairment (OR = 1.40; 95% CI = 0.94, 2.05) ( Patino et al., 2010 ). A loss of visual field was associated with fall-related fractures, and a relationship between a recently acquired decline in visual acuity and falls with fracture was observed in the Blue Mountain Eye Study ( Hong et al., 2014 ; Klein et al., 2003 ). Interestingly, both falls and falls with fracture were more likely in participants with a unilateral, rather than bilateral, visual acuity deficit, which is similar to the findings of an earlier study, suggesting that poor depth perception may be a contributor to falls ( Felson et al., 1989 ). Indeed, poor depth perception has been associated with hip fracture in other epidemiological studies ( Cummings et al., 1995 ). Poor contrast sensitivity is also associated with risk of fall-related fractures ( de Boer et al., 2004 ).

In a prospective study of seniors between the ages of 75 and 80 years, lowered vision 4 at baseline was associated with an increased risk of injurious accidents requiring hospitalization over 10 years of follow-up ( Kulmala et al., 2008 ). A visual acuity worse than 0.3 on the Landolt ring chart (roughly equivalent to 20/65) was not associated with a risk of injurious accidents, possibly because persons with more severe visual impairment restricted their activities, resulting in less opportunity for injury. However, in a separate study that used the National Health Interview Survey (NHIS) to follow more than 100,000 adults for up to 7 years, severe bilateral vision impairment was associated with a risk of death due to unintentional injury (HR = 7.4; 95% CI = 3.0, 17.8) ( Lee et al., 2003 ).

Mental Health

Compared to people with normal vision, those with vision impairment are at a higher risk for depression, anxiety, and other psychological problems ( Kempen et al., 2012 ). Among older adults with vision impairment, the rates of depression and anxiety are significantly higher than among both individuals of similar ages without vision impairment and those of similar ages suffering from other chronic conditions, such as asthma or chronic bronchitis, heart conditions, and hypertension ( Kempen et al., 2012 ). Distress related to vision loss is more strongly correlated with depression than other key risk factors such as negative life events or poor health status ( Rees et al., 2010 ). Among visually impaired individuals, those with depressive symptoms report more functional limitations. The reasons for the relationship between depression and poor visual function are unclear and may be bi-directional, but patient-level differences in eye disease and general medical condition did not account for the observed relationship ( Rovner and Casten, 2002 ; Rovner et al., 2006 ). One randomized, controlled trial of an integrated mental health and vision rehabilitation program (compared with vision rehabilitation with non-directed supportive therapy) for patients with macular degeneration and subsyndromal depressive symptoms found significantly reduced rates of depression symptoms and better functional outcomes in the intervention group ( Rovner et al., 2014 ). This work suggests that some of the functional and affective consequences of vision loss are remediable.

As discussed in Chapter 2 , children with uncorrected refractive error are more likely to underperform on some metrics of academic performance ( Kulp et al., 2016 ). Academic problems have been found to be negatively associated with anxiety, with the frequency increasing with age in both children and adolescents ( Mazzone et al., 2007 ). Similarly, among adolescents, vision impairment is associated with an increased prevalence of psychopathological symptoms, including depression and anxiety ( Garaigordobil and Bernarás, 2009 ). An analysis of data from NHIS did not show evidence for a direct relationship between vision impairment and death from suicide (HR = 1.50; 95% CI = 0.90, 2.49); however, the study did indicate an indirect effect of visual impairment on death from suicide due to poorer self-rated health (HR = 1.05; 95% CI = 1.02, 1.08) and the number of non-ocular health conditions (HR = 1.12; 95% CI = 1.01, 1.24). These results suggest that people with vision impairment may be at greater risk of suicide due to vision impairment's association with poor general health ( Lam et al., 2008 ).

Several studies have found that cognitive impairment is more prevalent and progresses more rapidly in older adults with vision impairment than in those without ( Lin et al., 2004 ; Ong et al., 2013 ; Reyes-Ortiz et al., 2005 ; Rogers and Langa, 2010 ; Tay et al., 2006 ; Whitson et al., 2007 ). About 4 percent of community-dwelling persons over age 65 have both cognitive and vision impairments, making the co-occurrence of these problems more prevalent than such well-recognized conditions as Parkinson's disease and emphysema ( Whitson et al., 2007 ). People with age-related macular degeneration (AMD) have higher rates of cognitive impairment than their peers, lower scores on cognitive tests, and a higher risk of incident dementia ( Baker et al., 2009 ; Clemons et al., 2006 ; Klaver et al., 1999 ; Pham et al., 2006 ; Wong et al., 2002 ; Woo et al., 2012 ). Other studies suggest that, even without dementia, AMD patients still perform more poorly on tests of verbal fluency and memory ( Clemons et al., 2006 ; Whitson et al., 2010 , 2015; Wong et al., 2002 ). Research has failed to demonstrate a clear genetic link between AMD and dementia ( Butler et al., 2015 ; Souied et al., 1998 ). These results suggest more research is needed to fully assess the reasons behind the link between vision and cognitive impairment in adults.

In children, uncorrectable vision impairment frequently occurs in the context of comorbid conditions, making it difficult to quantify the direct impact of visual impairment and blindness on cognitive skills, academic performance, and QOL. Many children who have been diagnosed with neurodevelopmental disorders (genetic or acquired) have been found to also have an associated vision problem that has led to visual impairment. Current research focuses on determining the prevalence of these eye health and vision disorders that occur with the underlying neurodevelopmental diagnosis ( Salt and Sargent, 2014 ). For example, children with cerebral palsy have been found to have a higher prevalence of strabismus, visual impairment due to uncorrected refractive error, eye movement disorders, and visual perceptual deficits than normally sighted children of the same age ( Lew et al., 2015 ; Salt and Sargent, 2014 ). A higher rate of vision impairment has also been documented for children with Down syndrome ( Cregg et al., 2003 ). It is difficult to ascertain the influence of the vision loss on cognitive or academic function in diagnoses that are already associated with cognitive impairment. One study demonstrated that children diagnosed with toxoplasmosis who present with reduced vision perform more poorly than children diagnosed with toxoplasmosis without vision impairment on verbal and performance measure of intellectual ability ( Roizen et al., 2006 ). A meta-analysis on children with cerebral palsy found that visual perceptual deficits were prevalent in those children but none of the studies had a control comparison group ( Ego et al., 2015 ). These children often perform below the level expected for their chronological ages, yet they have neither been categorized as visually impaired, nor referred for services ( Flanagan et al., 2003 ).

Although an association exists between vision impairment—as well as some specific eye disorders—and cognition, the mechanisms underlying this relationship are unclear. One possibility is that diseases of the eye have a negative effect on cognitive processes, either directly or indirectly. In people with vision impairment, the loss of cognitively stimulating activities, such as reading, may diminish other cognitive abilities ( Lindenberger and Baltes, 1994 ). Additionally, the brain is known to change in response to decreased visual input, and these changes may affect regions or neuronal pathways that support cognitive processes ( Liu et al., 2007 , 2010 ; Pascual-Leone et al., 2005 ). A second possibility is the “common cause” theory, which holds that genetic, environmental, or medical risk factors cause disease in the brain and eye simultaneously ( Klaver et al., 1999 ; Lindenberger and Baltes, 1994 ). Another possibility is that confounding factors, such as behavior and economic status, contribute to the observed relationship between vision impairment and cognitive impairment.

Hearing Impairment

The prevalence of co-existing impairment in vision and hearing, also referred to as dual sensory impairment (DSI), increases markedly with age. A range from 9 to 21 percent of adults over the age of 70 possess some degree of DSI ( Saunders and Echt, 2007 ). In an Australian cohort, the prevalence of DSI was even higher, reported to be 26.8 percent in participants ages 80 and older ( Schneider et al., 2012 ). In a cross-sectional study of a random sample of 446 older adults (mean age 79.9 years) from Marin County, California, eight measures of visual ability were associated with risk of hearing impairment (defined as moderate bilateral hearing loss, threshold >40 dB) ( Schneck et al., 2012 ). However, the relationship between vision impairment and hearing impairment only achieved statistical significance for three measures of visual acuity in low contrast conditions. Additional research is needed to determine whether vision loss is an independent risk factor for hearing loss and, if so, what factors underlie this relationship.

Several studies report associations between vision impairment and an increased risk for all-cause and injury-related mortality, as compared to controls with normal vision ( Christ et al., 2014 ; Lam et al., 2008 ; Lee et al., 2002 , 2003 ; Zheng et al., 2014 ). One possible cause of the greater mortality in visually impaired people may be their elevated risk of accidents and falls. In the longitudinal study by Christ and colleagues (2014) , the relationship between worse visual acuity and mortality was mediated by disability in instrumental activities of daily living, which suggests that some deaths may result from an impaired ability for self-care and disease management.

The relationship between vision impairment and mortality is certainly confounded by medical conditions (e.g., diabetes, obesity, hypertension, autoimmune disorders), lifestyle factors (e.g., smoking, alcohol use), and socio-demographic factors (e.g., race, age, socioeconomic disadvantage). As detailed in the next section, the complicated interplay between eye health and other medical comorbidities is an important factor in monitoring and reducing the overall public health burden of vision loss.

• MULTIPLE COMORBID CONDITIONS

The Office of the Assistant Secretary for Health defines chronic conditions as, “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living” ( Goodman et al., 2013, p. 3 ). Chronic conditions are associated with an increased risk of “early mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice” ( HHS, 2010, p. 2 ; see also, Hwang et al., 2001 ; Vogeli et al., 2007 ; Wolff et al., 2002 ). Expenditures related to chronic conditions are substantial, with an estimated 66 percent of total health care spending attributable to care for Americans with multiple chronic conditions ( HHS, 2010 ). Approximately 14 percent of Medicare beneficiaries with six or more chronic conditions accounted for 46 percent of total Medicare spending in 2010, while the 32 percent of beneficiaries with one or fewer chronic conditions accounted for 7 percent of spending ( CMS, 2012 ).

Irreversible vision impairment resulting from eye disease should be considered a chronic condition; it can amplify the adverse effects of other illnesses and injuries, and people with vision loss commonly live with multiple chronic conditions. As of 2012, 117 million people had at least one chronic condition, with one in four adults reporting two or more chronic health conditions ( CDC, 2016 ). Data from the Medical Expenditure Panel Survey show that among Americans over age 65 with eye disease, four out of five also had at least one of the following conditions: hypertension, heart disease, diabetes, or arthritis ( Anderson and Horvath, 2004 ). According to a 2008 NHIS, a substantial number of people with chronic diseases reported trouble seeing: 34.8 percent of those with chronic kidney disease, 30.9 percent of those with stroke, 23.8 percent of those with coronary heart disease, 23.6 percent of those with diabetes, 22.1 percent of those with arthritis, 19.7 percent of those with patients, and 19.4 percent of those with hypertension ( Crews and Chou, 2012 ). Whether or not any causal relationship exists between vision impairment and non-ocular comorbidities, it is clear that any successful efforts to alleviate the burden of vision impairment and loss will need to take comorbidities into account.

Vision Loss Amplifies the Effects of Other Conditions

A study of individuals ages 65 and older found that patients with a visual impairment and any of several other illnesses or conditions were many times more likely to have difficulty performing basic physical and social tasks than individuals in the same age range without visual impairment and without the particular illness or condition ( Crews et al., 2006 ). For example, elderly individuals with severe depression, visual impairment, or both were 10.0, 2.9, and 23.9 times more likely, respectively, to have moderate or severe limitations in their ability to socialize than people without either severe depression or visual impairment. Table 3-2 details the increased odds of encountering difficulty when undertaking these basic physical and social tasks among persons with visual impairment or a given comorbidity, or both. Whether or not comorbid vision impairment directly caused the excess disability (which cannot be inferred from descriptive data), vision impairment may help identify high-risk individuals or individuals with unmet needs who could be targeted for services and interventions across a variety of other clinical specialties.

Adjusted Odds Ratio for the Self-Reported Difficulty Performing Tasks Among U.S. Adults Ages 65 and Older with Vision Impairment and/or Other Condition or Disease.

Both cognitive impairment and vision impairment are disabling in their own right, but the co-occurrence of the two has been associated with even higher rates of disability and low self-rated health ( Whitson et al., 2007 , 2012a ). Dual sensory impairment (concurrent vision and hearing deficits) has been associated with a higher risk of cognitive decline, disability, depression, and mortality ( Gopinath et al., 2013 ; Heine and Browning, 2014 ; Lee et al., 2007 ; Lin et al., 2004 ; Schneider et al., 2011 ). Evidence is inconclusive regarding whether the combined effects of vision impairment and other impairments (cognition or hearing) on outcomes are synergistic or merely additive ( Schneider et al., 2011 ; Whitson et al., 2007 ).

Vision Loss Complicates the Management of Other Conditions

As reviewed above, vision loss creates significant challenges in daily life. The challenge of not being able to see well can affect various vision-reliant tasks that are frequently required for good chronic disease management, including self-care (e.g., foot checks in diabetics, preparing nutritious meals) and transportation (e.g., getting to and from clinic visits). In addition, vision loss may create difficulties in medication adherence and management (e.g., reading pill bottles, ordering refills) so that individuals who develop vision loss associated with chronic conditions, such as diabetes or glaucoma, are at a disadvantage in managing those chronic conditions. For example, vision loss makes it difficult to properly administer medications such as insulin or eye drops. Thus, affected individuals are at risk of entering a “vicious cycle” of worsening health.

Other Conditions Affect the Management of Eye Disease

Comorbidities also affect patients' ability to manage and cope with their vision impairment and eye health. One area of eye care where the impact of comorbid conditions has been studied is vision rehabilitation. Both cognitive impairment and depression have been associated with worse functional outcomes in vision rehabilitation ( Rovner et al., 2002 ; Whitson et al., 2012b ). A qualitative study of 98 older adults and their companions/caregivers in an outpatient vision rehabilitation clinic identified five themes regarding the impact of comorbid medical conditions on the patients' experiences in vision rehabilitation ( Whitson et al., 2011 ). Comorbidities had the following implications for the success of vision rehabilitation: (1) concurrent medical problems resulted in fluctuating health status with “good days and bad days” that were unrelated to eye disease, (2) comorbid conditions (e.g., hearing impairment, cognitive impairment) often amplified communication barriers between patients and providers, (3) participants and caregivers felt “overwhelmed” by competing health care demands, (4) comorbidities tended to delay progress in vision rehabilitation programs because of unexpected health events (e.g., falls, hospitalization, disease flares), and (5) some barriers imposed by comorbid conditions seemed to be reduced by the effective involvement of an informal companion 5 ( Whitson et al., 2011 ). A second qualitative study focused on the impact of comorbid cognitive impairment in vision rehabilitation ( Lawrence et al., 2009 ). This study interviewed 17 individuals with co-existing vision impairment and dementia, 17 family caregivers, and 18 vision or dementia health specialists involved in the patients' care ( Lawrence et al., 2009 ). The study found that vision-related service providers felt ill equipped to manage dementia-related needs, while visual needs were accorded a low priority by those providing dementia services; a lack of collaboration between the two services led to an overcautious approach ( Lawrence et al., 2009 ).

Comorbidities can also affect patients' ability to manage specific aspects of their eye care. In particular, the administration of eye drops can be challenging for patients with a limited range of motion in the neck, with arthritis or neuropathy involving the hands, or with cognitive impairments. The precise impact of these comorbidities on medication adherence and the proper administration of eye drops merits further research, but one multisite study that video-taped glaucoma patients self-administering a single drop reported that individuals with arthritis were significantly less likely to have the drop land in their eye ( Sayner et al., 2015 ).

• OVERVIEW OF EXPENDITURES

Few studies are available that examine the total costs associated with all eye disease and vision impairment on a national level. A 2013 analysis of the economic burden of vision loss and eye disorders that was commissioned by Prevent Blindness estimated prevalence and costs from National Health and Nutrition Examination Survey (NHANES) data, Medical Expenditure Panel Survey (MEPS) data, and data from the Survey of Income and Program Participation, the 2011 U.S. Census, and federal budgets ( Wittenborn and Rein, 2013 ). This analysis estimated the direct and indirect costs attributable to vision loss and eye disease to be $138.9 billion in the United States in 2013 dollars and found that costs for individual states ranged from $250 million in Wyoming to more than $15.6 billion in California ( Wittenborn and Rein, 2013 ). 6 The direct medical costs summed across all age groups attributable to, for example, diagnosed disorders, undiagnosed visual loss, and optometry 7 visits were $48.7 billion, $3.0 billion, and $2.8 billion, respectively ( Wittenborn and Rein, 2013 ). The total direct and indirect costs for eye disorders and vision loss per payer were $47.4 billion for government entities, $22.1 billion for private insurers, and $71.7 billion for patients ( Wittenborn and Rein, 2013 ).

Table 3-3 provides a breakdown of the comprehensive costs by age group for major categories of direct and indirect costs associated with eye care in the United States. Directs costs associated with diagnosed vision impairments along with indirect costs associated with productivity loss account for approximately 70 percent of the comprehensive costs across all age groups. Medical vision aids, which include eyeglasses and contact lenses, are the next largest expense category. Nursing home expenses account for an additional 30 percent of indirect costs but are attributable only to the over-65 population. These data suggest that interventions targeting the prevention and reduction of vision impairment have the potential to reduce overall costs. Although more data are needed for a comprehensive analysis of this assertion, shifting the burden of vision expenditures away from the possible downstream consequences of severe vision impairment toward items and services that promote the earlier diagnosis and treatment of vision-threatening diseases or conditions would extend the productivity and function of populations with vision impairment.

Economic Burden of Eye Disorders and Vision Loss (in millions of dollars).

The costs of eye disorders and subsequent vision loss are shared by the government, private insurance, and individuals, including patients and families. According to a recent analysis, the $47.4 billion that the government spends annually on eye disorders and vision loss is mostly for direct medical costs and long-term care ( Wittenborn and Rein, 2013 ). One systematic review examined the average annual expense per patient in a cohort of Medicare beneficiaries and found per-patient costs in 2011 dollars to range from $12,175 to $14,029 for moderate vision impairment, $13,154 to $16,321 for severe visual impairment, and $14,882 to $24,180 for blindness ( Köberlein et al., 2013 ). In comparison, the authors cited a mean expense of $8,695 for patients with no vision loss as the control, indicating that expenses for blind individuals can sometimes be more than double the control cost at the upper end of the range ( Köberlein et al., 2013 ). The total of all these costs is substantial, considering that Medicare had 52.2 million beneficiaries in 2013 ( CMS, 2014 ).

Private insurers covered approximately one-third of the total, or $22.1 billion ( Wittenborn and Rein, 2013 ). As with public insurance, the majority of these costs ($20.8 billion) were related to direct medical costs and supplies ( Wittenborn and Rein, 2013 ). Costs associated with diagnosed disorders were by far the most substantial costs for private insurers, at more than $17 billion. The relatively small amount spent for medical vision aids ($2.6 billion) reflects the limited available reimbursement coverage and accounts for the high spending burden for such aids by the individual payer ($9.7 billion) ( Wittenborn and Rein, 2013 ). The rest of the costs are attributable to reimbursement for long-term care. The costs associated with diagnosed blindness and vision impairment averaged (across all payers) $6,680 per year ( Wittenborn and Rein, 2013 ). By way of comparison, the annual costs for all different types of diagnosed medical disorders average $3,432 per person ( Wittenborn and Rein, 2013 ). Despite the high costs associated with vision impairment and loss, the per-person costs for vision correction average only $81 per year ( Wittenborn and Rein, 2013 ). One expert suggested that the cost to expand all required pediatric vision-related services under the Patient Protection and Affordable Care Act of 2010 to all beneficiaries covered by private insurance would range from $1 to $2 per member per month ( Spahr, 2015 ).

Individuals paid for slightly more than half—$71.7 billion—of the total cost of eye disorders and vision loss, “largely due to productivity and informal care losses” ( Wittenborn and Rein, 2013, p. 5 ). Of that $71.7 billion covered by individuals, direct costs accounted for approximately $15.5 billion primarily for medical vision aids ($9.7 billion), diagnosed disorders ($4.7 billion), aids and devices ($749 million), and undiagnosed vision impairment ($372 million) ( Wittenborn and Rein, 2013 ). Indirect costs accounted for more than $56 billion of the individual costs. Those indirect costs were due to productivity losses caused by reduced workforce involvement and lower wages, the costs of informal care, and long-term care costs ( Wittenborn and Rein, 2013 ). One national survey of working age adults found that 52 percent of them had less than $1,000 on hand to pay for out-of-pocket expenses associated with the diagnosis of an unexpected serious illness; 28 percent had less than $500 ( Aflac, 2015 ).

Figure 3-1 indicates that the costs attributed to eye and vision health increase with age across all payers and that the over-65 population is responsible for the vast majority of expenses for all payers, except private insurance. This is not surprising given the individual costs attributable to specific age-related eye diseases and conditions and the prevalence of diabetes in older populations. For example, diabetic retinopathy cost the United States $493 million in 2004, with 60 percent of the direct medical costs incurred by 40 to 60 years olds ( Rein et al., 2006 ). Similarly, in 2009, the estimated costs to Medicare from glaucoma reached $748 million ( Quigley et al., 2013 ). Schmier and Levine (2013) estimated the total loss in gross domestic product related to AMD was almost $42 billion in 2012 dollars. The costs attributable to individual cases vary by the severity of the disease or condition. For example, the distribution of AMD-associated costs varies by disease stage, “with greater cost for diagnosis procedures with earlier AMD and more on caregiving and institutional care with wet AMD” ( Schmier and Levine, 2013 ). One study found a four-fold increase in direct ophthalmology-related costs between asymptomatic ocular hypertension/earliest glaucoma ($623 per year) and end-stage glaucoma/blindness ($2,511 per year) ( Varma et al., 2011 ). The authors suggested that “early identification and treatment of patients with glaucoma and those with ocular hypertension at high risk of developing vision loss may reduce the individual burden of disease on [health-related quality of life] and also may minimize personal and societal economic burdens” (p. 5).

Costs by payer by age group for eye and vision health. a “Comprehensive” is the cumulative sum of costs borne by the three payer categories: patient, government, and insurance providers. b Government total includes transfer payment costs (more...)

In addition to incurring direct costs related to vision care, people with vision impairment tend to experience a lower QOL and decreased health status (as discussed in this chapter), and vision loss can complicate and exacerbate other comorbid conditions, driving up costs and worsening outcomes. For example, Bramley and colleagues (2008) demonstrated among Medicare beneficiaries with glaucoma that patients with any vision loss had 46.7 percent higher costs compared with patients without vision loss; the higher costs were the result of the increased risk for nursing home admission, depression, falls, accidents, and injury. These outcomes account for some of the most substantial health expenditures. As such, in order to secure population-level improvements in the field it will be critical to understand that the costs associated with vision impairment and eye disease are borne not only by individuals, but also by their caregivers, taxpayers, and employers. Without dedicated action, society as a whole will increasingly bear the burden of the direct costs from increasing yet avoidable Medicare spending and of the indirect costs from substantial lost productivity and a reduced labor force.

Vision impairment results in significant expenditures, both direct and indirect, and has the potential to affect almost every aspect of a person's life. Vision loss affects more than one's ability to see the world clearly. The consequences of vision impairment often negatively impact QOL, including the number of physical and mental unhealthy days and overall dissatisfaction with life. Individuals with vision impairment are also more likely to experience restrictions in their independence, mobility, and educational achievement, as well as an increased risk of falls, fractures, injuries, poor mental health, cognitive deficits, and social isolation.

Vision loss also amplifies the effects of other chronic conditions and is a chronic condition itself. People with a vision impairment and other illnesses or conditions are more likely to have difficulty performing tasks and reporting poor health. Vision loss can also complicate chronic disease management, including self-care, transportation to and from doctor's appointments, and the proper administration of medicine. Moreover, other conditions may affect the management of eye disease, including vision rehabilitation to improve the functionality and quality of life for those with vision impairments.

No studies are available on the total costs attributable to the promotion of eye and vision health and the economic impact of vision loss in the United States. However, the few studies available that have looked at overall direct and indirect costs found that national costs are in the billions each year and vary substantially by state. Total costs also vary by age and by payer, with substantial costs incurred by individuals, including costs of caring for family members with vision impairment. Population health approaches to improve eye and vision health will need to focus on the direct and indirect costs as objective measures of the impact of vision impairment but also as measures of equity among populations most likely to be affected by vision impairment.

• Aflac. National trends: 2015 fact sheet: Aflac workforces report. 2015. [April 7, 2016]. https://www ​.aflac.com ​/docs/awr/pdf/2015-detailed-findings ​/2015-national-fact-sheet.pdf .
• Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Reports. 2004; 119 (3):263–270. [ PMC free article : PMC1497638 ] [ PubMed : 15158105 ]
• Baker ML, Wang JJ, Rogers S, Klein R, Kuller LH, Larsen EK, Wong TY. Early age-related macular degeneration, cognitive function, and dementia: The Cardiovascular Health Study. Archives of Ophthalmology. 2009; 127 (5):667–673. [ PMC free article : PMC3001290 ] [ PubMed : 19433718 ]
• Bibby SA, Maslin ER, McIlraith R, Soong GP. Vision and self-reported mobility performance in patients with low vision. Clinical and Experimental Optometry. 2007; 90 (2):115–123. [ PubMed : 17311573 ]
• Bramley T, Peeples P, Walt JG, Juhasz M, Hansen JE. Impact of vision loss on costs and outcomes in Medicare beneficiaries with glaucoma. Archives of Ophthalmology. 2008; 126 (6):849–856. [ PubMed : 18541852 ]
• Brown JC, Goldstein JE, Chan TL, Massof R, Ramulu P., Low Vision Research Network Study Group. Characterizing functional complaints in patients seeking outpatient low-vision services in the United States. Ophthalmology. 2014; 121 (8):1655–1662. e1651. [ PMC free article : PMC6746569 ] [ PubMed : 24768243 ]
• Butler JM, Sharif U, Ali M, McKibbin M, Thompson JP, Gale R, Yang YC, Inglehearn C, Paraoan L. A missense variant in CST3 exerts a recessive effect on susceptibility to age-related macular degeneration resembling its association with Alzheimer’s disease. Human Genetics. 2015; 134 (7):705–715. [ PMC free article : PMC4460273 ] [ PubMed : 25893795 ]
• CDC (Centers for Disease Control and Prevention). Chronic disease overview. 2016. [April 7, 2016]. http://www ​.cdc.gov/chronicdisease ​/overview .
• Chai Y, Shao Y, Lin S, Xiong K, Chen W, Li Y, Yi J, Zhang L, Tan G, Tang J. Vision-related quality of life and emotional impact in children with strabismus: A prospective study. Journal of International Medical Research. 2009; 37 (4):1108–1114. [ PubMed : 19761693 ]
• Chatziralli IP, Sergentanis TN, Peponis VG, Papazisis LE, Moschos MM. Risk factors for poor vision-related quality of life among cataract patients. Evaluation of baseline data. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2012; 251 (3):783–789. [ PubMed : 23150044 ]
• Chaudry I, Brown GC, Brown MM. Medical student and patient perceptions of quality of life associated with vision loss. Canadian Journal of Ophthalmology. 2015; 50 (3):217–224. [ PubMed : 26040222 ]
• Cheng HC, Guo CY, Chen MJ, Ko YC, Huang N, Liu CJL. Patient-reported vision-related quality of life differences between superior and inferior hemifield visual field defects in primary open-angle glaucoma. JAMA Ophthalmology. 2015; 133 (3):269–275. [ PubMed : 25429608 ]
• Chia EM, Mitchell P, Ojaimi E, Rochtchina E, Wang JJ. Assessment of vision-related quality of life in an older population subsample: The Blue Mountains Eye Study. Ophthalmic Epidemiology. 2006; 13 (6):371–377. [ PubMed : 17169850 ]
• Christ SL, Zheng DD, Swenor BK, Lam BL, West SK, Tannenbaum SL, Munoz BE, Lee DJ. Longitudinal relationships among visual acuity, daily functional status, and mortality: The Salisbury Eye Evaluation study. JAMA Ophthalmology. 2014; 132 (12):1400–1406. [ PMC free article : PMC7894742 ] [ PubMed : 25144579 ]
• Clemons TE, Rankin MW, McBee WL. Cognitive impairment in the Age-Related Eye Disease Study: AREDS report no. 16. Archives of Ophthalmology. 2006; 124 (4):537–543. [ PMC free article : PMC1472655 ] [ PubMed : 16606880 ]
• CMS (Centers for Medicare & Medicaid Services). Chronic conditions among Medicare beneficiaries. Baltimore, MD: CMS; 2012.
• CMS (Centers for Medicare & Medicaid Services). Medicare enrollment—National trends 1966–2013. Baltimore, MD: CMS; 2014. [March 7, 2016]. https://www ​.cms.gov/Research-Statistics-Data-and-Systems ​/Statistics-Trends-andReports ​/MedicareEnrpts/Downloads/SMI2013 ​.pdf .
• Coleman AL, Cummings SR, Ensrud KE, Yu F, Gutierrez P, Stone KL, Cauley JA, Pedula KL, Hochberg MC, Mangione CM. Visual field loss and risk of fractures in older women. Journal of the American Geriatric Society. 2009; 57 (10):1825–1832. [ PMC free article : PMC3355977 ] [ PubMed : 19702619 ]
• Cox A, Blaikie A, MacEwen CJ, Jones D, Thompson K, Holding D, Sharma T, Miller S, Dobson S, Sanders R. Visual impairment in elderly patients with hip fracture: Causes and associations. Eye (London). 2005; 19 (6):652–656. [ PubMed : 15332096 ]
• Cregg M, Woodhouse JM, Stewart RE, Pakeman VH, Bromham NR, Gunter HL, Trojanowska L, Parker M, Fraser WI. Development of refractive error and strabismus in children with Down syndrome. Investigative Ophthalmology & Visual Science. 2003; 44 (3):1023–1030. [ PubMed : 12601024 ]
• Crews J, Chou CF. Vision impairment and multiple chronic conditions: Findings from the 2002, 2008 National Health Interview Survey. 2012. [April 7, 2016]. http: ​//visionproblemsus ​.org/presentations/Crews.pdf .
• Crews JE, Jones GC, Kim JH. Double jeopardy: The effects of comorbid conditions among older people with vision loss. Journal of Visual Impairment and Blindness. 2006; 100 :824.
• Crews JE, Chou CF, Zhang X, Zack MM, Saaddine JB. Health-related quality of life among people aged ≥65 years with self-reported visual impairment: Findings from the 2006–2010 Behavioral Risk Factor Surveillance System. Ophthalmic Epidemiology. 2014; 21 (5):287–296. [ PMC free article : PMC4924345 ] [ PubMed : 24955821 ]
• Crews JE, Chiu-Fung Chou CF, Stevens JA, Saadine JB. Falls among persons aged > 65 years with and without severe vision impairment—United States, 2014. Morbidity and Mortality Weekly Report. 2016a; 65 (17):433–437. [ PubMed : 27148832 ]
• Crews JE, Chou CF, Zack MM, Zhang X, Bullard KM, Morse AR, Saaddine JB. The association of health-related quality of life with severity of visual impairment among people aged 40–64 years: Findings from the 2006–2010 Behavioral Risk Factor Surveillance System. Ophthalmic Epidemiology. 2016b; 23 (3):145–153. [ PMC free article : PMC4924343 ] [ PubMed : 27159347 ]
• Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. New England Journal of Medicine. 1995; 332 (12):767–773. [ PubMed : 7862179 ]
• Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott A, Hausherr E, Meunier P, Breart G. Fall-related factors and risk of hip fracture: The EPIDOS prospective study. Lancet. 1996; 348 (9021):145–149. [ PubMed : 8684153 ]
• de Boer MR, Pluijm SM, Lips P, Moll AC, Volker-Dieben HJ, Deeg DJ, van Rens GH. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. Journal of Bone and Mineral Research. 2004; 19 (9):1539–1547. [ PubMed : 15312256 ]
• Ego A, Lidzba K, Brovedani P, Belmonti V, Gonzalez-Monge S, Boudia B, Ritz A, Cans C. Visual–perceptual impairment in children with cerebral palsy: A systematic review. Developmental Medicine & Child Neurology. 2015; 57 (s2):46–51. [ PubMed : 25690117 ]
• Evans K, Law SK, Walt J, Buchholz P, Hansen J. The quality of life impact of peripheral versus central vision loss with a focus on glaucoma versus age-related macular degeneration. Clinical Ophthalmology. 2009; 3 :433–445. [ PMC free article : PMC2724034 ] [ PubMed : 19684867 ]
• Felson DT, Anderson JJ, Hannan MT, Milton RC, Wilson PW, Kiel DP. Impaired vision and hip fracture: The Framingham Study. Journal of the American Geriatric Society. 1989; 37 (6):495–500. [ PubMed : 2715555 ]
• Flanagan N, Jackson A, Hill A. Visual impairment in childhood: Insights from a community-based survey. Child: Care, Health and Development. 2003; 29 (6):493–499. [ PubMed : 14616907 ]
• Fong CSU, Mitchell P, Rochtchina E, Teber ET, Hong T, Wang JJ. Correction of visual impairment by cataract surgery and improved survival in older persons: The Blue Mountains Eye Study cohort. Ophthalmology. 2013; 120 (9):1720–1727. [ PubMed : 23664468 ]
• Fong CSU, Mitchell P, Rochtchina E, De Loryn T, Tan AG, Wang JJ. Visual impairment corrected via cataract surgery and 5-year survival in a prospective cohort. American Journal of Ophthalmology. 2014; 157 (1):163–170. e161. [ PubMed : 24161249 ]
• Freedman BL, Jones SK, Lin A, Stinnett SS, Muir KW. Vision-related quality of life in children with glaucoma. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2014; 18 (1):95–98. [ PMC free article : PMC3973725 ] [ PubMed : 24568998 ]
• Garaigordobil M, Bernarás E. Self-concept, self-esteem, personality traits and psychopathological symptoms in adolescents with and without visual impairment. Spanish Journal of Psychology. 2009; 12 (01):149–160. [ PubMed : 19476228 ]
• Goodman RA, Posner SF, Huang ES, Parekh AK, Koh HK. Defining and measuring chronic conditions: Imperatives for research, policy, program, and practice. Preventing Chronic Disease. 2013; 10 :E66. [ PMC free article : PMC3652713 ] [ PubMed : 23618546 ]
• Gopinath B, Schneider J, McMahon CM, Burlutsky G, Leeder SR, Mitchell P. Dual sensory impairment in older adults increases the risk of mortality: A population-based study. PLoS ONE. 2013; 8 (3):e55054. [ PMC free article : PMC3587637 ] [ PubMed : 23469161 ]
• Harwood RH, Foss A, Osborn F, Gregson R, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: A randomised controlled trial. British Journal of Ophthalmology. 2005; 89 (1):53–59. [ PMC free article : PMC1772474 ] [ PubMed : 15615747 ]
• Hassell J, Lamoureux E, Keeffe J. Impact of age related macular degeneration on quality of life. British Journal of Ophthalmology. 2006; 90 (5):593–596. [ PMC free article : PMC1857044 ] [ PubMed : 16622089 ]
• Haymes SA, Johnston AW, Heyes AD. Relationship between vision impairment and ability to perform activities of daily living. Ophthalmic and Physiologic Optics. 2002; 22 (2):79–91. [ PubMed : 12014491 ]
• Heine C, Browning CJ. Mental health and dual sensory loss in older adults: A systematic review. Frontiers in Aging Neuroscience. 2014; 6 :83. [ PMC free article : PMC4030176 ] [ PubMed : 24860496 ]
• HHS (U.S. Department of Health and Human Services). Multiple chronic conditions—A strategic framework: Optimum health and quality of life for individuals with multiple chronic conditions. Washington, DC: HHS; 2010.
• Hirneiss C. The impact of a better-seeing eye and a worse-seeing eye on vision-related quality of life. Clinical Ophthalmology. 2014; 8 :1703–1709. [ PMC free article : PMC4159393 ] [ PubMed : 25214763 ]
• Hong T, Mitchell P, Burlutsky G, Samarawickrama C, Wang JJ. Visual impairment and the incidence of falls and fractures among older people: Longitudinal findings from the Blue Mountains Eye Study. Investigative Ophthalmology & Visual Science. 2014; 55 (11):7589–7593. [ PubMed : 25370514 ]
• Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Affairs (Millwood). 2001; 20 (6):267–278. [ PubMed : 11816667 ]
• Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: The Blue Mountains Eye Study. Journal of the American Geriatric Society. 1998; 46 (1):58–64. [ PubMed : 9434666 ]
• Kempen GI, Ballemans J, Ranchor AV, van Rens GH, Zijlstra GA. The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services. Quality of Life Research. 2012; 21 (8):1405–1411. [ PMC free article : PMC3438403 ] [ PubMed : 22090173 ]
• Klaver CC, Ott A, Hofman A, Assink JJ, Breteler MM, de Jong PT. Is age-related maculopathy associated with Alzheimer’s disease? The Rotterdam Study. American Journal of Epidemiology. 1999; 150 (9):963–968. [ PubMed : 10547142 ]
• Klein BE, Moss SE, Klein R, Lee KE, Cruickshanks KJ. Associations of visual function with physical outcomes and limitations 5 years later in an older population: The Beaver Dam Eye Study. Ophthalmology. 2003; 110 (4):644–650. [ PubMed : 12689880 ]
• Köberlein J, Beifus K, Schaffert C, Finger RP. The economic burden of visual impairment and blindness: A systematic review. British Medical Journal Open. 2013; 3 (11):e003471. [ PMC free article : PMC3822298 ] [ PubMed : 24202057 ]
• Kulmala J, Era P, Parssinen O, Sakari R, Sipila S, Rantanen T, Heikkinen E. Lowered vision as a risk factor for injurious accidents in older people. Aging Clinical and Experimental Research. 2008; 20 (1):25–30. [ PubMed : 18283225 ]
• Kulp MT, Ciner E, Maguire M, Moore B, Pentimonti J, Pistilli M, Cyert L, Candy TR, Quinn G, Ying GS. Uncorrected hyperopia and preschool early literacy. Ophthalmology. 2016; 123 (4):681–689. [ PMC free article : PMC4808323 ] [ PubMed : 26826748 ]
• Lam BL, Christ SL, Lee DJ, Zheng DD, Arheart KL. Reported visual impairment and risk of suicide: The 1986–1996 National Health Interview Surveys. Archives of Ophthalmology. 2008; 126 (7):975–980. [ PMC free article : PMC2630284 ] [ PubMed : 18625946 ]
• Lamoureux E, Pesudovs K. Vision-specific quality-of-life research: A need to improve the quality. American Journal of Ophthalmology. 2011; 151 (2):195–197. e192. [ PubMed : 21251493 ]
• Langelaan M, de Boer MR, van Nispen RM, Wouters B, Moll AC, van Rens GH. Impact of visual impairment on quality of life: A comparison with quality of life in the general population and with other chronic conditions. Ophthalmic Epidemiology. 2007; 14 (3):119–126. [ PubMed : 17613846 ]
• Lawrence V, Murray J, Ffytche D, Banerjee S. “Out of sight, out of mind”: A qualitative study of visual impairment and dementia from three perspectives. International Psychogeriatrics. 2009; 21 (3):511–518. [ PubMed : 19265571 ]
• Lee DJ, Gomez-Marin O, Lam BL, Zheng DD. Visual acuity impairment and mortality in U.S. adults. Archives of Ophthalmology. 2002; 120 (11):1544–1550. [ PubMed : 12427070 ]
• Lee DJ, Gomez-Marin O, Lam BL, Zheng DD. Visual impairment and unintentional injury mortality: The National Health Interview Survey 1986–1994. American Journal of Ophthalmology. 2003; 136 (6):1152–1154. [ PubMed : 14644228 ]
• Lee DJ, Gomez-Marin O, Lam BL, Zheng DD, Arheart KL, Christ SL, Caban AJ. Severity of concurrent visual and hearing impairment and mortality: The 1986–1994 National Health Interview Survey. Journal of Aging Health. 2007; 19 (3):382–396. [ PubMed : 17496240 ]
• Lew H, Lee HS, Lee JY, Song J, Min K, Kim M. Possible linkage between visual and motor development in children with cerebral palsy. Pediatric Neurology. 2015; 52 (3):338–343. e331. [ PubMed : 25701187 ]
• Lin MY, Gutierrez PR, Stone KL, Yaffe K, Ensrud KE, Fink HA, Sarkisian CA, Coleman AL, Mangione CM. Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. Journal of the American Geriatric Society. 2004; 52 (12):1996–2002. [ PubMed : 15571533 ]
• Lindenberger U, Baltes PB. Sensory functioning and intelligence in old age: A strong connection. Psychology and Aging. 1994; 9 (3):339–355. [ PubMed : 7999320 ]
• Liu T, Cheung S, Schuchard R, Glielmi C, Hu X, He S, Legge GE. Incomplete cortical reorganization in macular degeneration. Investigative Ophthalmology & Visual Science. 2010; 51 (12):6826–6834. [ PMC free article : PMC3055781 ] [ PubMed : 20631240 ]
• Liu Y, Yu C, Liang M, Li J, Tian L, Zhou Y, Qin W, Li K, Jiang T. Whole brain functional connectivity in the early blind. Brain. 2007; 130 (Pt 8):2085–2096. [ PubMed : 17533167 ]
• Lord SR. Visual risk factors for falls in older people. Age and Ageing. 2006; 35 (Suppl 2):ii42–ii45. [ PubMed : 16926203 ]
• Lord SR, Dayhew J. Visual risk factors for falls in older people. Journal of the American Geriatric Society. 2001; 49 (5):508–515. [ PubMed : 11380741 ]
• Lord SR, Clark RD, Webster IW. Visual acuity and contrast sensitivity in relation to falls in an elderly population. Age and Ageing. 1991; 20 (3):175–181. [ PubMed : 1853790 ]
• Lord SR, Ward JA, Williams P, Anstey KJ. Physiological factors associated with falls in older community-dwelling women. Journal of the American Geriatric Society. 1994; 42 (10):1110–1117. [ PubMed : 7930338 ]
• Marron JA, Bailey IL. Visual factors and orientation-mobility performance. American Journal of Optometry and Physiological Optics. 1982; 59 (5):413–426. [ PubMed : 7102800 ]
• Mazzone L, Ducci F, Scoto MC, Passaniti E, ’Arrigo VGD, Vitiello B. The role of anxiety symptoms in school performance in a community sample of children and adolescents. BMC Public Health. 2007; 7 (1):1–6. [ PMC free article : PMC2228292 ] [ PubMed : 18053257 ]
• Moyer VA. Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force Recommendation statement. Annals of Internal Medicine. 2012; 157 (3):197–204. [ PubMed : 22868837 ]
• Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. 1989; 261 (18):2663–2668. [ PubMed : 2709546 ]
• O’Day B. Employment barriers for people with visual impairments. Journal of Visual Impairment and Blindness. 1999; 93 (10):627–642.
• Ong SY, Ikram MK, Haaland BA, Cheng CY, Saw SM, Wong TY, Cheung CY. Myopia and cognitive dysfunction: The Singapore Malay Eye Study. Investigative Ophthalmology & Visual Science. 2013; 54 (1):799–803. [ PubMed : 23307956 ]
• Orta AÖ, Öztürker ZK, Erkul SÖ, Bayraktar Ş, Yilmaz OF. The correlation between glaucomatous visual field loss and vision-related quality of life. Journal of Glaucoma. 2015; 24 (5):e121–e127. [ PubMed : 25642814 ]
• Park Y, Shin JA, Yang SW, Yim HW, Kim HS, Park YH., Epidemiologic Survey Committee of the Korean Ophthalmologic Society. The relationship between visual impairment and health-related quality of life in Korean adults: The Korea National Health and Nutrition Examination Survey (2008–2012). PLoS ONE. 2015; 10 (7):e0132779. [ PMC free article : PMC4508049 ] [ PubMed : 26192763 ]
• Pascual-Leone A, Amedi A, Fregni F, Merabet LB. The plastic human brain cortex. Annual Reviews of Neuroscience. 2005; 28 :377–401. [ PubMed : 16022601 ]
• Patel I, Turano KA, Broman AT, Bandeen-Roche K, Munoz B, West SK. Measures of visual function and percentage of preferred walking speed in older adults: The Salisbury Eye Evaluation project. Investigative Ophthalmology & Visual Science. 2006; 47 (1):65–71. [ PubMed : 16384945 ]
• Patino CM, McKean-Cowdin R, Azen SP, Allison JC, Choudhury F, Varma R. Central and peripheral visual impairment and the risk of falls and falls with injury. Ophthalmology. 2010; 117 (2):199–206. e191. [ PMC free article : PMC2819614 ] [ PubMed : 20031225 ]
• Pham TQ, Kifley A, Mitchell P, Wang JJ. Relation of age-related macular degeneration and cognitive impairment in an older population. Gerontology. 2006; 52 (6):353–358. [ PubMed : 16902306 ]
• Quigley HA, Cassard SD, Gower EW, Ramulu PY, Jampel HD, Friedman DS. The cost of glaucoma care provided to Medicare beneficiaries from 2002 to 2009. Ophthalmology. 2013; 120 (11):2249–2257. [ PubMed : 23769330 ]
• Rees G, Tee HW, Marella M, Fenwick E, Dirani M, Lamoureux EL. Vision-specific distress and depressive symptoms in people with vision impairment. Investigative Ophthalmology & Visual Science. 2010; 51 (6):2891–2896. [ PubMed : 20164466 ]
• Rein DB, Zhang P, Wirth KE, Lee PP, Hoerger TJ, McCall N, Klein R, Tielsch JM, Vijan S, Saaddine J. The economic burden of major adult visual disorders in the United States. Archives of Ophthalmology. 2006; 124 (12):1754–1760. [ PubMed : 17159036 ]
• Rein DB, Wirth KE, Johnson CA, Lee PP. Estimating quality-adjusted life year losses associated with visual field deficits using methodological approaches. Ophthalmic Epidemiology. 2007; 14 (4):258–264. [ PubMed : 17896306 ]
• Reyes-Ortiz CA, Kuo YF, DiNuzzo AR, Ray LA, Raji MA, Markides KS. Near vision impairment predicts cognitive decline: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Journal of the American Geriatric Society. 2005; 53 (4):681–686. [ PubMed : 15817017 ]
• Rogers MA, Langa KM. Untreated poor vision: A contributing factor to late-life dementia. American Journal of Epidemiology. 2010; 171 (6):728–735. [ PMC free article : PMC2842219 ] [ PubMed : 20150357 ]
• Roizen N, Kasza K, Karrison T, Mets M, Noble AG, Boyer K, Swisher C, Meier P, Remington J, Jalbrzikowski J. Impact of visual impairment on measures of cognitive function for children with congenital toxoplasmosis: Implications for compensatory intervention strategies. Pediatrics. 2006; 118 (2):e379–e390. [ PubMed : 16864640 ]
• Rovner BW, Casten RJ. Activity loss and depression in age-related macular degeneration. American Journal of Geriatric Psychiatry. 2002; 10 (3):305–310. [ PubMed : 11994218 ]
• Rovner BW, Casten RJ, Tasman WS. Effect of depression on vision function in age-related macular degeneration. Archives of Ophthalmology. 2002; 120 (8):1041–1044. [ PubMed : 12149057 ]
• Rovner BW, Casten RJ, Hegel MT, Tasman WS. Minimal depression and vision function in age-related macular degeneration. Ophthalmology. 2006; 113 (10):1743–1747. [ PubMed : 16893569 ]
• Rovner BW, Casten RJ, Hegel MT, Massof RW, Leiby BE, Ho AC, Tasman WS. Low vision depression prevention trial in age-related macular degeneration. Ophthalmology. 2014; 121 (11):2204–2211. [ PMC free article : PMC4253064 ] [ PubMed : 25016366 ]
• Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clinical Geriatric Medicine. 2002; 18 (2):141–158. [ PubMed : 12180240 ]
• Salt A, Sargent J. Common visual problems in children with disability. Archives of Disease in Childhood. 2014; 99 (12):1163–1168. [ PMC free article : PMC4251159 ] [ PubMed : 25165073 ]
• Saunders GH, Echt KV. An overview of dual sensory impairment in older adults: Perspectives for rehabilitation. Trends in Amplification. 2007; 11 (4):243–258. [ PMC free article : PMC4111537 ] [ PubMed : 18003868 ]
• Sayner R, Carpenter DM, Robin AL, Blalock SJ, Muir KW, Vitko M, Hartnett ME, Lawrence SD, Giangiacomo AL, Tudor G, Goldsmith JA, Sleath B. How glaucoma patient characteristics, self-efficacy and patient-provider communication are associated with eye drop technique. International Journal of Pharmaceutical Practice. 2015; 24 (2):78–85. [ PMC free article : PMC5599214 ] [ PubMed : 26303667 ]
• Schmier JK, Levine JA. Economic impact of progression of age-related macular degeneration. Acta Ophthalmoligica. 2013; 93 (2):105–121.
• Schneck ME, Lott LA, Haegerstrom-Portnoy G, Brabyn JA. Association between hearing and vision impairments in older adults. Ophthalmic and Physiological Optics. 2012; 32 (1):45–52. [ PMC free article : PMC3237734 ] [ PubMed : 21999724 ]
• Schneider JM, Gopinath B, McMahon CM, Leeder SR, Mitchell P, Wang JJ. Dual sensory impairment in older age. Journal of Aging and Health. 2011; 23 (8):1309–1324. [ PubMed : 21596997 ]
• Schneider J, Gopinath B, McMahon C, Teber E, Leeder SR, Wang JJ, Mitchell P. Prevalence and 5-year incidence of dual sensory impairment in an older Australian population. Annals of Epidemiology. 2012; 22 (4):295–301. [ PubMed : 22382082 ]
• Souied EH, Benlian P, Amouyel P, Feingold J, Lagarde JP, Munnich A, Kaplan J, Coscas G, Soubrane G. The epsilon 4 allele of the apolipoprotein E gene as a potential protective factor for exudative age-related macular degeneration. American Journal of Ophthalmology. 1998; 125 (3):353–359. [ PubMed : 9512153 ]
• Spahr J. Presentation at second meeting on Public Health Approaches to Promote Eye Health and Reduce Vision Impairment. Washington, DC: 2015.
• Steinman B, Nguyen A, Pynoos J, Leland N. Falls-prevention interventions for persons who are blind or visually impaired. Insight: Research and Practice in Vision Impairment and Blindness. 2011; 4 :83–91. [ PMC free article : PMC6309321 ] [ PubMed : 30595966 ]
• Swenor BK, Munoz B, West SK. Does visual impairment affect mobility over time? The Salisbury Eye Evaluation study. Investigative Ophthalmology & Visual Science. 2013; 54 (12):7683–7690. [ PMC free article : PMC3835273 ] [ PubMed : 24176902 ]
• Tay T, Wang JJ, Kifley A, Lindley R, Newall P, Mitchell P. Sensory and cognitive association in older persons: Findings from an older Australian population. Gerontology. 2006; 52 (6):386–394. [ PubMed : 16921251 ]
• Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA. 2012; 308 (5):493–501. [ PubMed : 22851116 ]
• Tseng VL, Yu F, Lum F, Coleman AL. Ophthalmology. 2016. (Cataract surgery and mortality in the United States Medicare population). [ PubMed : 26854033 ]
• U.S. Census Bureau. American Community Survey (ACS). 2014. [June 7, 2016]. http://www ​.census.gov ​/people/disability/methodology/acs.html .
• Varma R, Lee PP, Goldberg I, Kotak S. An assessment of the health and economic burdens of glaucoma. American Journal of Ophthalmology. 2011; 152 (4):515–522. [ PMC free article : PMC3206636 ] [ PubMed : 21961848 ]
• Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General and Internal Medicine. 2007; 22 (Suppl 3):391–395. [ PMC free article : PMC2150598 ] [ PubMed : 18026807 ]
• Wang JJ, Mitchell P, Cumming RG, Smith W., Blue Mountains Eye Study. Visual impairment and nursing home placement in older Australians: The Blue Mountains Eye Study. Ophthalmic Epidemiology. 2003; 10 (1):3–13. [ PubMed : 12607154 ]
• Whitson HE, Cousins SW, Burchett BM, Hybels CF, Pieper CF, Cohen HJ. The combined effect of visual impairment and cognitive impairment on disability in older people. Journal of the American Geriatric Society. 2007; 55 (6):885–891. [ PubMed : 17537089 ]
• Whitson HE, Ansah D, Whitaker D, Potter G, Cousins SW, MacDonald H, Pieper CF, Landerman L, Steffens DC, Cohen HJ. Prevalence and patterns of comorbid cognitive impairment in low vision rehabilitation for macular disease. Archives of Gerontology and Geriatrics. 2010; 50 (2):209–212. [ PMC free article : PMC2815114 ] [ PubMed : 19427045 ]
• Whitson HE, Steinhauser K, Ammarell N, Whitaker D, Cousins SW, Ansah D, Sanders LL, Cohen HJ. Categorizing the effect of comorbidity: A qualitative study of individuals’ experiences in a low-vision rehabilitation program. Journal of the American Geriatric Society. 2011; 59 (10):1802–1809. [ PMC free article : PMC3662468 ] [ PubMed : 22091493 ]
• Whitson HE, Malhotra R, Chan A, Matchar DB, Ostbye T. Comorbid visual and cognitive impairment: Relationship with disability status and self-rated health among older Singaporeans. Asia Pacific Journal of Public Health. 2012a; 26 (3):310–319. [ PMC free article : PMC3408775 ] [ PubMed : 22535554 ]
• Whitson HE, Whitaker D, Sanders LL, Potter GG, Cousins SW, Ansah D, McConnell E, Pieper CF, Landerman L, Steffens DC, Cohen HJ. Memory deficit associated with worse functional trajectories in older adults in low-vision rehabilitation for macular disease. Journal of the American Geriatric Society. 2012b; 60 (11):2087–2092. [ PMC free article : PMC3498592 ] [ PubMed : 23126548 ]
• Whitson HE, Malhotra R, Chan A, Matchar DB, Ostbye T. Comorbid visual and cognitive impairment: Relationship with disability status and self-rated health among older Singaporeans. Asia Pacific Journal of Public Health. 2014; 26 (3):310–319. [ PMC free article : PMC3408775 ] [ PubMed : 22535554 ]
• Wittenborn J, Rein D. Cost of vision problems: The economic burden of vision loss and eye disorders in the United States. Chicago, IL: NORC at the University of Chicago; 2013.
• Wittenborn J, Rein D. The potential costs and benefits of treatment for undiagnosed eye disorders. 2016. [September 15, 2016]. (Paper prepared for the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health). unpublished. http://www ​.nationalacademies ​.org/hmd/~/media ​/Files/Report%20Files ​/2016/UndiagnosedEyeDisordersCommissionedPaper.pdf .
• Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine. 2002; 162 (20):2269–2276. [ PubMed : 12418941 ]
• Wong TY, Klein R, Nieto FJ, Moraes SA, Mosley TH, Couper DJ, Klein BE, Boland LL, Hubbard LD, Sharrett AR. Is early age-related maculopathy related to cognitive function? The Atherosclerosis Risk in Communities Study. American Journal of Ophthalmology. 2002; 134 (6):828–835. [ PubMed : 12470750 ]
• Woo SJ, Park KH, Ahn J, Choe JY, Jeong H, Han JW, Kim TH, Kim KW. Cognitive impairment in age-related macular degeneration and geographic atrophy. Ophthalmology. 2012; 119 :2094–2101. [ PubMed : 22705343 ]
• Zebardast N, Swenor BK, van Landingham SW, Massof RW, Munoz B, West SK, Ramulu PY. Comparing the impact of refractive and nonrefractive vision loss on functioning and disability. Ophthalmology. 2015; 122 (6):1102–1110. [ PMC free article : PMC4446156 ] [ PubMed : 25813453 ]
• Zhang S, Liang Y, Chen Y, Musch DC, Zhang C, Wang N. Utility analysis of vision-related quality of life in patients with glaucoma and different perceptions from ophthalmologists. Journal of Glaucoma. 2015; 24 (7):508–514. [ PubMed : 25415642 ]
• Zheng DD, Christ SL, Lam BL, Tannenbaum SL, Bokman CL, Arheart KL, McClure LA, Fernandez CA, Lee DJ. Visual acuity and increased mortality: The role of allostatic load and functional status. Investigative Ophthalmology & Visual Science. 2014; 55 (8):5144–5150. [ PMC free article : PMC4580215 ] [ PubMed : 25061115 ]

The EQ-5D is a generic instrument used to measure health-related QOL. The tool rates the impact of disease on a scale of 0 to 1 with a lower score indicating greater effect of the health condition. The EQ-5D has five dimensions—mobility, self-care, usual activities, pain or discomfort, and anxiety or depression.

The authors defined “mild visual impairment” as visual acuity between 20/32 and 20/63; “moderate visual impairment” as visual acuity between 20/80 and 20/60; and “severe visual impairment” as visual acuity worse than or equal to 20/200.

Uncorrected refractive error was defined as a binocular visual acuity of less than or equal to 20/30 that improved to greater than 20/30 with subjective refraction.

Visual acuity was assessed using the Landolt ring chart, which consists of 13 lines in which visual acuity is scored from 0.125 (worst), if the person can only see the first line, to 2.0 (best) if the person can correctly see the last line. Visual acuity between 0.3 and 0.5 in the better eye was defined as lowered vision, and vision better than 0.5 was defined as normal vision.

A friend or relative with whom the participant had at least weekly contact.

The state cost estimates were a function of the states' populations within each age group. State populations were identified for the age groups 0–17, 18–39, 40–64, and 65+ based on the 2011 U.S. Census data. The burden estimate was divided by age for each age group to derive per-person costs for each group, then multiplied by the state population costs for each age group. These estimates do not include state-specific unit cost or utilization estimates ( Wittenborn and Rein, 2013 ).

“These costs are measured separately from other medical costs in MEPS; they are not associated with diagnosis codes and are based on non-confirmed, self-reported expenditures” ( Wittenborn and Rein, 2013, p. 2 ).

• Cite this Page National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health; Welp A, Woodbury RB, McCoy MA, et al., editors. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington (DC): National Academies Press (US); 2016 Sep 15. 3, The Impact of Vision Loss.
• PDF version of this title (16M)

In this Page

Other titles in this collection.

• The National Academies Collection: Reports funded by National Institutes of Health

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Recent Activity

• The Impact of Vision Loss - Making Eye Health a Population Health Imperative The Impact of Vision Loss - Making Eye Health a Population Health Imperative

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Essay on Blindness

Students are often asked to write an essay on Blindness in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Blindness

Understanding blindness.

Blindness is a condition where a person can’t see at all or has very poor vision. It is a serious issue that affects millions of people around the world. Some people are born blind, while others lose their sight due to injury or disease.

Types of Blindness

There are different types of blindness. Total blindness means you can’t see anything. Legal blindness refers to vision that is 20/200 or worse. This means what a person with normal vision can see from 200 feet away, a legally blind person can only see from 20 feet away.

Causes of Blindness

Blindness can be caused by many things. Some people are born blind due to genetic reasons. Others lose their sight because of diseases like glaucoma or diabetes. Injuries to the eye can also cause blindness.

Living with Blindness

Living with blindness can be challenging but not impossible. Many blind people lead full and productive lives. They learn to use their other senses to navigate the world. They use tools like white canes or guide dogs to move around.

Preventing Blindness

Preventing blindness is possible in some cases. Regular eye exams can help detect problems early. Eating a healthy diet, not smoking, and protecting your eyes from injury can also help.

250 Words Essay on Blindness

Blindness is a condition where a person cannot see. It can be total or partial. Total blindness means no vision at all, while partial blindness means limited vision. It can happen at birth or develop later in life.

There are many causes of blindness. Some people are born blind due to genetic problems. Others might lose their sight due to diseases, injuries, or age. Common diseases causing blindness include glaucoma and cataracts.

Living with blindness can be challenging. Yet, blind people can lead fulfilling lives. They use their other senses, like touch and hearing, to understand their surroundings. They also use tools like white canes and guide dogs for mobility.

Education and Blindness

Education is crucial for blind people. Schools for the blind teach Braille, a system of raised dots that represent letters. This way, blind people can read and write. Technology also helps with special computers and software.

Blindness is a serious condition, but it doesn’t stop people from living fulfilling lives. With the right tools, education, and support, blind people can do many things that sighted people do. We must respect and support them, as they are just as capable as anyone else.

(Word count: 250)

500 Words Essay on Blindness

Blindness is a condition where a person cannot see. Some people are born blind, while others lose their sight due to injuries or diseases. It can be total, meaning no sight at all, or partial, where some sight remains.

There are different types of blindness. Complete blindness means a person cannot see anything. Legal blindness is when a person’s best eye, even with glasses, cannot see a certain amount. Color blindness is when a person cannot see certain colors. Night blindness is when a person has trouble seeing in low light.

Blindness can be caused by many things. Some people are born blind, which means they have been blind from birth. Others may lose their sight as they grow older or due to an accident. Diseases like diabetes and glaucoma can also cause blindness. Lack of vitamins A and E can also lead to blindness.

Being blind can be challenging. Blind people need to learn new ways to do things. They might use a white cane to move around or use a guide dog. They also rely on their other senses, like hearing and touch, more than sighted people do. They may learn to read Braille, which is a system of raised dots that represent letters and numbers.

Technology and Blindness

Technology is helping blind people in many ways. There are special computers and phones that talk. There are also machines that can turn printed words into speech or Braille. Some apps can even identify objects or read text out loud.

Blindness can be a challenge, but it does not mean a person cannot lead a full and happy life. With the right tools and support, blind people can do many of the same things sighted people can. They can go to school, work, play sports, and even create art. It’s important to remember that everyone is unique and has their own abilities, whether they can see or not.

In conclusion, blindness is a condition that affects many people around the world. It is caused by various factors and can manifest in different forms. Despite the challenges, blind individuals can lead fulfilling lives thanks to advancements in technology and support from society. Understanding blindness helps us to be more empathetic and supportive towards those who experience it.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Black Power Movement
• Essay on Black Panther
• Essay on Black Holes

Apart from these, you can look at all the essays by clicking here .

Happy studying!

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Skip to main content
• Keyboard shortcuts for audio player

You Must Read This

In saramago's 'blindness,' a vision of human nature.

Myla Goldberg

I am not a person who re-reads books. The world is too large, and life too short. A book re-read steals time away from a new book I have yet to discover, a book that on my death bed will have gone unread. So, when I tell you that I have read Blindness , by Jose Saramago, three times, you will know how serious I am about it. Three times is two times more than I've ever voluntarily read any other book in my adult life.

Blindness By Jose Saramago Paperback, 352 pages Mariner Books List Price: $15 Read An Excerpt

My favorite books are serious, but with a sense of humor, philosophical without being pedantic, and slightly fantastical without being silly. On top of that, they've got to be smart, insightful, honest and beautifully written. In Blindness , we learn that an epidemic of blindness is sweeping through a city, and from that premise, Saramago tackles all of human nature — love, loyalty, fear, jealousy, bravery, heroism, cowardice, violence, happiness, disappointment — it's all in there, revealed through characters so beautifully rendered, so vibrant on the page, that each time I read it, I immediately join Saramago's sightless band, tossed together by circumstance first into a chaotic quarantine center for the newly blind, and then loosed into a world that has fallen apart.

Saramago describes disaster's potential to bring out both the best and worst of people, from the misguided actions of the city government, to the clear-headed ministrations of a blinded doctor and the bravery of his sighted wife, who has feigned blindness in order to stay by his side when the blind are shut away from the seeing world.

Saramago was the first Portuguese writer to win the Nobel Prize for Literature. He died in June at age 87. Bengt Eurenius/AP hide caption

Saramago was the first Portuguese writer to win the Nobel Prize for Literature. He died in June at age 87.

In 2005, when I heard the horror stories that were coming out of New Orleans' Superdome in the wake of Hurricane Katrina, it was chilling how closely they matched the experiences of Saramago's quarantined characters, but it was also thrilling: Here was a writer who had gotten it right, who had nailed human nature so precisely that the real world was mirroring what his imagination had conjured, under slightly different circumstances, years before.

OK, so maybe the book is a little dark — all right, more than a little dark — but it's also a rollicking adventure story, and a love story, and a story of triumph over adversity. Saramago tells his tale with humor and compassion, and with an imagination that is boundless enough to conjure an impossible epidemic without losing sight of the exigencies of actual life, achieving that rare blend of magic and reality in which the fantastical allows us to see our own world more clearly, from a perspective that brings out details we might not have otherwise considered.

Myla Goldberg is the author of Bee Season and The False Friend. Jason Little hide caption

Myla Goldberg is the author of Bee Season and The False Friend.

Plus, there's a happy ending, and not a cheesy happy ending, but an uplifting one that is wholly earned. Blindness expanded my own vision of humanity, and of fiction's potential. Just saying all this makes me want to sit down and read it again.

You Must Read This is produced and edited by Ellen Silva.

Excerpt: 'Blindness'

We will keep fighting for all libraries - stand with us!

Internet Archive Audio

• This Just In
• Grateful Dead
• Old Time Radio
• 78 RPMs and Cylinder Recordings
• Audio Books & Poetry
• Computers, Technology and Science
• Music, Arts & Culture
• News & Public Affairs
• Spirituality & Religion
• Radio News Archive

• Flickr Commons
• Occupy Wall Street Flickr
• NASA Images
• Solar System Collection
• Ames Research Center

• All Software
• Old School Emulation
• MS-DOS Games
• Historical Software
• Classic PC Games
• Software Library
• Kodi Archive and Support File
• Vintage Software
• CD-ROM Software
• CD-ROM Software Library
• Software Sites
• Tucows Software Library
• Shareware CD-ROMs
• Software Capsules Compilation
• CD-ROM Images
• ZX Spectrum
• DOOM Level CD

• Smithsonian Libraries
• FEDLINK (US)
• Lincoln Collection
• American Libraries
• Canadian Libraries
• Universal Library
• Project Gutenberg
• Children's Library
• Biodiversity Heritage Library
• Books by Language
• Additional Collections

• Prelinger Archives
• Democracy Now!
• Occupy Wall Street
• TV NSA Clip Library
• Animation & Cartoons
• Arts & Music
• Computers & Technology
• Cultural & Academic Films
• Ephemeral Films
• Sports Videos
• Videogame Videos
• Youth Media

Search the history of over 866 billion web pages on the Internet.

Mobile Apps

• Wayback Machine (iOS)
• Wayback Machine (Android)

Browser Extensions

Archive-it subscription.

• Explore the Collections
• Build Collections

Save Page Now

Capture a web page as it appears now for use as a trusted citation in the future.

Please enter a valid web address

• Donate Donate icon An illustration of a heart shape

An essay on blindness. ... Interspersed with several anecdotes of Sanderson, Wilton, and others. ...

Bookreader item preview, share or embed this item, flag this item for.

• Graphic Violence
• Explicit Sexual Content
• Hate Speech
• Misinformation/Disinformation
• Marketing/Phishing/Advertising
• Misleading/Inaccurate/Missing Metadata

Copyright is on title page. Some text runs into the gutter Some text printed askew.

plus-circle Add Review comment Reviews

Download options, in collections.

Uploaded by Francesca Marchetti on August 22, 2022

SIMILAR ITEMS (based on metadata)

by Jose Saramago

Blindness study guide.

In this 1998 book by Nobel Prize winner José Saramago, an unnamed city is beset by an epidemic of the "white sickness," a disease that instantly turns everyone blind. Everyone, that is, except for one woman. The novel follows the story of seven people who are quarantined along with 300 other people in an abandoned madhouse. These seven are forced to band together in order to survive not only the horrors of living in a blind world, but also the most base elements of humanity that take hold in the quarantine. Once out of the quarantine the band must now try to make their way in a completely blind city, where humanity has all but descended into animal chaos. Only through the help of the one woman who has miraculously been saved her sight is the band able to hold on to some shred of humanity and recognize what it is to be human.

Blindness was first published as Ensaio sobre a cegueira in Portugal in 1995. The English translation was released in 1998. This book has been Saramago's most widely read book, partly because of the 2008 release of the movie, directed by Brazilian director Fernando Meirelles, based on novel. Blindness comprises the first half of a two part series of "essays" (the original Portuguese title translates as Essay on Blindness). The second one has not seen a theatrical release, but has published in translation as Seeing .

Blindness has a number of stylistic elements that are characteristic of Saramago's work. Firstly, the premise of his book is somewhat fantastic. In the novel, the entirety of society is stricken by an epidemic of blindness that turns everyone's field of vision into a milky white as opposed to the usual black. No amount of quarantining, disinfecting or vaccines can stop the spread of the disease–many citizens think that it is spread by eye contact. Secondly, Saramago avoids the use of personal pronouns of any kind. This gives the novel a sense of floating without any concrete reference to reality. Finally, Saramago refuses to use quotation marks or dialogue attribution, meaning that it is difficult to determine who is speaking at times. This helps sustain the disoriented tone of the novel.

Blindness Questions and Answers

The Question and Answer section for Blindness is a great resource to ask questions, find answers, and discuss the novel.

resumen sobre la obra ensayo sobre la ceguera de José Saramago

GradeAver tiene disponible una lista completa de resúmenes brevesen su guía de estudio para esta unidad.

Theme topic

You can chck out the themes below:

https://www.gradesaver.com/blindness/study-guide/themes

How could the doctors wife be considered a mother throughout the book?

She takes it upon herself during the book to take care of the blind, as she believes that it is her duty since she can still see. It began with her husband, she is shown to have motherly instincts and courage when she sacrifices herself to go to...

Study Guide for Blindness

The Blindness study guide contains a biography of Jose Saramago, literature essays, quiz questions, major themes, characters, and a full summary and analysis.

• About Blindness
• Blindness Summary
• Character List

Essays for Blindness

Blindness literature essays are academic essays for citation. These papers were written primarily by students and provide critical analysis of Blindness by Jose Saramago.

• Social Behavior in Saramago's Blindness
• Overcoming Sexual Wrongdoing: Blindness v. Salvage the Bones
• Proverbs and False Comfort in Blindness

Lesson Plan for Blindness

• About the Author
• Study Objectives
• Common Core Standards
• Introduction to Blindness
• Relationship to Other Books
• Bringing in Technology
• Notes to the Teacher
• Related Links
• Blindness Bibliography

Wikipedia Entries for Blindness

• Introduction
• Plot summary

Blindness and the age of enlightenment: Diderot's letter on the blind

Affiliation.

• 1 Department of Ophthalmology, University of South Florida, Morsani College of Medicine, Tampa, FL 33612, USA. [email protected]
• PMID: 23307219
• DOI: 10.1001/jamaophthalmol.2013.559

Several months after anonymously publishing an essay in 1749 with the title "Letter on the Blind for the Use of Those Who Can See," the chief editor of the French Encyclopédie was arrested and taken to the prison fortress of Vincennes just east of Paris, France. The correctly assumed author, Denis Diderot, was 35 years old and had not yet left his imprint on the Age of Enlightenment. His letter, which recounted the life of Nicolas Saunderson, a blind mathematician, was intended to advance secular empiricism and disparage the religiously tinged rationalism put forward by Rene Descartes. The letter's discussion of sensory perception in men born blind dismissed the supposed primacy of visual imagery in abstract thinking. The essay did little to resolve any philosophical controversy, but it marked a turning point in Western attitudes toward visual disability.

Publication types

• Historical Article
• Attitude to Health
• Blindness / congenital
• Blindness / history*
• Encyclopedias as Topic
• History, 18th Century
• Imagination*
• Pattern Recognition, Visual
• Philosophy / history*

Personal name as subject

• Denis Diderot

Mindblindness : An Essay on Autism and Theory of Mind

Simon Baron-Cohen, Professor in Developmental Psychopathology and Director of the Autism Research Centre at the University of Cambridge, is the author of Mindblindness (MIT Press, 1997) and The Essential Difference: The Truth about the Male and Female Mind .

In Mindblindness , Simon Baron-Cohen presents a model of the evolution and development of "mindreading." He argues that we mindread all the time, effortlessly, automatically, and mostly unconsciously. It is the natural way in which we interpret, predict, and participate in social behavior and communication. We ascribe mental states to people: states such as thoughts, desires, knowledge, and intentions.

Building on many years of research, Baron-Cohen concludes that children with autism, suffer from "mindblindness" as a result of a selective impairment in mindreading. For these children, the world is essentially devoid of mental things.

Baron-Cohen develops a theory that draws on data from comparative psychology, from developmental, and from neuropsychology. He argues that specific neurocognitive mechanisms have evolved that allow us to mindread, to make sense of actions, to interpret gazes as meaningful, and to decode "the language of the eyes."

A Bradford Book

• Permissions
• Cite Icon Cite

Mindblindness : An Essay on Autism and Theory of Mind By: Simon Baron-Cohen https://doi.org/10.7551/mitpress/4635.001.0001 ISBN (electronic): 9780262267731 Publisher: The MIT Press Published: 1995

Download citation file:

• Ris (Zotero)
• Reference Manager

Table of Contents

• Series Foreword Doi: https://doi.org/10.7551/mitpress/4635.003.0001 Open the PDF Link PDF for Series Foreword in another window
• Foreword Doi: https://doi.org/10.7551/mitpress/4635.003.0002 Open the PDF Link PDF for Foreword in another window
• Preface Doi: https://doi.org/10.7551/mitpress/4635.003.0003 Open the PDF Link PDF for Preface in another window
• Acknowledgements Doi: https://doi.org/10.7551/mitpress/4635.003.0004 Open the PDF Link PDF for Acknowledgements in another window
• On the Term "Mindblindness" Doi: https://doi.org/10.7551/mitpress/4635.003.0005 Open the PDF Link PDF for On the Term "Mindblindness" in another window
• Chapter 1: Mindblindness and Mindreading Doi: https://doi.org/10.7551/mitpress/4635.003.0006 Open the PDF Link PDF for Chapter 1: Mindblindness and Mindreading in another window
• Chapter 2: Evolutionary Psychology and Social Chess Doi: https://doi.org/10.7551/mitpress/4635.003.0007 Open the PDF Link PDF for Chapter 2: Evolutionary Psychology and Social Chess in another window
• Chapter 3: Mindreading: Nature's Choice Doi: https://doi.org/10.7551/mitpress/4635.003.0008 Open the PDF Link PDF for Chapter 3: Mindreading: Nature's Choice in another window
• Chapter 4: Developing Mindreading: The Four Steps Doi: https://doi.org/10.7551/mitpress/4635.003.0009 Open the PDF Link PDF for Chapter 4: Developing Mindreading: The Four Steps in another window
• Chapter 5: Autism and Mindblindness Doi: https://doi.org/10.7551/mitpress/4635.003.0010 Open the PDF Link PDF for Chapter 5: Autism and Mindblindness in another window
• Chapter 6: How Brains Read Minds Doi: https://doi.org/10.7551/mitpress/4635.003.0011 Open the PDF Link PDF for Chapter 6: How Brains Read Minds in another window
• Chapter 7: The Language of the Eyes Doi: https://doi.org/10.7551/mitpress/4635.003.0012 Open the PDF Link PDF for Chapter 7: The Language of the Eyes in another window
• Chapter 8: Mindreading: Back to the Future Doi: https://doi.org/10.7551/mitpress/4635.003.0013 Open the PDF Link PDF for Chapter 8: Mindreading: Back to the Future in another window
• Notes Doi: https://doi.org/10.7551/mitpress/4635.003.0014 Open the PDF Link PDF for Notes in another window
• References Doi: https://doi.org/10.7551/mitpress/4635.003.0015 Open the PDF Link PDF for References in another window
• Index Doi: https://doi.org/10.7551/mitpress/4635.003.0016 Open the PDF Link PDF for Index in another window
• Open Access

A product of The MIT Press

Mit press direct.

• About MIT Press Direct

Information

• Accessibility
• For Authors
• For Customers
• For Librarians
• Direct to Open
• Media Inquiries
• Rights and Permissions
• For Advertisers
• About the MIT Press
• The MIT Press Reader
• MIT Press Blog
• Seasonal Catalogs
• MIT Press Home
• Give to the MIT Press
• Direct Service Desk
• Terms of Use
• Privacy Statement
• Crossref Member
• COUNTER Member  
• The MIT Press colophon is registered in the U.S. Patent and Trademark Office

This Feature Is Available To Subscribers Only

Sign In or Create an Account

• Skip to main content
• Skip to secondary menu
• Skip to primary sidebar
• Skip to footer

Study Today

Largest Compilation of Structured Essays and Exams

Essay on Blindness

December 9, 2017 by Study Mentor Leave a Comment

Table of Contents

Vision and Beauty

We are able to experience the beauty of the world, because we are able to see the beauty from our own eye. The role of eyes plays a very important role in any life form, because any matter for example, can be seen or experienced only through our eyes.

Eyes are the gateway for what we perceive and understand, only when we are able to see something, can we understand a thing in its totality, and we can realize and analyze situations first and foremost by seeing them through our own eyes.

They say, seeing is believing. What it means is, if we happen to hear a word or two from others, we may have our own doubts about their legitimacy, but if we have seen them from our own eyes, we can be sure of believing them.

Blindness alters this scenario completely. A person who is blind cannot experience the world the way a normal person does. They have to put extra effort on their other senses to compensate for the lost vision in their eyes and try to perceive the world from those senses.

Many eminent people who were unfortunately blind have made big wonders in the world and famous names include Helen Keller, John Milton, Madhu Singhal, Tiffany Brar, etc. There are many who use their natural talent, not worrying about their disability and therefore they could make a great name for themselves.

For learning purposes, blind people make use of the Braille technology where characters are present in the form of raised dots so that they could be recognized by touch.

Based on the difference in the dots being raised at a particular point and the pattern in which they are formed, blind people can easily recognize what character they are feeling through their fingers.

What Blind People have in Store

The world is full of bright, colorful matter around us, nature has painted a very beautiful picture of mother earth around us, but sadly a few people cannot experience the beauty by seeing through their eyes. Nevertheless, god also makes for the loss by providing them with special powers in their other senses.

Blind people make use of other senses to perceive the world around them, gradually they become so accustomed to perceiving and sensing things through the other four senses of the body that it becomes a habit and they start gaining something special from them.

Blindness can be in many forms – it could be total blindness, partial blindness, color blindness or night blindness among other deformities of the eye. In total blindness, the person suffers total loss of vision and thereby he cannot see anything from his eyes.

This could be a result of some fatal accident or could occur during birth itself due to genetic disorders. A person with total blindness needs help in carrying out his daily activities and his family needs to support a lending hand to him/her to aid them carry out their daily tasks smoothly.

Different Types of Blindness

In case of Partial blindness, a person could be able to see things at a closer proximity to him, but may not be able to see things at a far distance. Things may appear vague or blurred when he sees something, yet he is able to recognize the presence of a thing in front of him.

This mainly appears in people due to ageing. As people get older, it is a natural phenomenon for the body parts to deteriorate as the years roll down and it could be or could not be reversed with surgical procedures.

In case of color blindness, it is not that the person is impaired and cannot recognize colors. But the primary defect he faces is his inability to distinguish between two colors. Red and green colors lying next to each other may appear as a single green color or a single red color to a person suffering from this ailment.

Even the red color that he sees may not be true red, in the sense that he may vaguely be able to recognize the color but many not be able to differentiate between its contrast colors. This defect could also be from birth or could be due to age progression.

Night blindness mainly occurs in people due to deficiency of vitamin A. Such people may find it difficult to walk around at night times, as they have a weak vision as day light draws to a close.

They may be able to see things clearly in broad daylight, but as it become darker during night time, they may find it difficult to see anything with their eyes, even if they are able to see, it could be a blurred vision. This also happens due to specific genetic disorders, but can be treated.

There are millions of other deformities associated with eye, such as hyper metropia, myopia, cataracts, retinitis, etc. The eye is a powerful organ, it beautifies the world around us, and we are able to see anything only because of our eyes.

We believe in things because we see them happen in front of our eyes, we can talk about things because we have seen them right through our eyes. Whatever we haven’t seen, we would be unsure if they have really taken place or not.

Care and Concern

Such a delicate organ needs special care and we cannot take them for granted. Any cosmetic that we apply on our faces need to be applied with care so as to not touch the eye area. Instructions on brands of creams and facials contain special instructions about the application of such creams and lotions.

Whatever we apply, soap, shampoo, cream or lotion should be restricted to the skin outside the skin area and to never touch the area in the eye. Even if by accident, a small portion of the cream goes inside our eyes, we have to wash our eyes immediately and take proper precautions to not let them protrude the inner regions of the eye.

Every year, hundreds of children lose their eye sight and turn blind because elders do not supervise them when they lit fireworks.

Fireworks are bright and colorful when handled properly, but they are a deadly menace and can cause deep injuries to the eye, sometimes resulting in permanent loss of vision, when handled without elderly supervision or following the wrong methods of lighting the fireworks.

Therefore, we have to guide our children and tell them to be careful when lighting fireworks as they can cause heavy eye injuries, and vision lost once cannot be gained a second time.

These days, eye donation and pledging our eyes for donation when we leave this world are fast gaining popularity among youth. Many eye hospitals have taken special initiatives in this regard.

Charitable centers hold special awareness processions and educate citizens about the need and importance of donating our eyes. The sanctity it holds in providing eyesight to another needy person, when it’s no longer useful to us after we have passed away takes service to a totally new level and many come forward to contribute towards the cause.

Providing eyesight to a needy person is equivalent to providing a beautiful life that was dull and lifeless till now. A person who suddenly starts seeing the world around him, compared to have seen nothing when he was blind achieves a dream that turned true for him and holds regards to the person who made it come true for him.

Precautions

Whenever a dust particle falls into our eyes, the eye turns red indicating an infection. The redness is caused because the eye senses a foreign particle inside it and the firs thing it does is to get rid of it.

In such cases, we must first wash our eyes with flowing, clear water to keep the eyes clean and get rid of any infection that may be caused due to the foreign particle. Mild dust infections happen frequently in much polluted cities and towns.

Places where there is smog creation due to high level of pollution create blurred vision for riders and drivers leading to accidents, especially early in the morning, so care has to be taken.

Reader Interactions

Leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Top Trending Essays in March 2021

• Essay on Pollution
• Essay on my School
• Summer Season
• My favourite teacher
• World heritage day quotes
• my family speech
• importance of trees essay
• autobiography of a pen
• honesty is the best policy essay
• essay on building a great india
• my favourite book essay
• essay on caa
• my favourite player
• autobiography of a river
• farewell speech for class 10 by class 9
• essay my favourite teacher 200 words
• internet influence on kids essay
• my favourite cartoon character

Brilliantly

Content & links.

Verified by Sur.ly

Essay for Students

• Essay for Class 1 to 5 Students

Scholarships for Students

• Class 1 Students Scholarship
• Class 2 Students Scholarship
• Class 3 Students Scholarship
• Class 4 Students Scholarship
• Class 5 students Scholarship
• Class 6 Students Scholarship
• Class 7 students Scholarship
• Class 8 Students Scholarship
• Class 9 Students Scholarship
• Class 10 Students Scholarship
• Class 11 Students Scholarship
• Class 12 Students Scholarship

STAY CONNECTED

• About Study Today
• Privacy Policy
• Terms & Conditions

Scholarships

• Apj Abdul Kalam Scholarship
• Ashirwad Scholarship
• Bihar Scholarship
• Canara Bank Scholarship
• Colgate Scholarship
• Dr Ambedkar Scholarship
• E District Scholarship
• Epass Karnataka Scholarship
• Fair And Lovely Scholarship
• Floridas John Mckay Scholarship
• Inspire Scholarship
• Jio Scholarship
• Karnataka Minority Scholarship
• Lic Scholarship
• Maulana Azad Scholarship
• Medhavi Scholarship
• Minority Scholarship
• Moma Scholarship
• Mp Scholarship
• Muslim Minority Scholarship
• Nsp Scholarship
• Oasis Scholarship
• Obc Scholarship
• Odisha Scholarship
• Pfms Scholarship
• Post Matric Scholarship
• Pre Matric Scholarship
• Prerana Scholarship
• Prime Minister Scholarship
• Rajasthan Scholarship
• Santoor Scholarship
• Sitaram Jindal Scholarship
• Ssp Scholarship
• Swami Vivekananda Scholarship
• Ts Epass Scholarship
• Up Scholarship
• Vidhyasaarathi Scholarship
• Wbmdfc Scholarship
• West Bengal Minority Scholarship
• Click Here Now!!

Mobile Number

Have you Burn Crackers this Diwali ? Yes No

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Blindness, by José Saramago

2012, Philia Filia

Related Papers

philia & filia (Porto Alegre, Brazil) 3.1

Ingo Berensmeyer

Philia Filia

kim worthington

CYnthia Chase

Philia & Filia

Ana Cláudia Romano Ribeiro

Marcus De Martini

Roosevelt Rocha

Leonidas Zelmanovitz

The intention with this paper is to present a timeline of the development of ideas about money, starting with Aristotle. The first section explores in some detail the contribution of Aristotle to the philosophy of money. The second section brings a short inspection of the different thinkers that carried the debate about the fundamentals of money until the end of the nineteenth century. The timeline may clarify the evolution of the relevant concepts about the main characteristics of money in the contemporary debate.

Luciana Villas Bôas

Resumo: O Journal de Voyage en Italie par la Suisse et l'Allemagne en 1580 et 1581 de Michel de Montaigne, publicado postumamente em 1774, costuma ser tratado como um texto subsidiário à interpretação dos Essai, publicados com o aval do autor em 1580. No entanto, enquanto aide-mémoire manuscrito e privado de uma viagem, o Diário abre margem para a experimentação e o registro da diversidade de costumes imponderáveis no contexto da auto-estilização calculada dos Ensaios. Um dos aspectos mais notáveis desta abertura, é a curiosidade de Montaigne pelas religiões de cada lugar, que abrange as novas de zwinglianos, calvinistas e luteranos e as antigas, de judeus e católicos, e inclui a perspectiva de leigos e ministros, questões de doutrina e culto. Este artigo examina como no auge dos conflitos religiosos a religião se torna etnografável. Argumenta-se que a etnnografia do Diário é determinada menos pela "emancipação" da religião, ou por um observador cujo ponto de vista é secularizado, do que pela linguagem e as condições específicas do dissenso religioso. Palavras-Chave: Michel de Montaigne, Journal de Voyage, Abstract: Michel de Montaigne's Journal de Voyage en Italie par la Suisse et l'Allemagne en 1580 et 1581, published posthumously in 1774, tends to be held as an ancillary text for interpreting the Essais, published under the author's supervision in 1580. Yet, as a private, handwritten aide-mémoire, the Diary opens space for an experimentation and recording of cultural diversity that is unthinkable in the context of the Essay's calculated self-fashioning. One of the most remarkable aspects of this openness is Montaigne's curiosity for the religion Philia&Filia, Porto Alegre, vol. 03, n° 1

Enéias Tavares

JAA TORRANO

RELATED PAPERS

Iwa Kuntadi

Marine and Petroleum Geology

Ferran Estrada

Psychiatric Genetics

Janet Munro

Zaidin Mohamad

Expert Systems with Applications

Sylvain Giroux

Applied Sciences

Kin Peng Hui

White Paper, Boeing …

Jeffrey M. Bradshaw

Alper DEMİREZEN

Frontiers in Psychology

Szymon Mizak

Sri Nivetha

Akerele kunle

Boundary Elements and other Mesh Reduction Methods XLII

Carlos Albino

EPRA International Journal of Economic and Business Review

Päivi Galambosi

Lingüística y Literatura

Heraclia Castellón Alcalá

哪里购买temple学位证书 天普大学毕业证学位证书留信人才入库原版一模一样

Annals of Biomedical Engineering

Annelies Pool- Goudzwaard

Nigerian Journal of Clinical Practice

GOLDA EKENEDO

IUB学位证 印第安纳大学伯明顿主校区毕业证

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

William Shakespeare

Ask litcharts ai: the answer to your questions.

The tragic errors that King Lear and Gloucester make in misjudging their children constitute a form of figurative blindness—a lack of insight into the true characters of those around them. Reminding the audience of this fact, the language of the play resounds with references to eyes and seeing from the very beginning. Cornwall and Regan make these images and metaphors of (failed) vision brutally literal when they blind Gloucester in 3.7. For the remainder of the play, Gloucester serves as a kind of walking reminder of the tragic errors of blindness that he and Lear have committed. Yet, Gloucester's greater insight into the character of his two sons after he is blinded reflects an irony: literal blindness ironically produces insight. Only when Gloucester is blind can he see things for what they are.

Throughout the play, characters allude to, and call upon, the gods and the heavens watching over them. As noted above, the gods and heavens suggest order and eventual justice. However, as watchers of the action of the play, the gods also become a kind of audience, and like the audience they both see the story of what is happening more completely than the individual characters on stage and can't seem to do anything to stop it.

Blindness and Insight ThemeTracker

Blindness and Insight Quotes in King Lear

trending now in US News

Mom fined $88K after kids collect 72 clams from Calif. beach...

Here's how large a crowd Trump's rally in deep blue South Bronx...

Sean 'Diddy' Combs 'incensed' at leak of Cassie Ventura violent...

Pennsylvania dad detained in Turks and Caicos for having ammo in...

What the feds plan to use from Hunter Biden's infamous laptop in...

Harvard student goes off script in commencement speech to rip...

Family of dancer who died from eating mislabeled Stew Leonard's...

Missouri rep's missionary daughter, son-in-law killed in Haiti...

Fbi was authorized to use ‘deadly force’ in classified docs search at trump’s mar-a-lago, court filings reveal.

• View Author Archive
• Get author RSS feed

Thanks for contacting us. We've received your submission.

The Department of Justice authorized “the use of deadly force” when FBI agents swarmed former President Donald Trump’s Mar-a-Lago residence in August 2022 looking for classified documents, according to court filings Tuesday .

Agents in the Aug. 8 raid were tasked with seizing “classified information, [National Defense Information], and US Government records,” reads to an operations order revealed in evidence as part of Trump’s criminal case involving the allegedly mishandled documents in Florida.

The authorities also were told to conceal their “law enforcement equipment” and come armed with “ammo,” “handcuffs” and “medium and large sized bolt cutters,” notes the filing by lawyers for the former president.

“The FBI followed standard protocol in this search as we do for all search warrants, which includes a standard policy statement limiting the use of deadly force,” the agency said in a statement. “No one ordered additional steps to be taken and there was no departure from the norm in this matter.”

According to the lawyers, Todd Blanche and Christopher Kise, the nearly 10-hour “unconstitutional” search swept through the Palm Beach estate’s gym and kitchen, as well as the bedroom suite of former first lady Melania Trump and the bedroom of the couple’s teenage son Barron Trump.

FBI agents only discovered classified documents in a basement storage room, an office of the former president and rooms adjacent to the office.

The government says Trump illegally removed the documents, which include “national defense information,” from the White House, while the former president says he has done nothing illegal.

Deputy Assistant Attorney General George Toscas, in a phone call in the days leading up to the raid, allegedly said he “frankly [didn’t] give a damn about the optics” of the recovery operation.

Attorney General Merrick Garland has said he “personally approved the decision to seek a search warrant.”

Evidence in the court filing reveals an earlier back-and-forth between Trump’s lawyer and a prosecutor working for special counsel Jack Smith over retrieving the documents.

But Steven D’Antuono, the assistant director-in-charge of the FBI’s Washington Field Office, had told the House Judiciary Committee in an interview last year that he expressed concerns about executing the search warrant without the consent of one of Trump’s lawyers.

Smith went on to land an indictment against the former president on 37 criminal counts in June 2023 for allegedly retaining more than 100 classified documents at Mar-a-Lago that the FBI seized in the raid and lying to his lawyer and the federal authorities who sought them.

Trump’s lawyers, in another motion Tuesday, asked for that evidence to be suppressed along with audio recordings from one of his lawyers, Evan Corcoran, that bolstered prosecutors’ allegations of obstruction of justice.

Smith fired back in filings of his own , as prosecutors prepare for hearings before US District Judge Aileen Cannon on Wednesday in Fort Pierce, Fla.

The special counsel revealed additional evidence that Trump valet Walt Nauta, who was indicted as a co-defendant in the case, conspired with maintenance worker Carlos De Oliveira to delete camera footage of them moving boxes full of classified documents from Mar-a-Lago.

In a previously sealed opinion, DC US District Senior Judge Beryl Howell wrote that prosecutors had presented evidence of Corcoran tipping Trump off about a subpoena for video footage at Mar-a-Lago.

News of the subpoena apparently prompted the former president to ask Nauta to return some boxes with the sensitive files to basement storage — but “avoid the surveillance cameras he then understood to have been deputized by the government,” Howell said.

Prosecutors were later unable to find video footage of the boxes returning, she added.

Cannon indefinitely postponed the trial over the classified documents earlier this month, writing in an order that to stick to the May 20 deadline would “be imprudent and inconsistent with the Court’s duty to fully and fairly consider the various pending pre-trial motions … and additional pretrial and trial preparations necessary to present this case to a jury.”

Share this article:

Advertisement

• Share full article

Advertisement

Supported by

Guest Essay

Occupation Has Corrupted the Humanity of Israel’s Military

By Avner Gvaryahu

Mr. Gvaryahu is the director of Breaking the Silence, an organization of veterans opposed to the occupation of Gaza and the West Bank.

Israel’s military has brought utter devastation to the Palestinians of Gaza after the attack by Hamas on Oct. 7. But the extreme response is not only a reaction to the horrors of that day. It is also a product of the decades-long role the military has played in enforcing Israeli occupation of Palestinian territories.

The occupation has cultivated a longstanding disregard among Israeli soldiers for Palestinian lives and similar impulses in the words and actions of commanders can be seen to lie behind the horrors of what we are witnessing today.

Israel has governed a people denied basic human rights and the rule of law through constant coercion, threats and intimidation. The idea that the only answer to Palestinian resistance, both violent and nonviolent, is greater — and more indiscriminate — force has shown signs of becoming entrenched in the Israel Defense Forces and in Israeli politics.

I know this through the numerous testimonies collected by my organization, Breaking the Silence, which was formed in 2004 by a group of Israeli veterans to expose the reality of Israel’s military occupation. We know firsthand and from thousands of soldiers that military occupation is imposed on civilians through fear, which is instilled by the growing and often arbitrary use of force.

For 20 years, we have heard these soldiers speak of the gradual erosion of principles that, even if never fully upheld, were once seen as fundamental to the moral character of the Israel Defense Forces. We have continued our work despite criticism from the military and the government.

I also know this because I myself have undergone this moral corruption. I, like many Israeli soldiers, went into the military thinking I knew the difference between right and wrong and had a clear sense of the boundaries on legitimate use of force. But every boundary is destined to be redrawn in a military occupation, whose very existence relies on terrorizing a civilian population into submission.

I clearly remember one of the first times I entered the home of a Palestinian family, as a sergeant, in a village near Nablus in the West Bank in 2007. It was in the middle of the night and we were told that the house would make a good observation point. As we approached, we heard an elderly woman next door screaming in fear. We broke the window of her home and shone a flashlight. She was terrified, speaking unintelligibly. Her family was looking in from the other room, too scared to enter and calm her down. These people weren’t suspects. They just lived next door to the house we needed.

I was horrified, but I soon grew accustomed to such scenes. As soldiers, we used people’s houses for our purposes. We used people’s things. We used people. From home invasions to checkpoints, patrols to arrests, we eventually stopped seeing Palestinian civilians as real, living people. I quit asking myself: What do they feel? What do they think? How would I feel if soldiers barged into my house in the middle of the night? These questions, so crucial for morality and humanity, lost their meaning.

Since the Oct. 7 attack by Hamas on Israel in which 1,200 people were killed and 240 kidnapped, over 35,000 Palestinians have been killed, some 1.7 million Palestinians have been displaced and 1.1 million Palestinians are facing catastrophic levels of food insecurity, according to the United Nations.

And so, as the war grinds on, we Israelis are not who we think we are. We may think we know our boundaries and principles; we may think we are on the side of right; we may think we are in control. Yet what was once unthinkable soon becomes the norm. The innocent, we say, must be protected. But we have lived for too long as an occupying power; too many among us see no one as innocent anymore. We see threats everywhere and in anyone, threats that, we feel, justify almost anything.

That may include using suffering to achieve military goals. “The international community warns of a humanitarian disaster in Gaza and of severe epidemics,” Giora Eiland, a retired major general and former head of the Israel National Security Council, wrote in November. “We must not shy away from this, as difficult as that may be,” he said, adding, “This is not about cruelty for cruelty’s sake, since we don’t support the suffering of the other side as a goal, but as a means.”

Israel has repeatedly maintained that it is doing all that it can to protect civilians. But the heart of this pattern of moral deterioration is in the military’s determination of who is a combatant.

The shifting sense of who is an enemy combatant and who isn’t, both in military procedures and soldiers’ attitudes, is especially clear in Israel’s periodic wars in Gaza, where the withdrawal of Israeli settlements and ground forces in 2005 cleared the way for harsher and less discriminate methods of war.

Take Operation Cast Lead, in 2008 and 2009, which began with an aerial attack on police stations in Gaza City and ultimately killed more than 240 policemen and injured around 750. After the fact, Israel claimed it did not violate the laws of war by targeting policemen since the “collective role of the Gaza ‘police’” was “an integral part of Hamas armed forces” and as such, they were effectively considered enemy combatants. But according to a United Nations fact-finding mission, the policemen killed in the attacks “cannot be said to have been taking a direct part in hostilities.”

Operation Protective Edge, in the summer of 2014, was the deadliest Israeli military campaign in the Gaza Strip since 1967 until the current war. More than 2,200 Palestinians were killed, 1,391 of them civilians , according to the Israeli human rights organization B’Tselem. Many soldiers who took part in the operation have told Breaking the Silence that very little was required by their commanders to label a person an enemy combatant. Two unarmed women walking in an orchard, talking on their phones, were suspected of scouting Israeli forces — and were killed, one soldier told us. After a commander ordered their bodies to be checked, the conclusion was, “They were fired at — so of course, they must have been terrorists,” said the soldier whose identity like that of many of our witnesses we have kept anonymous to protect his safety.

Israel’s conduct in the current war demonstrates this viewpoint even more. A reservist officer recently told a journalist: “De facto, a terrorist is anyone the military kills inside the zone of combat.” This reckless interpretation of the rules of war has resulted in meaningless loss for Palestinians and Israelis alike. In December, the Israeli military mistakenly killed three Israeli hostages in Gaza who had been shirtless, unarmed and bearing a makeshift white flag.

The military said the shooting of the three men had violated its rules of engagement. But soldiers who participated in previous wars in Gaza report ed being instructed, upon entering areas where civilians had been warned to evacuate, to shoot anything that moves because anyone who stayed was considered a threat and a legitimate target. Similar reports are surfacing now.

In contrast to these attitudes, consider the 2002 Israeli bombing of the home of a top Hamas commander in Gaza City that killed him and 14 others, including eight children. A government committee concluded that faulty intelligence led to the high civilian death toll and implied that had it been known there were many civilians on site, the attack would have been aborted.

The shocking numbers of civilian casualties in the current war — nearly 13,000 women and children, according to Gazan authorities — may be the result, to some degree, of other changes in Israel’s targeting policies, too. According to intelligence sources that +972 Magazine and Local Call spoke with , on previous operations senior military operatives were defined as “human targets” who could be killed in their homes even if civilians were around. In the current war, the sources reportedly said, the term “human target” covers all Hamas fighters.

This has clearly led to a sharp increase in the number of targets, which has probably meant that the lengthy process of justifying operations has had to speed up. The military has employed artificial intelligence to help. According to the intelligence sources who spoke with +972 and Local Call, A.I. marked some 37,000 Palestinians in Gaza in the early days of the war for targeting as suspected Hamas militants, most of them of junior rank . It is unclear how many of that group have been killed. The Israeli military has disputed some of these allegations.

A military that controls civilians by force for decades is bound to lose its ethical compass. So does a society that sends its military on such a mission. The horrors of Oct. 7 have accelerated and intensified this process. The death and destruction that have been brought upon Gaza will shape the future of Palestinians and Israelis for generations to come. There will have to be a profound moral reckoning.

Avner Gvaryahu is the director of Breaking the Silence, an organization of Israeli veterans opposed to the occupation of Gaza and the West Bank.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .