THE ENCYCLOPEDIA of BLINDNESS and VISION IMPAIRMENT Second Edition

THE ENCYCLOPEDIA OF BLINDNESS AND VISION IMPAIRMENT Second Edition

Jill Sardegna; Susan Shelly; Allan Richard Rutzen, M.D.; Scott M. Steidl, M.D., D.M.A. The Encyclopedia of Blindness and Vision Impairment, Second Edition

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Library of Congress Cataloging-in-Publication Data

The encyclopedia of blindness and vision impairment / Jill Sardegna . . . [et al.].—2nd ed. p. cm. — (The Facts on File library of health and living) First ed. cataloged under the m.e.: Sardegna, Jill according to AACR2. Includes bibliographical references and index. ISBN 0-8160-4280-2 (hardcover : alk. paper) 1. Blindness—Dictionaries. 2. Blind, Apparatus for the—Dictionaries. 3. Vision disorders—Dictionaries. 4. Visually handicapped—Dictionaries. I. Sardegna, Jill. II. Series. [DNLM: 1. Vision Disorders—encyclopedias.] RE91 .S27 2002 362.4’1’03—dc21 2001055653

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To Ann, For the ﬂowers in my life

CONTENTS

Preface to the First Edition ix Preface to the Second Edition xi Acknowledgments xiii Entries A–Z 1 Appendixes 271 Bibliography 311 Index 325

PREFACE TO THE FIRST EDITION

he Encyclopedia of Blindness and Vision Impairment is however, will prove useful as a basic guide and can Tthe first A-to-Z compendium on the subject of serve as a reference to other sources of informa- blindness and its inherent issues and topics. In more tion. This volume includes a brief list of references than 500 entries, the volume encompasses all aspects at the end of each main article and a substantial of blindness, including health issues, surgery and bibliography. medications, social issues, myths and misconceptions, In an effort to maximize limited space, we have economic issues, education, adaptive aids, and organi- occasionally attempted to save words by using the zations. phrase “the blind” rather than more ideal alterna- The encyclopedia can be of use to both the pro- tives such as “blind individuals” or “people who are fessional and lay person. For the lay person, we blind.” In a similar manner, the pronoun “he” have tried to cover the issue with a minimum of appears in place of “he or she.” technical jargon while accurately presenting the We have taken care to avoid significant errors of facts. Though not intended as a diagnostic tool, the fact or interpretation. We accept, however, that in text provides basic information to enable the user a volume of this scope and length, minor errors to make informed decisions with the help of his may have inadvertently been included. Changing physician. statistics and daily medical breakthroughs may ren- For the professional we have been thorough and der the described current treatments and tech- avoided the simplistic, providing a handy guide niques outdated. We intend to remain current in covering aspects of vision impairment that may fall the field and update the information in future edi- outside the particular individual’s expertise. tions. We understand that a volume of this limited size may not meet every need of all who use it. Because —Jill Sardegna of the concise format, we may have failed to San Jose, California include entries needed by some individuals or —T. Otis Paul, M.D. given other entries limited treatment. The book, San Francisco, California

PREFACE TO THE SECOND EDITION

ight is one of human beings’ most precious and yet that have been significantly revised and updated. Smost taken-for-granted gifts. Most of us routinely Among the new topics covered are increasingly go about our daily business, relying on our sight to get common technologies and treatments such as ker- around, complete our work, recognize friends and atotomy, LASIK surgery, and progressive addition family, read, and generally make our lives easier and lenses; newly recognized potential causes of vision more enjoyable. Too often, only when we develop damage, such as automobile air bags and shaken problems with our eyes or eyesight do we appreciate baby syndrome; and new options for the blind, what a miracle the sense of sight is—or was. such as Braille music, the Employment Assistance The Encyclopedia of Blindness and Vision Impair- Referral Network, and guide horses. Also included ment, Second Edition, is an A–Z compendium on the are such recent milestones as the World Blind Sail- subject of blindness and issues and topics that ing Championship and the Mount Everest expedi- relate to blindness. It addresses topics as far-rang- tion of Eric Weihenmayer, who became the first ing as the mechanics of the eye to traditional biases blind person to climb the legendary peak. and prejudices against blind people. It seeks to help More than 100 entries have been updated to readers achieve a better understanding of how the reflect new developments and information, partic- eyes work and of the problems that can occur with ularly medical breakthroughs and current the eyes and with vision. It also addresses laws research, improvements and advances in existing affecting blind or visually impaired individuals, devices and technology to aid the blind and vision- procedures and medicines used to treat vision impaired, and changes to laws and government problems, and diseases and disorders that can affect programs. Eleven appendixes have been com- the eyes and their sight. pletely redone to provide accurate information The encyclopedia is designed to be a functional about various schools, organizations, associations, tool for a consumer or patient looking for informa- and publications of interest to the blind and vision tion relating to the eyes, as well as for the profes- impaired. All information included in this book is sional who is looking for information outside of his as current as possible. However, with rapidly or her area of expertise. While the book is not occurring medical advances and constantly chang- intended to be used as a diagnostic tool, it should ing statistics, some of the information may be out- be useful in providing readers with information dated, and minor errors may have inadvertently that can be used to make informed decisions in been included in this work. conjunction with their doctors. —Susan Shelly A great deal has changed regarding blindness Shillington, Pennsylvania and vision problems since the publication of the previous edition more than 10 years ago. This new —Allan Rutzen, M.D., and Scott Steidl, M.D. edition features many new entries, as well as many University of Maryland School of Medicine

ACKNOWLEDGMENTS

rofessional people working with all aspects of Foundation Fighting Blindness, Tom Moore, Eye Pblindness and vision impairment generously Bank Association of America, Mary Ellen Mulhol- gave of their time and talents to advise, counsel and land and Dr. Sandra Timmerman, American Foun- inform us. We would like to acknowledge their con- dation for the Blind, Dr. Harry Murphy and Neil tributions and offer our appreciation to Roger R. Scott, California State University, Northridge, Diane Cackler, County of Santa Clara Social Services, Dr. B. Piastro, Carol Ranalli, James C. Riley, California Peter D’Alena, Richard E. Dietl, The President’s State Department of Rehabilitation, Arnay Rosen- Committee on Employment of People with Disabil- blat, National Multiple Sclerosis Society, Victoria ities, Juliet Esterly, Council of Rehabilitation Spe- Shefﬁeld, Helen Keller International, Sandy Smith cialists, Dr. Deborah Gilden, Smith-Kettlewell and Kenneth Stuckey, Perkins School for the Blind, Institute of Visual Sciences, Jessie A. Goehner, Michael A. Thoennes, Foundation for the Junior National Industries for the Blind, Joseph J. Hen- Blind, Todd Turiff, National Society to Prevent nessey, Western Blind Rehabilitation Center, E.K. Blindness, Heidi Williams, Vivian Younger, our Hudson, National Association for Parents of the friends at ABLEDATA, M.C. Migel Memorial Library Visually Impaired, Michelle Laboda, American and Information Center and National Rehabilitation Academy of Ophthalmology, Diane Lipton and Pam Information Center. Our special thanks to our edi- Stenberg, Disability Rights, Education, and Defense tors, Nicholas Bakalar and Kate Kelly. Fund, Joe Jackson, Media Access Ofﬁce, Michael Thanks also to Allan Rutzen, M.D., F.A.C.S., and Larsen and Elizabeth Pomada, Sally Mangold, Cali- Scott Steidl, M.D., of the University of Maryland fornia State University, San Francisco, Marc Mauer, School of Medicine; the Wyomissing Optometric National Federation of the Blind, George McNally, Center in Wyomissing, Pennsylvania; and to Bert United Cerebral Palsy, Michaelann R. Meehan, RP Holtje and Gene Brissie of James Peter Associates.

xiii

ENTRIES A–Z

abacus The abacus is used to teach mathematics Contact: skills to blind and visually impaired students. The ABLEDATA Cranmer abacus is an adaptive device that has a 8401 Colesville Road, Suite 200 backing behind the beads to prevent accidental Silver Spring, MD 20910 movement or sliding. 800-227-0216 (ph) It is used to add, subtract, multiply, and divide 301-608-8958 (fax) whole numbers and decimals. Calculations can be done faster on a talking computer or a calculator, but the Cranmer abacus is considered to be faster Access-Able Travel Source An online service that provides access information about travel to and easier to use than a BRAILLE WRITER, TAYLOR disabled persons, including those who are blind or SLATE, or PEGBOARD. Schools for blind students offer visually impaired. Access-Able provides informa- courses in the use of the Cranmer abacus. tion about cruise lines, various hotels and destina- tions, and tips for travelers with special needs. It ABLEDATA A database that lists and describes also has links to other travel and disability sites, products for people with disabilities. It is funded by information about travel magazines and travel the National Institute on Disability and Rehabilita- agents, and real-life travel stories from disabled tion Research of the U.S. Department of Educa- people who have used Access-Able. tion. Contact: As the nation’s largest information source on disability-related products, it contains over 17,000 Access-Able Travel Source commercially available products for use in personal www.access-able.com care, transportation, communication, independent living, and recreation. Each product entry lists the accessibility The ability to enter and navigate generic name, brand name, manufacturer, avail- through a building or environment and to use all ability, cost, and product description. Products are its facilities or services. To ensure integration of dis- listed from over 2,000 companies. The database is abled persons into all aspects of society, Congress updated continuously. has issued laws and regulations that prohibit those Individuals may request a custom search of who accept federal funds from discriminating ABLEDATA by telephone or written request. against disabled persons by limiting accessibility. Searches of eight or fewer pages are free of charge. Federal accessibility standards are outlined by Single copies of fact sheets containing detailed the American National Standards Institute (ANSI) information about speciﬁc products are available in the document “The American National Standard free of charge. An ABLEDATA thesaurus is avail- Speciﬁcations for Making Buildings and Facilities able for a fee and includes the listing of categories Accessible to, and Usable by, the Physically Handi- and product names. capped.” Compliance with the standards is moni- Individuals may access the database for indepen- tored by the Architectural and Transportation dent searching on the Internet at www.abledata. Barriers Compliance Board, an organization within com. the Department of Health, Education and Welfare.

1 2 accommodation

Although ANSI works with architects, public method, also known as the approach system, is officials, organizations that serve the disabled, and used by people with low vision. disabled individuals, the federal requirements may not be the complete solution to accessibility. The Act to Promote the Education of the Blind standards represent only minimum levels of acces- Passed by Congress in 1879, this act mandates that sibility and do not encourage efforts to exceed the AMERICAN PRINTING HOUSE FOR THE BLIND, a non- these levels. Federal regulations do not solve prob- profit agency, produce and distribute specially lems that result from the conflicting needs of two designed and adapted educational materials to or more types of disabilities; for example, street blind students in public schools in America. crossing curb cuts that serve wheelchair users may Such materials are necessary so that blind stu- be hazardous for visually impaired persons. dents have equal access to public education, and Accessibility requirements for visually impaired include textbooks in Braille and large type, tangible persons may be inadequate as well. The standards teaching devices, educational tests, and special are generally misunderstood and underdeveloped instructional aids, tools, and materials adapted for because blind people and those working profes- students who are legally blind. The American sionally in services for the visually impaired have Printing House for the Blind received federal fund- been unable to reach a consensus on accessibility ing to produce and distribute materials. needs. Excellent methods of orientation and mobility have been developed to enable visually impaired persons to successfully compensate for activities of daily living See DAILY LIVING SKILLS. their sight loss. As a result, the visually impaired segment of the disabled community may lack the acyclovir Acyclovir, also known as ACV or Zovi- urgency felt by other members who cannot com- rax, is an ANTIVIRAL DRUG used to treat ocular herpes. pensate for physical barriers. The drug suppresses the enzyme thymidine kinase, Groups representing blind and visually impaired which is vital to the virus. Acyclovir is distinctive in persons are in place and working to improve acces- that, unlike other antiviral medications, it attacks sibility. The World Wide Web Consortium is in the the viral cells only and disregards normal cells. process of finalizing accessibility guidelines to Acyclovir is available in pill, cream, injection, or assure that all people have equal access to the ointment form. It is commonly used to treat HERPES Internet. These efforts are a collaboration of indus- SIMPLEX type 1 and type 2 of the skin, mouth, eyes, try, disability, and research organizations, as well as brain, genitals and lungs and in newborn infants. It various governments from around the world. has also been proven effective against the HERPES For more information about federal accessibility ZOSTER virus associated with shingles and chicken standards and ANSI, contact: pox. There are no significant side effects associated American National Standards Institute with this drug. 1819 L Street, NW, Suite 600 Acyclovir is not a cure. The drug can attack the Washington, DC 20036 virus only when it is active. It inhibits the virus 212-642-4900 from reproducing, but the virus retreats to the gan- www.ansi.org glion and remains latent. The virus may become reactive at any time, because the drug is ineffective against herpes during periods of latency. accommodation The adjustment the lens of the Acyclovir is available through prescription only. eye makes in order to focus on close or distant Cream or ointment forms of this drug should never objects. Our ability for accommodation begins to be placed in the eye directly. diminish at around age 10, but the decline is not normally noticed until about age 40. Accommoda- tion also refers to the method of bringing an object adaptive aids Adaptive aids (or daily-living aids, closer to the eye in order to see it better. This independent-living aids) are devices and tools that adaptive aids 3 have been adapted or invented to enable visually 60 times normal size. Portable models are available impaired persons to perform sight-related tasks and constantly improving. independently. Often, an unadapted tool or utensil NONOPTICAL or environmental aids improve vision is marked with raised dots, braille, or large print to but do not use lens magnification. These factors become an adaptive aid. Other aids are equipped improve the environment rather than the device or with voice simulators. object of regard. They include illumination, light Adaptive aids may require prescription by an transmission, reflection control, and contrast. OPHTHALMOLOGIST or low-vision specialist and may Illumination is improved through use of brighter require special training for use. Adaptive aids are or dimmer room lighting, as needed according to available through adaptive-aids catalogs or are con- the cause of disability. Light transmission is structed or adapted by the users themselves. improved through lenses, filters, and absorptive Health aids are instruments that can be used by lenses, which reduce glare and highlight contrast. visually impaired persons to monitor their health Reflection is controlled by visors, sideshields, or administer medicine. Devices for monitoring specially treated lenses, and typoscopes. Contrast is temperature, blood pressure, pulse, and glucose are enhanced by using highly contrasting colors near marked in braille or announce the measurement in one another, such as black ink on white paper or a synthesized voice. Pill splitters divide pills into fluorescent strips on stair risers. even halves, and guides are available for measuring TALKING AIDS, or auditory aids, allow the user to liquid medications. Diabetes-related devices mea- access information by the sense of hearing. They sure insulin to preset levels and serve as needle are devices that play or read the text, message, guides. Many syringes are marked in large print. measurement, or degree according to a preset in- Household aids include cooking devices, such as a terval of time or on activation of the voice. liquid level indicator (which hooks over the lip of a Tape recorders are used to play and/or record cup and beeps or vibrates as the liquid nears the communications and recorded materials such as top of the cup), one-cup beverage makers (which TALKING BOOKS. Some models are available with heat liquids for soup, coffee, etc.), electromagnetic stop/start foot pedals to allow for typing while lis- stoves (which heat food without flames or heating tening. Many tape recorders and players contain elements), elbow-length oven mitts, and knife slic- variable speed adjustments to reduce the time ing guides. spent listening. Other aids for the home include self-threading Speech compressors are machines that control needles, sewing-machine magnifiers, magnetic the speed of the audio of a tape by deleting portions padlocks (which require no combination and open of the pauses between words or by shortening with a magnetic sensor), raised large-print tele- vowel sounds. The material is rerecorded in the phone dials, one-button automatic telephone-dial- shorter version, and the sound of the speech is not ing systems, and brailled clothing tags. affected. Magnification aids, or MAGNIFIERS, include hand- Accelerated speech is text that is recorded at held devices such as a bar magnifier, which enlarges normal speed but reproduced and played at an one line of print, and hand-held aspheric magni- accelerated speed. Highly accelerated speech may fiers, which magnifies three to 10 times the normal produce a distortion in the sound of the voice, size. Magnifiers may lie on the page as a sheet mag- although some models contain pitch-controlling nifier, may be held by stands at a precise distance options. from the page or object, or may be attached to spec- Talking books and other recorded texts are avail- tacles and swung down into place when needed. able through talking-book programs or the Library Magnifiers may be telescopic and enable the user to of Congress. Books on cassette tape are also avail- see street signs or other distant objects. able through commercial publishers. Electronic magnifiers or visual aids include Synthetic speech is the computerized production CLOSED-CIRCUIT TELEVISION (CCTV), which employs a of sounds into words and is used in the voice output camera and a zoom lens to magnify a page of print of reading machines and computers. The Kurzweil 4 adaptive aids

Reading Machine is a talking device that uses a com- Braille books, magazines, musical materials, and puter-controlled camera to scan lines of print. A maps are available to those who read braille. Large- voice synthesizer “reads” the print to the user. print materials employ larger lettering for use by Talking adaptive aids are tools that supply a voice those with partial vision. Written materials are reading of the information normally gained by sight. recorded on tape or gramophone and are available Such aids include the talking scale, clock, watch, to visually impaired persons. timer, blood-pressure monitor, thermometer, blood- A script-writing guide is a template with an glucose monitoring kit, talking wallet (which identi- opening that corresponds to one line of space on a fies bills of $1–$10 denominations), label makers, lined page. The device can be lowered one line at a calculators, and computer-speech output. time as the writer progresses down the page. Many Tools and instruments include rulers, yardsticks, designs allow adaptations for drawing vertical lines and tape measures with raised tactual readings or and for use on nonstandard-size paper. braille markings, saw guides with raised markings at Bold-line paper is lined writing paper with specific degree points, drill guides and squares, heavy, dark lines in place of standard light blue calipers, and micrometers with raised-dot markings. lines. The bold lines (often used with a thick-tipped Light probes and metal or voltage detectors locate felt pen) may be all that is necessary to allow per- light or flame, metal objects, or live electrical cur- sons with low vision to write independently. rent and sound an audible signal to alert the user. Templates or stencils are available in myriad TRAVEL AIDS allow the user to move in an envi- forms for tasks that range from envelope address- ronment safely and independently. These include ing to check writing. They are made from plastic canes, folding or rigid, and electronic travel aids or metal and have openings or windows that that are prescribed by an optometrist or ophthal- correspond to the type of document. Many tem- mologist and include the laser cane, the Path- plates can be made to order to suit the user’s sounder, the Sonic Guide, and the Mowat Sensor, needs or documents. A signature guide is a tem- all of which require specialized training to use. plate that has one opening to place on the signa- Electronic travel aids send out light beams or ture line. ultrasound waves that come into contact with A RAISED-LINE DRAWING KIT involves a penlike objects in the path. When the beam or waves hit an stylus for forming letters or drawings on special object, the device responds by vibrating or emitting plastic paper or mylar covering a drawing board. a sound. Drawn lines are visible and can be tactually traced. ORIENTATION AIDS familiarize a visually impaired A similar device, a dot inverter, involves embossed traveler to the layout of a particular building or dots that can be used to make simple maps or fig- site. Orientation aids include tactile maps, three- ures. dimensional maps that include raised lines and are THERMOFORM is a system that uses an oven to read with the fingertips, models, three-dimensional heat plastic sheets. The heated sheets can be scale representations of the site, and verbal record- embossed into dots or shapes including braille let- ings of site descriptions or travel routes. ters or maps. The thermoform sheets can be used to Watches, clocks, and timers are available in a vari- duplicate braille pages from a master sheet. ety of forms. Watch covers are designed to open so Label makers include designs that make adhe- the user can feel the hands in relation to the raised sive-backed or magnetic labels in large print, dots at each hour. Time pieces may be tactually braille, raised-line letters, or “talking” labels. marked with dots at each hour or at set intervals on Three-D markers allow writing three-dimen- the dial. Many feature large print or bold, high- sional letters or figures that can be felt with the fin- contrast numbers. Some designs announce the gertips. The ink may be brightly colored and may time audibly at the touch of a button, and others be used on cloth, plastic, and metal. automatically announce the time at set intervals. Braille writers or braillers are used to type Writing and communication aids enable users to braille. A slate and a stylus are portable writing perform writing and reading tasks independently. devices for printing braille. aging 5

The OPTACON is a reading device used by those ally for their own children, or in groups to repre- who read braille. The user sweeps a line of print sent the needs of similarly disabled children, par- with a small camera held in one hand. The other ents are an effective force. For example, during the hand rests on a console that receives the print and epidemic of cases of retrolental fibroplasia in the converts it to a series of vibrating pins that simulate 1940s and 1950s and later in the 1960s following print letters. an epidemic of rubella, parents formed advocacy Standard typewriters or word processors can be groups that forced schools to provide special edu- used for those with touch typing skills. Computers cation for their visually impaired and multihandi- that print braille or standard print are available capped children and to include these children into with speech output. public schools and mainstream classes. Many advances in computer access for visually A parents advocacy group active today is the impaired persons have been made in recent years. National Organization of Parents of Blind Children, Special tools are available that convert documents affiliated with the National Federation of the Blind. into text, which can be read by a screen-reading It can be accessed on the Internet at www.nfb.org/ program that synthesizes text as audible speech. nopbc. In some cases, regular computers can be con- Successful advocacy usually includes phases of verted and made accessible to blind or visually preparation, action, and evaluation. During the impaired users. preparation phase, the advocate identifies the spe- See also COMPUTERS. cific need, researches the existing organizations that provide services and aid and identifies which advocacy An advocate is one who pleads the agency or individual is best prepared to fill the case of another. Advocacy among persons with dis- need. abilities often centers on working to change legisla- In the action phase, the advocate contacts the tion, to fill unmet needs or to take advantage of agency or individual, convinces the individual of denied opportunities or rights ensured by law. the needs of the disabled person and the ability, Advocacy measures may involve issues of legisla- appropriateness or responsibility of the agency to tion, medical rights, housing rights, fair compensa- provide for those needs, works with the individual tion, nondiscrimination, employment rights, to target specific methods to meet needs and devel- educational rights, use of public transportation or ops a timetable or plan for fulfilling the needs. facilities, and rights of privacy. During the evaluation phase, the advocate The Rehabilitation Act of 1973 established the determines whether the needs have been met discretionary creation of advocates or client assis- according to the agreement and remains in contact tants at the state level. These assistants work as with the agency until the needs are met. ombudsmen with disabled individuals and service providers to ensure that individuals receive the ser- age-related maculopathy (ARM) See MACULAR vices they seek. Many states have established spe- DISEASE. cific state protection and advocacy agencies to serve as advocates. Local governmental social service offices may provide additional help in gaining aging More than 50 percent of all individuals appropriate services and aid. with severe vision impairments are over 65. In Professional, consumer, and advocacy organiza- addition, a study by Lighthouse International tions and agencies for the blind and visually showed that one in six people age 45 or older report impaired on the national, state, and local level some type of visual impairment. More than half of serve as self-advocates by informing and educating these people describe the impairment as severe. lawmakers, providing services and information to Changes with age occur both in the external and the public, and offering referral services. internal portions of the eye. Externally, the globe Parents of disabled children frequently merge to itself may seem to have sunken into the skull. This form advocacy groups. Whether working individu- is the result of a breakdown or natural degeneration 6 aging of the retrobulbar fat that supports the globe in the aging retina is duller and exhibits a less responsive bony socket. Fortunately, the bony socket, called light reflex. The optic disc may be paler also. the orbit, is not susceptible to osteoporosis, as are VISUAL ACUITY, or the ability to see small objects other bones in the body. The orbit does not weaken under normal lighting and contrast conditions, or become thin and brittle with aging. may suffer with age. The reduction may occur as a The eyelids may lose elasticity and tone causing result of the smaller pupil and/or the aging, opaci- PTOSIS (drooping eyelid). This may cause a reduc- fied lens. Decreased visual acuity may affect the tion in the area of visual field. ability to perform tasks such as reading or driving. ENTROPION (a turning inward of the eyelid) and The aging eye requires more light than a ECTROPION (a turning outward of the eyelid) are younger eye. It is estimated that for every 13 years common complaints associated with aging. Both of life, twice the amount of light is needed to func- conditions can be successfully treated with surgery tion effectively. This may be due to the smaller if they produce discomfort or a threat to vision. pupil and less transparent lens. The CONJUNCTIVA, or white portion of the eye, CONTRAST sensitivity and spatial perception becomes slack and more susceptible to chronic reductions may occur with age. The ability to inflammations with age. As it slackens, a section detect and recognize contrast is controlled by the may become caught between the lids during blink- neural circuitry of the retina and brain. As neu- ing. Harmless degenerative plaques may appear on ronal changes occur, contrast sensitivity decreases. the white of the eye. Spatial perception depends on contrast detection, ARCUS SENILIS may appear on the margin of the so any reduction in contrast perception affects this cornea. This harmless white circle bordering the ability as well. CORNEA is a common occurrence in the elderly. Adaptation, the ability to be sensitive to chang- Composed of cholesterol and its derivatives, the ing light levels and adjust to them, is diminished by presence of arcus senilis does not necessarily indi- age. An elderly eye may require more time to cate an overall raised cholesterol level. recover from glare or a bright light such as a flash- Most aging eyes become presbyopic, a condition bulb or car headlights. This is a result of the in which the hardened lens is unable to bend and smaller, less adaptive pupil and the opacified lens. focus effectively on objects at close range. PRESBY- Color vision may fade or change with age. The OPIA usually surfaces near age 45 and affects both yellowing lens tends to absorb and scatter blue nearsighted and farsighted eyes. The condition is light, rendering blues darker and less intense. The treated with reading glasses or bifocals. unimpeded red and yellow light is allowed to pass The lens often becomes opacified with age. through and cast a warm, reddish glow onto Degrees of OPACIFICATION vary and are not termed objects. CATARACT until a significant opacification develops. In addition to visual changes, vision loss occurs The lens may yellow and cause color vision as a result of diseases that are associated with changes and nearsightedness. aging. The four leading causes of vision loss among The pupil loses its ability to accommodate elderly individuals are AGE-RELATED MACULOPATHY, quickly with changing light. The pupil becomes cataracts, GLAUCOMA, and DIABETIC RETINOPATHY. smaller and reduces the light entering the eye to Age-Related Maculopathy (ARM) is a progres- approximately 30 percent of normal levels. sive disease in which the macula, or area of The VITREOUS of the aging eye may contain opac- sharpest central sight, deteriorates. Central vision ities that become visible to the individual as and contrast enhancement is lost but peripheral floaters, or spots that bounce or float in the field of vision often remains intact. Some types of macular vision. The vitreous may collapse or detach from disease may be treated with laser therapy, and the retina. This may cause a more serious condi- other advances in the treatment of ARM are occur- tion, RETINAL DETACHMENT, and vision loss. ring rapidly. Doctors and scientists are optimistic The arteries and veins of the RETINA become nar- about new treatments for ARM, and are working rower with age, reducing the flow of blood. The hard to find a cure for this disease. Aid to Families with Dependent Children 7

Cataracts are opacifications or cloudy spots on AIDS Acquired immunodeficiency syndrome, or the lens of the eye. Senile cataracts, those associ- AIDS, is a disease of the immune system character- ated with aging, are usually progressive and may ized by a deficiency of thymus-derived lympho- exist for several years before requiring surgical cytes. These lymphocytes, identified by the removal. Removal of cataracts is highly successful, phenotypic marker T4, function as helpers to the and entails removal of the lens. The lens is re- immune system. The lack of T4 lymphocytes leads placed by an artificial intraocular lens or by a con- to a breakdown in the immune response and allows tact lens or glasses. The results of cataract removal, the body to become host to opportunistic infections although generally successful, vary from person to and neoplasm (tumor) development. AIDS is person. caused by a virus called HIV (human immunodefi- Glaucoma is an increase in the intraocular pres- ciency virus). Having HIV is not the same as having sure. This occurs when the eye produces an over- AIDS. AIDS is the late stage of HIV infection. abundance of AQUEOUS FLUID or when the eye fails Visual disorders or disturbances affect over 50 to drain the fluid adequately. The increase in pres- percent of AIDS patients. One-third of these sure may damage organs of the eye and result in patients have cytomegalovirus retinitis, an infec- vision loss. Glaucoma can be treated and controlled tion of the retina caused by the cytomegalovirus with medication or surgery. (CMV). Cytomegalovirus is a member of the herpes Diabetic retinopathy is an eye disease that virus family and may cause primary, latent, and results from diabetes. The small blood vessels that persistent infections. support and nourish the retina become damaged Cytomegalovirus retinitis progressively destroys and weak. These may hemorrhage and cause an tissue that leads to scar formation, and possible accumulation of fluid in the retina that limits or retinal detachments. Symptoms of the condition alters vision. New, weaker vessels may proliferate, include blind spots, blurred vision, and loss of hemorrhage and form vision-limiting scar tissue. peripheral vision, although the infection may be The scar tissue may trigger a retinal detachment, present without any apparent symptoms. The and permanent vision loss may result. infection progresses rapidly and may cause blind- Aging eyes may benefit by changes in the envi- ness if left untreated. ronment and lifestyle of the individual. Increased Current treatment for cytomegalovirus retinitis lighting and color contrast coupled with reduced involves the use of two ANTIVIRAL DRUGS: ganci- glare may aid residual vision, increase effectiveness clovir and foscarnet. Ganciclovir stops the progres- in the performance of tasks, and enhance safety. sion of the disease and may save the residual ADAPTIVE AIDS may improve or enhance remaining vision. The drug is contraindicated for use with vision, aid in the performance of skills and tasks, AZT. The drug is given by daily intravenous infu- and increase independence. Biannual eye exami- sion, but an oral form has recently been developed nations for those over 40 may uncover an eye dis- and is in testing. order at its earliest and most treatable stage. Foscarnet also stops the progression of the infection. It is given intravenously but can be taken in American Foundation for the Blind. Aging and Vision. conjunction with AZT. Foscarnet may be less effec- New York: AFB, 1987. Carroll, Thomas J. “A Look at Aging,” The New Outlook tive in preventing relapses of CMV retinitis after (April 1972): pp. 97–103. the initial high-dose induction phase of treatment. Denby, Dorothy. “Aging and Blindness,” Aging and the Foscarnet may have the additional advantage of Human Condition, New York: Human Services Press, being effective in combatting HIV activity. Inc. 1982. Galloway, N. R. Common Eye Diseases and their Management. Berlin: Springer-Verlag, 1985. Aid to Families with Dependent Children American Society on Aging. Visual Disorders and Aging. (AFDC) A federal cash-assistance program for www.asaging.org/ameritech/V002_visual_disorders. needy children. The program is administered by html, 2000. each state’s Department of Social Services. 8 air bags

Eligible children are those who have been laceration of the eyelid, inflammation of the iris, deprived of support or care of one or both parents corneal lesions and abrasions, black eye, and by death, disability, absence, or unemployment. swelling and hemorrhage of blood vessels under Children may be eligible for the program if they are the outer surface of the eyeball. under age 17. Children 18 years old and enrolled in high school full time may be eligible. albinism A hereditary condition in which all or The parent or caretaker is usually included in part of the body lacks pigment. Albinism may af- the grant, and two-parent households may be eli- fect the skin, eyes, and hair of the individual. It is gible if both parents are unemployed. Parents must thought to be caused by an enzyme deficiency register for work, unless they are exempt from involving the metabolism of melanin during prena- employment. tal development. Children living in foster homes also may qualify There are two major types of albinism: oculocu- for AFDC funds. taneous albinism and ocular albinism. Oculocuta- Some state AFDC programs, such as that in Cal- neous albinism involves a lack of pigmentation in ifornia, include a homeless assistance (HA) compo- the eyes, skin, and hair. The condition is subdivided nent that grants payments to acquire temporary into two groups, tyrosinase-positive or tyrosinase- shelter and/or permanent housing. An AFDC eligi- negative, according to the presence or absence of ble family qualifies for HA funds if the family lacks the enzyme tyrosinase in the hair bulbs. Tyrosinase a permanent nightly residence, has a nightly resi- inhibits the formation of pigment in the body. dence that is a publicly or privately operated shel- Tyrosinase-negative individuals have white hair, ter for temporary living accommodations, or lives pink skin, and pale blue eyes, and tyrosinase-posi- in a public or private place that is not designed for tive individuals produce some melanin and vary as residence, such as a bus station or building lobby. to physical condition and coloring. Ocular albinism involves the lack of, or reduced air bags Protective devices that are installed in amount of, pigmentation of the eye. Individuals many cars. Air bags, also known as inflatable with ocular albinism may exhibit no lack of pig- restraint systems, are designed to inflate immedi- mentation of the skin and hair. ately upon impact, in the course of an automobile Those with ocular albinism and tyrosinase-neg- accident. They are designed to prevent the driver ative oculocutaneous albinism usually experience and front-seat passenger from being thrown severe visual disorders. These may include a visual against the steering wheel, dashboard, or window acuity of 20/200 or less, NYSTAGMUS (an involun- or from being thrown from the car. tary movement or jerking of the eyes), AMBLYOPIA Although they are credited with saving lives and (a condition in which the brain does not receive preventing many injuries, there are risks, including information from one or both eyes as a result of a eye injuries, associated with air bags. This is partic- failure of the vision development as an infant or ularly true with regard to children. child), iris transillumination (the ability of light to An article in the August 2000 issue of Oph- pass through the normally pigmented iris), lack of thalmology, the journal published by the American fundus pigmentation, and PHOTOPHOBIA (a sensitiv- Academy of Ophthalmology, concluded that air ity to light). bags can cause serious eye injuries to children and Albinism cannot be cured. Symptoms such as that to avoid such injuries, children should not be loss of visual acuity, nystagmus, amblyopia, and photophobia may be treated with therapy, surgery, permitted to ride in the front seat of an automo- corrective lenses, or light-reducing lenses. bile. Some possible eye injuries that could result from air bag deployment include cataracts, glaucoma, alcohol amblyopia A visual condition unique to blood in the front chamber of the eye, alkali burn, alcoholics or those who have a history of chronic, temporary loss of consciousness and visual acuity, severe drinking problems. The disorder involves amblyopia 9 lost vision, including SCOTOMAS (blind spots) and Alva Access Group Alva Access Group is a decreased visual acuity within the central portion Netherlands-based company that specializes in the of the visual field. The painless, bilateral sight loss development and production of Braille displays gradually worsens. The disorder is caused by the and software that make computers accessible for toxic effects of alcohol on the OPTIC NERVE. The tox- those who are blind or visually impaired. icity causes optic neuropathy, a condition in which Its primary products, in addition to Braille dis- the optic nerve swells. plays, are a screen magnifying software program Alcohol amblyopia may be linked with a thi- called inLARGE and a screen reader software pro- amine (vitamin B1) deficiency, a condition that can gram called outSPOKEN. Its products can be inte- lead to optic-nerve damage. Alcohol consumption grated in most computer systems and operate in all may interfere with the absorption or activation of commonly used languages and all common Braille nutrients and vitamins within the body, including tables. thiamine and zinc. Alva, which was founded in 1984, acquired Alcohol amblyopia may be treated with proper Berkley Systems, a software development and pub- diet and vitamin supplements. The condition is lishing company that specializes in products for the usually reversible but may lead to permanent visually impaired, in 1996. vision loss if untreated. For the worldwide distribution of its products, ALVA maintains and supports a widespread distrib- Burde, Ronald M., Peter J. Savino and Jonathan D. Trobe, Clinical Decisions in Neuro-Ophthalmology. St. ution network. Louis: C.V. Mosby Company, 1985. Contact: Havener, William H. Ocular Pharmacology. St. Louis: C.V. Alva Access Group, Inc. Mosby Company, 1970. 436 14th Street, Suite 700 O’Brien, Robert, and Morris Chafetz. The Encyclopedia of Oakland, CA 94612 Alcoholism. New York: Facts On File Publications, 1982. 510-451-2582 510-451-0878 (fax) www.aagi.com Alliance for Eye and Vision Research The Alliance for Eye and Vision Research is a nonprofit amaurosis The loss of sight due to disease. organization founded in 1993 by the Association for Research in Vision and Ophthalmology, the Also known as “lazy eye,” a condition American Academy of Ophthalmology, and the amblyopia in which an otherwise healthy eye provides poor Association of University Professors of Ophthal- vision. This occurs in an infant or child when one mology. Its goal is to achieve the best eye care pos- eye presents less visual information to the brain sible for all Americans and to educate the public than the other eye due to abnormal vision develop- and Congress about the importance of the research ment. The weaker eye’s corresponding visual brain conducted by the National Eye Institute that affects cells have impaired function and receive less infor- public vision and eye care. mation from the eye. According to the National Eye The Alliance is the parent group of the National Institute, amblyopia occurs in approximately 2 per- Alliance for Eye and Vision Research, which is pri- cent to 4 percent of the population and is a major marily a lobbying organization. cause of visual impairment in young children. It is Contact: frequently unilateral, but can be bilateral. Alliance for Eye and Vision Research In normal vision, each eye looks at an object and 426 C Street, NE sends electrical impulses to the brain describing Washington, DC 20002 each separate image of that object. The brain’s 202-544-1880 visual cells receive and translate these impulses 202-543-2565 (fax) into one three-dimensional image as “seen” in the www.eyeresearch.org brain. 10 American Academy of Ophthalmology

When one eye is crossed (STRABISMUS), causing Since a young child’s brain cells can reverse different images sent to the brain, or when one eye themselves and regenerate more effectively during sends more accurate information to the brain, this the first few years of life, it is important to diagnose interferes with the image-making process. The mes- and treat amblyopia as early as possible. Children sages of one eye may be suppressed or ignored by of any age can be screened for amblyopia during an the brain. The ignored eye becomes nonfunctional. ophthalmologic examination, but it is more effec- The vision cells of the brain that serve the tive after six months and most effective at five ignored eye become dysfunctional, causing the eye years of age. Treatment is very successful in chil- to lose vision and become amblyopic. Children are dren up to age six. After age nine, treatment is especially susceptible to amblyopia since visual sys- much less effective. tems take years to fully develop and can be altered TOBACCO or ALCOHOL AMBLYOPIA are conditions easily in the formative years. in which the excessive use of tobacco or alcohol Amblyopia can be caused by any disorder or impairs central vision. The vision is often blurred condition that interrupts normal vision processing. and is accompanied by numbness or tingling in the Strabismus, or crossed eyes, is responsible in hands and fingers. The condition usually rights approximately 50 percent of all cases. itself when tobacco or alcohol use is discontinued Conditions that block an image from the eye’s or drastically reduced. retina can also induce amblyopia. CATARACTS, ptosis (a drooping eyelid), corneal scarring, or nontrans- parent sections in other parts of the eye can cause American Academy of Ophthalmology The amblyopia in children. These obstructions may largest association of ophthalmologists in the cause an eye to send impaired images to the brain. United States. More than 90 percent of all practic- The developing visual system within a child’s brain ing American ophthalmologists are Academy may cease to accept the impaired information, and members, and an additional 5,000 ophthalmolo- the corresponding brain cells become amblyopic. gists are international members. ANISOMETROPIA often causes amblyopia. Ani- The academy was incorporated in 1979 when sometropic eyes have unequal refractive powers, the parent organization, the American Academy of requiring a stronger lens prescription in one eye Ophthalmology and Otolaryngology, was divided than another. Without corrective lenses, one eye into two separate academies: one for the eye, the sends less reliable and accurate information to the other for the ear, nose and throat. In 1981, the brain. The brain concentrates on the information American Association of Ophthalmology merged from the better eye and ignores that from the with the academy. weaker eye. Occasionally, minor degrees of ani- The goal of the academy is to help the public sometropia exhibit no symptoms. maintain healthy eyes and vision. The primary Amblyopia may be caused by hereditary diseases focus of the Academy is education. The Academy or conditions such as albinism or by the accompa- holds a five-day annual meeting offering scientific nying strabismus caused by hereditary conditions. papers, symposia, instructional courses, multime- To treat amblyopia, the original cause such as dia presentations, and exhibits to educate ophthal- cataract, strabismus or anisometropia must be diag- mologists and other interested parties about new nosed and corrected. Therapy for the amblyopia advances in eye care and treatment. itself follows and includes the prescription eye- Courses are offered throughout the year, in glasses and/or a patch for the nonamblyopic eye. locations around the country, with hands-on labo- Once the better eye is patched, the brain is forced ratory instruction and updates on important to accept information from the amblyopic eye. developments in ophthalmology. The academy Visual brain-cell deterioration begins to reverse offers its members educational programs and itself, and the eye becomes functional again. The materials covering practice management, patch may be worn a portion of the day or all day, Medicare billing and coding guidelines, and policy and recovery may take up to several months. and procedures. American Council of the Blind 11

The academy develops and produces education sionals working within the health-care field, and and training materials, texts, videotapes, slide-script interested individuals. programs, and a subscription series for practicing The organization maintains service programs, ophthalmologists, nonophthalmic physicians, and represents the deaf-blind community during pub- other medical eye-care practitioners. The academy lic-policy matters, refers individuals to services, and produces public- and patient-information materials compiles statistics. and maintains a public-information program AADB holds an annual convention. AADB through the news media. Policy and information members meet with parents and community agen- statements concerning current eye-care topics are cies to provide training in methods of communica- developed and disseminated to the public. tion and discussion of needs for deaf-blind persons. The academy’s Office of Governmental Relations AADB maintains a library of information con- in Washington, D.C., represents ophthalmologists cerning deaf-blindness and publishes the Deaf-Blind and their patients in state and federal legislative American, a quarterly journal. matters by monitoring and submitting statements Contact: on proposed regulations and legislation. American Association of the Deaf-Blind In 1980, the academy established the Founda- 814 Thayer Avenue tion of the American Academy of Ophthalmology, Silver Spring, MD 20910 a charitable organization that supports and devel- 800-735-2258 (ph) ops public-service programs, preserves ophthalmic 301-588-8705 (fax) historical collections, and fosters innovative pro- 301-588-6545 (tty) grams to promote and enhance optimal public eye www.tr.wov.edu/dblink/aadbz.htm care. As a first project, the foundation developed the Museum of Ophthalmology, a historical collection that traces the development and growth of American Council of the Blind (ACB) A non- ophthalmology. profit organization that serves as a national clear- The foundation sponsors the National Eye Care inghouse for information on blindness and Project, a program to aid disadvantaged elderly per- organizations and institutions that serve the blind. sons. The program provides eye care and services to The organization works to improve conditions maintain and protect the eyes and vision of elderly and services concerning those with visual impair- people who cannot afford to pay for ophthalmo- ments. It provides advisory assistance on issues logic care. concerning disability-related legislation, affirma- Contact: tive action, civil rights, education of disabled persons, increased participation in vending facility The American Academy of Ophthalmology programs, improvement of Social Security and P.O. Box 7424 other federal benefits, reading and library services, San Francisco, CA 94120-7424 low-vision technology, and eye research. 415-561-8500 (ph) The ACB provides professional support in cases 415-561-8575 (fax) of class action and public interest litigation. It offers www.eyenet.org group health insurance and supports public education concerning the needs and abilities of the visu- American Association of the Deaf-Blind ally impaired. The organization awards Floyd (AADB) The American Association of the Deaf- Qualls Memorial postsecondary scholarships each Blind, Inc. (AADB), formerly the American League year to visually impaired students. for Deaf-Blind, was founded in 1937. It is a non- The ACB publishes the bimonthly The Braille profit organization dedicated to the advancement Forum and holds an annual convention. It also of economic, educational and social welfare of operates ACB Radio, a webcasting service with deaf-blind persons. Membership consists of deaf- three Internet radio stations. It can be accessed at blind individuals, their families and friends, profes- www.Live365.com. 12 American Foundation for the Blind

Contact: Much of the library’s collection is accessible to blind and visually impaired people via on-site computer- American Council of the Blind ized reading devices. The library holds the Helen 1155 15th Street NW, Suite 720 Keller archives, a collection of letters, photographs Washington, DC 20005 and memorabilia given to AFB by Helen Keller, 800-424-8666 (ph) who worked for the AFB for more than 40 years, 202-467-5085 (fax) and her teacher, Anne Sullivan Macy. http://acb.org AFB records and manufactures over 500 titles of talking books each year for the Library of Congress. American Foundation for the Blind (AFB) A It conducts research, surveys the needs of visually national, nonprofit organization, founded in 1921, impaired people and studies the current services dedicated to providing direct service and programs, provided by agencies. It consults with Congress and referral services and improvement of the standards governmental agencies on legislative issues. It of service for blind and visually impaired people. manufactures and sells publications, and products AFB works in conjunction with public schools and for visually impaired people. universities, senior centers, businesses, and more AFB publishes The Journal of Visual Impairment than 1,000 specialized agencies. Headquartered in and Blindness, AFB News, Long Cane News and AFB New York City, AFB has regional centers in Wash- Directory of Services for Blind and Visually Impaired Per- ington, D.C., New York, San Francisco, Chicago, sons in the United States. AFB began publishing Access Dallas, and Atlanta. World in January 2000. Printed six times a year, the AFB provides national consultation services to publication provides the latest information on schools, agencies, and organizations of and for adaptive technology and visual impairments. AFB blind people on topics concerning visual impair- sponsors the annual Helen Keller Seminar and the ment, including education, orientation and mobil- annual Josephine L. Taylor Leadership Institute for ity, low vision, early childhood, employment and professionals in the field. aging. It offers regional consultation services for Contact: technical assistance, staff training, regional fund- raising, public education, and public-relations pro- American Foundation for the Blind gram development. 11 Penn Plaza, Suite 300 AFB serves as a clearinghouse for information New York, NY 10001 about blindness and visual impairment. It publishes 212-502-7661 (ph) and distributes books, pamphlets, periodicals and 212-502-7777 (fax) audio/visual materials. It maintains a public educa- www.afb.org tion program that utilizes publications, personal presentations, exhibits, and media releases. American Printing House for the Blind (APH) AFB houses the National Technology Center Founded in 1858, the American Printing House for (NTC), a research and development facility that ex- the Blind (APH) is the oldest American nonprofit plores, develops and evaluates technological organization for the blind. It is the largest indepen- devices for visually impaired people and consults dent publishing house of materials for the visually with manufacturers in the development of new impaired in the world. devices. The NTC maintains a database of con- The APH publishes books and magazines in sumer information about products, training pro- BRAILLE, large print, tape, and flexible disc. It programs, funding resources, and evaluation reports. vides writing tools and recording equipment, voca- AFB also houses the M.C. Migel Memorial tional materials, educational aids, and computer Library and Information Center. The 37,000-vol- products to visually impaired adults and students. ume collection of printed materials is one of the The educational aids and materials are used to largest collections on blindness and the largest cir- teach math, science, reading, and social studies to culating library on blindness in the United States. students of all ages. Other aids aim to improve LOW Americans With Disabilities Act 13

VISION or sensory, motor, and conceptual skills. national members. It is headquartered in Washing- Tools include braille writing equipment, study and ton, D.C., and has offices in New York City. school supplies, recording and playback machines, Contact (Washington): and specialized lamps. APH also provides hardware American National Standards Institute and software materials for use with microcomput- 1819 L Street, NW, 6th Floor ers, such as speech-synthesizing devices and Washington, D.C., 20036 enlarged screen images. 202-293-8020 (ph) APH maintains a Department of Educational 202-293-9287 (fax) Research to conduct studies about blindness. Through this research, new materials and product Contact (New York): manufacturing methods are developed. APH also American National Standards Institute provides a national data base of materials for the 11 West 42 Street, 13th Floor visually impaired called Louis, in honor of Louis New York, NY 10036 Braille. The comprehensive database contains more 212-642-4900 (ph) than 135,000 listings for large type, Braille, 212-398-0023 (fax) recorded, computer disk, and tactile graphic publi- www.ansi.org cations. It is fully speech accessible. The American Printing House maintains a library of 3,500 volumes and publishes the maga- American Thermoform Corporation (ATC) A zine APH Slate. It holds an annual convention in company that produces Brailon materials, Braille Louisville, Kentucky. text duplicators, Braille printers, computer Braille Contact: paper, Braille translation software, thermoform machines, and graphic machines. American Printing House for the Blind Brailon is the trade name for the paper used in P.O. Box 6085, 1839 Frankfort Avenue a thermoform duplicator. Each plastic sheet is Louisville, KY 40206 placed atop a page of Brailled paper and inserted 800-223-1893 (ph) into a thermoform machine. The machine heats 502-899-2274 (fax) the Brailon sheet and creates a duplicate of the http://aph.org Brailled sheet. The company introduced Dot & Print in June 2000. A Braille and print printer, the American National Standards Institute The machine allows someone to produce Braille and American National Standards Institute (ANSI) was print on the same piece of paper, utilizing one founded in 1918 to administer and coordinate a printer. It also prints Braille only or print only. voluntary standardization system among the Contact: American private sector. It is a private, nonprofit American Thermoform Corporation organization that is supported by many different 1758 Brackett Street, organizations from both the private and public sec- La Verne, CA 91750 tors. 800-331-3676 (ph) ANSI is important to blind and visually impaired people because it works with architects, public offi- 909-593-8001 (fax) cials, and organizations to establish standards www.atcbrleqp.com aimed at creating accessibility for all disabled persons. Although ANSI does not develop standards, it Americans With Disabilities Act (ADA) An act facilitates their development by encouraging con- passed by Congress on July 26, 1990, that “prohibits sensus concerning the standards among various discrimination on the basis of disability in employ- groups. ment, programs and services provided by state and ANSI has more than 1,000 company, organiza- local government, goods and services provided by tion, government agency, institutional, and inter- private companies, and in commercial facilities.” 14 ametropia

The act was intended to make all areas—includ- Refractive errors such as HYPEROPIA (farsighted- ing the workplace, recreational facilities, restau- ness), MYOPIA (nearsightedness), ASTIGMATISM (dis- rants, places of worship, schools, and so forth torted image) or PRESBYOPIA (aging eyes) result in —accessible to those with any kind of disability, blurred vision. Ametropia can be diagnosed in a including blindness or vision disorders. It is aimed routine ophthalmologic examination and is usually at giving disabled people the same rights, access, corrected with eyeglasses or contact lenses. and opportunities in areas such as employment, health care, child care, and participation in every- Amsler grid A specialized testing device, day civic life. As a result, elevators and automated invented by Professor Marc Amsler and used to teller machines must include Braille instructions, detect disorders and SCOTOMA (blind spots) in the and public documents and financial statements central field of vision. It is routinely used to screen must be available in alternative formats, such as patients for AGE-RELATED MACULOPATHY during the Braille, large print, and audiotape. Curbs must be ophthalmologic exam. cut out at the corner to allow wheelchair access, The Amsler grid is a black-on-white grid of 400 and wheelchair ramps must be included in build- squares. It is composed of 20 horizontal squares by ings covered under the act. TTY terminals are 20 vertical squares. A black dot is in the center of required in public buildings for people who are the grid where the two central horizontal and ver- deaf or have speech disabilities. There are many tical lines intersect. regulations contained within the act. With one eye covered, the patient is asked to Recently, the ADA has been extended to apply look at the center dot. The patient is asked whether to cyberspace. In 1996, the U.S. Department of Jus- the center dot is visible, all the sides are visible, the tice, which oversees the ADA, stated that the act applies to Internet access. Any entity that is entire grid is visible, any lines are wavy or bent, included under the ADA is required to “provide there are any blurs, color differentiations or distor- effective communication, regardless of whether tions within the grid. If any lines appear wavy, if they generally communicate through print media, some of the lines disappear, or if all four corners are audio media, or computerized media such as the not visible, scotomas or age-related maculopathy Internet.” The act also requires that covered enti- may be present. ties that use the Internet for communications regarding their programs, goods, or services must be aneurysm A diseased or weakened section of a prepared to offer those communications through blood vessel that fills with blood and dilates. accessible means. Aneurysms may occur within blood vessels A disabled person who feels that his or her rights throughout the body. are being violated because of a covered entity’s Aneurysms within the blood vessels of the brain noncompliance with the ADA is entitled to file a may be the result of ARTERIOSCLEROSIS. They may complaint with the U.S. Department of Justice. rupture and bleed into the cerebral fluid, a condi- More information about the ADA in general, tion called a subarachnoid hemorrhage. A sub- compliance with the act, or how to file a complaint arachnoid hemorrhage may cause increased is available by calling a toll-free ADA information pressure within the brain and decreased blood sup- line. The line is maintained by the U.S. Department ply, resulting in a STROKE. Paralysis of the limbs, of Justice. The number is 1-800-514-0301. sudden changes in the field of vision, speech and memory disorders and thinking or reasoning prob- ametropia A vision problem caused by the eye’s lems may follow. inability to focus properly. Ametropia occurs when Aneurysms of the eye’s RETINA may occur as a the CORNEA and the LENS of the eye cannot effec- result of another disease or disorder such as DIA- tively focus light, and the resulting image, onto the BETIC RETINOPATHY. In this disease, the retinal ves- RETINA. This focusing impairment is also called sels are weakened by diabetes. They tend to bulge REFRACTIVE ERROR. and leak, hemorrhaging into the retina and causing anterior chamber 15 vision loss. As the disease progresses, neovascular- may vary from minute measurements to noticeable ization occurs producing weakened blood vessels degrees. The size difference may be variable during that rupture, hemorrhage and may cause RETINAL the course of a day. DETACHMENT and scar tissue resulting in permanent On the average, women tend to have larger vision loss. pupils than men have, and blue or less pigmented irises are larger than brown, more pigmented irises. aniridia Aniridia (or irideremia) is the absence of Myopic (nearsighted) individuals usually have larger pupils than those with HYPEROPIA (farsight- the IRIS within the eye. It is a congenital or acquired condition. Congenital aniridia is a geneti- edness). cally determined condition. In many cases, a vesti- Anisocoria may be congenital or acquired, as gial portion of the iris root or margin is present. The from ingestion of oral contraceptives. The condi- congenital condition is usually bilateral and often tion may be a first indication of pupillary defects but may also exist in the absence of ocular disor- seen in conjunction with congenital CATARACT. der. One or both anisocoric pupils that fail to prop- GLAUCOMA tends to develop in early adolescence in approximately 25 percent of congenital aniridia erly react to light may indicate neurological cases, due to the abnormal angle of the anterior problems. chamber and blockage by the iris root. Individuals with congenital aniridia are photo- anisometropia A common condition in which phobic and may experience AMBLYOPIA (loss of the eyes have unequal refractive power or unequal vision in one eye due to disuse) and NYSTAGMUS ability to focus and see. The degree of ani- (involuntary jerking of the eyes). Associated retinal sometropia can be determined during an ophthal- abnormalities or malformations may exist. The mologic examination. Anisometropia is corrected condition, which develops at about the 12th week by prescribing a stronger prescriptive lens for one of pregnancy, is very rare, affecting 1 in 500,000 to eye than the other to equalize the eyes’ refractive 1 in a million children. powers. Contact lenses often can greatly reduce the Acquired aniridia occurs as a result of trauma effects of anisometropia. or injury. The iris is dislodged or torn from the Without correction, anisometropia can cause CILIARY BODY. It contracts into a small pellet and AMBLYOPIA in children. The weaker anisometropic moves to the outlet of the anterior chamber, eye sends less reliable information to the brain where it may form a blockage and cause sec- than does the stronger eye. The visual cells of the ondary glaucoma. brain ignore the information of this eye, become The glaucoma of both types of aniridia is treated dysfunctional and cause the eye, however healthy, with medications or with surgical procedures such to become amblyopic. as goniotomy or trabeculotomy if the medication proves ineffective. The prognosis for the vision of anterior chamber A section of the eye between those with aniridia is generally poor. the CORNEA and the LENS. The chamber is filled with a clear liquid called AQUEOUS FLUID. anisocoria A condition in which the pupils differ The cornea and the lens of the eye lack blood in size. Average-size pupils range from three to four vessels, which deliver nutrients and carry away millimeters. waste. The aqueous fluid, produced by the CILIARY All pupils are small at birth. Differences in size BODY, provides these services as it circulates within become more apparent as the individual grows and the anterior chamber. The aqueous fluid leaves the achieves maximum pupil size by adolescence. The chamber through the Schlemm’s canal, a channel pupil may become smaller with advancing age. where the IRIS and the cornea meet. If the channel Approximately 17 percent of the population becomes blocked, fluid may build up in the eye and have minor amounts of anisocoria, but only 4 per- cause a rise in intraocular pressure, a condition cent have pronounced cases. The difference in size known as GLAUCOMA. 16 antibiotics antibiotics DRUGS that fight infections caused by not taken intravenously or internally. They are bacterial microorganisms. They are commonly pre- available in ointment or drop form only. scribed for those who have a bacterial eye infection A new group of drugs, including acyclovir and or who undergo eye surgery. Antibiotics are often ARA-A, has since been developed that attack only taken prior to surgery to avoid the possibility of the viral cells and leave the body’s healthy cells infection. intact. These drugs, also known by the names ACV, Antibiotics may be topical (applied outside the Zovirax, vidarabine, Vira-A, and adenine arabino- body) or systemic (taken internally). Antibiotics side, are less toxic and can be prescribed in drop, prescribed to treat eye disorders may be in oint- ointment, injection, or pill form. ment, eye-drop, or pill form. None of these drugs is a cure for the herpes sim- Antibiotics are classified as one of two types, plex virus. They can treat the virus only when it is bacteriocidal or bacteriostatic. Bacteriocidal antibi- active in the body. The drugs discourage the virus otics, such as penicillin, ampicillin, and amoxicillin, from generating new cells, and the virus then re- disrupt the natural cell formation of microorgan- treats into the ganglion of the body where it re- isms to eliminate them. Bacteriostatic antibiotics, mains latent. The drugs are ineffective against the such as tetracycline, doxycycline, and erythro- virus during periods of latency. The drugs cannot mycin, hinder reproductive chemical processes to stop the virus from becoming active, which could eradicate the unwanted microorganisms. occur at any time. When an infection is suspected in the eye, a cul- Antibiotics may also be used to treat viruses. ture may be taken from the conjunctival sac. A TRACHOMA, a leading cause of blindness in the wide-spectrum antibiotic may be prescribed until world, is often successfully treated with tetracy- the cause of the infection is isolated. Once the cline hydrochloride ointment. cause is determined, both systemic and topical antibiotics may be required. aphakia Aphakia refers to an eye without a LENS. After CATARACT surgery, during which the lens of the eye is removed, the eye is aphakic. A monocu- antiviral drugs DRUGS that fight viruses that infect the body. Viruses that affect the eye usually lar aphake is a person without the lens from one result in inflammation or infection. These infec- eye. A bilateral aphake is a person missing both tions may lead to serious, vision-limiting condi- lenses. Without the lens, the eye is unable to accom- tions such as KERATITIS (corneal inflammation) or modate or adjust to focus on an object. Commonly, IRITIS (inflammation of the IRIS). elderly cataract surgery patients experience limited Since HERPES SIMPLEX is a major cause of viral infection in the eye, several antiviral drugs have accommodation before surgery and therefore been developed for the purpose of treating this surgery-induced aphakia minimally affects their condition. Drugs most often prescribed include vision. People with aphakia are at a greater risk for some types of retinal detachment than those who IDOXURIDINE, TRIFLURIDINE, ACYCLOVIR, and ARA-A. Idoxuridine and trifluridine were the first drugs are not aphakic. to be developed to treat the inflammation of the Aphakia also distorts the size of objects, makes images appear larger, and may bend or curve CORNEA (or keratitis), associated with ocular herpes. They are also known by the names Herplex, straight lines. Distance judgment problems may Stoxil, Dendrid, TFT, F3T, and Viroptic. These drugs result. Changes in color-perception may also occur. are antimetabolite agents that affect the metabolic Colors may appear brighter, pinker, or bluer. system of the body. Highly toxic, they cannot dif- Aphakia can be corrected with glasses, contact ferentiate between healthy human cells and viral lenses, or intraocular lenses, also called IOLs. cells in the body. They may destroy the healthy cells in the process of ridding the body of unwanted appetite suppressants Systematic use of appetite viral cells. Because of their toxicity, these drugs are suppressants, including amphetamines, dextroam- arcus senilis 17 phetamines, methamphetamines, and phen- ARA-A is used to treat HERPES SIMPLEX types 1 and metrazine compounds, can affect the eyes, causing 2 of the eyes, including herpes KERATITIS, a condition such side effects as pupil dilation and impaired involving the cornea. It is also effective in the treat- vision. These drugs also can cause difficulty with ment of herpetic encephalitis, a brain infection. accommodation and convergence, which can make ARA-A is not a cure for herpes keratitis or her- reading difficult. Persistent use of these drugs petic encephalitis. It can only destroy viral cells also can lead to closed-angle glaucoma in some when the virus is active. During periods of herpetic people. latency, the drug is ineffective. aqueous fluid The aqueous fluid (or aqueous architectural barriers See ACCESSIBILITY. humor) is the clear liquid that fills the ANTERIOR CHAMBER of the eye, located between the CORNEA and the LENS. The cornea and lens must be trans- Architectural Barriers Act The Architectural parent to function and, therefore contain no blood Barriers Act of 1968 requires buildings designed, vessels. The aqueous fluid functions as blood ves- constructed, or altered with federal funds to be sels by delivering the nutrients and antibodies and accessible to physically disabled persons. The Act carrying away the waste normally. was amended to include access to public buildings The clear, thin fluid is produced by the CILIARY and government-leased buildings for public use or BODY at a rate of approximately two cubic millime- where disabled individuals might be employed. ters (about one drop) per minute. The nutrients Later legislation required government agencies to and antibodies are pumped from blood vessels perform continuous surveys to ensure compliance within the ciliary body and mix with the aqueous. with the Act. The aqueous flows from the ciliary body, behind The Rehabilitation Act of 1973 founded the the IRIS, across the lens, through the PUPIL into the Architectural and Transportation Barriers Compli- anterior chamber, and along the back surface of the ance Board, which ensures compliance with the cornea. It circulates in the anterior chamber, bring- Act. The board reports to Congress and the presi- ing nutrients and carrying away waste from the dent each year. Complaints about facilities that do avascular cornea and lens. not comply with the act must be submitted in writ- The aqueous fluid drains from the eye at the ing to: base of the cornea, an outflow channel called the The Access Board, Office of Compliance and Schlemm’s canal. The aqueous fluid is strained of Enforcement waste and collected in the canal. It then flows to 1331 P Street, NW, Suite 100 small veins in the sclera and joins the body’s blood Washington, D.C. 20004-111 stream. When the draining channels become blocked or (See ACCESSIBILITY.) if the eye overproduces aqueous, the fluid may U.S. Department of Education. Summary of Existing Legis- build up. Intraocular pressure builds within the lation Affecting Persons with Disabilities. Washington, eye, damaging the nerve endings of the RETINA. D.C.: USDE, 1988. This condition is known as GLAUCOMA. arcus senilis Arcus senilis is a grey or white ring ARA-A An ANTIVIRAL DRUG prescribed in the or arc that appears on the edge of the IRIS, or col- treatment of ocular herpes. Available in ointment ored part of the eye, where it borders the SCLERA, and pill form, it is also known by the names vidara- or white part of the eye. The ring is actually located bine, Vira-A and adenine arabinoside. Unlike IDU on the margin of the CORNEA, the clear, protective or TFT, drugs that attack healthy as well as infected covering of the eye. cells, ARA-A is less toxic and attacks only viral The condition is caused by aging and is most cells. often noticed in dark-eyed people. Arcus senilis is a 18 argon laser harmless condition that does not affect vision and GLAUCOMA, a disease in which the intraocular fluid is not a sign of another eye disorder. Arcus senilis fails to properly drain from the eye, accumulates also is known as a cornea ring. and causes elevated intraocular pressure. If untreated, glaucoma causes a loss of peripheral vision and eventual blindness. The argon is a LASER often used to argon laser When medication fails to lower the intraocular treat DIABETIC RETINOPATHY, a leading cause of blind- pressure, laser trabeculoplasty with the argon may ness in the United States. A complication of dia- be used to open the drainage area located where betes, diabetic retinopathy occurs as a result of the cornea meets the IRIS. A series of burns are damage to retinal blood vessels that leak or hemor- placed in the drainage area, which causes scarring rhage. The retinal tissue loses oxygen normally and openings within the meshwork of drainage brought by the vessels and develops new vessels channels. The fluid drains more easily from the (neovascularization) that tend to be weak and eye, and intraocular pressure is reduced. bleed. Continuous leaking and the formation of retinal scars may lead to blindness. Berland, Theodore, and Richard A. Perritt. Living With If neovascularization has occurred, unhealthy, Your Eye Operation. New York: St. Martin’s Press, 1974. Eden, John. New York: Penguin Books, oxygen-deprived tissue is treated with the laser. The Eye Book. 1978. The directed energy of the laser causes scarring Krames Communications. The Retina Book. Daly City, and prohibits the tissue from forming new, weak Calif.: KC, 1987. vessels. Reynolds, James D., “Lasers in Ophthalmology.” Health- The argon laser, which was invented in 1964 by Net Library. Columbus: CompuServe, 1989. William Bridges, a scientist at Hughes Aircraft, may Shulman, Jules. Cataracts. New York: Simon and Schus- be used to treat subretinal neovascularization, a ter, 1984. disorder caused by AGE-RELATED MACULOPATHY (ARM), a major cause of blindness associated with arterial occlusion A blockage of the arteries of aging. ARM produces scarring of the macula, the the RETINA. When this occurs, blood is prevented region of the RETINA that allows for sharpest vision. from reaching the retina, and vision is threatened. Subretinal neovascularization is caused by a break Arterial occlusions may be caused by carotid artery in the pigment epithelium, a layer below the stenosis, retinal artery emboli, retinal artery occlu- retina. A collection of blood vessels below the sion and temporal (also called giant cell) arteritis. retina bleeds into the retina through the break and Arterial occlusion occurs most frequently in causes scarring. people between the ages of 50 and 80. During argon laser treatment, burns are placed Carotid artery stenosis occurs when one of the around the neovascularization areas to cauterize carotid arteries, which lie on each side of the neck the bleeding. However, the bluegreen light of the and supply blood to the brain, becomes narrowed argon laser is absorbed by the pigment of the inner with arteriosclerotic plaque. The blood flow to the retina, above the deeper affected layers. This may brain and the eye is decreased, and a TIA, transient cause damage to the inner retina. ischemic attack, or ministroke may occur. The red krypton laser is often substituted for the TIAs are warning signals of more serious argon on this procedure since it is absorbed only in impending strokes and include the symptoms of the melanin pigment of the deepest layers of the tingling in the face or limbs, difficulty speaking, retina where the neovascularization occurs. Treat- headache, dizziness, vision disturbances, inability ment with the krypton laser is preferred since it to swallow, mental confusion, and loss of memory. allows the inner, unaffected retinal layers to During a carotid artery stenosis or TIA, vision remain untouched while treating only the deep, may be suddenly lost in one eye. The loss is usually affected layers. painless and generally lasts for a short period of Laser therapy called laser trabeculoplasty may time. Temporary loss of vision of this type may be be an alternative to surgery in the treatment of accepted as a symptom or warning sign of a TIA. arteriosclerosis 19

Individuals with any symptom or combination of Gurwood, Andrew S., Alan G. Kabat, and Joseph W. symptoms of a TIA should be examined by a physi- Sowka. “Handbook of Ocular Disease Manage- cian immediately. Treatment for carotid stenosis ment.” Review of Optometry Online, Jobson Publishing, may include anticoagulants or a surgical procedure 2002. called carotid endarterectomy, which removes arte- Reynolds, James D. “Ocular Artery and Vein Occlusion.” HealthNet Library, Columbus: CompuServe, 1989. riosclerotic plaque from the carotid artery. Retinal artery emboli are small particles of blood clots that enter the blood’s circulation and become arteriosclerosis A condition in which the arteries wedged in a retinal artery. These emboli may cause become narrow and blocked, also known as hard- obstructions that result in vision loss. ening of the arteries. The condition is a leading The loss of vision is usually swift and painless. If cause of stroke and is associated with heart disease treatment is not begun within minutes, vision may and other disorders. Arteriosclerosis produces fatty be permanently lost. Results from current treat- material, called plaque, that accumulates and lines ments to restore vision are often disappointing. the artery walls. The arteries become smaller in Therapy should include treatment of the underly- diameter, then clogged. This results in decreased ing cause such as arteriosclerosis, hypertension, blood circulation or cessation of the blood flow. As and heart disease. the body’s organs receive less blood and oxygen, Retinal artery occlusion is a blockage of the reti- they may fail to function properly. When the blood nal artery that does not involve emboli. This is most flow is blocked, blood fails to reach the brain, and common in hypertension patients as a result of a STROKE results. ARTERIOSCLEROSIS. The sight loss is usually sudden, Arteriosclerosis is a factor in the formation of painless and permanent. Treatment is directed to blood clots. Platelets, blood-clotting cells in the the underlying hypertension and arteriosclerosis. blood, tend to adhere to the arteriosclerotic plaque Temporal or giant-cell arteritis is a chronic con- and further block the arteries. When the clot of dition that involves inflammation of all the body’s platelets is jarred loose from the artery, it is termed arteries. The inflammation causes the artery walls an embolism. The embolism can travel through the to thicken, which may block the flow of blood to blood stream, become wedged into a smaller blood vital organs, including the eyes. Symptoms include vessel and cause a stroke. dizziness, headache, weight loss, scalp tenderness, Arteriosclerosis may also cause heart attacks, jaw pain, depression, low-grade fever, and vision heart failure, heart disease, angina, kidney damage, loss. Vision loss may be sudden and permanent. poor circulation, and vision loss. It is associated The disease may be diagnosed with a blood test with aging and high blood pressure, or hyperten- that reveals the presence of giant cells and a sion, and is linked to obesity, improper diet, smok- biopsy. The disease is treated with corticosteroids. ing, stress, and lack of exercise. Vision in one eye may be lost before the diagnosis Arteriosclerosis may affect the eyes as the blood is made but careful monitoring and treatment of vessels of the RETINA become constricted. A normal the unaffected eye may prevent further loss of RETINA, the light-sensitive layer in the back of the vision. eye, gathers light information about an object and Temporal arteritis may last from two to three encodes it into electrical impulses. The impulses months and is rarely seen in patients under 50 travel along the optic nerve to the brain where years of age. Approximately 25 percent of cases they are translated into an image. A retina result in permanent blindness. impaired by arteriosclerosis cannot function ade- (See HYPERTENSIVE RETINOPATHY, STROKE and quately, and vision may be blurred or lost. VENOUS OCCLUSION.) Retinal arteriosclerosis, when coupled with American Heart Association. 1989 Stroke Facts. Dallas: hypertension, is a condition called HYPERTENSIVE AHA, 1988. RETINOPATHY. Although the condition alone is rarely Galloway, N. R. Common Eye Diseases and Their Manage- vision-threatening, it may lead to other eye dis- ment. Berlin: Springer-Verlag, 1985. eases such as AGE-RELATED MACULOPATHY. 20 arteritis

Age-related MACULOPATHY (ARM) is a condition Adapettes, Comfort Drops, Moisture Eyes, and in which the macula, the center of the retina and Hypo Tears. point of clearest vision, deteriorates. As the macula Henkind, Paul, Martin Mayers and Arthur Berger, eds. degenerates, central vision is lost. ARM may be Physicians’ Desk Reference for Ophthalmology 1987. caused by heredity, chronic sun exposure, or arte- Oradell, N.J.: Medical Economics Company Inc., riosclerosis. It is a progressive disease without a 1987. cure but that can sometimes be treated with photocoagulation or laser treatments. artificial vision system A system that uses tech- Arteriosclerosis is often present without symp- nology to produce images that can be detected and toms. The condition may be detected during a med- recognized by blind people. Developed by Dr. ical or ophthalmologic examination. It is treated William H. Dobelle, the device is battery operated with medication for high blood pressure or antico- and weighs about 10 pounds. It works through a agulants that increase blood circulation and dis- miniature digital video camera and an ultrasonic courage the accumulation of plaque. Patients are distance sensor, which are built into a pair of sun- often urged to make changes in diet and exercise glasses. The sensor connects through a cable to a and to reduce smoking and stress. small computer, which the blind person wears around his or her waist. arteritis See ARTERIAL OCCLUSION. The computer processes the video and distance signals, then uses computer-imaging technology to Artic Technologies A company founded in 1984 transmit the image to the person wearing the to develop products using speech synthesis, such as device. Once the image has been transmitted, the custom computers and braille notetakers, to be computer triggers a second computer, which sends used by the blind. Artic updates its products fre- pulses to 68 platinum electrodes that have been quently to take advantage, and keep abreast, of surgically implanted onto the part of the brain that changing technology. controls vision. The second computer is screwed Contact: into the wearer’s skull bone, with its shaft protruding through the skin. Artic Technologies When the electrodes are stimulated, they gener- 55 Park Street ate a display of phosphenes, which are bursts of Troy, MI, 48083 light caused by pressure on the eyeball. Phos- 248-588-7370 (ph) phenes appear as black-and-white images, and the 248-588-2650 (fax) wearer of the device possibly can learn to recognize www.artictech.com patterns and distinguish images. Reportedly, one blind man who received the artificial vision system artificial tears Artificial tears are used to treat made such progress that he was able to recognize dry eye, a condition brought about by allergy, ker- different character sets commonly used in visual atoconjunctivitis (corneal and conjunctival inflam- acuity tests. The system also has an electronic inter- mation), extreme vitamin-A deficiency, TRACHOMA, face that is a radio frequency. It can replace the chemical burns, and disorders and diseases, such as camera and allows patients to watch television and BELL’S PALSY. Many artificial tears are available use a computer. without prescription. The artificial vision system, also called a visual These drugs are known by the generic names prosthesis, is still in the testing stages, but is hydroxyethylcellulose, hydroxyproplycellulose, hy- expected to be available on a limited commercial droxypropl methylcellulose, methylcellulose, poly- basis sometime in 2002. Dobelle, who heads the vinyl alcohol, and other polymeric solutions. Dobelle Institute at Columbia Presbyterian Medical Numerous trade names include Clerz, Lacrisert, Center in New York City, and the Institute Dobelle Isopto Alkaline, Muro Tears, Methopto, Methulose, AG in Zurich, Switzerland, has been working on Aqua Tears, Liquifilm Tears, aqua-FLOW, Refresh, the vision system for 30 years. attitudes 21

Reuters Health. “Artificial Vision System Gives ‘Sight’ to Re:View, a quarterly journal, and “Job Exchange,” a the Blind.” Rx.com Magazine, January 18, 2000. monthly listing of available jobs within the field. Contact: A-scan An A-scan is a test that uses ultrasonic Association for the Education of the Blind and waves to determine the length of the eye. An A- Visually Impaired scan is performed prior to CATARACT surgery to pre- determine the power of an intraocular lens 4600 Duke Street, Suite 430 implant or to ascertain whether an implant is nec- Alexandria, Virginia 22347 essary. 703-823-9690 (ph) The average eye is approximately 24 millimeters 703-823-9695 (fax) from the CORNEA to the RETINA. A shorter eye is usu- www.aerbvi.org ally farsighted, or hyperopic. A longer eye is usually nearsighted, or myopic. A shorter eye needs a Association of Parents Having a Kid in Contacts stronger lens to focus properly. A longer eye needs (APHAKIC) An on-line group for parents of chil- a weaker lens to focus. An extremely long eye may dren with vision problems, especially those who not require an implant. wear contacts or other corrective lenses. The web- The information from this painless test is site offers advice, information and support for analyzed by a computer along with the results of parents, as well as recommendations for ophthal- KERATOMETRY. The computer evaluates the infor- mologists and other eye specialists. mation and determines the power of the needed The group has an on-line newsletter and offers implant. discussion groups and bulletin boards where parents can share questions and concerns. APHAKIC Association for Education and Rehabilitation of can be accessed on the Internet at http://members. the Blind and Visually Impaired (AER) An or- aol.com/aphakic. ganization founded in 1984 as a consolidation of the Association for Education of the Visually Hand- astigmatism A common disorder in which the icapped (AEVH) and the American Association of visual image is distorted because the corneal sur- Workers for the Blind (AAWB). The goal of the face is not completely spherical. Light entering the organization is to promote the advancement of eye at different angles is focused unequally, creat- education and rehabilitation of blind and visually ing the distortion. An individual with astigmatism impaired persons. may not recognize the distortion because the brain It is a private nonprofit organization of 41 state compensates for it and presents a reasonable groups and 7 regional groups. The organization has image. over 6,000 members internationally. Symptoms of astigmatism include eye strain and The membership includes anyone interested in headaches. Cylindrical lenses are prescribed in the the education, vocational rehabilitation, guidance, form of eyeglasses or contact lenses and may be or occupational placement of visually impaired combined with a prescription for near- or farsight- persons. The membership encompasses educators, administrators, ophthalmologists, social workers, edness. Patients may experience a feeling of being professionals in the field of rehabilitation, parents, tilted or off balance for the first few days of wear- agencies, organizations, and schools. ing the cylindrical lenses as the brain learns to read AER works with universities and colleges to pro- the new, correct image. vide workshops and conferences and extend oppor- Astigmatism levels off after the eye stops grow- tunities for the visually impaired. It maintains ing, but can change with age, due to PRESBYOPIA, certification programs, presents awards, offers job- changes in the eyelid, and cataract formation. exchange services, and provides public information services. attitudes Attitudes toward blind persons are AER holds a biennial convention and issues two formed by and reflect the society in that blind peo- publications, AER Report, a bimonthly newsletter, ple live. Historically, blind or visually impaired 22 attitudes persons have been viewed negatively as either lia- blind persons to being considered burdens on soci- bilities or wards of the society. Although strides ety. It ignores the fact that blind people can be self- have been made by visually impaired individuals in supporting and self-sufficient. According to the modern history, they are to some extent still stereotype, blind people are considered generally viewed as a separate group—“the blind” rather unhappy persons who lead dependent, bitter, than as blind individuals. unsatisfying lives. Society lacks full social, economic and voca- The stereotype of blind persons as evil or sinister tional integration of the visually impaired. There- also exists. Negative blindness stereotypes stem fore, large segments of society have little contact from our very language. Phrases such as “blind with, or knowledge of, the true abilities and in- alley,” “blind stupor” or “blind fury” reinforce the dividuality of blind people. This segregation per- concept of blindness with darkness, fear, ignorance, petuates “handicapism,” a term for stereotyping, and evil. prejudice, and discrimination by society against Historically, blindness was considered a mark of disabled people. Handicapism reinforces negative disapproval from the gods or a punishment for sins. stereotypes and increases barriers to integration. In ancient societies, blind children were left in the Society develops and maintains stereotypes elements to die. Literature such as the Oedipus leg- about disabled people through superstitious beliefs, end depicts the hero’s self-imposed blindness as a fairy tales, folklore, comic books, literature, reli- punishment for his sins. gious beliefs, the media, and many charity organi- According to another stereotypical attitude, zations that serve disabled persons. These serve as blind people are held to be self-pitying. In response information sources when personal experiences to complaints about discrimination, society often are limited. instructs that the individual should “get on with The most commonly held stereotypes place life” or “when life gives you lemons, make lemon- visually impaired persons (or any disabled person) ade.” The individual is considered bitter and angry in one of two roles: either very good and right- rather than an activist. eous or very bad and evil. The stereotype of Blind people are generally regarded as physically the blind person as heroic is common. The indi- and recreationally less active than others, although vidual is considered admirable by “overcoming all the lack of sight may be their only physical limita- obstacles” to achieve modest, everyday goals such tion. Blind skydivers, swimmers, bowlers, golfers, as going to school or holding a job. This under- and skiers abound but are rarely depicted in the mines the feasibility of such goals for most blind media or noted by society. people. The misconception of the blind person as seden- The situation is also sometimes exaggerated to tary and homebound is tied to the belief that blind- portray the blind person who has overcome all ness is a disease rather than a sensory loss. This odds to achieve ambitious goals by use of compen- breeds the fear that, like a disease, blindness can be sating powers or abilities. In films and literature, “caught” or transmitted. blind persons are falsely attributed with ESP, Blind persons using a dog guide are generally heightened hearing or touch, or higher IQs as pow- accepted as the norm, although a very small per- ers that develop through Nature’s compensation centage of blind persons actually own a dog guide. program to offset the loss of sight. Society mistakenly holds that the dog knows the Films and literature often depict blind persons as directions to the destination, checks the color of righteous and in positions of jeopardy, so that plots the traffic lights, and directs its owner when to of good versus evil can be enacted. This reinforces cross the street. In reality, the dog is directed by the the stereotype of blind persons as victims of vio- owner, is color-blind, and is basically used only to lence, people to be pitied. avoid obstacles and occasionally protect its owner The pitiful character is seen as helpless and per- from danger. petuates the reasoning that blind people lack in- Seldom depicted, but in reality more common, dependence and must be cared for. This reduces is the concept of the blind person who uses a auditory aids 23 long cane. Although a person traveling with a “Clearly, familiarity breeds an empathy, an under- cane is generally competent, graceful, and self- standing, a sense of equality,” Harris said. “Lack of assured, the stereotype features a distracted bum- familiarity breeds concerns, doubts, and outright bler who inadvertently destroys objects with a hostility.” wildly swinging cane. This stereotype gives rise to Biklen, Douglas, and Robert Bogdan. “Media Portrayals the concept of the blind person as laughable or of Disabled People: A Study in Stereotypes,” Interracial foolish. Books for Children Bulletin vol. 8, nos. 6–7 (1977), pp. Another stereotypical view is that blind persons 4–9. are less intelligent than their sighted peers. It is Goldberg, Maxwell H., and John R. Swinton. Blindness held that since sighted persons require vision to Research: The Expanding Frontiers. University Park: learn and confirm knowledge, the lack of sight dis- Pennsylvania State University Press, 1969. allows learning. Lukoff, Irving, et al. Attitudes Toward Blind Persons. New The loss of sight is also linked with the loss of all York: American Foundation for the Blind, 1972. the senses, particularly hearing. This prompts some Weinberg, Nancy, and Rosina Santana. “Comic Books: people to shout questions at a blind person who Champions of the Disabled Stereotype.” Rehabilitation Literature vol. 39, nos. 11–12 (November–December has normal hearing. 1978), pp. 327–331. Blind persons are often believed by society to be nonsexual. Castration and blindness are linked in the Oedipus legend, in the result of blindness from auditory aids Auditory aids and devices enable venereal disease and in the superstition that mas- the visually impaired user to access information turbation leads to blindness. with the sense of hearing. These include tape In light of these stereotypes, sighted people may recorders and players, speech compressors, acceler- react with conflicting emotions when interacting ated speech, talking books, synthetic speech, and with blind people. A sighted person may feel fear, talking aids. anxiety, pity, revulsion, superiority, generosity, Cassette tape recorders are used to record or shame, helplessness, or suspicion. These attitudes play back recorded material. Some models are negatively influence hiring practices, legislative pri- available with stop/start foot pedals to allow for orities, economic opportunities, and social poten- typing while listening. tialities of disabled persons. Speech compressors are machines that control Although many of these stereotypes and atti- the speed of the audio of a tape by deleting portions tudes still prevail, there are indications that public of the pauses between words or by shortening attitude toward people with disabilities is starting vowel sounds. The material is rerecorded in the to change. In 1991, the polling firm Louis Harris & shorter version. The sound of the speech is not Associates conducted the first poll regarding public affected. attitude toward disabled people. The poll, commis- Accelerated speech is text that is recorded at sioned by the National Organization on Disability, normal speed but reproduced and played at an revealed that movies depicting people who are in accelerated speed. Highly accelerated speech may some way disabled are making the public more produce a distortion in the sound of the voice, aware of, and empathetic toward, those who are although some models contain pitch-controlling disabled. options. Films such as Rain Man, in which a main char- Talking books and other recorded texts are acter is autistic, and Children of a Lesser God, recorded by, and available through, talking-book in which a main character is deaf and played by programs or the Library of Congress. Books on cas- a deaf actress, were cited as examples of movies sette tape are also available through commercial that have influenced attitudes. Harris said that publishers. people who are exposed to conditions such as Synthetic speech is the computerized produc- blindness, either in actuality or through a film, tion of sounds into words and is used in the voice become more comfortable and familiar with them. output of reading machines and computers. The 24 auditory aids

Kurzweil Reading Machine converts print placed scale, clock, watch, timer, blood-pressure monitor, onto its scanner into synthetic speech. thermometer, blood-glucose monitoring kit, talk- Talking aids are tools that provide auditory reading wallet (which identiﬁes bills of $1–$10 denom- ings or speech to supply the reading or information inations), label maker, and calculator. normally gained by sight. These include the talking B

Bell’s palsy A disorder involving unilateral facial The eye may be treated with occasional applica- weakness or paralysis. The condition usually has its tions of ARTIFICIAL TEARS such as methylcellulose onset over a two- to five-day period. During that solution during the day and a lubricating cream or time, the patient may experience a loss of facial ointment such as Lacri-Lube S.O.P. at night. The sensation, a numbness, drooling, delay in blinking, eye may be taped shut or protected with an eye- inability to close the eye, excessive tearing, paraly- shield. sis of one side of the face, or noticeable drooping of Dryness or irritation, increased sensitivity to the mouth or face. Half of those with Bell’s palsy light or symptoms of infection may develop and experience pain behind the ear, but the condition require further treatment. A partial TARSORRHAPHY, does not cause hearing impairments. a surgical procedure in which the upper and lower The symptoms of Bell’s palsy, named for Sir eyelids are stitched together at the corner, may be Charles Bell, the 19th-century physician who first performed. The tarsorrhaphy is reversible and may described the disease, may be confused with those be temporarily effective but may cause corneal of a stroke. Bell’s-palsy symptoms, however, usu- breakdown, irritation to the cornea from eyelashes ally affect the entire side of the face from forehead or scars along the lashline. to chin, whereas stroke symptoms are usually The treatment of Bell’s palsy may include phys- located below the eye. Bell’s-palsy symptoms do ical therapy, a combination of heat application and not include classic stroke indications, such as facial massage or facial exercises. In severe cases, weakness in limbs, slurred speech or double vision. corticosteroids may be prescribed for 10–14 days. Bell’s palsy is caused by a swelling of the facial In 85 percent of cases, recovery begins to occur nerve due to immune disorders or a viral disease. within 10 days to 3 weeks. The remaining 15 per- The nerve is constricted, the blood supply is limited cent of cases may require up to 12 months to and the nerve becomes ischemic, or anemic, due to recover. The condition tends to recur in 10 percent lack of blood flow. Nerve degeneration may follow. of cases and usually affects the opposite side of the Individuals who contract Bell’s palsy are typi- face. Pregnancy has been linked to recurrences, as cally in good health, but a history of DIABETES, SAR- has multiple sclerosis. COIDOSIS, or LYME DISEASE has been linked to the disorder. It has been associated with influenza, Dyke, Peter J., Gunter Haase and Mark May. “Diagnosis colds, and headaches and may be triggered by such and Care of Bell’s Palsy.” Patient Care (October 1988): illnesses. Bell’s palsy may occur to either sex at any 107–118. age but is most prevalent after the age of 40. The Bell’s Palsy Network Frequently Asked Questions. www.bellspalsy.net, 1997. Bell’s palsy poses the greatest threat to the eye’s CORNEA, the clear, protective cover of the eye. When the eyelid, which normally protects the bifocals Bifocals or bifocal lenses contain two cornea, functions incorrectly, the cornea becomes prescription lenses put together in one lens. Each dry and is vulnerable to the elements. Constant contact or eyeglass lens has two focusing abilities, exposure may result in KERATITIS (corneal infec- one for seeing near objects and one for seeing dis- tion), ulceration or injury, causing a loss of vision. tant objects.

25 26 binocular indirect ophthalmoscope

Bifocals are usually needed after age 40. They of the frame shines a vertical beam of light through are a common aid in the treatment of PRESBYOPIA, the cornea. The light that is reflected back gives an aging eyes. As the eye ages, its LENS loses the abil- illuminated, magnified cross-section of the front ity to focus on close objects. part of the eye. Prescription of reading glasses alone would solve The biomicroscope examination is used to check the problem, but the wearer would have to remove for abrasions, erosion or scarring, inflammation, the glasses to see distant objects. The wearer presence of blood vessels, or change of shape in the requiring a distance vision correction would have cornea; inflammation or thinning of the SCLERA, to constantly switch between reading glasses and inflammation or irregularities of the iris; and sub- distance glasses. Bifocals eliminate the necessity of luxated or shifted lens and CATARACTS. swapping glasses when changing tasks. The biomicroscope may also be used to examine Although modern bifocals are essentially the the eye during tests such as those to determine same two pairs of glasses combined into one frame intraocular pressure (TONOGRAPHY) or the junction that Benjamin Franklin invented, today’s lenses are of the cornea and the iris (GONIOSCOPY). It also is custom-designed for the wearer. The reading and used as a tool in some laser treatment procedures. distance segments of each lens may be small or large and placed high or low in the frame. The lens bioptics Optical aids that consist of small tele- size and placement are determined by the needs of scopes fused onto the upper portion of spectacles, the wearer. Using an updated method of polishing, on one or both lenses. The bottom portion of the bifocals today can be made without a noticeable spectacles contains the individual’s corrective pre- line. These are called “blended bifocals,” and are scription. preferred by many people. The bioptics involving both eyes enable the low- The clerk whose job requires copious amounts vision user to view distances when walking or dri- of reading and occasional distance viewing will ving or to view closer objects or material if need a large reading segment and a smaller section magnification is needed. The bioptics that involve for distance at the top of the lens. The factory one eye only are used for near and intermediate supervisor who manages a long assembly line will distance viewing for reading material. need a smaller reading section located low in the Bioptics are prescribed by an ophthalmologist or lens to avoid obstructing a distance view. low-vision expert and must be properly centered to Bifocal wearers must adopt new head move- the eyes of the wearer. Magnification may extend ments to use bifocals correctly and safely. The to six times normal size when used for distance wearer may have to raise his chin when reading viewing. Wide-angle lenses may be incorporated something at a level higher than normal or learn to into the device. Thirty states permit driving with lower his head, rather than just his eyes, when the aid of bioptics. Regulations vary from state to navigating a cluttered path. state. binocular indirect ophthalmoscope See OPH- blepharitis Blepharitis is a common condition of THALMOSCOPE. the eyelids. The margin of the eyelid becomes swollen and red with inflammation, and a crusty biomicroscope The biomicroscope (or slit lamp) discharge may gather at the base of the lashes. is an instrument used to examine the eye. It mag- Some lash loss may occur, but in milder cases the nifies the ANTERIOR CHAMBER of the eye, including lashes grow back. In severe cases, the lash follicles the CORNEA, IRIS and LENS. are destroyed and permanent lash loss results. A biomicroscope examination is one step in a Causes of blepharitis, sometimes called eyelash routine eye exam. It is painless. The patient places dandruff, are unknown. It is often associated with his chin on a chin rest centered at the bottom of an allergies, a disorder in the lipid layer of the tear open square-shaped frame. A bright light in front film or seborrhoea of the scalp. Although blephar- blindisms 27 itis is a difficult condition to treat, it rarely results Contact: in loss of vision. Blinded Veterans Association It is important to keep the eyelid area very clean 477 H Street, N.W. in order to cut the buildup of secretions. Ophthal- Washington, D.C. 20001–2694 mologists may treat the symptoms of blepharitis 800-669-7079 with ANTIBIOTICS, but since there is no cure, the dis- www.bva.org order may become chronic. Chronic blepharitis may involve CONJUNCTIVITIS and inflammation of the CORNEA. blindisms Stereotypical mannerisms or behaviors of blind children or infants are commonly called “blindisms.” The term is misleading, since the same Blinded Veterans Association (BVA) An asso- mannerisms are also stereotypical of children with ciation founded in 1945 by a group of veterans other disabilities, such as autism. blinded in World War II. In 1958, the BVA was These stereotypical behaviors include rocking, chartered by an act of Congress to represent all shaking or turning the head, shaking the hands, blinded veterans. It is the only service association mouthing the hands or objects, and eye poking or committed exclusively to meeting the needs of vet- pressing. The repetitive and unconsciously per- erans with severe vision impairments. This non- formed mannerisms are most often found in those profit organization has a membership of 6,500, who are congenitally blind but may be acquired by consisting of veterans who have lost their sight those with adventitious blindness. while serving in the armed forces and veterans Some studies indicate that children create these who have since lost their vision in ways unrelated mannerisms of self-stimulation to compensate for to the armed services. the lack of sensory stimulation and activity in their The BVA maintains two major outreach pro- lives. Others cite the lack of opportunity and ability grams: The Field Service Program and the Outreach of blind children to imitate the acceptable behav- Employment Program. Blinded veterans serving as iors of others and to develop a sense of unaccept- representatives of the Field Service Program pro- able behaviors. vide emotional support, encouragement and assis- Behaviors related to the vision loss may appear tance to fellow veterans seeking services, to be blindisms. A child may hold the head unnat- rehabilitation training and benefits from local, urally to one side in order to make the best use of state, and Veterans Administration agencies. In residual vision or a reduced visual field or may gri- 1988, the Field Service Program made nearly 1,400 mace in an effort to see an image. contacts to assist visually impaired veterans. Blindisms may lead to social segregation if the The Outreach Employment Program assists vet- mannerisms are considered distracting or un- erans in finding satisfying employment and devel- sightly. They may falsely indicate to others the oping independence. Blinded veterans serving as presence of mental retardation, autism, or emo- representatives of this program aid in all aspects of tional disorders. Blindisms may become injurious job placement, ranging from resume writing to to the individual, since eye rubbing and poking can acquisition of vocational training. Both programs cause bruising and callous formation. are available to veterans at no cost. Blindisms may be prevented by the use of stim- The BVA also serves as a clearinghouse for infor- ulating, physical activity (including the use of mation to alert veterans and others to new legisla- motion furniture such as rocking chairs and tion, rights, benefits and technology. The BVA swings), development of an interest in the envi- maintains a public-awareness program regarding the ronment and frequent opportunities for new expe- capabilities and productivity of blinded veterans. riences. The association publishes the journal BVA Bul- Established blindisms may be corrected if the letin and a newsletter, BVA Update. The BVA holds child is given a substitute activity for the physical an annual convention in August. movement. The effort of flapping the hands may be 28 blindness redirected to playing an instrument or fondling a in the world living in sub-Saharan Africa, China, stuffed toy. and India. The World Health Organization estimates that up to 80 percent of global blindness is pre- Bonfanti, Barbara H. “Effects of Training on Nonverbal and Verbal Behaviors of Congenitally Blind Adults,” ventable through nutritional, therapeutic, and san- Journal of Visual Impairment and Blindness (January itation-improvement programs. Other common 1979): 1–9. causes of blindness worldwide are Vitamin A defi- The Canadian National Institute for the Blind. The Impact ciency, ONCHOCERCIASIS, LEPROSY, DIABETIC RETINOPA- of Vision Loss on the Development of Children from Birth to THY, MACULAR DISEASE, RETINITIS PIGMENTOSA, eye 12 Years. www.cnib.ca/pamphlets_publications/vision, injuries, and congenital or hereditary disorders. 2000. In the United States, there are about 1 million Cutsworth, T. The Blind in School and Society. New York: people who are legally blind, and another 2.3 mil- American Foundation for the Blind Inc., 1951. lion who are visually impaired, according to Pre- Eichel, Valerie J. “A Taxonomy for Mannerisms of Blind vent Blindness America, formerly known as the Children.” Journal of Visual Impairment and Blindness (May 1979): 167–177. National Society to Prevent Blindness. The most Fraiberg, S. Insights from the Blind. New York: Basic Books, common causes of blindness in the United States 1977. are age-related glaucoma, macular degeneration, Harper, Florine Watson. “Gestures of the Blind.” Educa- diabetic retinopathy, and hereditary disorders such tion of the Visually Handicapped (Spring 1978): 14–20. as retinitis pigmentosa and Stargardt’s disease. Hoshmand, Lisa T. “Blindisms: Some Observations and The terms blind and blindness are defined in a Propositions.” Education of the Visually Handicapped variety of ways according to the user. Rehabilita- (May 1975): 56–59. tion experts, doctors and ophthalmologists, educa- Knight, John J. “Mannerisms in the Congenitally Blind tors and leaders in the field determine and define Child.” The New Outlook (November 1972): 297–301. the terms according to their own preferences and Miller, Barbara S., and William H. Miller. “Extinguishing viewpoints. ‘Blindisms’: A Paradigm for Intervention.” Education of the Visually Handicapped (Spring 1976): 7–14. Over the past 150 years, blindness has been Scholl, Geraldine, ed. Foundations of Education for Blind described using various terms including medically and Visually Handicapped Children and Youth. New York: blind, legally blind, partially blind, partially seeing, American Foundation for the Blind Inc., 1986. low vision, functionally blind, braille blind, voca- Warren, D. H. Blindness and Early Childhood Development. tionally blind, economically blind, visually defec- New York: American Foundation for the Blind Inc., tive, visually impaired, visually handicapped and 1984. visually disabled. Medical diagnostic guidelines define blindness blindness Blindness, or loss of vision, is a condi- as no light perception (NLP), or light perception tion that is prevalent throughout the world. The and projection, or central acuity up to hand move- World Health Organization estimates that there are ments plus a large field loss. Hand movement and between 40 million and 45 million blind people in hand motion are terms used to describe someone the world, and an additional 120 million suffering who cannot see the separate fingers but who can from disabling low vision. In addition, the organi- discern some movement when the hand is waved. zation predicts that, unless decisive public health Light perception, or LP, describes the person who action is taken, the numbers of people who are can perceive only light or its absence. NLP or no blind or visually impaired will double by the year light perception refers to one who is unable to dis- 2025. cern any light. Worldwide, the most common causes of blind- The American Foundation for the Blind recom- ness are CATARACT, TRACHOMA, and GLAUCOMA. mends that the term blind be reserved for those These three conditions account for more than 70 individuals with no usable sight at all, and that the percent of the world’s blindness. Nine out of 10 of terms visually impaired, low vision or partially sighted the world’s blind people live in developing coun- be used to describe persons with some usable tries, with nearly 60 percent of all the blind people vision, regardless of how little. blindness 29

Legal blindness is the term used by the Internal people to earn a living, an outdated notion. Visually Revenue Service and other governmental agencies defective is a negative, archaic term. to determine whether an individual is eligible for Visually impaired is a term that describes a recog- federal or state benefits. The classification for legal nizable defect or malfunctioning of the eye. Impair- blindness is determined by measuring visual acuity ments are diagnosed and defined by a medical (how much detail one sees at a specific distance) doctor. Visual impairments range from total blind- and visual field (the area of vision). ness to low vision. A person is classified as legally blind if the visual The term visually impaired is also used frequently acuity of the better eye, with correction, is 20/200 to describe those persons who have sight loss in or less. This involves a loss of central vision. one or both eyes but are not legally blind. These One may also be described as legally blind if the include individuals who cannot read newsprint visual field of the better eye, even with 20/20 with prescriptive lenses (severely impaired) or who vision, is limited to 20 degrees or less. An individ- are monocularly blind or who have otherwise ual with loss in the visual field may experience unclassified visual impairments. peripheral or central vision loss. Handicapped refers to individuals who are disad- Loss in the peripheral, or side, vision may result vantaged in the performance of tasks due to expec- in tunnel vision. Loss in the central, or straight- tations or attitudes about their impairment. The ahead, vision may result in difficulty in seeing an term visually handicapped is commonly used almost object in the center or direct line of sight. Because interchangeably with visually impaired. When the classification involves measurement of the bet- applied to children, visually handicapped notes the ter eye only, people who are blind in one eye are requirement for special education provisions due to not considered legally blind. sight loss. Legally blind people should not necessarily be Visually disabled applies to the actual effect the considered totally blind. The term includes a wide impairment has on the functioning of the individual. range of visual abilities, since two individuals with It is the limitation or restriction caused by the lack of 20/200 visual acuity or 20 degree visual fields may sight. Disabilities are not necessarily handicaps. have vastly different vision levels. Over 75 percent Terms such as congenital blindness, adventitious of legally blind individuals have some remaining blindness, cortical blindness, hysterical blindness, vision. These people are often able to utilize their and snow blindness are well defined and accepted. remaining vision to work, read, travel and con- Each refers to the cause of vision loss. tinue their daily routine by using adaptive devices Congenitally blind refers to an individual blind at or by developing accommodating body or head birth or during the first five years of life. A congen- movements. itally blind child may not have visual memory. Partially seeing is a term that replaced partially Adventitiously blind refers to an individual who blind. It is defined as a central visual acuity of becomes blind after five years of age. This individ- between 20/60 and 20/200 in the better eye with ual will probably have some visual memory and correction. Low vision is defined as between 20/50 can use visualization. and 20/200 in the better eye with correction. Cortical blindness occurs as a result of lesions on Functionally blind refers to the ability of the indi- both occipital lobes where the visual cortex is vidual to function or perform daily tasks. Certain located. The lobes control the visual field of each diagnoses relate to specific functional guidelines. eye. Lesions on both lobes causes bilateral loss of For instance, NLP requires braille for reading and vision with normally reactive pupils. A lesion on long canes or dog guides for independent traveling. one occipital lobe may result in hemianopsia, loss “Braille blind” refers to a person’s inability to read of half the field of vision, but does not affect the large print even with optical aids and, therefore, central vision acuity. the person’s need for braille. Cortical blindness is most common in aging eyes Vocationally blind and economically blind are terms affected by vascular disease. There may be a history little used today. Each refers to an inability of blind of cerebrovascular incidents and loss of cerebral 30 blind spot function. Cortical blindness may be a temporary Galloway, N. R. Common Eye Diseases and Their Manage- condition that follows a cerebrovascular embolism ment. Berlin: Springer-Verlag, 1985. or circulatory occlusion caused by a stroke, myo- Kelley, Jerry D., ed. Recreational Programming for Visually cardial infarction, or heart surgery. Impaired Children and Youth. New York: American Hysterical blindness is a condition of blindness Foundation for the Blind, 1981. National Association for Visually Handicapped. Problems caused by the need to physically resolve an emo- of the Partially Sighted. New York: NAVH, 1980. tional upset or shock. The condition is usually bilat- National Information Center for Handicapped Children eral and often occurs suddenly. Often the blindness and Youth. General Information about Handicaps and Peo- is not total and is restricted to a particular field. ple with Handicaps. Washington, D.C.: NICHCY, 1982. Additional symptoms include lack of regard for the Prevent Blindness America. Facts and Figures, www.pre- loss of sight, ability to travel within surroundings, ventblindness.org, 1998–2000. and normal blink response. An eye examination Scholl, Geraldine T. Foundations of Education for Blind and reveals that the pupils react normally and the fun- Visually Handicapped Children and Youth, New York: dus (back of the eye) appears normal, discounting American Foundation for the Blind, 1986. damage to the optic nerve, cortical blindness, chi- World Health Organization. Blindness and Visual Disabil- ity. www.who.int, 1998. asmal lesions, or other ocular disease. The condition is usually diagnosed in light of information gathered through the eye examination and study blind spot The blind spot is a point of blindness of the patient’s psychological history. Treatment of or blocked vision found in normal PERIPHERAL hysterical blindness may include reassurance that VISION. This spot is caused by the OPTIC DISC. The the condition will right itself, evidence of ability to optic disc is the spot on the RETINA where the OPTIC see, and placebo medicine therapy. The patient NERVE meets the eye. may recover from the hysterical blindness only to The retina is the light-sensitive layer of the back replace it with another physical illness. Psychiatric of the eye. It contains cells called RODS AND CONES, counseling is often recommended to address the which receive light and provide information about underlying emotional problem. the viewed object. The retina encodes this informa- Snow blindness is the term for an eye injury tion into electrical impulses. The impulses are sent caused by intense light reflected off snow. The to the brain via the optic nerve, a cord of nerve bright light in prolonged exposure produces an fibers that connects the brain to the eye and sup- ultraviolet burn on the cornea of the eye. Symp- plies blood to the retina. The brain translates the toms of snow blindness are bilateral and include impulses into an image. The optic nerve is joined to extreme pain, a feeling of sand in the eyes, and the retina at the optic disc. The optic disc is devoid severe sensitivity to light. The symptoms are usu- of photosensitive rods or cones and is unable to col- ally delayed two to nine hours after exposure. lect information about an object. As a result, the The burn heals itself within two to three days. disc is “blind.” Antibiotic or steroid drops may be prescribed to Since the blind spot is small and located within ease discomfort and discourage infection. Snow the peripheral (side) field of vision, it does not blindness can be prevented by wearing protective interfere with normal vision. The optic disc may be goggles or glasses. (See TERMINOLOGY, VISION IMPAIR- observed during an ophthalmologic exam or by MENT, WORLD BLINDNESS.) moving an object into the field of the blind spot. This is easily accomplished by marking a piece of American Foundation for the Blind. Low Vision Questions white paper with an X. Approximately two inches to and Answers. New York: AFB, 1987. the right of the X, mark a dark circle. Close the left Barraga, Natalie C. Visual Handicaps and Learning. Belmont, Calif.: Wadsworth Publishing Company Inc., 1976. eye and look directly and steadily at the X. Move the ERIC Clearinghouse on Handicapped and Gifted Children. paper forward or back until the circle disappears. ERIC Digest: Visual Impairments. Reston, Va.: ERIC, 1982. This circle lies in the sphere of the optic disc. Foundation for the Junior Blind. California Services for Per- The blind spot does not affect normal vision. sons with Visual Impairments. Los Angeles: FJB, 1987. Constant eye movements deflect attention from Braille, Louis 31 the blind area and the brain compensates for its braille was developed in England and contains over lack by completing any incomplete lines and filling 200 contractions and short forms for common in any gaps. words. In 1932, Grade 2 or Standard English Braille was officially adopted as the braille of choice for English-speaking nations. Grade 3 braille is an books for the blind See NATIONAL LIBRARY SERVICE expansion of Grade 2. It extends the list of contrac- FOR THE BLIND AND PHYSICALLY HANDICAPPED. tions and deletes vowels. Grade 3 is used most often for ease in writing rapidly or for taking notes. braille A tactile language made up of a system of Braille is embossed onto thick paper or plastic raised dots. The reader of braille feels the dots to sheets by a braille press, braille writer or brailler, recognize the letter. Braille makes reading, writing, braille computer printer, or manual slate and sty- note taking, and communicating possible for visu- lus. Because braille requires a large amount of ally impaired, blind, and deaf-blind users. space, the braille edition of a book or magazine is Braille was invented in 1824 by LOUIS BRAILLE,a several times longer than the print edition. blind French student. He based his system on a Braille is read with the finger tips of the index method of raised dots and dashes called night writ- finger and/or middle finger or ring finger of one or ing or Sonography. Sonography was developed by both hands. An average reading speed of a reader Charles Barbier de la Serre to enable soldiers to read using one hand is approximately 104 words per messages passed during night maneuvers. Braille minute. Ambidextrous readers may increase the and Barbier met to discuss possible alterations to the rate to 200 or more words per minute. system. When Barbier insisted that the method Braille is not used by all visually impaired or remain unaltered, Braille developed a new system blind people. Some visually impaired persons have that involved raised dots in a fresh configuration. sufficient remaining vision to read with the use of Although the braille system was met with an optical aid such as a magnifier. Others with less enthusiasm by blind users, the system was not first useful residual vision may opt to forgo learning accepted officially by educators until 30 years later, braille due to physical problems such as diabetic in 1854. This may have been caused by resistance neuropathy (decreased sensitivity in the fingers to change from the proven methods of instruction, due to diabetes) or because of advanced age. a lack of willingness on the part of sighted instruc- The wide availability of recorded books, other tors to learn a new method, or the simultaneous reading materials and synthetic speech output for development and promotion of other new lan- computers may have had an effect on the willing- guage systems for the blind. ness of visually impaired persons to learn braille. The braille system is based on a cell, a configu- However, braille reading is accepted as a necessary ration of dots forming two columns of three dots skill for learning the basic literacy skills of reading, each. Each letter of the alphabet and each punctu- grammar, and diction. ation mark is made up of one or more of the possible six dots that make up a cell. Sixty-three Braille, Louis Louis Braille is the inventor of combinations or patterns are possible. braille, a language of raised dots read by the fingers In addition to the alphabet, there are 189 con- and used by visually impaired persons. tractions and short forms or abbreviations for Braille was born in 1809 in Coupvray, France, words that are formed in the cells. These same the son of a harness maker. At the age of three, he braille cells are also assigned different meanings to injured his eye while playing with his father’s write music, foreign languages, numbers, and sci- leather-working tools. The initial injury became ence terms. infected, spread to both eyes and left him com- Different forms or grades of braille are available. pletely blind. Grade 1 braille is the form developed by Louis He was sent to the Royal Institution for Blind Braille and utilizes one character per each letter of Youth in Paris when he was 10. The students in the the alphabet. It contains no contractions. Grade 2 school were taught orally through lessons repeated 32 braille music to them by their instructors or through books from his native Coupvray for reburial in the Pan- printed in embossed letters in a system developed theon, the highest honor that can be bestowed on by the founder of the school, Valentin Haüy. Later, a French citizen. (See BRAILLE.) the school adopted Sonography, an adaptation of a American Foundation for the Blind. A Different Way of See- system of night writing developed by an army cap- ing. New York: AFB, 1984. tain, Charles Barbier de la Serre. The night-writing American Foundation for the Blind. Louis Braille. New system was used to write messages and maneuver York: AFB, 1987. instructions that could be read in the dark by the American Foundation for the Blind. Understanding Braille. fingertips. New York: AFB, 1970. Sonography employed a complicated system of Davidson, Margaret. Louis Braille, New York: Hastings raised dots and dashes that spelled words phoneti- House Publishers, 1971. cally. It was based on a 12-dot cell for each letter Kugelmass, J. Alvin. Louis Braille. New York: Julian Mess- that used considerable space on a page. Braille ner, 1951. began to experiment with the writing system, making changes and improvements. Braille met with braille music Music printed in braille traditionally Barbier, who rejected the changes and insisted that was produced manually by a limited number of peo- the system remain as introduced. ple who specialized in the service. Musicians often Over the next three years, Braille worked con- were frustrated by having to wait weeks, sometimes tinuously to develop his own language of dots. In months, to have their music transcribed. 1824, at the age of 15, his work was complete. He In 1997, a company called Dancing Dots Braille had developed a reading and writing system of dot Music Technology introduced a braille music trans- patterns or characters based on a six-dot cell. Each lator program that allows music to be produced character represented one letter of the alphabet or locally by sighted copyists. The service is based on one numeral. He went on to adapt systems that a software program called GOODFEEL. With this could be used for musical notation and a method program, braille music can be produced by people for drawing letters using a slate and stylus, called with no special training. Braille scores are pro- Raphigraphy. duced from the same computer music files that are Although the Braille method was immediately used to print staff notation. adopted by pupils at the school, it was officially The technology was spearheaded by Bill rejected. This may have been for reasons of fear on McCann, president and founder of Dancing Dots, the part of sighted teachers, hesitancy to revamp who is also a blind musician and programmer. The current teaching methods, and reluctance to make company also offers other music-related products obsolete teaching tools that had been difficult and for visually impaired people. expensive to purchase. Contact: It was not until 1843, at the inauguration of the Dancing Dots Braille Music Technology new building of the Institution for Blind Youth, 1754 Quarry Lane where an exhibition of the system was given, that P.O. Box 927 braille gained official recognition. In 1854, at the Valley Forge, PA 19482-0927 insistence of the students and blind teachers, braille 610-783-6692 (ph) was adopted as a teaching method by the school. 610-783-6732 (fax) Acceptance for the system spread throughout [email protected] Europe. It was first taught in America in about 1859 www.dancingdots.com or 1860 at the St. Louis School for the Blind. Today, braille is universally used as a language of reading and writing for the blind and visually impaired. braille writer A braille writer, or brailler, is a Louis Braille did not live to see the acceptance of machine used to write braille. Similar to the func- his writing system. He died in 1852 of tuberculosis. tion of a typewriter, braillewriters come in manual A century later, in 1952, his remains were moved or electric forms. They are more practical for large Business Enterprise Program 33 writing tasks than a slate and a stylus, which is the ual State Department of Rehabilitation. The pro- equivalent of paper and a pen for a sighted person. gram was established by the Randolph-Sheppard The first brailler, the Hall Braillewriter, was intro- Act in 1936 and amended in 1974. The program duced in 1892 by Frank H. Hall, superintendent of provides employment opportunities to qualified the Illinois School for the Blind. blind persons, licenses blind vendors, and estab- Braille writers have six keys and a space bar. lishes vending facilities in federal, state, county, Each key corresponds to a dot of the six dot braille and some private buildings. cell. To form a braille letter, the user simultane- Vending facilities may sell newspapers, periodi- ously pushes the keys corresponding to the needed cals, confections, tobacco products, foods, bever- dot combination. The dots are pressed onto light- ages. and other articles or services. The articles or weight manila tag paper. Users can attain writing services may be dispensed automatically or ma- speeds of up to 60 words per minute. nually and are prepared on the premises. The facil- Braille writers vary in size by maker but gener- ity may also be a cafeteria, snack bar, or a dry/wet ally are approximately 15” × 9” × 5” and weigh 10 facility. pounds. Current braille writers include the Perkins To qualify for the BEP training program, an Brailler, the Lavender Braillewriter, and the Hall applicant must be a citizen of the United States, Braillewriter. legally blind, emotionally and physically qualified to operate a vending facility as verified by medical Brailon The trade name for the paper used in a and vocational evaluation, have independent living thermoform duplicator. Each plastic sheet is placed skills, and have a reasonable expectation to succeed atop a page of brailled paper or tactual paper and in the program. inserted into the thermoform machine. The An applicant entering the BEP program must machine heats the Brailon plastic sheet and creates complete a training program. Those who have had a duplicate of the tactual sheet. prior management experience in food service may Brailon is used to make duplicates of braille be eligible to demonstrate their skills by completing books and other tactual materials such as tactile two months on-the-job training with another ven- maps. The Brailon exchange is the agreement of dor and passing the final exam covering all the many educational agencies or organizations for the training program material with a grade of 85 per- blind to provide a braille copy of a book in cent or better. exchange for an equal number of Brailon sheets. The standard training program is seven months long and consists of pretraining evaluation, basic (See THERMOFORM.) training, and on-the-job practical experience. All trainees must pass a comprehensive final exam. B-scan A test performed prior to cataract surgery Those who complete the program are certified as to view the RETINA. The retina is usually examined eligible for licensing as a BEP vendor. As locations with a binocular indirect OPHTHALMOSCOPE, but in become available, students are notified and can some cases, the cataract is dense enough to apply for a specific location. Applicants are inter- obstruct the view of the retina. In these instances, viewed by a selection panel of business people who a painless, ultrasonic B-scan affords a picture of the decides which vendor is to be assigned. Selection is hidden retina. based on prior work experience, education, train- The health of the retina must be determined ing, experience, and performance on the oral inter- before cataract surgery to rule out the possibility of view. Vendors are considered trainees until the first a detached retina. Without this knowledge, the year of vending has been completed. surgery could successfully remove the cataract, The income from vending machines that com- only to reveal a non-functioning eye. pete with BEP vendors may be accrued to a maximum and paid to the vendor. The income may be Business Enterprise Program (BEP) A federally used to establish a fund for sick leave, vacation, or supported program administered by each individ- retirement benefits.

C cancer Cancer of the eyes is relatively rare. iris. Little is known about the cause and progres- According to the American Cancer Society, ocular sion of these tumors. cancer is responsible for approximately 2,500 new Malignant melanomas are generally treated by cases of cancer each year and for approximately enucleation, or removal of the entire eye. An 400 deaths from cancer each year as compared uncertain diagnosis may lead to a period of obser- with lung and breast cancers, which are responsi- vation augmented by chemotherapy or radiation ble, respectively, for 144,000 and 115,000 new treatments. Melanomas of the iris are extremely cases of cancer each year. slow-growing and are often treated during obser- Cancer of the eyes usually develops into tumors. vation. Approximately 60 percent of those diag- The tumors may be found in the eyeball, the orbit, nosed and treated for malignant melanomas are or the eyelids. Because ocular tumors are often hid- alive five years after treatment. den deep in the eye and therefore resist biopsy, it is RETINOBLASTOMA is the most common type of often difficult to differentiate a malignant tumor malignant intraocular (inner eye) tumor in chil- from a nonmalignant or benign tumor. dren. It occurs in one out of every 12–20,000 chil- Cancerous or malignant tumors differ from dren. This tumor develops in the eye’s retina. benign tumors in several ways. The cancerous cells Retinoblastomas may be hereditary or may develop are different from their surrounding tissue, often sporadically. The less common hereditary type is grow quickly and uncontrollably, rarely stop grow- usually present at birth and has its onset near one ing, and tend to spread or metastasize to other parts year of age. In both types, the condition is almost of the body. Malignant tumors threaten life as well always expressed by age five. It is often bilateral as vision. (affects both eyes). The three most common types of malignant Although hereditary retinoblastomas are pre- tumors are malignant melanoma, retinoblastoma, sent in family histories, any occurrence of bilateral and metastatic tumors. Each is a serious disorder retinoblastoma should be considered hereditary that benefits from early and appropriate treatment. and capable of being passed to further generations. MALIGNANT MELANOMA is the most common of Infants of hereditary families should be screened all tumors that originate in the eye. This type of regularly for tumors. tumor grows from melanin-laden cells in the eye’s Sporadic tumors are not hereditary. They are CHOROID, IRIS, or CILIARY BODY. It generally affects generally unilateral (affecting one eye only) and one eye only and may develop spontaneously or appear at approximately two years of age. from a mole within the eye. It is usually slow to The first symptoms of retinoblastoma include grow and metastasize. The onset may be at any age redness, pain, and inflammation. As the tumor and is more common among whites than blacks. grows, the eyes may cross and the pupil may They occur more often in people who have skin change from black to white or gray, a condition melanoma. called leukokoria. The light color is the hue of the Symptoms of malignant melanoma include red- tumor visible through the hole of the pupil. ness, inflammation, loss of vision, and GLAUCOMA. Retinoblastoma is treated by enucleation, radia- Pupil distortion may be present in melanoma of the tion, or cryotherapy (freezing treatments). In bilat-

35 36 Carroll Center for the Blind eral cases, the more affected eye may be removed in children. The tumor spreads rapidly but can be and the other eye may receive chemotherapy or detected by a biopsy taken through the eyelid. radiation treatments. If left unchecked, the tumor Treatment may include radiation or chemotherapy. could grow and spread up the optic nerve to the Cure rates for rhabdomyosarcoma range from 30 brain. percent to 40 percent. The cause of retinoblastoma is due to the absence of both retinoblastoma genes on the 13th Carroll Center for the Blind The Carroll Center chromosome. Although it has the one of the high- for the Blind Inc. is a rehabilitation center founded est rates of spontaneous regression among all in 1936 by Reverend Thomas J. Carroll. tumors, little is known about the cause of regres- The center offers a residential rehabilitation pro- sion. The cure rate for retinoblastoma ranges from gram, primarily for newly blinded adults aged 16 85 percent to 90 percent. and older. The average age of clients in this pro- Metastatic tumors are malignant tumors that gram is 44. The program specializes in mobility, originate in other parts of the body and spread to homemaking, self-care, sensory development, the eyes. Among those that can metastasize to the braille, handwriting, record keeping, tape record- eyes are tumors of the lung, breast, kidney, and ing, communications, shop, low-vision devices, prostate. These secondary tumors are bilateral diabetic care, and individual and group counseling. approximately 25 percent of the time. The program lasts approximately 16 weeks. Symptoms of metastatic tumors may include The Carroll Center operates computer assess- redness, pain, vision loss, or glaucoma. Often, ment and training programs for those seeking symptoms of the ocular tumor may present them- vocational careers, special educators, high school selves before those of the primary tumor. Because students, and rehabilitation instructors. Residential metastatic tumors look much like primary ocular options are available for these programs. tumors, diagnosis can be problematic. The Orientation and Mobility Travel Skills ser- Once a metastatic tumor has been diagnosed, vice provides the visually impaired with commu- the primary tumor can be appropriately treated. nity instructors who teach clients skills in Depending on the size and growth rate of the ocu- orientation and mobility and provide low-vision lar tumor, treatment may include surgery, services in their own homes. The Outdoor Enrich- chemotherapy, or radiation treatments. ment Program allows visually impaired persons to Malignant tumors of the eyelids include the participate in recreational activities year-round. basal-cell carcinoma and the squamous-cell carci- Activities include skiing, ice-skating, hiking, canoe- noma. The more common basal-cell carcinoma, the ing, sailing, and bicycling. The program matches a result of sun damage to the skin, ﬁrst appears as a sighted guide to each participant. slight bump on the eyelid. It develops into a saucer- The center coordinates more than 200 volun- like shape with a raised edge. teers who serve as drivers, readers, clerical work- Since the tumor is on the eyelid, it is easy to ers, rehabilitation aides, and recreation assistants. remove and submit to biopsy. If left untreated, the It serves as a public information and education tumor may spread to the underlying bone. Ad- source, presents programs on blindness and the vanced basal-cell carcinomas are treated with radi- curriculum of the center to interested organizations ation therapy. or groups, maintains a 1,000-volume library, and Squamous-cell carcinomas appear in observa- operates an information and referral program. tion much like basal-cell carcinomas but can be The Carroll Center publishes a biennial newslet- identiﬁed through biopsy. This type of tumor tends ter. It publishes a review of aids for visually to spread to the lymph nodes of the upper or lower impaired consumers and directs a braille menu eyelid and may metastasize to other parts of the program to produce copies of menus in braille for body. restaurants throughout Massachusetts. The center Rhabdomyosarcoma is a highly malignant holds a semiannual convention in the spring and tumor of the orbit. It is a rare tumor that develops fall. cataract 37

Contact: performed in the United States. There are two main types of cataract surgery: phacoemulsification and Carroll Center for the Blind extracapsular. During phacoemulsification, which 770 Centre Street is the most common method of cataract removal, a Newton, MA 02158 small incision is made on the side of the cornea, 617-969-6200 or 1-800-852-3131 and a tiny probe is inserted into the eye. The probe 617-969-6204 (fax) produces ultrasound waves that break up the www.carroll.org cloudy center of the lens. The lens can then be removed using suction. In extracapsular surgery, a cataract Cataract is a leading cause of blindness slightly longer incision is made on the side of the in the United States and the world. The National cornea, and the surgeon removes the hard center Eye Institute reports that more than half of Amer- of the lens. The remainder of the lens is then icans age 65 or older have a cataract, and, accord- removed using suction. ing to Prevent Blindness America, cataracts are Once the cloudy lens has been removed, it is responsible for one out of every seven cases of usually replaced with a clear artificial lens called an blindness in people 45 years and over. intraocular lens (IOL). The IOL becomes a perma- A cataract is a clouding of the crystalline LENS of nent part of the eye and does not require any addi- the eye, which results in dim or blurred vision. tional care or attention. The person wearing the Cataracts may also cause glare or halos in the pres- IOL does not feel or see it. In some cases, patients ence of bright lights or a change in color vision. cannot have an IOL, due to problems that occur One or both eyes may be affected. The individ- during surgery or as the result of another eye prob- ual may have opaque visual areas mixed with clear lem. In these cases, a soft contact lens or glasses areas within the same eye. The progressive cloud- may be used instead. ing of the lens is usually slow and may take years Prior to surgery, several tests may be performed to progress to the point where surgery must be per- to determine the power of an intraocular lens formed. implant or the necessity of an implant. The tests Most cataracts are the natural result of aging. may include keratometry, A-scan, B-scan, and an These are termed senile cataracts. Little is known endothelial cell count. about their cause, although heredity, environment, KERATOMETRY is a test to determine the curva- nutrition and general health may be contributing ture of the CORNEA. A keratometer is used to mea- factors. sure the curvature in order to prescribe the IOL. A Secondary cataracts may be caused by birth nearsighted eye has a more pronounced curve and defects (congenital cataracts), eye injuries, exposure requires a weaker degree of lens implant than does to ultraviolet or infrared light, medications such as a farsighted eye. A very nearsighted eye may cortisone steroids, or diseases such as Down’s syn- require such a weak lens as to make an implant drome, rubella, MARFAN’S SYNDROME, allergic der- unnecessary. matitis, myotonic dystrophy, and diabetes. Diabetics An A-SCAN uses ultrasound to measure the have an increased risk of cataracts and diabetes is length of the eye. A nearsighted eye is longer than present in approximately 10 percent–15 percent of the normal length of approximately one inch. The cataract patients. more long or nearsighted the eye, the weaker the Once a cataract is diagnosed, it is monitored by implant lens required. The results of the keratome- a physician. Corrective lenses may be prescribed to try and the A-scan are analyzed by a computer to correct the patient’s changing vision. Surgery to determine the power of the needed implant. remove the cataract is performed only when the A B-SCAN uses ultrasound to supply a clear pic- decreased vision begins to seriously interfere with ture of a RETINA obscured by a particularly dense the patient’s ability to function. cataract. The B-scan can alert the OPHTHALMOLOGIST With over 500,000 operations performed each to a detached retina, which may nullify the effects year, cataract removal is the most common surgery of successful cataract surgery. 38 Center for the Partially Sighted

An endothelial cell count is performed to deter- Cataracts are one of the leading causes of WORLD mine the number of healthy endothelial cells BLINDNESS, and are common to all parts of the remaining in the CORNEA. The endothelial cells line world. Lack of trained personnel and facilities lim- the cornea and protect it from leakage of AQUEOUS its the number of cataract surgeries performed in FLUID, which could damage vision. The cells are the third world. World health and governmental destroyed with aging and as a side effect of surgery. agencies operate limited mobile clinics or surgery A minimum number of cells, approximately 1,000, units to address the needs of those with cataracts in is needed to achieve satisfactory results from the developing countries. surgery. The cells are photographed by an endothe- Bath, Patricia E. “Blindness Prevention Through Pro- lial cell camera, and the resulting photograph is grams of Community Ophthalmology in Developing analyzed for cell quantity. Countries.” In Ophthalmology. Vol. 2. Edited by K. Cataract surgery is performed with either a local Shimizu and J. Oosterhuis. Amsterdam: Excerpta or general anesthetic and is usually done on an Medica, 1979. outpatient basis. The process may take up to an Freese, Arthur S. Cataracts and Their Treatment, Public hour with additional time to induce anesthesia. Affairs Pamphlet #545. New York: Public Affairs Pam- The patient can continue a normal daily routine, phlets, 1977. with a few exceptions, such as driving. Galloway, N. R. Common Eye Diseases and Their Manage- Postsurgery treatment includes the prescription ment. Berlin: Springer-Verlag, 1985. of glasses for those with the implant and either Helen Keller International. Facts About Helen Keller Inter- aphakic spectacles (cataract glasses) or contact national. New York: HKI, 1988. Kelman, Charles D. Cataracts: What You Must Know About lenses plus glasses for those without an intraocu- Them. New York: Crown Publishing Inc., 1982. lar lens implant. It also may include steroid or Leflar, Robert B., and Helen Lillie. Cataracts. Washington, cortisone eye drops such as Pred-Forte, Inflamase, D.C.: Public Citizen’s Health Research Group, 1981. Ecopred, or Decadron to control inflammation. National Eye Institute. Information for Patients-Cataract. Antibiotic drops may be prescribed to fight infec- www.neinih.gov, 2000. tion, and medication may be used to treat ele- Phillips, Calbert I. Basic Clinical Ophthalmology. London: vated pressure within the eye. Some people Pitman Publishers Limited, 1984. experience blurred vision following cataract Prevent Blindness America, Frequently Asked Questions surgery. This is because the eye from which the about Cataracts. www.preventblindness.org, cataract has been removed needs time to adjust so 1998–2000. that it can focus properly with the other eye. Reynolds, James D. Cataracts. HealthNet Reference Patients with IOLs may notice changes in colors. Library. Columbus: CompuServe, 1989. Shulman, Julius. Cataracts. New York: Simon and Schus- Colors may appear to be very bright or have a ter, 1984. blue tinge. Exposure to bright sunlight might cause everything to have a reddish tinge for a short period of time. These color sensitivities are Center for the Partially Sighted (CPS) A com- not uncommon and should disappear within a prehensive visual rehabilitation service center few months. founded in 1978 for those with visual impairments If part of the natural lens remains in the eye, as but who are not totally blind. sometimes occurs, it can become cloudy in time The center offers professional assistance to par- and result in blurred vision. This can occur months tially sighted persons in the areas of low-vision or years after the cataract surgery and is called an examinations, training in the use of loaned and after-cataract. After-cataracts are usually treated prescribed low-vision aids, professional psycholog- with a YAG laser, which is a type of infrared laser ical counseling, support groups, diabetic education that creates shocks that destroy membranes within groups, transportation services, independent-living the eye. This procedure is called a YAG laser capsu- skills, orientation and mobility training, and refer- lotomy. Normally it is painless and done on an out- ral to community resources. The center supplies an patient basis. ongoing follow-up program to assess changing cerebral palsy 39 needs. Patients retain contact with the center Age-related maculopathy (ARM) is the most through telephone calls or home visits. common form of this disease. It is a progressive dis- CPS maintains an internship program to educate ease in which the macula deteriorates, and central and train interns in the field of low vision and vision is lost. ARM may in some cases be treated serves as a clearinghouse for information about the with laser therapy, but there is no cure for the dis- partially sighted. It disperses information to the ease. It is seldom responsible for total blindness, public concerning low vision, low-vision examina- since some peripheral vision usually remains tions and aids, the location of low-vision services intact. elsewhere in North America, orientation and ARTERIOSCLEROSIS, or hardening of the arteries, mobility, and other related topics. may cause macular degeneration. In this condition, Contact: the arteries become clogged and smaller in dia- Center for the Partially Sighted meter. Blood circulation slows, and the body’s or- 12301 Wilshire Boulevard, Suite 600 gans are denied oxygen. In some cases, the retinal Los Angeles, CA 90025 blood vessels become clogged and the macula 310-458-3501 (ph) degenerates. 310-458-8179 (fax) AMBLYOPIA of disuse, or lazy eye, is a condition www.low-vision.org that affects central vision. It is a condition of childhood in which one eye is misaligned to the other. The eyes are unable to focus together and double central vision Central vision is the “straight- vision occurs. The vision of the misaligned eye is ahead” vision in the visual field. Central vision is suppressed by the brain, which accepts only infor- controlled by the MACULA, a tiny section of the mation from the aligned eye. In effect, the unused RETINA. Although the macula occupies only 1 per- eye ceases to develop and becomes “blind” or cent of the retina, it is responsible for distinguish- amblyopic. In the treatment of amblyopia, the ing all detail in vision. aligned eye is usually patched to encourage the The retina is the light-sensitive layer between amblyopic eye to function. The central vision of the the choroid and the vitreous gel. It contains RODS amblyopic eye is affected, but it usually retains AND CONES that receive light information about an some peripheral vision. object in view. The rods react to faint light, move- TOBACCO AMBLYOPIA is a condition in which the ment, and shape, and are responsible for peripheral excessive use of tobacco impairs central vision. The or side vision. The cones distinguish color and condition usually rights itself when tobacco use is detail but require high levels of light to function. discontinued or drastically reduced. They are responsible for central vision. The cones responsible for central vision need The retina encodes the information from the light to function and to survive. Eyes denied light rods and cones into electrical impulses. The for long periods may lose central vision. A com- impulses are sent via the OPTIC NERVE to the brain, plete lack of vitamin A in the diet may also result where they are translated into an image. in cone or retinal dysfunction and cause blindness. The cones of the retina are concentrated into a central section called the macula. Within the macula is an indentation called the FOVEA. The fovea cerebral palsy (CP) Cerebral palsy (CP) is not a contains the greatest concentration of cones and is disease, but rather a group of conditions caused by the site of sharpest vision. Light is focused by the damage to the motor area of the brain before, dur- cornea and the LENS onto the macula, and specifi- ing or directly following birth. The condition affects cally onto the fovea. When the macula or fovea are about 500,000 persons in the United States and damaged, central vision is affected. is the most prevalent lifelong disability in the MACULAR DISEASE is a common problem affecting country. central vision. It may be caused by an injury, hered- Over one-third of those with CP are teenagers or ity, other diseases such as arteriosclerosis, or aging. young adults. Each year, approximately 5,000 40 cerebral palsy babies are born with CP and an additional 1,500 parts of the eyes that process or transmit informa- acquire CP before the age of five. tion such as the retina or optic nerve. Corrective The condition usually involves nerve and mus- lenses or surgery may be necessary to improve or cle dysfunction and may exhibit such characteris- correct vision. tics as difficulty in walking; loss of muscle Early detection and treatment of CP are essential coordination or manual dexterity; spasms; seizures; in achieving the best possible management of the tremors; hearing, speech, or vision impairments; condition. Symptoms of CP in infants may include learning disabilities; mental retardation; and psy- irritability, difficulties in feeding or sucking, and chological or behavioral problems. abnormally delayed development of muscle control There are five types of cerebral palsy: spastic, or coordination. Less noticeable symptoms may be athetoid, rigid, ataxia, and tremor. Spastic CP, the detectable by a pediatrician during a medical exam- most common type, involves the trait of tense, con- ination. tracted muscles. Athetoid CP entails uncontrol- Cerebral palsy currently cannot be cured, but lable, constant movement of the head, limbs, and management or treatment may reduce the limita- body. Rigid CP is characterized by contracted mus- tions it imposes. Treatment may include physical, cles that resist movement. occupational, speech, language, hearing, or behav- Ataxia encompasses coordination and balance ioral therapy. Neurological or orthopedic surgery problems. Tremor CP is the most rare and is similar may increase control over muscles. Braces may to the athetoid type since it involves uncontrollable strengthen and support the body and correct defor- tremors or trembling of the limbs that hinders bal- mities. Medications may reduce rigidity and ease ance and coordination. Most individuals with CP nerve-damage problems. are affected by more than one type of CP, a condi- Congenital cerebral palsy can often be pre- tion termed “mixed type.” vented. Pregnant women can maintain good nutri- Brain damage that results in CP can be caused tion, avoid alcohol, smoking, and unnecessary X by acute or chronic anoxia or oxygen deprivation, rays or medications, and control diabetes and ane- a result of premature separation of the placenta mia. Routine tests for Rh incompatibility in the from the uterine wall, improper birth position, pro- mother and immunization with Rhogam within 72 longed or abrupt labor, complications during labor, or obstruction by the umbilical cord. hours after delivery can eliminate problems in Other congenital causes may include maternal future pregnancies. viral infections such as rubella (German measles), Infants with blood incompatibility may receive a Rh and A-B-O blood-type incompatibilities, poor blood transfusion. Premature infants and those at health, excessive smoking or alcohol consumption high risk can be monitored closely in neonatal by the mother, premature birth and untreated intensive care units. Infants and young children jaundice of the newborn causing kernicterus, a can of course be protected from trauma. disease that involves damage to the nervous There is much help available for those suffering system and is also caused by Rh-factor incom- from cerebral palsy and for their families. The patibility. United Cerebral Palsy Association, founded in 1949 Acquired CP is a more rare occurrence and as a voluntary organization, has more than 150 results from an injury to the head due to trauma or state and regional affiliates. The agency, through its infection. Cerebral palsy is not hereditary. It is not affiliates, serves more than 30,000 children and a progressive condition and is not communicable. adults with cerebral palsy and other disabilities Each case of CP is unique. The amount of damage every day. It offers assistive technology training, to the brain, the site of damage and the degree to community living, referrals, employment assis- which the nervous system is involved produce tance, advocacy, early intervention programs, ther- varying symptoms. apy, and so forth. Vision may be affected if the damage affects the To find out more about the organization that portion of the brain that controls the eyes or the serves your area. children 41

Contact: The law orders the administration of medical treatment to disabled infants except in the cases of United Cerebral Palsy Association irreversible and chronic coma or if the treatment 1660 L Street, NW, Suite 700 would only extend the dying process. The law Washington, DC 20036-5602 directs state child protection agencies to respond to 800-872-5827 (ph) reports of treatment denial. The act was amended 202-973-7197 (TTY) again in 1996 to provide for a community-based 202-776-0414 (fax) family-resource and support-grants program. The www.ucpa.org program includes temporary childcare for children Listings of local affiliates are available from the with disabilities and a crisis nursery program for website. children who are thought to be at risk. Mann, Richard C. Diagnosis: Cerebral Palsy. Oklahoma U.S. Department of Education. Summary of Existing Legis- City: United Cerebral Palsy of Oklahoma, 1986. lation Affecting Persons with Disabilities. Washington, United Cerebral Palsy Association. What Is Cerebral Palsy? D.C.: USDE, 1988. New York: UCPA, 1978. UCP Net. Cerebral Palsy-Facts and Figures, www.ucp.org, 2001. Child Nutrition Act As amended, the Child Nutri- tion Act of 1966 establishes federal-assistance funds chalazion An inflammation of the eyelid gland. to initiate and manage school-meal programs. The It is caused by a blockage of the meibomian gland Act outlines programs that supplement and expand duct. those described in the National School Lunch Act. A chalazion appears as a bump or swelling on Daytime and residential schools and child-care pro- either the top or bottom eyelid. It is painless and grams that serve disabled children are eligible to may develop slowly over many weeks. Treatment participate in the School Milk, School Breakfast, and of chalazion may include warm compresses and Nutrition Education and Training Programs. sulfonamide eye drops. The School Milk Program was designed to Once the chalazion has grown large enough to encourage school children to consume milk. The press on the eyeball, it may cause damage to vision program funds grants to states to provide free milk by producing an astigmatism. In such cases, to eligible children. Eligible nonprofit schools, surgery to remove the chalazion may be required. child-care centers, and camps are reimbursed for The eye is patched after surgery, and antibiotic eye the milk served. Schools and centers are eligible, drops are often prescribed. provided they are not recipients of National School Chalazions may become chronic. Prevention Lunch Act or Child Nutrition Act program funds. may be achieved through strict hygiene and the The School Breakfast Program provides breakfasts application of warm compresses at the first sign of served at school to eligible children. Eligible non- inflammation. If they do reoccur, it could be an profit public or private schools, including those for indication of a more serious condition and should disabled children, are reimbursed for the breakfasts. be checked. The Nutrition Education and Training Program provides grants to states for training on nutrition and management to instructors and food-service Child Abuse Prevention and Treatment Act The personnel and instructional nutrition programs in Child Abuse Prevention and Treatment Act, first school classrooms. (See NATIONAL SCHOOL LUNCH ACT.) enacted in 1974, was amended in 1984 to mandate proper medical treatment of infants born with U.S. Department of Education. Summary of Existing Legis- physical or mental disabilities. The amendments lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. were in response to reports to Congress that appropriate medical treatment was withheld from disabled infants. children See DEVELOPMENT OF BLIND CHILDREN. 42 chlamydia chlamydia A type of sexually transmitted disease often spreads to the overlying retina, resulting in that can cause conjunctivitis, both in adults and chorioretinitis. When this occurs the vision babies, who are affected at birth. Caused by a bac- becomes acutely blurred. If the inflammation in- terium, chlamydia is the leading sexually transmit- volves the macular region of the retina, permanent ted disease in the United States. About 4 million central-vision loss could occur. new cases occur each year. Chorioretinitis may be treated with systemic Early symptoms include abnormal genital dis- (given orally) or local corticosteroids. charge or pain when urinating, but symptoms can be very mild and may not even be noticed. As the choroid The choroid is the dark, middle tissue disease progresses, it can cause eye infection and layer between the RETINA and the SCLERA, or white proctitis and urethral infection in men. part of the eye. It is the back portion of the uveal Newborns affected while in the birth canal may tract, a vascularized tissue layer that supplies blood develop conjunctivitis or pneumonia. Typically, to the eye. Blood circulates through the choroid symptoms of eye problems will occur within the layer to nourish and support the eye. first 10 days of life. The eye infection can be treated The UVEA or uveal tract contains the pigmented with antibiotics in both newborns and adults. portions of the eye. These consist of the IRIS, the Many doctors advise that all pregnant women be CILIARY BODY, and the choroid. When uveitis, or tested for chlamydial infection because of the risk it inflammation of the uvea occurs, the choroid may presents to newborns. be involved. Inflammation of the choroid is called CHOROIDI- chorioretinitis A secondary condition caused by TIS or posterior UVEITIS. Symptoms of choroiditis CHOROIDITIS, a swelling of the CHOROID (also called may include pain, redness of the eye, and light sen- posterior UVEITIS). Chorioretinitis occurs when the sitivity. However, choroiditis is often present with- inflammation of the choroid spreads to the under- out symptoms, and since it may be present only in lying RETINA. the peripheral field, it may persist unnoticed. The The choroid is the pigmented tissue layer inflammation may spread to the retina and the VIT- SCLERA between the retina and the (white part of REOUS, in which case, the vision becomes blurred. the eye). It is the posterior section of the uveal Choroiditis may be caused by parasites (as it is in tract, a vascularized tissue layer that supplies blood TOXOPLASMOSIS), viruses, or other diseases such as to the eye and that includes the IRIS and CILIARY tuberculosis or syphilis. Choroiditis and posterior BODY in the anterior section. uveitis are usually treated with steroid pills, drops, The retina is the light sensitive layer at the back or ointments. of the eye. The retina receives light information from the RODS AND CONES located there. It converts the information into electrical impulses that it choroiditis Choroiditis is an inflammation of the sends to the brain. The brain transforms the CHOROID, the vascular layer between the RETINA impulses into an image. and the SCLERA. It is a type of UVEITIS, an inflam- Symptoms of choroiditis include redness of the mation of the uveal tract, and is sometimes referred eye, light sensitivity, and lost or blurred vision. The to as arthritis of the eye. symptoms of choroiditis may not be noticeable to The uveal tract is composed of the IRIS, the CIL- the patient if they are located in the areas of IARY BODY, and the choroid. The iris is the colored peripheral vision. part of the eye that controls the pupil and enables Choroiditis may occur spontaneously. It may it to open and shut to control the amount of light also be linked to viruses, injuries, TOXOPLASMOSIS, entering the eye. The ciliary body produces aque- arthritis, tuberculosis, VENEREAL DISEASE, parasites, ous fluid and moves the lens to focus properly by and SARCOIDOSIS. changing its shape. The choroid, which supplies Because of the close proximity of the choroid blood to the eye, is a vascular layer between the and the retina, the inflammation of choroiditis retina and the sclera. closed-circuit television 43

Uveitis is categorized as either anterior or poste- discrimination and violations of civil rights. The rior. When the iris and ciliary body are involved, Commission also conducts fact-finding examina- the condition is termed anterior uveitis. When the tions and provides the public with information choroid is involved, it is termed posterior uveitis, or from its clearinghouse. The Civil Rights Commis- choroiditis. sion influences public opinion but has no authority Choroiditis is usually less painful than anterior to enforce the law against violators. uveitis. It may be accompanied by redness of the The Civil Rights Commission Act was amended eye, light sensitivity, and lost or blurred vision. The in 1978 to include provisions that prohibit discrim- symptoms of choroiditis that occur in the areas of ination on the basis of disability. This allowed the peripheral vision may not be noticeable to the Commission to investigate violations of disabled patient. persons’ rights. Choroiditis may occur spontaneously. It may U.S. Department of Education. Summary of Existing Legis- also be linked to viruses, injuries, TOXOPLASMOSIS, lation Affecting Persons with Disabilities. Washington, arthritis, tuberculosis, VENEREAL DISEASE, parasites, D.C.: USDE, 1988. and SARCOIDOSIS. If choroiditis is not treated, it may spread to the retina, a condition called CHORIORE- TINITIS, and to the VITREOUS. Once in the retina, it Civil Service Reform Act The Civil Service may affect the MACULA, and result in a loss of cen- Reform Act of 1978 authorized widespread tral vision. changes in federal employment practices. Among Choroiditis is treated with steroid pills or drops. other reforms, the Act allowed agency directors to Immunosuppressive medications may be pre- hire assistants for visually impaired or hearing- scribed in severe cases. It tends to reoccur. impaired employees to enable them to do their jobs effectively. These assistants included reading aides for visually impaired employees and interpreters ciliary body The ciliary body is the group of cil- for hearing-impaired employees. iary muscles that are attached to the ZONULE,a group of fibers that hold the LENS in place. The cil- U.S. Department of Education. Summary of Existing Legis- iary muscles change the shape of the lens when lation Affecting Persons with Disabilities. Washington, focusing, and they open and shut the PUPIL. D.C.: USDE, 1988. The ciliary muscles contract to bulge the lens forward and focus on a near object. The muscles closed-circuit television (CCTV) A low-vision expand to flatten the lens and focus on a distant aid that electronically magnifies a distant object or object. printed material. It is widely used by visually The ciliary body also produces the aqueous fluid impaired persons in schools, libraries, offices, and of the eye. The aqueous fluid flows through the homes. anterior chamber of the eye where it nourishes the The CCTV consists of a video camera with a lens and CORNEA and carries away waste. Changes zoom lens and a monitor. The camera focuses on in the ciliary body may affect the production and print material or distant objects such as a black- flow of the aqueous fluid, which can result in an board and electronically transmits the enlarged increase in intraocular pressure and glaucoma. image to a video monitor. The user employs hand Iritis, an inflammation of the IRIS, can cause or foot controls to scan the material and focus on a inflammation of the ciliary body, known as CYCLI- specific sentence, phrase or word. The user may TIS. This results in pain, redness, light sensitivity, choose to see the print as black letters on a white and constricted pupil. Iritis and cyclitis are usually background or white letters on a black background. treated with steroid pills, eyedrops, or ointments. The CCTV can magnify objects or print from 1 to 60 times normal size without distortion. Since it Civil Rights Commission Act The Civil Rights operates on electronic image intensification rather Commission is a council that investigates claims of than optical projection, the image contrast and the 44 coloboma illumination light source are better than a projec- anopia, or by faulty visual pigment, known as an tion magnifier. anomaly. Individuals lacking visual pigment are Closed-circuit televisions are offered in models termed dichromats; those with faulty pigment are that allow the user to type or use a personal com- termed anomalous trichromats. puter. Portable models are available for use away Most people with color blindness see some color. from home or office. Many see all three primary colors but in the wrong proportions and may require brighter shades to recognize a particular hue. Other individuals may coloboma A cleft or notch in the IRIS, RETINA, be red or green blind. A person with red blind- and/or CHOROID due to incomplete formation or ness sees reds and oranges as shades of gray or closure of the optic cup during gestation. The cleft black. A person with green blindness sees reds, produces a section of missing iris, retina, and/or oranges, and greens as much the same shade and choroid that may extend from the optic disc to the cannot distinguish between them. Blue blindness periphery of the FUNDUS. is extremely rare, as is complete color blindness, Coloboma most often appears as a keyhole- a condition usually attributable to other visual shaped pupil. The condition may be bilateral, but problems. usually one eye is more acutely affected than the Color blindness may be detected during the other. If the iris is minimally affected, vision inter- routine ophthalmologic examination. A common ference may be insignificant. However, if the retina screening device called the Ishihara Test uses cir- (particularly the macular area) and choroid are cles of different sizes and hues to form a mosaic involved, vision loss could be serious. picture. The picture shows a two-digit number in a Coloboma is a birth defect that is inherited in a background field of circles. Those with normal dominant pattern. It sometimes is accompanied by color vision are able to see the number formed other developmental flaws. There is currently no with colored circles. Those with color blindness treatment to correct coloboma. cannot detect a number from the background field. color blindness Difficulty in recognizing or dis- There is no cure or treatment for hereditary tinguishing one color from another. It may be one color blindness although some experimentation is of two types, hereditary or acquired. The heredi- being done with tinted contact lenses, such as the tary variety is the most common. It is present at X-CHROM LENS, and filters. The individual may not birth in 1 out of 12 men and 1 out of 200 women. be able to see color with the lenses but may be able It is a genetic defect that affects both eyes and does to distinguish between colors better as a result of not change in severity over a lifetime. wearing them. The RETINA contains photoreceptor cells called Acquired color blindness can occur as a result of RODS AND CONES. They change light energy into aging or disorders such as retinal optical-nerve information about the object in view. The retina conditions, TOXIC AMBLYOPIA, MACULAR DISEASE, changes the information into electrical energy that CATARACT, GLAUCOMA, and DIABETIC RETINOPATHY. is sent to the brain and translated into an image. The diseased eye is generally the only eye affected, Each cone contains visual pigments that are sen- and effective treatment of the illness may result in sitive to one of the three primary-color light wave- an improvement in color vision. lengths. One group of cones recognizes green, one Drugs can temporarily alter an individual’s color red and one blue. By blending these three colors, vision. Barbiturates given as sedatives and large the eye is able to distinguish all the colors of the doses of vitamin A may affect the yellow or yellow- spectrum. This is known as normal trichromatic green vision, and caffeine has been shown to affect color vision. and alter all colors. The popular drug Viagra also Color blindness occurs when one group of cones has been found to cause temporary changes in does not recognize its color properly. This may be blue/green colors and increased sensitivity to light caused by a lack of visual pigment, called an in some cases. computers 45

Committee for Purchase from People Who Are ing systems and programs involve high resolution, Blind or Severely Disabled A small federal which enhances magnification. Large-print capable agency established as a result of the JAVITS-WAGNER- printers and multiple fonts and character sizes O’DAY (JWOD) Act. The act, amended in 1971 to improve readability of hard-copy output. replace the Wagner-O’Day Act of 1938, established The standard keyboard may be adapted for use a program in which federal agencies can purchase by blind or visually impaired users through home- selected goods and services from workshops for the key indicators such as raised dots or indentations. blind. Other adaptations feature felt appliques, large print Members of the Committee for Purchase from appliques, and larger key replacements for the People Who Are Blind or Severely Disabled include most frequently used keys. senior officials from federal procurement agencies, Blind persons may access computer information as well as private citizens representing people who through audio output that relates information on are blind or otherwise disabled. Citizens are the screen via a synthetic voice. The speech syn- appointed to the board by the U.S. president. The thesizers process the text to speech and produce committee administers the JWOD program, with human-sounding voices. The voices are available in the mission of creating employment opportunities various forms of male, female, or robotic voice; for blind people. adult or child voice; voice pitch; speed rate; and Contact: volume. The voice speaks English words, letters, and numbers, and some versions offer foreign lan- The Committee for Purchase from People Who guages, singing and music. Are Blind or Severely Disabled Screen-reading software, activated by the stan- 1421 Jefferson Davis Highway dard keyboard or an auxiliary keyboard, enables Jefferson Plaza 2, Suite 10800 the user to locate and identify sections of the screen Arlington, VA 22202-3259 or specific sentences, words or letters to be read. 703-603-7740 (ph) The program can be directed to read specific sec- 703-603-0655 (fax) tions or positions on the screen, such as columns, www.jwod.gov and to provide audio output during data entry so that the user can audibly verify the text as it is computers Computers and related technology entered. are tools used by visually impaired and blind per- Optical character readers and the accompanying sons to access and manipulate information. Recent software recognize print and translate it into com- developments and inventions, many of which were puter recognizable data. Some systems read pages designed to meet the needs of those with vision of print with a scanner and send them directly to losses, allow for full competitiveness in most edu- computer files. The files can then be accessed and cational and employment settings. read aloud by the voice synthesizer. Other systems Persons with low vision or some usable residual read the print and immediately speak the text vision may find standard print on a computer aloud. screen or printed output too small to read. Text may be entered into the computer through Enlarged output or magnification and large print a braille keyboard by use of specialized software or adaptations have been developed for these users. hardware. Braille embossers or printers produce These include magnification lenses or devices embossed braille paper output. Paperless braille placed in front of the standard computer screen systems allow access to material through braille that enlarge the text two to three times normal tactile displays. The tactile displays use retractable size, software programs that magnify the text up to pins to form braille characters read by the fingertips eight times, hardware and software combinations of the user. Another tactile system, the Optacon II, that result in magnification of up to 16 times and presents information from the computer screen to closed circuit television systems that magnify the the user through a vibrating tactile display that rep- output up to 60 times normal size. Many magnify- resents printed letters. 46 congenital disorders

Many software programs allow for translation ens to interfere with the child’s performance at from braille to print and print to braille. This school or home. Patients may develop AMBLYOPIA enables blind and visually impaired persons to or RETINAL DETACHMENT following surgery. share computer-produced information with sighted COLOBOMA is a congenital condition involving a persons. Other programs translate to different defect in the closure of the optic cup. The defect grades of braille. may cause a wide area of missing retina and Through modems and related support software, CHOROID, or a segment of missing iris. If a segment users can access telephone lines to exchange of the MACULA is involved, vision may be affected. machine-readable information, enter remote data When both eyes are involved, commonly one eye banks and participate in electronic bulletin boards. is less severely affected. Coloboma may be inher- They can access telephone directories, automati- ited. cally dial the telephone, and accomplish electronic Corneal degenerations, such as KERATOCONUS, mailing, banking, and shopping. Similar software may be inherited and congenital. The condition includes talking calculators and general file-man- may appear in both eyes and results in a progres- agement systems. sive thinning of the cornea, which may necessitate The documentation and manuals for such sys- a corneal graft. tems and programs may be available in formats Inherited MACULAR DYSTROPHIES are usually seen other than standard print. Many companies offer at birth or up to the age of six. The condition is this material in audio cassette, large print, braille, marked by a destruction of the macula, the site of or machine-readable formats. sharpest vision in the retina. Macular degeneration As computer technology improves overall, we blurs and may eventually destroy central vision, also can expect improvements in technology for although some peripheral vision may be retained. the blind and visually impaired. Specific informa- Congenital NYSTAGMUS involves involuntary tion regarding this topic is found under listings for movement of the eyes. It may be an inherited con- individual products and in the Appendix. dition or may be caused by congenital cataract, albinism, aniridia, optic atrophy, or another disease or disorder. congenital disorders Congenital disorders are OPHTHALMIA NEONATORUM is an infection of the those diseases or conditions that appear at birth. conjunctiva and cornea acquired during birth They may be inherited or caused in utero by other through organisms in the maternal birth canal. The means. Several eye conditions and diseases are condition was common during the early part of the commonly seen congenitally. Congenital CATARACT century but is now rare due to the instillation of sil- may be inherited or acquired in utero due to conver nitrate into newborns’ eyes. ditions such as rubella. The cataracts may be pre- PTOSIS is a congenital, inherited condition in sent in both eyes and vary in severity. which one or both of the upper lids droop. This ALBINISM is an inherited condition that involves may cause an obstruction to vision and can be cor- reduced or absent pigmentation of the skin, hair, rected surgically. and eyes. Ocular albinism affects only the eyes. The RETINITIS PIGMENTOSA (RP) is an inherited degen- condition often causes NYSTAGMUS, myopic ASTIG- erative disease of the retina. It may be present at MATISM, and PHOTOPHOBIA. birth or surface later in childhood or young adult- ANIRIDIA, the absence of the IRIS, is a congenital hood. RP destroys peripheral vision and causes condition. Those with aniridia may develop sec- night blindness. When an individual with RP has a ondary GLAUCOMA as a result of the blockage of the hearing loss, the condition may be called USHER’S anterior chamber by the iris root. Aniridia may be SYNDROME. inherited or may occur as the result of trauma. RETINOBLASTOMA is a congenital intraocular Severe cataracts may be removed shortly fol- malignant tumor of the retina. It is usually present lowing the neonatal period, but often the surgery is at birth in one or both eyes. The condition is usu- postponed until the density of the cataracts threat- ally inherited but may occur in families with no contact lenses 47 history of the condition. Enucleation (removal of sation. Treatment involves shielding the eye from the eye) may be necessary to save the life of the excessive light and allowing it to heal with time. patient. Viral conjunctivitis—which is truly pink eye STRABISMUS (squint) is a nonalignment of the because it does, indeed, cause the eye to become eyes. The condition may be inherited or may de- pink, as opposed to bright red or yellowish from velop after an illness or injury. Strabismus may discharge—is caused by one of the viruses respon- cause double vision and amblyopia of disuse. sible for the common cold. It is extremely conta- Because many babies have strabismuslike condi- gious. This form of conjunctivitis usually occurs tions at birth that later self-correct, strabismus is seven to 10 days after contact with an infected per- often not diagnosed until after six months of age. son, and causes the eye to become itchy and watery. Like a cold, this form of conjunctivitis can linger for weeks. It can be treated with antihista- The conjunctiva is the transparent conjunctiva mine eye drops and cold compresses on the eye to mucous membrane that covers the inside of the relieve swelling but, generally, it simply has to run eyelid and the SCLERA, the protective white part of its course. Avoiding viral conjunctivitis is difficult the eye. Conditions that are commonly associated because it is so contagious. It can be spread by a pil- with the conjunctiva include CONJUNCTIVITIS, hem- lowcase, towel, washcloth, article of clothing, tis- orrhage, pinguecula, and pterygium. sue, and so forth. Conjunctivitis, or “pink eye,” is an inflammation Bacterial conjunctivitis normally is characterized of the conjunctiva. It may be caused by allergies, by eyes that are noticeably inflamed, bright red, viral infections, bacterial infections, or overexpo- and discharge a thick yellow mucous. It is easy to sure to light. Symptoms of conjunctivitis may contract because bacteria are so easily introduced include redness of the eye, itching, burning, or dis- into the eyes. While the conjunctiva, just like the charge. mouth, normally contains bacteria, those bacteria A hemorrhage in the conjunctiva, called a sub- that cause conjunctivitis are not normally present conjunctival hemorrhage, may occur due to an there. Antibiotic eye drops generally are prescribed injury, excessive rubbing, or coughing and sneez- to treat bacterial conjunctivitis. In some cases, oral ing. A hemorrhage shows itself as a bright red mark antibiotics may be necessary. on the sclera (white of the eye). The hemorrhage Allergic conjunctivitis, which can be caused by a looks frightening but rarely has any long-term host of irritants ranging from pollen to rabbit fur, effect and generally goes away without treatment. results in the eyes becoming red, itchy, swollen, Pinguecula is a small, yellowish, raised mark on and teary. Some eye-care products, such as the the sclera. It is usually associated with age and is a preservatives used in eye drops, also can cause harmless condition. allergic conjunctivitis. Pollutants and chemicals Pterygium is a patch of raised vascular tissue on also can cause allergic conjunctivitis. This condition the sclera. If the pterygium grows into the cornea, normally is treated with antihistamines and cold it may block vision. compresses. Over-the-counter pain relievers may be used to relieve discomfort. conjunctivitis Conjunctivitis is a common infec- Conjunctivitis can produce serious damage and should be treated by a physician. tion of the CONJUNCTIVA. Conjunctivitis can be caused by large doses of ultraviolet light, as in snow-blindness, by allergies to pollen, medications, contact lenses An alternative to eyeglasses, con- food or smoke, or by bacteria or viruses. While all tact lenses are small, thin discs of plastic that rest in forms of conjunctivitis are commonly referred to as place on the cornea. Held in position by the natural “pink eye,” only the viral form is pink eye in the moisture of the cornea, contacts have several true ophthalmic sense. advantages over glasses. Many people find contacts Conjunctivitis caused by overexposure to light to be more comfortable and convenient than can cause redness of the SCLERA and a burning sen- glasses, and they provide better peripheral vision 48 contact lenses than glasses do. Because the lens rests directly on wear lenses can occasionally be worn overnight, the eye, size differences that sometimes occur with but they are not designed to be worn constantly. glasses are minimized, giving a more natural Disposable extended-wear lenses have been avail- appearance to what you see. able since the late 1980s and are just what they are Contacts have become increasingly popular called—disposable. They are designed to be placed since 1972, when soft lenses were first introduced, in the eye, worn for about a week, and then but the idea for them has been around for cen- thrown away. Lenses that are disposed of after one turies. In fact, Leonardo da Vinci is credited with day of use were introduced in the mid-1990s. having come up with the idea for contact lenses in All contact lenses should be kept very clean in about 1550. It was a scientist in Switzerland, how- order to avoid the risk of infecting the eyes. There ever, who actually made the first contact lens out are three basic methods of disinfecting contact of glass in the late 1800s. These glass lenses were lenses: with heat, chemicals, or a peroxide oxida- not successful because they were very uncomfort- tive disinfectants. Heat systems destroy bacteria on able to wear. Plastic lenses, which we still use, were the lenses with high temperatures. Lenses are first introduced in the 1940s, although many innova- cleaned and rinsed, then they are placed into a heat tions and improvements have been made since unit, during which time bacteria are destroyed. then. Contact lenses are made today to correct Using heat to kill bacteria is a fairly quick process, almost any vision problem, and there are many and there is no need to use solutions that contain varieties. Basically, however, they are divided into preservatives and chemicals, to which some people two major categories: hard and soft. are allergic. A downside to heat cleaning is that it Hard contacts, the kind that were first intro- can cause coatings to build up on the lenses. Also, duced in the 1940s, can correct nearsightedness, heat cleaning is not safe for all types of lenses. farsightedness, and astigmatism. Hard lenses were Chemical disinfectants kill bacteria over a period much improved upon during the 1970s, when a of several hours. They are effective at cleaning and gas-permeable model was developed. Gas perme- disinfecting lenses, but, as mentioned above, can able lenses are hard but allow air to flow through cause allergic reactions in people with sensitivity. them to the eye. They are more flexible than the Peroxide oxidative disinfectants were developed earlier hard lenses, and they generally fit better. in the early 1980s and are considered to have some They are made with computer-controlled lathes advantages over heating or chemical systems. and can be ground to correct various vision prob- Although the disinfectants are based on a hydrogen lems. They also can be made into bifocal lenses. peroxide solution, they have built-in neutralizers Gas-permeable lenses also can be used to correct that break down the peroxide so that it does not corneal problems that cause vision to be distorted. remain on the contact lenses. Because of the neu- Soft contacts are available to correct nearsight- tralization, there are no chemical residues. Nor is it edness, farsightedness, astigmatism, and presby- necessary to heat the lenses. opia (the inability to focus at near distances). They Bifocal contact lenses are available in both hard are flexible, and they absorb and hold water. Soft and soft lenses and contain two prescriptions to contacts are sometimes called hydrogels. Many correct refractive errors. Crescent bifocal lenses are more people can wear soft lenses today than in the similar to traditional bifocal spectacles in that the past, due to advances in the way they are made. prescription for distance is at the top part of the Soft contacts also can be made into bifocal lenses. lens and the prescription for close vision is in a Daily-wear contact lenses are those designed to crescent segment at the bottom. The lenses are be placed in the eye in the morning and taken out either weighted or truncated (flattened) at the bot- at the end of the day. Extended-wear contacts are tom to keep them from rotating out of position. those that can be worn for more than 24 hours. Concentric bifocal lenses differ in that the close Extended-wear lenses are designed to allow the vision prescription is in a ring around the inner cir- eye to receive sufficient oxygen, so they can be cle of distance vision prescription. This design cir- worn even while the wearer is sleeping. Flexible- cumvents the problem of rotation. Copyright Act 49

Toric contact lenses are soft lenses that correct Other aids can be used to improve contrast. A astigmatism. In the past, astigmatism had to be cor- sheet of yellow or amber acetate can be placed over rected with hard lenses because the soft lenses pale or bluish print to increase visibility. A typo- tended to mold themselves to the irregularities of scope, or slit reader, isolates one line of print to the cornea. The toric lens provides the correction of reduce the page glare and add contrast. the hard lens and the comfort of the soft. Like bifocal lenses, toric lenses require a predictable, nonro- convergence The coordinated movement of the tating position in the eye. They are often weighted eyes to focus together on a near object. Conver- or truncated to discourage rotation. Toric lenses are gence is tested in an eye examination by slowly typically more expensive than other lenses. bringing a light or object close to the bridge of the The X-Chrom lens is a contact lens for those with nose. The patient is instructed to keep the object in red-green color blindness. It is a deep red lens worn focus as long as possible. in the nondominant eye and intensifies the color of As the object moves closer to the nose, the eyes red and green objects. This allows the nondomi- turn inward to a cross-eyed position. Divergence nant eye to feed information to the brain about occurs when the object can no longer be seen as colors it could previously not determine. The dom- one image and the eyes move from the convergent inant eye continues to relate information about position. colors that it normally sees. The lens is not a cure The near point of convergence is the last point at for color blindness, but rather an aid in the which the object could be seen as one image. This improvement of color perception. point is measured in millimeters as the distance As compared with glasses, contact lenses have from the bridge of the nose to the object. A normal the advantage of providing more natural, distor- near point of convergence is approximately 50 mil- tion-free vision, unaffected by weather (raindrops limeters. and snowflakes), steam or glasses’ frame obstruction. In the presence of high myopia (extreme near-sightedness), APHAKIA (loss of natural lens due Copyright Act The Copyright Act of 1976 to cataract surgery) or corneal diseases, contacts extended copyright privileges and protection to correct vision better than glasses. songwriters, artists and authors and outlined Because the contact lens is a foreign substance infringement exemptions concerning works in the eye, complications such as tearing, redness, directed primarily for deaf and blind audiences. itching, corneal abrasions, or infections can arise. The act cited four exemptions. Broadcast performances of nondramatic literary works are exempted if they are broadcast without commercial contrast Contrast enhancement is a non-optical, advantage by a governmental body on a noncom- or environmental, aid that maximizes residual mercial educational station, radio subcarrier, or vision. Contrast is enhanced by using dissimilar cable system and directed primarily at blind and colors or brightness levels to make an object more deaf individuals. visible. Highly contrasting colors near one another A broadcast of a single performance of a dra- enhance contrast. Complementary colors that can matic literary work is permissible if the work was be used together to create improved contrast in- published at least 10 years before the performance clude reds with greens, blues with oranges, and date and is directed primarily at blind audiences yellows with violet hues. and the broadcast is made without commercial Light objects on a dark background or the re- advantage through facilities of a radio subcarrier verse improve contrast. Light plates on a dark table- and one performance only is completed by the cloth improve visibility. Black letters on a white or same actors or by the same organization. yellow page are more readable than blue letters. Ten recorded copies of copyrighted materials Dark stairs are more easily seen when next to a light may be made by a nonprofit organization for wall or when lined with a fluorescent strip. broadcast by radio information service carriers for 50 cornea performances aimed at blind or deaf individuals. blurred vision. Common disorders of the cornea Braille copies are permitted of imported nondra- include ARCUS SENILIS, KERATITIS, KERATOCONUS, matic, English language works not produced in the abrasions, vascularization and, ulceration. United States or Canada. Arcus senilis is a harmless, cloudy ring that The act directed the Register of Copyrights to appears around the corneal edge. It is associated develop forms and procedures to obtain clearance with aging. to reproduce nondramatic literary works in braille Keratitis is an inflammation of the cornea. The or recorded form. Certificate of copyright registra- inflammation may be caused by an infection due to tion forms now include a section in which the an injury or abrasion or by transmission of applicant may grant permission to the Library of microorganisms through the blood. Keratitis may Congress to reproduce the copyrighted material in result in opaque scars and impaired vision. braille and phonorecords and distribute the copy- Keratoconus is a condition in which the center righted material to blind and physically disabled of the cornea thins and protrudes forward into a individuals only. The Copyright Act was amending cone shape. This condition results in an impair- in 1996, allowing nonprofit organizations to repro- ment of normal vision. Keratoconus can be treated duce and distribute braille, recorded, and digital surgically with a corneal replacement or transplant. books for the blind without having to negotiate Corneal abrasions are common and occur when with each publisher. the outer layer of the cornea is breached or scratched. Overwear of contact lenses is a frequent U.S. Department of Education. Summary of Existing Legis- cause. Abrasions may result in pain, excessive tear- lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. ing, and sensitivity to light. Department of Education, Statement by Tuck Tinsley, III, Vascularization of the cornea occurs when blood Ed.D, on 1998 Request for the American Printing vessels penetrate the normally avascular cornea. House for the Blind, 1997. This may be due to an infection, inflammation, injury, or disease. Corneal ulceration occurs when the surface is cornea The cornea is the transparent tissue in worn down by viral (such as herpes), fungal, or the front section of the eye. It is the curved, clear bacterial infections. Ulceration may result in per- cover over the colored IRIS. The cornea is sur- manent scarring and infiltration to the remainder rounded by the tough, protective SCLERA, the white of the cornea. portion of the eye. Healthy human corneas may be transplanted to The cornea is instrumental in refracting the light replace diseased corneas. Corneal transplantation is that enters the eye. Light that falls on an object is the most commonly performed human transplant reflected to the cornea. The cornea refracts or surgery. Over 90 percent of the corneal grafts trans- bends and focuses the light before it passes through planted in the United States are successful in the PUPIL to the LENS. restoring sight. The cornea must remain transparent to preserve vision and therefore contains no blood vessels. The nourishment and waste disposal normally provided corneal degeneration The term for the break- by the blood’s circulatory system is supplied by the down of the cornea. Corneal degenerations are AQUEOUS FLUID, a clear liquid produced by the CIL- fairly rare disorders that may be caused by genetic IARY BODY. The aqueous circulates through the or environmental conditions. Most disorders that anterior chamber of the eye, along the back of the cause corneal degeneration are inherited. Among cornea, to bring nutrients and carry away waste. these hereditary diseases are the two most com- Although the cornea is devoid of blood vessels, it mon, keratoconus and FUCH’S ENDOTHELIAL DYSTRO- retains numerous pain receptors, making any injury PHY. to the corneal tissue extremely painful. Injuries or Keratoconus is a disorder that may be inherited disorders of the cornea often result in distorted or from a recessive trait. The disorder affects both eyes corneal transplant 51 and is usually seen in children or adolescents. In Corneal edema may be caused by infection, this condition, the central part of the cornea thins corneal endothelial dysfunction (FUCH’S ENDOTHE- and eventually protrudes forward into a cone LIAL DYSTROPHY), a viral corneal inflammation (KER- shape. Distortion and loss of vision result. It is esti- ATITIS), a rise in intraocular pressure (as in mated to affect one of every 2,000 persons in the GLAUCOMA), postoperative changes, trauma, over- general population. wear of contact lenses, and ill-fitting contact lenses. Keratoconus is a chronic, progressive disease The condition is treated according to its cause. that develops slowly. It can be corrected in mild Edema caused by an infection or a corneal forms with spectacles and, more advanced forms, endothelial disorder may be treated with STEROIDS with contact lenses. or other medications. Viral KERATITIS may be Advanced conditions of keratoconus may be treated with ANTIVIRAL DRUGS. A rise in intraocular corrected with corneal transplants, called KERATO- pressure may be controlled by glaucoma medica- PLASTY. Keratoplasty to correct keratoconus is a tion or surgery. Postoperative conditions and highly successful procedure since the cornea trauma may be treated with medications and prop- remains relatively free of blood vessels. erly fitted and worn contact lenses may alleviate Fuch’s dystrophy is an uncommon hereditary the symptoms related to their use. disorder. It is more common in women than in Corneal edema may become a chronic condi- men, and normally appears only after a person is tion. As the condition progresses and worsens, the 50. In this disease, the endothelium layer degener- corneal nerves become ruptured and exposed, ates and impairs vision. Fuch’s dystrophy may causing extreme pain. Treatment of acute edema cause further complications such as corneal edema, may include a TARSORRHAPHY, in which a portion of a rise in intraocular pressure. Corneal transplanta- the lids are stitched together, or a corneal graft. tion may improve or restore vision. Little is known about the causes and develop- corneal transplant A corneal transplant, or ker- ment of corneal degenerations. It is thought that atoplasty, is the most common form of human some degenerations may result from irregularities transplant surgery performed today. There are within corneal fibroblasts, the cells that develop more than 40,000 corneal transplants done each into fibrous tissue. The fibroblasts are central to the year in the United States. Keratoplasty uses a donor processes of healing a corneal injury. CORNEA to replace a diseased cornea. Although In addition, some corneal degenerations may be cornea transplants are generally successful in caused by environmental influences. They may restoring vision, about 10 percent of transplanted result from corneal infections or inflammations corneas are rejected. Most rejections, however, can (KERATITIS) or from accidental injuries such as alkali be prevented if treated early. Signs of rejection burns. include sensitivity to light, redness, persistent discomfort, and changes in vision. Immunosuppres- corneal edema A condition in which the CORNEA sive drugs are available to reduce the possibility of becomes overly hydrated. In order to remain trans- cornea rejection, including an oral vaccine devel- parent, the cornea is normally kept relatively dry oped especially for that purpose. through oxygen supplied in tears and the drain of Donor transplants come from people who have water by the corneal endothelium. Any changes to decided that when they die they want their corneas the dehydration process or an influx of fluid can to be donated to others. The donor transplants are impede the process and allow fluid to accumulate. often kept in eye banks that help match appropri- Symptoms of corneal edema included blurred ate corneas to needed hosts. vision or the appearance of halos around lights. Donor transplants are selected according to age, Later symptoms include severe pain as corneal cause of death, condition of the eye, and time nerves are damaged. Since the early symptoms are between death and transplant surgery. Blood and similar to those of CATARACT, an ocular examination tissue typing are not required as with kidney or is necessary for proper diagnosis. heart transplants but time is a critical factor since 52 corneal ulcer the cornea should be transplanted within four days corneal ulcer Corneal ulcers occur when the of donation. cornea is worn down or damaged by injury or Donor corneas are most desirable from individu- exposure and bacterial, viral, or fungal infections. als between the ages of 25 to 35 and who died from Ulceration may lead to scarring and loss of sight. It injury or disease. The donor corneas are screened is a common cause of blindness around the world. for eye disease and the presence of venereal disease. Injuries or overwear of contact lenses usually An individual becomes a candidate for a corneal result in minor corneal abrasions or scratches. The transplant when all vision in that eye is lost due to symptoms are extreme pain with a feeling of a for- injury, corneal dystrophy diseases such as KERATO- eign body within the eye. Anaesthetic drops may CONUS, chemical burn, or infection. A transplant be administered to examine the eye that is then also may be performed to repair injuries or tears in generally bandaged shut. The eye may be allowed the cornea, to relieve chronic pain, or to correct a to heal itself or an antibiotic ointment may be pre- cosmetically unattractive eye. scribed to avoid infection. A normal cornea is avascular, or lacks blood ves- Ulcers due to exposure occur in cases of injury, sels. In order to perform a successful keratoplasty, facial palsy (Bell’s palsy) or unconsciousness in the transplant must be placed into the eye in a which the lid does not adequately protect the manner that discourages vascularization, or the cornea, allowing bacteria to enter and infection to growth of blood vessels, into the cornea. Vascular- result. Exposure-related ulcers may be treated with ization of the transplant may destroy it. eyepads and/or anesthetic ointments. Certain disorders or diseases such as kerato- Ulcers caused by bacteria are often associated conus, or a bulging cornea, lend themselves best to with the staphylococcus or streptococcus bacterias. corneal transplants because of the lack of corneal Other bacterias may infect the eye when the blood vessels involved with this disorder. Other cornea is weakened by disease or additional infec- conditions, such as corneal scars, are less effectively tions. Bacterial ulcers are usually treated with corrected with transplants because of heavy vascu- ANTIBIOTICS or antibiotic-steroids. larization present in the cornea. Ulcers due to viruses are most often caused by The surgery may replace part or all of the host the HERPES SIMPLEX virus. In infants, the virus is cornea. A section of donor cornea is measured to passed from the mother to the child as it travels the precise needs of the host with an instrument through the birth canal. A rash may appear around called a trephine. This section is removed from the the eyelids of the newborn, and the child may donor cornea with scissors. A corresponding sec- develop a fever. tion of host cornea is measured with the trephine The condition is serious and may result in death, and removed with scissors. The donor cornea is blindness, or damage to other organs of the body. placed into the remaining cavity and sewn into The virus is treated with ANTIVIRAL DRUGS and position with small sutures. antibiotics. The procedure is performed with either local or The herpes virus may appear in adults after general anesthesia and may take from an hour to development of another illness. The virus, which an hour and a half. It is often done on an outpa- had remained latent in the body, is reactivated and tient basis, but many patients require a day or two settles in the eye. This gives rise to KERATITIS,or of hospitalization. inflammation, and the formation of star-shaped, or For several weeks after surgery, the patient is dendritic, ulcers. As the ulcers heal, they may leave discouraged from bending, lifting, or straining. The scars that could impair vision. patient wears a protective eye patch or shield and An antiviral drug such as IDOXURIDINE, TRIFLURI- is treated with EYE DROPS for several months. The DINE, or ACYCLOVIR along with an antibiotic may be stitches are removed after a period of six months to prescribed as treatment. These drugs cannot cure two years. Ophthalmologists recently began using the herpes simplex virus, but they effectively stop artificial corneas is certain transplant cases. (See the reproduction of viral cells and prevent infec- EYE BANK.) tion. STEROIDS are not recommended since they Council for Exceptional Children 53 impair the body’s rejection of the herpes simplex scribed in drop or ointment form. Equivalent prod- virus. ucts include Triple-Gen and triple antibiotic. Side Fungal-related ulcers are most often caused by effects from use of this drug may include burning yeasts. The condition may require hospitalization or stinging of the eyes, redness, blurred or reduced and treatment with antibiotics. Healing of these vision, and headache. Eye pain, changes in vision, ulcers often results in scarring of the cornea. and headache indicate a serious problem that Damage to the corneal nerve, a vitamin-A defi- should be checked by a physician. ciency, or the onset of other diseases or disorders The drug should not be prescribed for fungal or may also trigger corneal ulcers. Any situation in viral eye infections or those that involve the back which the cornea is inflamed (corneal keratitis) sections of the eye. Those with an allergy to hydro- should be monitored for ulcers. cortisone or any other ingredient, as well as those with tuberculosis, should not use this drug. Those cortical blindness Cortical blindness is a rare with inner-ear problems, myasthenia gravis, or condition that occurs as a result of lesions on the kidney disease should use the drug with caution. occipital lobes where the visual cortex is located. The eye infection should be monitored during The lobes control the visual field of each eye. the time the drug is taken, even if the drug is used A lesion on one occipital lobe may result in for a short period of time. If the drug is used long- HEMIANOPSIA, loss of half the field of vision, but term, the eye should be examined regularly for the does not affect the central vision acuity. Lesions on development of CATARACT or a secondary infection. both lobes cause bilateral loss of vision with normally reactive pupils. This is known as cortical Council for Exceptional Children (CEC) A blindness. professional organization founded in 1922 and Cortical blindness can be a congenital problem, dedicated to providing appropriate educational but is most commonly seen in aging eyes affected experiences for exceptional children. The organiza- by vascular disease. There may be a history of cere- tion recognizes the special needs of visually brovascular incidents and loss of cerebral function. impaired, hearing-impaired, physically disabled, Cortical blindness may be a temporary condition mentally retarded, and mentally gifted children, as that follows a cerebrovascular embolism or circula- well as those with speech, behavioral, or learning tory occlusion caused by a stroke, myocardial disorders or disabilities. The membership includes infarction, or heart surgery. teachers, educators, administrators, counselors, parents, and others involved in the education of cortisone A steroid hormone used in drugs to gifted or disabled students. treat eye disorders. Cortisone may be an ingredient The organization has four major priorities. It in prescribed EYE DROPS, ointments, or pills. It is advances and improves access to education for often used to combat inflammation and prevent exceptional people; improves professional condi- scarring, as in corneal disease. tions and establishes professional standards for Cortisone must be used with caution since it those working with exceptional children; ensures increases the eye’s susceptibility to infection. the quality, support, and development of instruc- Antiviral or antibacterial drugs are often taken at tion provided to exceptional persons; and improves the same time to augment the eye’s natural communication between members and those defenses. involved with exceptional children. Cortisone should be used in the eyes for the pre- The CEC develops and sponsors workshops and scribed period of time only. Long-term use of corti- conferences, generates programs in special educa- sone may cause GLAUCOMA or CATARACT. tion technology, offers technical aid to government legislators and educators, and maintains a network cortisporin ophthalmic antibiotic A drug used to champion educational rights. The organization to treat bacterial eye infections. It may be pre- directs the ERIC Clearinghouse on Handicapped 54 cryosurgery and Gifted Children and maintains a library of position. The band remains permanently in the eye 63,000 volumes. but is neither seen nor felt. CEC publishes the journals Exceptional Children Berland, Theodore, and Richard A. Perritt. Living With and TEACHING Exceptional Children. The organiza- Your Eye Operation. New York: St. Martin’s Press, 1974. tion holds an annual convention. Eden, John. The Eye Book. New York: Penguin Books, Contact: 1978. Council for Exceptional Children Krames Communications. The Retina Book. Daly City, Cal- ifornia: KC, 1987. 1110 North Glebe Road, Suite 300 Reynolds, James D. “Lasers in Ophthalmology,” HealthNet Arlington, Virginia, 22201-5704 Library. Columbus: CompuServe, 1989. 888-232-7733 (ph) 703-264-9446 (TTY) 703-264-9493 (fax) crystalline lens The crystalline or natural LENS is www.cec.sped.org the transparent, elastic lens of the eye located behind the posterior chamber. The lens changes shape to focus light that enters the eye through the cryosurgery Cryosurgery is a procedure that uses PUPIL. The lens is held in place by fibers called very low temperatures to induce adhering scars in ZONULES. The zonules are attached to ciliary mus- tissue. Cryosurgery employs a cryoprobe, a pencil- cles, which contract or expand to change the shape like probe with a tip that is cooled to a tempera- of the lens. The lens bulges forward to focus on a ture between 30 and 70 degrees below freez- near object and flattens to focus on a distant object. ing. Cryosurgery is used to repair RETINAL DETACH- The crystalline lens is subject to common eye MENTS. disorders. It may become subluxated or develop A retinal detachment occurs whenever the cataracts. A subluxated lens is one that has shifted RETINA is disconnected to the back layers of the eye. out of place due to a birth defect or an injury. The The retina normally adheres closely to the pigment placement of the lens, usually downward from its epithelium and is supported by the VITREOUS gel. normal position, determines the degree of affected When the retina detaches or separates from the vision. epithelium layer, vision is threatened and surgery Cataracts are a clouding or opaque spot on the is needed to reattach it. surface of the lens that may develop over long peri- In order to reattach the retina, the CHOROID, ods of time. Most cataracts, termed senile cataracts, which lies just below the epithelium and the retina, are those associated with aging. Cataracts may also must be irritated to form adhering scar tissue. The be caused by birth defects, injuries, over-exposure surgeon may use surgical diathermy, a procedure to light, medications, diabetes, Down’s syndrome, in which a needle transmitting high-frequency Marfan’s syndrome, and other diseases. electrical current is touched to the SCLERA. The heat Cataracts may be removed surgically. In some of the electricity is transmitted to the choroid, procedures, a portion of the crystalline lens is which is stimulated to form scar tissue. removed, and an artificial, plastic lens is placed in An alternative method uses cryosurgery. The the eye. This intraocular lens, or IOL, replaces and cryoprobe is touched to points on the sclera, which serves as a permanent substitute for the removed is unaffected by the procedure. A hypodermic nee- section of natural lens. dle is then inserted to drain any fluid that has accu- See also EYE, CATARACT, IOL SURGERY. mulated under the retina. The surgeon may then make an indentation in the back of the eye and place a silicone buckle or cyclitis An inflammation of the CILIARY BODY band around the eye to indent it slightly inward. of the eye. The ciliary body lies behind the IRIS This pushes the epithelium into contact with the and is attached to ZONULES, which hold the LENS retina. Adhering scar tissue forms in the frozen in place. The ciliary body produces AQUEOUS FLUID, area and ensures that the retina will remain in which flows into the anterior chamber to nou- cytomegalovirus retinitis 55 rish the CORNEA and lens and carry away waste cycloplegic drops Cycloplegic, or mydriatic, matter. It also moves the lens, allowing it to focus drops are eye drops that dilate the pupils. Cyclo- properly. plegics are most often used during the ophthalmo- Cyclitis is associated with UVEITIS, an inflamma- logic examination to observe the back of the eye. tion of the uveal tract that sometimes is referred to Most drops reach a maximum effect after 15 min- as arthritis of the eye. The ciliary body, the iris and utes and last approximately three hours. Stronger the CHOROID make up the uveal tract. When the cycloplegics may last for 24 hours and are fre- choroid becomes inflamed, as in CHOROIDITIS, it is quently used in young children or for lengthy termed posterior uveitis. When the iris or ciliary examinations. body becomes involved, it is termed anterior In diseases in which the LENS and the IRIS have uveitis. Since the ciliary body is linked so closely to developed adhesions, such as IRITIS, cycloplegics the iris, the inflammation soon spreads from one to may be used to suspend accommodation, or move- the other. Because of this, cyclitis is often seen in ment, of the PUPIL. Atropine, a drug commonly cases of IRITIS, or inflammation of the iris. administered in such cases, may last up to seven The symptoms of cyclitis include extreme pain, days. contracted pupil, blurred vision, light sensitivity, Occasionally, the instillation of cycloplegic drops and redness of the eye. It may develop quickly induces GLAUCOMA. This occurs when the dilated within a 24-hour period. pupil further constricts the space in an unusually Cyclitis may develop spontaneously. It has been narrow anterior chamber. This impedes the flow of linked to other conditions such as arthritis, tuber- AQUEOUS FLUID from the eye, and intraocular pres- culosis, VENEREAL DISEASE, SARCOIDOSIS, sinus disor- sure rises. Pilocarpine or other meiotics, drugs that ders, viruses, and injuries. An ophthalmologic constrict the pupil, can reverse the problem. examination plus X rays of the sinuses, skull, and In rare instances, the patient may have an chest, as well as blood tests may be involved to allergy to an ingredient in the cycloplegic eye determine the cause of the condition. drops. This may result in irritation, redness of the Treatment of this condition usually involves eye or dermatitis that should dissipate as the effec- steroid eye drops and cycloplegic eye drops to dilate tiveness of the drug wears off. the pupil. Untreated cyclitis may spread to the choroid, retina, and vitreous, or may result in secondary GLAUCOMA. cytomegalovirus retinitis See AIDS.

D dacryocystitis An inflammation of the tear instruction, or formal rehabilitation training. The drainage sac caused by an infection. It usually goal of daily living skills instruction is to teach the affects one eye only and may become a chronic dis- visually impaired person to independently perform order. It is most commonly found in adult females. a task in a safe, conﬁdent, socially acceptable man- Dacryocystitis may be caused congenitally, from ner. Each skill is separated into distinct parts in a a blockage or obstruction of the tear duct or from a task analysis. The analysis determines the steps trauma or injury. The resulting infection is caused needed to complete the task, the sequence of steps, most often by bacteria such as Staphylococcus aureus and the adaptations necessary for completion by a and beta-hemolytic Streptococcus and by fungi such visually impaired individual. as Candida albicans. See NONVERBAL COMMUNICATION, REHABILITATION. Symptoms may include constant tearing, Kwitko, Marvin L., and Frank J. Weinstock. Geriatric Oph- swelling, discharge and tenderness of the eye. A thalmology. New York: Grune and Stratton Inc., 1985. culture of the discharge may identify the infecting Scholl, Geraldine. Foundations of Education for Blind and agent. The condition can be difficult to treat Visually Handicapped Children and Youth. New York: because the sac is located deep within the tissues American Foundation for the Blind Inc., 1986. surrounding the eye. Also, the condition can be hard to pinpoint and sometimes remains unde- Dancing Dots Braille Music Technology A com- tected for long periods, leading to scarring and tear- pany founded in 1992 by Bill McCann, a blind musi- ing problems. cian and programmer, to develop and adapt music Dacryocystitis is usually treated with warm technology for the blind. It released its ﬁrst product, compresses and topical or systemic ANTIBIOTICS. the GOODFEEL Braille music translator in 1997. Blocked nasolacrimal ducts of infants may be mas- The GOODFEEL software automates transcrip- saged to encourage dilation. If the duct fails to tion of Braille music, eliminating the need for a open, it may require surgical dilation. If the condi- human transcriber. The software allows sighted tion produces an abscess, it may be drained. musicians to prepare braille scores without needing to be braille music specialists, and allows blind musicians to make sound recordings, as well as daily living skills Living skills that allow an in- print and Braille editions of their own composi- dividual to complete routine activities or daily tions. tasks. Also called activities of daily living skills, Dancing Dots also is an authorized distributor techniques of daily living, or independent-living for many more assistive technology and music skills, these skills include personal-grooming skills, products. clothing labeling and care, eating skills, cooking, Contact: home-management skills, money management, communication skills, and child care. Dancing Dots Braille Music Technology Daily living skills are learned by visually 1754 Quarry Lane impaired persons through self-discovery, informal P.O. Box 927 teaching by parents or peers, school or teacher Valley Forge, PA 19482-0927

57 58 deaf-blind

610-783-6692 (ph) Once the child learns that motor movements 610-783-6732 (fax) can be used to communicate, language develop- www.dancingdots.com ment begins. The individual’s residual vision and hearing and fine motor skills will determine which deaf-blind Deaf-blind persons are those who method of communication is used. have a severe hearing impairment in addition to a Some individuals who retain enough hearing or vision impairment. The combination of severities become deaf after learning to speak can use speech. varies according to the individual and often results Those without residual hearing may use finger- in some residual hearing or vision. Deaf-blind indi- spelling, American Sign Language (ASL) or Signed viduals may retain enough residual hearing or sight English, three sign languages that can be used by to benefit from hearing aids or prescriptive lenses. deaf and totally blind persons. Deaf-blindness may be caused genetically and be In order to communicate with sighted and hear- present at birth, may develop over time as a result ing individuals, the deaf-blind person may use the of RUBELLA or USHER’S SYNDROME or may be the alphabet glove, the Braille Alphabet Card, or the result of aging. Usher’s syndrome is a leading cause Tellatouch device. The alphabet glove is a thin, cot- of deaf-blindness and responsible for approxi- ton glove printed with the letters of the alphabet at mately 10,000 of the deaf-blind individuals in the specific spots that are memorized by the wearer. United States. The user or sighted person spells out words by Deaf-blind infants may exhibit autisticlike ten- touching the letters on the glove. dencies and are often misdiagnosed as retarded or The Braille Alphabet Card is a pocket-size card emotionally ill. Parents of deaf-blind infants and that has both braille and printed letters on it. The children are urged to hold their children as much deaf-blind individual must read braille to use the as possible to provide the information that some- card. The user or the sighted person spells out the one is close by. They are encouraged to talk, sing, words by touching the letters on the card. and hum to their children and to hold the children The Tellatouch is a small, typewriterlike device near their chests to allow them to feel the vibration that raises braille letters under the deaf-blind read- of the sounds. ers fingertip as the other communicator types on If a child has some residual hearing, he can be the keyboard. The device also includes braillewriter encouraged to make sounds. Parents can expose keys for use by blind persons. the child to as many vibrations as possible, from Education for deaf-blind children can begin the vacuum cleaner to the stereo speaker. Parents through early intervention programs or preschools can place their hands on the child’s face and bend for deaf-blind persons. Those children with greater to the child’s face level while talking to the child. hearing and less sight may be placed in programs Children can be stimulated with toys or move- for visually impaired students. Those with greater ment to avoid unwanted mannerisms (see residual vision and little or no hearing may be placed in programs for the hearing impaired. BLINDISMS). Playing with drums, whistles, or other vibration instruments may be helpful. If the child Deaf-blind children entering kindergarten are has some residual hearing, the association of protected by the Education for All Handicapped sounds and actions or sounds and people helps to Children Act, which ensures them a free, appropri- define the world. ate, public education in the least restrictive setting, Deaf-blind children can be gently urged to sit which includes special education according to each child’s needs. A leading advocacy group for deaf- up, crawl, stand, and walk with encouragement blind people is the American Association of the from parents. The child should always have sup- Deaf-Blind. port until he can stand by himself. Self-care activi- Contact: ties such as eating, toilet training, and dressing can begin early and should be consistent and reason- American Association of the Deaf-Blind able in practice. Specific movements or signals may 814 Thayer Avenue be used to cue activities such as meal or bath time. Silver Spring, MD 20910 development of blind children 59

800-735-2258 (ph) adults with disabilities; and, its National Institute 301-588-8705 (fax) on Disability and Rehabilitation Research supports 301-588-6545 (TTY) research to improve the quality of life of people with disabilities. More information about the American Foundation for the Blind. The Preschool Deaf- Blind Child: Suggestions for Parents. New York: AFB, Department of Education’s Office of Special Educa- 1974. tion and Rehabilitative Services can be found on American Foundation for the Blind. What to Do When You the Internet at www.ed.gov. Meet a Deaf-Blind Person, New York: AFB, 1985. U.S. Department of Education. Summary of Existing Legis- Esche, Jeanne, and Carol Griffin. A Handbook for Parents of lation Affecting Persons with Disabilities. Washington, Deaf-Blind Children. Lansing, Michigan: Michigan D.C.: USDE, 1988. School for the Blind, 1980. McInnes, J. M., and J. A. Treffry. Deaf-Blind Infants and Children. Toronto: University of Toronto Press, 1982. development of blind children Visually impaired Scholl, Geraldine T. Foundations of Education for Blind and and blind children develop according to the same Visually Handicapped Children and Youth. New York: patterns and stages that govern the development of American Foundation for the Blind, 1986. sighted children. The effect the loss of vision has on Walsh, Sara R., and Robert Holzberg, eds. Understanding and Educating the Deaf-Blind/Severely and Profoundly each child depends on the severity, the type of loss, Handicapped. Springfield, Illinois: Charles C. Thomas the age at which the loss occurred and the child’s Publisher, 1981. overall functioning level. Each visually impaired child is an individual; therefore, there is no typical visually impaired Dendrid See IDOXURIDINE. child. Each develops according to his own timetable and abilities. However, many visually Department of Education Organization Act of impaired children have certain traits and needs in 1979 In 1979, a law was enacted to create a new common. Department of Education. This Cabinet-level Blind or visually impaired children may depend department was formerly the Office of Education, a more on their parents initially. They rely on their component of the Department of Health, Educa- parents to bring the world to them. Parents need to tion and Welfare. This agency was renamed the fill the gaps presented by the lack of sight with Department of Health and Human Services under experiences involving all the senses, including the Act. making the best use of any residual vision. The Department of Education took responsibil- Severe impairments may require the children to ity for most of the programs previously operated by be hospitalized and separated at birth from their the Office of Education, including the Overseas parents for extended periods. At the end of such Defense Department schools and additional federal time, the children may resist cuddling and not like educational services and programs. However, juris- to be held. The parents and children may respond diction of veterans education, the Head Start Pro- negatively to the lack of eye contact. gram, child nutrition, and National Science Parents of visually impaired babies and children Foundation educational, art and humanities pro- may need to hold, stroke, and talk to their child- grams was given to other agencies. ren more than normal in order to reassure the chil- The act also established an Office of Special Edu- dren that someone is near. Although some visually cation and Rehabilitative Services. impaired children react negatively to being held or The mission of the Office of Special Education picked up from the crib, this is not a rejection of and Rehabilitative Services (OSERS) is threefold: affection, but may rather be a reaction to the sud- Office of Special Education Programs supports den interruption. Babies who lie quietly in the crib programs that assist with educating children with may be concentrating on sounds in the environ- special needs; its Rehabilitation Services Adminis- ment and become frightened or confused at a sud- tration provides for rehabilitation of youth and den jostling. Parents may substitute voice contact 60 development of blind children for eye contact by speaking and crooning to the stereotypical behaviors, sometimes called “blind- children and imitating sounds the children make. isms.” These movements include rocking, head The lack of vision may also affect the ability of swaying, and poking or rubbing the eyes. Often children to distinguish between self and nonself. described as a reaction to a need for stimulation Sighted children develop the concept by use of and activity, these behaviors may be curtailed by vision. They are able to see themselves as separate providing a stimulating environment and ample from their environment and from others by watch- opportunities for movement, including such activi- ing others come forward or move away. Parents ties as climbing and riding a rocking horse. may encourage their visually impaired children to Fine motor skills such as using a crayon, tying develop this concept through auditory means by shoes, and playing with blocks or pegs should also be talking to their children as they enter and leave a stressed. These skills help children explore the world room. and prepare them for learning to read and write. Up to age four months, visually impaired chil- Abstract concepts are more difficult for children dren and sighted children vary little in their devel- with a sight loss, since they are often linked to opment. At about four months of age, the sighted visual concepts. Concepts such as dirty and clean, child may become fascinated with watching his in and out, open and shut, up and down, and for- hand, an activity that the visually impaired child ward and behind are crucial to the full develop- may miss. This hand-watching encourages the ment of any child. Parents of visually impaired child to direct his attention to the outside world. children may have to try methods based on other Because of the impairment or lack of sight, visu- sensory experiences, in repeated exposures, to ally impaired children may not reach out to explore teach these concepts to their visually impaired chil- their world and depend on their parents to bring dren. objects to them. Blind or visually impaired babies Language and speech development tend to be may mouth objects for a longer period of time dur- comparable in sighted and visually impaired chil- ing development (extending into childhood) than dren. If children have had a limited amount of their sighted peers. An abundance of tactile sensors gross motor experiences, however, language devel- in the lips makes this a logical way to gain infor- opment may be delayed. mation in the presence of a sight loss. Visually impaired and blind children may repeat Vision provides useful stimulation for motor or echo what other people say for a longer period development, motivating babies to hold their heads of time than their sighted peers. This repeating, up, reach for objects, sit, participate in imitative called echolalia, may be an attempt to practice link- activity, crawl, and walk. Parents of babies with a ing words to the concepts they stand for. sight loss may have to develop creative ways to Nonverbal communication develops in sighted motivate their children into movement to teach children when they smile in response to smiles by them these actions. Babies without this stimulation others. Later, they imitate and experiment with may become passive. facial expressions to determine the kinds of reac- As the children grow, they may be encouraged tion they can elicit. Visually impaired children may to participate in the same activities and sports as not participate in this kind of imitative activity, their sighted peers, including group games, jump which may limit their development of nonverbal rope, skating, running and riding a tricycle. Visu- communication. As children grow, they can be ally impaired or blind children who are physically instructed verbally as to the kinds of facial expres- active tend to show little difference in gross motor sions and postures that are socially acceptable in skills as compared with their sighted peers and order to avoid embarrassment and misunderstand- have a better awareness of body image and spatial ings in social interaction. orientation than blind or visually impaired children During preadolescent and adolescent years, the who are not physically active. emphasis of development is placed on educational If visually impaired children lack sufficient and social needs. Visually impaired and blind chil- opportunities for movement, they may develop dren are entitled by law to a free and equal EDUCA- diabetes 61

TION, including special education programs to fit or opacities of the lens, and an additional 11 per- each child’s needs, in the least restrictive environ- cent have been diagnosed with GLAUCOMA, a condi- ment. Children may go to school in a variety of set- tion in which intraocular pressure builds within tings and may begin to use ADAPTIVE AIDS and the eye and causes vision loss. These rates are over devices to complete their studies. twice those for the general population. Social needs center on feelings of belonging. Those most at risk of developing diabetes Group participation in activities such as Girl or Boy include members of families with a history of dia- Scouts, and school sports and clubs increases feel- betes, women (by a two-to-one margin over men), ings of confidence and acceptance by peers. Self- obese or overweight people, people over 40, blacks, acceptance should be stressed and children should Hispanics, native Americans, and those from low- actively participate in determining their own activ- income groups. ities and future pursuits. The disease affects many organ groups and causes complications such as retinopathy (disease American Foundation for the Blind. Is Your Child Blind? New York: AFB, 1975. of the retina), nephropathy (disease of the kidney), American Foundation for the Blind. Parenting Preschoolers. neuropathy (disease of the nerves), arteriosclerosis New York: AFB, 1987. (hardening of the arteries), and skin disorders. American Foundation for the Blind. Touch the Baby. New Carbohydrates are broken down into glucose by York: AFB, 1987. the body’s digestive juices. When glucose enters National Association for Visually Handicapped. Family the blood stream, the beta cells of the pancreas pro- Guide: Growth and Development of the Partially Seeing duce and release insulin, which helps the body tis- Child. New York: NAVH, 1985. sues absorb the energy-producing glucose. Warren, David H. Blindness and Early Childhood Develop- Diabetes is present when the beta cells fail to ment. New York: American Foundation for the Blind, react to the elevated glucose level in the blood. As a 1977. result, the blood glucose level rises above normal, the liver produces sugar from protein in the body, diabetes Diabetes or diabetes mellitus (DM) is a glucose appears in the urine, and the individual name for a group of inherited medical conditions or experiences frequent urination, constant thirst, and diseases in which the body is unable adequately to weight loss. If untreated, the disease can cause dan- process and store glucose. According to the Ameri- gerous levels of acid in the blood and diabetic coma. can Diabetes Center, 15.7 million Americans are Three main types of diabetes exist. Type I, afflicted with this serious disease. It is the sixth insulin-dependent diabetes mellitus (IDDM), is major cause of death by disease. characterized by insulin dependency; the presence Diabetes, specifically DIABETIC RETINOPATHY,is of HLA, DR3 and DR4 genetic markers; the appear- one of the chief causes of blindness in the United ance of circulation antibodies that attack the cells States. Approximately 150,000 diabetics in the of the pancreas; and a predisposition to acquire United States experience a significant degree of ketoacidosis, high levels of ketones, fatty acids, and vision loss, and 3 percent have a severe vision loss glucose in the blood. as a result of this condition. Type I diabetes is also called juvenile-onset dia- Diabetic retinopathy, a disease of the RETINA, is a betes and occurs in children and adolescents. The complication of a general circulatory problem onset of the disease often follows an infection or caused by diabetes. This disorder causes the blood virus. Several viruses including rubella, mumps, vessels that nourish the retina, a light-sensitive Coxsackie B, and Echo viruses are being explored inner lining in the back layer of the eye, to weaken, as possible links to a cause. disintegrate, or become blocked. The vessels may Type II, noninsulin-dependent diabetes mellitus leak fluid, bleed, grow unnaturally, bulge, or stop (NIDDM), occurs generally in middle-aged adults. functioning completely. NIDDM patients secrete insulin, lack HLA genetic According to the National Institute of Health, 12 markers, are insulin resistant, and are usually over- percent of diabetics have experienced CATARACTS, weight. 62 diabetic retinopathy

Since six out of seven Type II patients who tion of the disease. People with Type I (insulin develop the disease after age 45 are overweight, dependent) juvenile diabetes often take longer to studies are being conducted to determine whether develop the disease than people who are diagnosed inheritance may interact with obesity to trigger the as having diabetes as adults, but since the younger disease. individuals have the disease for a longer period of Type III diabetes is a milder form of the disease. time, they are more likely to develop the disease. It is non-progressive and has no known cause However, the disease does not always follow a pre- beyond inheritance. It affects young and old alike. dictable pattern. It can occur within a few years of Treatment for diabetes may include dietary mea- diagnosis or it may be the first indication of dia- sures, exercise, oral drug treatment, insulin injec- betes. tions, daily monitoring of blood glucose levels in The disease has three stages: exudative or back- the blood or urine, and regularly scheduled med- ground, preproliferative, and proliferative retino- ical examinations. It is extremely important that pathy. Each can be detected through a routine anyone who has diabetes get regular, thorough eye examination with an ophthalmoscope. Small red exams. The severity of many diabetes-related eye spots or microaneurysms may be visible in early problems can be reduced if the problem is detected stages of the disease, called background or exuda- early. tive retinopathy. See also DIABETIC RETINOPATHY. In this case, the damage has occurred in the retina and retinal vessels. The vessels may swell, U.S. Department of Health and Human Services, NIH. Facts About Insulin-Dependent Diabetes. NIH Publication bulge, or leak fluid that can collect in the retina and No. 80-2098. Washington, D.C.: Government Printing alter vision. The retina can remain in this stage for Office, 1980. years or indefinitely. National Diabetes Data Group, NIH. Diabetes in America. Preproliferative retinopathy occurs typically in NIH Publication No. 85-1468. Washington, D.C.: Gov- young people with uncontrolled diabetic condi- ernment Printing Office, 1985. tions. This stage of retinopathy is marked by American Diabetes Association, Diabetes Facts and Fig- increased hemorrhages, expansion of retinal ves- ures, ADA website, 2000. sels, and soft exudates, exuded material from a retinal infarct (dead tissue area that resulted from a diabetic retinopathy A disease of the RETINA and vascular obstruction). a leading cause of blindness and vision impairment. Examination of the disease at later stages shows Seven percent of all blind persons are impaired as a larger hemorrhages indicating proliferative result of diabetic retinopathy, a figure estimated by retinopathy. This more dangerous stage concerns the National Society to Prevent Blindness as the growth of new, abnormal blood vessels, or neo- 33,000. It is responsible for 1 in every 10 new cases vascularization. The new vessels often bleed into of blindness in the United States each year. the retina and VITREOUS and cause sudden, severe Approximately 150,000 diabetics in the United vision loss. Although it is not entirely clear why States experience a significant degree of vision loss these new vessels grow, it is thought that it is in due to diabetic retinopathy. Three percent have a response to blood vessel changes caused by a lack severe vision loss as a result of this condition. of oxygen to the retina. The retina, in effect, sends Diabetic retinopathy is a complication of a gen- a chemical message to the damaged blood vessels, eral circulatory problem caused by diabetes. The which respond by growing and releasing tiny new diabetes causes the blood vessels that nourish the vessels into the retina. retina, a light-sensitive inner lining in the back The formation of scar tissue from the healed layer of the eye, to weaken, disintegrate, or become vessels can pull the retina away from its position in blocked. The vessels may leak fluid, bleed, grow the back of the eye as the vitreous tends to shrink unnaturally, bulge, or stop functioning completely. and move toward the center of the globe. The The risk of developing retinopathy is determined retina may become detached or torn causing seri- by the age of the patient at diagnosis, and the dura- ous or total blindness. diplopia 63

Diagnosis and treatment of some cases of dia- Vaughn, Daniel and Taylor Asbury. General Ophthalmology. betic retinopathy includes FLUORESCEIN ANGIOGRA- Los Altos, California: Lange Medical Publications, PHY. During this procedure fluorescent dye is 1977. injected into the arm of the patient. The eye is Cassel, Gary H., Michael D. Billig, and Harry G. Randall. examined as the dye travels through the body, The Eye Book. Baltimore: Johns Hopkins University Press, 1998. including the eye, where it points out the damaged retinal vessels. The dye test, other than the injection itself, is painless and has few side effects. The diopter A unit of measurement for the power of dye may cause a patient’s skin to look slightly yel- a lens. It measures the extent light rays will bend as low and cause changes in the color of the urine. they pass through the lens. These side effects normally last only about 12 Diopters are written in prescriptions as O.D. or hours. O.S. followed by a plus or minus sign and a num- Treatment of the damaged vessels may include ber. The O.D. stands for the Latin oculus dexter, or photocoagulation or laser therapy. During this right eye. The O.S. stands for oculus sinister, or left treatment, an argon laser is focused on the leaking eye. blood vessels and cauterizes them. Over 1,000 laser Plus signs indicate convex or farsighted lenses. burns are placed on the retina, excluding the mac- Minus signs stand for concave or nearsighted lenses. ular area. The cauterization destroys the tissue, dis- A +3.00 prescription calls for a 3 diopter convex lens couraging regrowth of abnormal vessels and for a farsighted eye. A -1.5 prescription requires a 1- allowing the limited blood supply to reach and 1/2 diopter concave lens for a near-sighted eye. The nourish the MACULA, or area of sharpest sight. The stronger the lens is, the higher the number. procedure is performed with a local anesthetic and Prescriptions to correct astigmatism employ involves little discomfort. Overnight hospitalization cylindrical lenses that are often incorporated into a is usually not required. convex or concave lens to curve it more in one Laser therapy may be administered to those direction. Astigmatism prescriptions indicate the with background retinopathy when damage is diopter degree of near- or farsightedness, plus the severe or when accompanied by MACULAR EDEMA. word “axis” and a number from 1 to 180. The axis Laser therapy is almost always prescribed for those number refers to the number of degrees on a pro- with proliferative retinopathy. Laser therapy is not tractor and determines to which degree the cylin- a cure. Vision is often not improved, but the pro- drical lens must be oriented. gression of the disease can be stopped and greater The prescription -3.25–2.00 axis 95, calls for 3- loss of vision prevented. 1/4 diopters of nearsightedness with 2 diopters of VITRECTOMY is also used to treat severe reti- astigmatism. The axis 95 indicates the degree at nopathy. A specialized instrument is inserted into which the cylindrical lens must be oriented (95 the vitreous where it breaks down blood depo- degrees in this case). sits and scar tissue. It then removes the matter and the diseased vitreous fluid by suction. Simul- taneously, a sterile saline fluid is injected to re- diplopia The term for double vision. Diplopia is place the vitreous fluid. Approximately two thirds often confused with blurred vision when cited as a of those who undergo vitrectomy gain improved patient complaint. Blurred vision is a cloudy or vision. hazy image, but diplopia is the sighting of two sep- See PROLIFERATIVE RETINOPATHY. arate images at the same time. Diplopia may be constant or intermittent and Galloway, N. R. Common Eye Diseases and Their Manage- binocular or monocular. Monocular diplopia occurs ment. Berlin: Springer-Verlag, 1985. National Society to Prevent Blindness. Facts and Figures: if the double image persists when one eye is closed. Diabetic Retinopathy. New York: NSPB, 1980. This is a common form of diplopia and is often Rhoade, Stephen J., and Stephen P. Ginsberg. Ophthalmic caused by cataract. Binocular diplopia occurs when Technology. New York: Raven Press, 1987. the diplopia is corrected when one eye is closed. 64 disability

Diplopia may go unnoticed in adults or children Phillips, Calbert I. Basic Clinical Ophthalmology. London: due to poor general vision or suppression of image. Pitman Publishers Limited, 1984. Children often accommodate to the double image by suppressing the image of one eye, a condition disability There is no complete consensus on called AMBLYOPIA. This condition may lead to vision terms concerning the topic of blindness and vision loss. impairment. Rehabilitation experts, doctors, edu- Diplopia is a serious symptom and requires cators, and other leaders in the field determine and examination of the eyes. The examination involves define terminology according to their own prefer- testing of the gross eye movements to check the ences and viewpoints. In recent years, those degree of separation of images in various positions. involved in the field of blindness and vision impair- The Hess chart, red-glass test, or the cover-uncover ment have made efforts to standardize terms such test may be used. as disability to eliminate confusion or misinterpre- The Hess chart test involves placing a red filter in tation. front of one eye and a green filter in front of the A disability may be defined as the way an other. The patient looks at a screen of small white impairment (a diagnosed defect or malfunctioning dots. The patient is asked to point to specific dots of a body part or organ) affects an individual’s abil- with a pointer. The amount of mislocation is mea- ity to function. It is the limitation, restriction, or sured. disadvantage due to the malfunction. The red-glass test involves placing a red glass in See TERMINOLOGY. front of the right eye and a green glass in front of the left. The patient looks at a light 20 feet away and disability insurance benefits See SOCIAL SECURITY then at a separate light 14 inches away. The patient BENEFITS. tells the examiner if separate red and green lights are seen while fixating on the near or far light. During the cover-uncover test the patient looks Disability Rights Education and Defense Fund at a letter or object at 20 feet. One eye is covered (DREDF) A nonprofit advocacy group founded in and the other is observed to see whether it moves 1979 by leaders in the disability rights movement. to fixate on the object. If the eye moves, a disorder It is the only advocacy organization that represents is present. The other eye is tested at 20 feet and all disabled persons as a class. The goal of DREDF is then both are tested at 14 inches. to change policies and attitudes that contribute to Diplopia may be caused by misalignment of the discrimination of disabled persons and prevent eyes, as in STRABISMUS (or a latent strabismus from them from fully participating in all aspects of life. childhood), an ocular muscle imbalance; third, The organization addresses laws and policies that fourth or sixth cranial nerve palsy; orbital lesions; will ensure disabled persons integration into muscle lesions; cataracts; nerve lesions; multiple schools, jobs, and community life. sclerosis; myasthenia gravis; injury to the orbit; Nationally, DREDF advises Congress and other thyrotoxicosis, in which extraocular muscles policy makers concerning disability civil rights become inflamed; stroke; or intracranial tumor. issues; participates in civil rights coalitions, includ- Diplopia may often be treated with corrective ing those representing women’s and disability lenses, surgery or medication therapy of the under- groups; provides a national network of legislative lying cause. information for disabled persons and their families; and coordinates and submits to the U.S. Supreme Burde, Ronald, Peter J. Savino and Jonathan D. Trobe. Court “friend of the court” briefs on disability rights Clinical Decisions in Neuro-Ophthalmology. St. Louis: C.V. issues. Mosby Company, 1985. Eden, John. The Eye Book. New York: Penguin Books, On a local level, DREDF provides legal represen- 1978. tation to disabled persons and their families in cases Galloway, N. R. Common Eye Diseases and their Management. of school placement, respite and child care, and dis- Berlin: Springer-Verlag, 1985. crimination by employers, landlords, and businesses. dog guide laws 65

It educates and advises the California state legis- Although the above minimum statutes apply in lature on issues affecting the rights of disabled all 50 states and Puerto Rico, some dog-guide laws persons. designate specific restrictions while others extend DREDF publications include the Disability Rights rights. Some states require the dog guide to be in Education and Defense Fund News. harness or compel the owner to muzzle the dog Contact: guide upon request. Others specifically note that dog guides may not occupy a seat or that the blind Disability Rights Education and Defense Fund, person must carry and show, on request, the iden- Inc. Government Affairs Office tification card issued by the school that trained the 1629 K Street NW, Suite 802 dog. Others allow dog guides to be exempt from Washington, DC, 20006 licensing regulations or fees. 202-986-0375 (ph) In Hawaii, dog guides, like all dogs entering the 202-775-7465 (fax) state, must undergo a 120-day quarantine. How- DREDF’s main office is located at: ever, dog guide users may stay with their dogs in special cottages on quarantine grounds. Dog guides 2212 Sixth Street are not exempt from the regular quarantine fee. Berkeley, CA 94710 Some state laws order drivers to use every safe- 510-644-2555 (voice and TTY) guard to avoid injury or endangerment to a dog- 510-841-8645 (fax) guide user traveling the streets. Drivers must yield www.dredf.org the right of way to a crossing user and bring the car to a stop if necessary. divergence Divergence is the movement of the Many states include in the dog-guide law assur- eyes from a convergent position. Convergence is ances that dog-guide users have the right to equal the turning-in movement of the eyes to focus on a accommodation in commercial housing. The defin- near object. When the object is too close to the ition for commercial housing varies greatly from nose to be seen as one image, the eyes diverge, or state to state. It may be described as one or more of move from the convergent position. the following: a self-contained dwelling unit; property offered for rent, lease, or compensation; group dog guide laws All of the 50 states, plus Puerto homes; residential communities; or public-assisted Rico, have enacted statutes that regulate dog housing. Many states make specific exceptions for guides. All states guarantee the legal right of a blind single-family private homes that offer one rental person to be accompanied by a trained dog guide room only. Some stipulate that a fee cannot be on all public transportation and in all public accom- charged due to the presence of the dog guide; oth- modations. ers allow the landlord to levy a limited security Public transportation is described as all modes of deposit against possible damage incurred by the public conveyance and includes airplanes, trains, dog guide. boats, buses, taxis, and elevators. Public accommo- Some states express the right of dog-guide users dations are anywhere the public is invited. They to have equal employment opportunity in state include city streets, stores, restaurants, hotels, lodg- employment, public schools, or any employment ing places, resorts, amusement parks, educational supported by public funds, so long as the person is institutes, and public buildings. The blind person qualified to perform the job. cannot be charged a fee for the dog guide but is A number of Canadian provinces have enacted liable for any damage to the premises that the dog dog-guide laws that closely resemble the basic might cause. statutes of those in the United States. Dog-guide Violation of the law by a person or organization users must carry a current health record for the dog generally results in a fine or imprisonment. Some guide, including proof of rabies vaccination, when states allow dog-guide users who are denied their crossing the Canadian-American border. Users are civil rights to take the offending parties to court. advised to include an identification card from the 66 dog guides dog-guide training school and a muzzle, because in trained to be dog guides do not pass the training many provinces muzzling is required. requirements. They are usually offered to the foster family for adoption or placed in other good homes. After graduation from training, the dog is dog guides Dog guides are specially trained dogs matched with a blind person. The student and dog that provide protection, independent travel and live, eat and train together at the school for four companionship to blind persons. Approximately 1 weeks. Training sessions include traveling skills, percent of the nation’s blind persons use dog transportation use in both residential and urban guides. settings, and grooming, rewarding, and disciplining The training of dogs began in Germany during the dog guide. World War I. Dogs used to carry messages onto the The blind student learns to direct the dog and to battlefield were found to locate wounded soldiers understand the signals felt through the U-shaped and lead rescuers to their aid. As a result, the Ger- handle of the leather harness. Dogs are color blind mans began to train these dogs as guides for men and therefore cannot distinguish a red traffic light blinded during the war. Dorothy Harrison Eustis, from a green. The blind student must listen to traf- an American living in Switzerland, learned of this fic to determine when to cross streets as well as development and developed a training program for direct the dog guide to the desired destination. dog guides. Eustis returned to the United States Since public interference is the greatest distraction and established the first American dog guide to dog guides, users learn to discourage strangers school, The Seeing Eye Inc., in 1929. Although from speaking to or touching the dog while it is in modern dog guide schools vary in the services they harness. offer, many breed and train dogs, train dog guide Applicants for dog guides generally must be instructors, instruct blind persons on how to use legally blind, over 16 years old, able to travel inde- and care for dog guides, and provide public infor- pendently, and physically and psychologically able mation. to care for the dog. Although dog guides are often Both male and female Labradors, golden retriev- provided free of charge, some training schools ers, and German shepherds are most often pre- require a fee. Most schools will not disqualify an ferred as dog guides, although boxers, Doberman applicant due to lack of funds. pinschers and collies are also used. New puppies Dog guides generally live and work for 10 years. are examined and tested at the school to determine Dog guides that become sick or disabled are offered physical health, intelligence, responsibility, and to the blind owner to keep as a pet or are returned willingness to learn and please. Suitable puppies to the school and placed in an adoptive home. If are sent to live with a foster family. The puppies the dog dies, the blind person may generally return live with the family for approximately one year in to the school for a new dog. If the dog’s owner dies, which they learn socialization and, in some cases, it may remain with the family, be placed with a obedience skills. The 4-H Clubs and other volun- new dog guide user, or be retired at the school. teer puppy-raising organizations often work closely with schools to place new puppies in homes. After dominant eye In normal, healthy eyes, one eye a year or longer, the dogs return to the dog-guide is usually in some degree dominant over the other. school for formal training. They are taught basic Eye dominance follows the same principle as right- obedience skills and are introduced to the leather or left-handedness and often complies with hand harness that is worn when traveling. dominance. The dogs learn to lead rather than walk in the In normal vision, both eyes focus on an object. heel position, to stop at curbs and stairs, to avoid Each eye sends a slightly different view of the obstacles, both on the ground and overhead, to sighted object to the brain where the two views are ignore distractions and to disobey instructions that processed into one three-dimensional image. The put the user in danger. The training may last from normally dominant eye is the sighting eye that three to six months. Roughly half of the dogs finds and focuses on the object, whereas the non- dreams 67 dominant eye focuses just off center, the dominant small stature, heart abnormalities, and obesity. eye is usually used unconsciously to look through Down’s syndrome occurs most often in children a telescope, into a microscope, or through the sight born to women over 35. of a camera. To find the dominant eye, punch a Ocular conditions associated with Down’s syn- hole in a piece of paper and then, without think- drome include high MYOPIA (nearsightedness), ing, quickly look through the hole. The eye used to hyperplasia of the iris, STRABISMUS, narrow palpe- look through the hole is the dominant eye. bral (eyelid) fissures, epicanthus (vertical folds of Overdominance of one eye may affect or limit the eyelids), and CATARACT. Cataracts may be slight vision. If one eye or its muscles are weakened or or serious enough to warrant surgical removal. impaired by conditions such as MYASTHENIA GRAVIS, MULTIPLE SCLEROSIS, brain tumor, STROKE, or infection, the eyes may become uncoordinated and fail dreams Dreams of the blind have long been a to focus on the same object. When this occurs, subject of interest to psychologists. Research, how- DIPLOPIA, or double vision, results. ever, has been sparse, and few investigations have When one eye turns in (esotropia) or out been launched into the activities and objects in (exotropia), a condition called STRABISMUS,or dreams of the visually impaired. crossed-eyes, occurs. The aligned eye becomes the Two early studies, Heermann (1838) and Jas- dominant eye over the misaligned eye. Diplopia trow (1888), drew four major conclusions that are occurs as a result of strabismus. Strabismus may still widely held today. They discovered that no occur at any age but generally is present in young visual images exist in the dreams of the congeni- children. Strabismus may affect over 1.6 million tally blind, nor for those blinded before age five, children in the United States. but that the dreams of those who become blind As the brain receives two images from the mis- between five and seven may or may not contain aligned eyes, it relies increasingly on the dominant visual imagery and that most optical imagery tends eye for information about the object viewed. It may to fade markedly with time. begin to suppress the information from the non- McCartney (1913) discovered that dreams of the dominant eye, causing the vision to deteriorate blind contained a high ratio of fearful objects in from lack of use of the eye. This condition is known their dreams when compared with those of sighted as amblyopia. The suppressed or amblyopic eye subjects. Blank (1958) found that dreams of the may become less functional or lose vision due to blind contained more thought and language than lack of light stimulation. Amblyopia usually occurs those of sighted subjects, and Von Schumann in young children and affects over 2.5 percent of all (1959) related that intellectual activity, dynamic children in the United States. body movement, and falling were characteristic An overdominant eye can often be corrected traits of dreams of the visually impaired. with surgery to repair or reinforce weakened eye Hall (1966, 1972) proposed that dreams, includ- muscles, or with nonsurgical techniques such as ing those of the blind, must be continuous with glasses, exercise therapy, or patching of the domi- waking behavior in that they must reflect actions nant eye. Early diagnosis generally results in the or conscious thoughts or attitudes. The studies dis- most favorable results. counted the compensation theory that contends that dreams can embody complete reversals of waking tendencies. double vision See DIPLOPIA. Findings from separate investigations by Kirtley and Cannistraci (1973) and Kirtley and Hall (1975) Down’s syndrome Down’s (or Down) syndrome, agreed that the dreams of blind or visually im- or mongolism, is a genetic condition produced by a paired persons differed significantly from those of chromosomal abnormality involving an additional sighted persons in regard to the activities and 21st chromosome. Down’s syndrome is marked by objects found in the dreams. The investigators con- mental retardation, mongoloid facial characteristics, cluded that these differences are caused by the 68 dreams physical limitations and “special reality problems” as running, walking, and climbing but the ac- of the blind that exist in their waking life. tivities tended to take place in a limited area or Kirtley and Cannistraci created five categories— space. mobility, aggressive behavior, friendly interactions, Kirtley and Sabo (1983) compared the aggres- self-perception, and perception of the physical sion content of dreams of visually impaired females environment—to describe the differences between and normally sighted females and found that the the dreams of sighted and visually impaired per- visually impaired women exhibited more verbal sons. In their dreams, the visually impaired were and covert aggression. These findings agreed with more restricted in physical movement, and settings the Kirtley and Cannistraci (1973) report that tended to be indoors rather than outdoors. found less physical aggression in the dreams of The dreams of the blind were lower in incidence visually impaired persons (both male and female) of physical aggression, yet when incidents did but a higher incidence of verbal and covert aggres- occur, they were unusually extreme. There were sion. Rainville (1994) concluded that dreams are few incidents of self-aggression. Verbal aggression extremely important in the rehabilitation of people incidents were much more frequent than those of who are newly blind. They are vital to a person’s sighted subjects. The study showed that the dreams adjustment to blindness, he says. of the blind contained more incidents of friendly Helen Keller described her dreams in her book speech and thoughts but fewer of friendly acts The World I Live In and in the article “My Dreams.” involving long-term relationships, physical contact, Although edited for print, they reflect the images of and gift giving. the visually impaired. The study cited more references to body parts Keller related that her dreams were filled with and extremities, including the head, and fewer to sensations, odors, tastes, and ideas. She described clothing. Concerning the environment, the study seeing but not with her eyes and hearing but not concluded that blind subjects cited fewer incidents with her ears. She explained that she did not often of building materials and descriptions of size, talk with her fingers or read with her fingers in including thinness, narrowness, lowness, crooked- dreams and that she possessed greater freedom of ness, crowding, and vacancy. mobility. Kirtley and Sabo (1979) compared the dreams She recounted seeing a brilliant light of “flash of visually impaired students, including partially and glory.” Keller mentioned colors such as the blind, congenitally blind, and adventitiously blind “velvety green of moss,” “the soft whiteness of individuals, with those of normally sighted stu- lilies,” and the “distilled hues and sweetness of a dents. The findings revealed that the dreams of the thousand roses.” visually impaired group as a whole contained less Keller, Helen. “My Dreams,” Century Magazine, vol. 77, symbolism than those of the sighted subjects. They no. 1 (1908): pp. 134–165. concluded that the concreteness of the dreams was Keller, Helen. The World I Live In. New York: Century a result of the fact that blindness is an internalized Company, 1908. stress condition that creates more waking-hour Kirtley, Donald, and Katherine Cannistraci. “Dreams of reality problems. the Visually Handicapped: Toward a Normative Sabo and Kirtley (1982) discovered that blind Approach.” AFB Research Bulletin #27 (April 1974): subjects tended to dream more often about food 111–133. and drink; parts of the torso; land areas limited Kirtley, Donald. The Psychology of Blindness. Chicago: Nel- by boundaries such as cities, parking lots, yards, son-Hall, 1975. Kirtley, Donald, and Kenneth Sabo. “Aggression in the and swimming pools; and construction materials Dreams of Blind Women.” Journal of Visual Impair- such as bricks, lumber, and boards. They con- ment and Blindness, vol. 77, no. 6 (June 1984): cluded that this is a result of how the blind learn 269–270. their environment and the limitations surround- Kirtley, Donald, and Kenneth Sabo. “Symbolism in the ing their handicap. The study revealed a signi- Dreams of the Blind.” International Journal of Rehabili- ficant number of active physical activities such tation Research vol. 2, no. 2 (1979): 225–232. drugs 69

Rainville, Raymond E. “The Role of Dreams in the Reha- tozoal. Antibiotics are used to treat corneal ulcers bilitation of the Adventitiously Blind.” Dreaming and intraocular infections. Antibiotics may be topi- (1994): pp. 155–164. cal or systemic and include the generic ampicillin, Sabo, Kenneth, and Donald Kirtley. “Objects and Activi- bacitracin, carbenicillin, cefazolin, cephalothin, ties in the Dreams of the Blind.” International Journal chloramphenicol, clindamycin, colistin sulfate, ery- of Rehabilitation Research, vol. 5, no. 2, (1982): thromycin, gentamycin sulfate, lincomycin, methi- 241–242. cillin, neomycin, penicillin, polymyxin B sulfate, silver nitrate, streptomycin, sulfacetamide sodium, drugs Topical and systemic drugs are used in sulfisoxazole diolamine, tetracycline, tobramycin, ophthalmology to treat eye diseases and disorders, and vancomycin. They are known by numerous to prepare eyes of examination or surgery, to treat trade names, including Baciquent, Ak-Lor, Anti- or prevent inflammation, and to diagnose disease biopto, Coly-Mycin S. Ilotycin, Garamycin, Genop- or disorders. tic, Aerosporin, Ak-Sulf, Gantrisin, Achromycin, Mydriatics are drugs that dilate the pupils. They and Tobrex. are generally either sympathomimetics or Antifungal drugs are used to treat infections parasympatholytics. Sympathomimetics imitate or such as fungal KERATITIS and fungal ENDOPHTHALMI- initiate the release of adrenaline and direct the TIS. Generic antifungal agents include amphotericin action to the dilator muscle of the iris. Parasympa- B, nystatin, flucytosine, natamycin, miconazole, tholytics dilate the PUPIL and retain it in position so and ketoconazole. that the pupil cannot accommodate its size to Antiviral drugs are used to treat infections such changes in light. as HERPES SIMPLEX. Generic antiviral drugs include Generic sympathomimetics include phenyle- idoxuridine, trifluridine, vidarabine (ARA), and phrine HCl, hydroxyamphetamine HBr, and co- acyclovir; trade names for these drugs include Den- caine; trade names include Ak-Dilate, Efricel, drid, Herplex Liquifilm, Stoxil, Viroptic, Vira-A, Mydfrin, Neo-Synephrine HCl, Penoptic, and Pare- and Zovirax. Two antiviral drugs, ganciclovir and drine. Generic parasympatholytics include atropine foscarnet, are used to treat cytomegalovirus retini- sulfate, cyclopentolate HCl, homatropine HBr, tis, an infection of the retina associated with AIDS. scopolamine, and tropicamide; trade names include Antiprotozoal drugs are used to treat some types Ak-Pentolate, Cyclogyl, Homatrocel, Isopto Homa- of UVEITIS. These drugs include Pyrimetha- tropine, Isopto Hyoscine, Mydramide, Mydriacyl, mine, Sulfadiazine, Clindamycin, and corticoste- and Topicacyl. roid preparations. Miotics are parasympathomimetics that are used Anti-inflammatory drugs are used to treat to treat GLAUCOMA and ESOTROPIA. Cholinergic inflammatory disorders such as BLEPHARITIS, CON- (direct-acting) miotics include the generic carba- JUNCTIVITIS, KERATITIS, SCLERITIS, uveitis, and optic chol, pilocarpine hydrochloride, and pilocarpine neuritis. Corticosteroids are often prescribed under nitrate, and the trade names Carbacel, Isopto Car- the generic names hydrocortisone, prednisolone, bachol, Adsobocarpine, Akarpine, Almocarpine, dexamethasone, and progesteronelike compounds. Isopto Carpine, Pilocar, Pilocel, Pilomiotin, Pilopine Trade names for these drugs include Hydrocortone gel hs 4 percent, Ocusert Pilo, Piloptic, and P.V. acetate, Optef drops, Pred Mild/Pred Forte, Infla- Carpine. Anticholinesterasic (indirect acting) mase, Ak-Dex, Decadron, Maxidex, HMS, and miotics include the generic physostigmine sulfate, FML. physostigmine salicylate, demecarium bromide, Anesthetic drugs may be topical or regional. echothiophate iodide and isoflurophate (DFP), and They allow the physician to perform procedures on the trade names Eserine Sulfate, Isopto Eserine, the eye. Topical anesthesia includes the generic Humorsol, Echodide, Phospholine Iodide and cocaine hydrochloride, proparacaine hydrochloride Floropryl. and tetracaine hydrochloride, and the trade names Ocular infections are treated according whether Ak-taine, Alcaine, Ophthaine, Ophthetic, Anacel, the infecting agent is bacterial, fungal, viral, or pro- and Pontocaine. Regional anesthetics include Tetra- 70 dry eye caine, Procaine, Hexylcaine, Bupivacaine, Lido- treatment of the wet form of age-related macular caine, Mepivacaine, Prilocaine, and Etidocaine. degeneration. Representatives of the American Drugs used to treat glaucoma include sympath- Academy of Ophthalmology said they are hope- omimetics and parasympathomimetics, which ful that Visudyne will be the start of a new era in increase the flow of AQUEOUS FLUID from the eye; treating a leading cause of blindness among older adrenergic antagonists and carbonic anhydrase people. inhibitors, which decrease the aqueous fluid sup- American Academy of Ophthalmology Medical Library. ply; and hyperosmotic agents, which decrease American Academy of Ophthalmology Says Newly Approved intraocular pressure. Drug, Visudyne, Is Promising. 2000. Adrenergic agents include the generic epineph- Henkind, Paul, Martin Mayers and Arthur Berger, eds. rine bitartrate, epinephrine hydrochloride, epi- Physicians’ Desk Reference for Ophthalmology 1987. nephrine borate, dipivefrin hydrochloride, timolol Oradell, N.J.: Medical Economics Company Inc., maleate, levobunolol, and betaxolol. Trade names 1987. include E, Epitrate, Mytrate, Murocoll, Epifrin, Glaucon, Epinal, Eppy/N, Propine, Timoptic, Beta- gan, and Betoptic. dry eye Dry eye is a condition in which the eye Carbonic anhydrase inhibitors include the lacks the necessary amount or quality of tears. generic acetazolamide, acetazolamide sodium, Tears protect, nourish, and moisturize the eye. dichlorphenamide, and methazolamide, and trade Without proper tear function, the CORNEA and CON- names Ak-Zol, Cetazol, Diamox, Daranide, Oratrol, JUNCTIVA may become dry and develop disorders. and Neptazane. Hyperosmotic agents include the In the normal eye, the tear film is made up of generic glycerin, isosorbide, mannitol, and urea three layers that are produced by the lacrimal gland and the trade names Glyrol, Osmoglyn, Ismotic, and accessory lacrimal glands and cells. The Osmitrol, and Ureaphil. lacrimal glands are located in the orbit and inner Artificial tears are used to treat dry eye condi- eyelid. The accessory glands and cells are located in tions. These drugs are known by the generic the conjunctiva. hydroxyethylcellulose, hydroxyproplycellulose, The top layer of tears is formed by the secretion hydroxypropl methylcellulose, methylcellulose, of the meibomian glands and is oily in nature. The polyvinyl alcohol, and other polymeric solutions. second layer is composed of watery tears from the Numerous trade names include Clerz, Lacrisert, lacrimal glands, and the third layer, which lies next Isopto Alkaline, Muro Tears, Methopto, Methulose, to the cornea, is of mucuslike consistency and is Aqua Tears, Liquifilm Tears, aqua-FLOW, Refresh, produced by accessory glands. The layers are main- Adapettes, Comfort Drops, and Hypotears. tained by constant blinking and are all necessary Drugs are used in procedures to examine or test for proper health of the eye. the eyes and diagnose disorders. Small strips of Dry eye may occur as a result of poor tear pro- paper impregnated with fluorescein dye are used to duction (called keratoconjunctivitis sicca), poor test the CONJUNCTIVA and corneal epithelium. tear quality, or inadequate blinking, which leaves Sodium fluorescein is injected intravenously to the eye open to the drying elements or does not study the circulation of blood in the RETINA and properly wet the entire surface of the eye. Condi- CHOROID. tions that can cause dry eye include sarcoidosis, Rose bengal is a solution used to test the con- rheumatoid arthritis, vitamin A deficiency, pem- junctiva and corneal epithelium for unhealthy phigoid, trachoma, Stevens-Johnson syndrome, cells. chemical burns, neuroparalytic and exposure ker- Doctors and scientists are working hard to find atitis, and aging. new drugs to treat vision disorders, and new uses Dry eye may lead to corneal damage, permanent for existing drugs. One of these promising drugs corneal scarring, and opacification. Once the is Visudyne, approved by the U.S. Food and cornea has opacified, vision is lost. Symptoms of Drug Administration in April 2000 and used in the dry eye include redness, discomfort or irritation, Duxbury Systems, Inc. 71 decreased corneal luster, and loss of visual acuity. medications that stimulate tear production are Dry eyes can become extremely sensitive to wind, being investigated. low humidity, heating, air conditioning, and so forth. Excess tearing may occur if the tears pro- Duxbury Systems, Inc. A company formed in duced are inadequate in quality. 1975 to develop braille software for minicomput- Dry eye is diagnosed through a thorough eye ers. Two of Duxbury Systems’s founders, Robert examination, including a slit-lamp examination, a Gildea and Joseph Sullivan, were members of a Schirmer’s test, and a tear film break-up test. The team that in 1970 developed DOTSYS III, the first slit lamp is used to examine the tear film for the braille translator written in a portable program- presence of extraneous microscopic filaments, ming language. DOTSYS III was developed for the epithelial cells, and corneal erosion that are ap- Atlanta Public School system. parent and will stain when exposed to rose In 1975, Gildea, Sullivan, and their partner bengal. Anne Simpson developed the Duxbury Braille The Schirmer’s test involves inserting one end of Translator, which was capable of translating braille of a narrow strip of paper into the lower lid. The in six languages. strip is left in place for five minutes during which Since 1975, Duxbury Systems has become a time it absorbs tears. At the end of the time, the world leader in software for braille with Windows, strip is removed and measured for the amount of Macintosh, DOS, and Unix programs. The Duxbury tears present. Dry eye may be indicated if the mea- Braille Translator and MegaDots, a program devel- surement is less than 10 millimeters. oped by a company called Braille Planet, originally During the tear-film break-up test, the tear film Raised Dot Computing, continue to be the com- is watched to determine the time needed to break pany’s flagship products. the film once the blinking has stopped. The tears Duxbury acquired the Madison, Wisconsin– are stained with fluorescein dye and the eye is held based Braille Planet in August 1999. Raised Dot open. In cases of dry eye, the tear film may break Computing, founded in 1981, produced software in less than 10 seconds. that enabled transcribers to produce braille books Treatment of dry eye includes treating the and create graphics using an Apple computer. It underlying cause or disease and the administration also provided on-line electronic Braille libraries of artificial tears. In some cases, antibiotics may be and educational services, and produced and distrib- prescribed and the use of home vaporizers or uted materials relating to blindness issues. humidifiers advised. Contact: Surgery may be performed to close the tear drainage ducts to ensure better utilization of Duxbury Systems, Inc. reduced tear production. If the cornea is severely 270 Littleton Road, Unit 6 scarred and vision is lost, a CORNEAL TRANSPLANT or Westford, MA 01886-3523 keratoplasty may be indicated. However, those 978-692-3000 (ph) with dry-eye conditions are generally poor candi- 978-692-7912 (fax) dates for a successful corneal transplantation. Some www.duxburysystems.com

E early intervention A term used to describe pro- over- or undercorrection of the problem. Compli- grams and services offered to families of visually cations may include bleeding, infection, or recur- impaired children and preschools for visually rence. impaired children. They provide information on home management and educational child-develop- education Formal education of the visually ment skills and opportunities for children to impaired prior to the middle 1700s was a private develop skills and participate in socialization. The matter, lacking in systematic programs or educa- programs work closely with parents to maximize tional formats. Many who lacked educated advo- the potential for growth and development among cates or resources were not educated at all. these children. Services vary and may include The first school for blind children, the Institu- home visitations, small group instruction, and tion des Jeunes Aveugles (Institute for Blind community facilities programs. Youth), was established in 1784 in Paris by The Individuals with Disabilities Education Act Valentin Hauy. The residential school presented a was signed into law in 1997. Formerly known as curriculum orally and through embossed print or the Education of the Handicapped Act, the law enlarged raised letters, read tactually. mandates that services, such as early intervention In 1824, Louis Braille, one of the school’s stu- programs, vision services, assistive technology and dents, developed the BRAILLE method of communi- services, and transportation be provided for three- cation. Braille is a tactually read language involving to five-year-old children with disabilities, including a series of configurations of raised dots based on a visual impairment. six-dot cell. The braille method made writing pos- The intent of the act is to provide appropriate sible and reading more accessible to those with public education to all eligible children. Schools vision impairments and revolutionized the ability must comply with the regulations of the act in of blind students to obtain an education. order to receive certain funding. In the early 1800s, the first three schools for the blind were founded in the United States. In 1829, the New England Asylum for the Blind, later echolocation See SENSES. renamed the Perkins School for the Blind, was incorporated and opened in 1832 under the direc- ectropion A disorder of the eyelids in which the tion of Samuel Gridley Howe. In 1831, the New lower lid turns outward. Ectropion is generally York Institution for the Blind, later renamed the caused by aging but may result from scarring of the New York Institute for the Blind, opened under the eyelids or nerve palsy. The exposure of the inner lid direction of Dr. John Dennison Russ. The Pennsyl- may cause tearing, irritation, and conjunctivitis. vania Institution for the Instruction of the Blind, Ectropion can be corrected with minor outpa- now named the Overbrook School for the Blind, tient surgery using a local anesthetic. During the was started by Quakers in 1833 under the director- procedure, a portion of the sagging lid or scar tissue ship of Julius R. Friedlander. may be removed. Skin grafting may be required. The schools were residential, privately financed, Corrective surgery for ectropion may result in an and based on the programs offered by the Institute

73 74 education for Blind Youth in Paris. The first students were The American Foundation for the Blind, the children of families who could afford to pay the National Society for the Prevention of Blindness tuition and boarding fees. and other organizations sponsored conferences, The first tuition-free, state-supported school was service programs, scholarships for teacher training, established in 1837 in Ohio. In the next 45 years, and original educational objectives to meet future over 30 additional public and private residential needs. As a result, day schools grew and expanded schools were established and constituted the sole to serve over 80 percent of visually impaired stu- source of education for visually impaired students. dents. Residential schools reevaluated their pur- Most of the current residential schools were poses and extended their programs to include established before 1900, and there is now at least multi-handicapped children. one in nearly all of the 50 states. Those states with- Education of visually impaired children includes out schools for the blind or visually impaired pay all the goals of general education for nondisabled the tuition for students to attend residential schools children and encompasses teaching competencies in other states. skills to live, work, and play satisfactorily and suc- In 1871 at a convention of the American Asso- cessfully in society. ciation of Instructors of the Blind (AAIB), Howe, of Special education is a supplement to general the Perkins School, described and advocated a cot- education that meets the needs and provides the tage-family-based system of education adopted in skills necessary to achieve general educational 1911 by John Bledsoe at the Maryland School for goals for disabled students. It supplies adaptations the Blind. or modifications to the general education curricu- In Chicago in 1900, in reaction to demands from lum, materials, learning methods, task skills, envi- parents of visually impaired students for education ronmental factors, and teaching techniques. with nondisabled children, Frank H. Hall, superin- Education of a visually impaired student is tendent of the Illinois School for the Blind, directed implemented by four major organizational bodies: one of his teachers to conduct an integrated pro- the federal government, the state department of gram. The teacher, John Curtis, instituted a plan in education, the local education agency, and organi- which the city was divided geographically into zations that serve the visually impaired. grids. One school in each grid taught visually The federal government, through the executive impaired students who attended regular classes and and judicial branches, enacts laws that shape and received services from special teachers in typing control education for all students in the United and braille skills. The grid program was widely States. One such law, the Education of the Handi- adopted throughout the United States in following capped Act (EHA), also known as the Education of years. All Handicapped Children Act, ensures all disabled The education system was altered in the years students, including those with visual impairments, between 1949 and 1966 by two epidemics, RETINO- the right to a free and appropriate elementary and PATHY OF PREMATURITY and RUBELLA. Retinopathy of secondary education in the least restrictive setting prematurity (ROP), or retrolental fibroplasia (RLF), from ages six through 21. The law further ensures increased the population of visually impaired chil- the right of parent participation in the educational dren by nearly 40 percent. The vision-destroying and decision-making process, protects the rights of disorder was caused by overexposure to oxygen in disabled students and their parents, and ensures the incubation cradles. Low-weight, premature infants student of an individualized educational program. were primarily affected. Rubella epidemics in the The State Department of Education fulfills the mid-1960s caused disabilities to an additional requirements mandated by the laws and imple- 30,000 children, up to 20 percent of which ments the EHA. A state consultant from the depart- included visual impairments. Both epidemics cre- ment acts as an advocate and facilitator for quality ated a generation of students with special needs education for visually handicapped students. The who outnumbered the facilities established to pro- consultant serves as a liaison to the public, the vide them. medical community, the U.S. Office of Education, education 75 teacher preparation schools, national organiza- statement of annual goals, a list of special educa- tions, and consumer groups. tional services to be supplied, the dates the services The Local Education Agency (LEA), such as the will begin and end, and the evaluation which will school district or residential school, acts to provide be used to determine whether the goals were met. the basic curriculum and special education accord- The needs and goals stipulated in the IEP will ing to the needs of the student. The teacher serves determine the setting where the education will be as the primary advocate for the visually impaired delivered. The student may have a choice of either student within the school. The district or school a residential setting or a public school. program administrator is responsible to obtain ser- Those who attend public school are sometimes vices of a qualified teacher, to secure necessary referred to as “mainstreamed” students. Main- resources to provide the needed services and to streaming is a term used to describe the practice of evaluate program effectiveness. The residential educating disabled students, including those with school in a state or district acts as an additional visual impairments, in a standard, public classroom resource to all districts in the state. for nondisabled children. Today, although residen- Organizations that serve the visually impaired tial schools still provide vital education and training supply support services, resources, equipment, or services, the American Foundation for the Blind materials to visually impaired students. They may estimates that nearly 90 percent of disabled stu- supplement or enhance the program offered by the dents receive all or part of their education in local federal government. General or special education public schools. begins before the child formally enters school at Students may be mainstreamed into a public age five or six. It begins at birth or as soon as pos- school program through several models of delivery sible after the visual handicap has been diagnosed. including the itinerant-teacher model, the teacher- Early intervention programs, services to families consultant model and the resource-room model. and preschools for blind and partially sighted chil- These are three of five basic models or educational dren provide information on home management plans for the education of visually impaired stu- and educational child-development skills and dents that also include the self-contained classroom opportunities for skills development and socializa- model and the residential school model. tion. The programs maximize the potential for An itinerant teacher is one who travels to public growth and development among these children. schools to provide special education modifications Once a child has reached six years of age and is to the instructional program of visually impaired ready to enroll in kindergarten, he must be assured children. The visually impaired student lives at of a free and appropriate educational program. In home and spends most of the instructional day in a order to ensure appropriateness, the school may regular classroom. request a formal student assessment to determine The itinerant teacher visits every two or three whether the student is eligible for special education days to work with the student in a section of the services. classroom, the library, the hall, the office, or any The assessment is conducted by a professional available space. The itinerant teacher provides spe- staff of educational, psychological, and medical cial equipment, training, and materials adapted to experts. It must be complete, nondiscriminatory, the student’s learning needs and consultation ser- and given with consent of the parent. Assessment vices to the regular classroom teacher. may follow a regular periodic schedule of once a A 1976 study by Moore and Peabody found that month to once a year and not less than once every itinerant teachers spend just over half their time, three years. 59 percent, working directly with students, while Once the need for special education has been spending the remaining 41 percent of their time assessed and determined, an individualized educa- driving, in consultation relating to the student, and tional plan (IEP) is developed. This written plan is in administrative duties. a blueprint for the child’s education. It lists the stu- The success of the itinerant-teacher program is dent’s present level of educational performance, a dependent on the regular classroom teacher’s 76 education attitude and willingness to adapt regular teaching impairments or other disabilities. The teacher of practices to the mainstreamed visually impaired the class provides general curriculum instruction child. The model is most effective for students who and special education. The program is designed to are self-directed and independent in learning skills fit the unique needs of each individual. and least effective for students who lack academic Although one-fifth of all programs for visually learning skills and lag in social development in impaired students centered on self-contained class- comparison with their peers. rooms in the early 1960s, the model has since lost The teacher-consultant is a special educator who popularity except in large metropolitan areas serv- advises regular classroom teachers, teacher aides, ing multihandicapped blind students. administrators, and other school personnel in In order to achieve maximum enrollment, self- methods that will meet the visually impaired stu- contained classrooms are centered in one or a few dent’s needs. The greatest proportion of the work is schools within a district. This often necessitates consultative, rather than instructive. busing the visually impaired student to a school The teacher-consultant travels from school to outside his neighborhood. school, and often from county to county, to work Residential schools are those in which visually with personnel. Since traveling time is significant, impaired students live and receive educational little time remains for direct instruction with the instruction. It is the oldest form of education for student. the visually impaired and is offered in nearly every The teacher-consultant model works best for state. Many residential schools for the visually students who work independently and require impaired share a campus or facilities with schools minimal skills training. The program is least effec- for the deaf and are referred to as “dual” schools. tive for students who require intensive skills train- Residential schools may be either state operated or ing or lack coping behaviors for study in a regular private. State operated residential schools are classroom. funded by state legislatures, are tuition free, and do The resource room is a specially equipped room not charge for room, board, or transportation. Pri- staffed with special education personnel trained to vate residential schools charge fees that may be work with blind or visually impaired students. The paid by the public school district of the student. students live at home and attend public school in The campus, schoolrooms, and educational pro- regular classrooms and are taught by teachers who gram of residential schools are designed and provide general curriculum instruction. Students equipped to meet the needs of visually impaired visit the resource room at regularly scheduled students. The educational materials and curriculum intervals or when needed. The resource-room can be designed, or the students may be grouped, teacher provides specialized skills instruction and to meet each individual’s instructional require- counseling relating to vision loss and academic ments. Trained staff, including houseparents, are remediation. Special instruction may take place on duty 24 hours a day to provide general cur- individually or in small groups. riculum instruction, academic remediation, com- The resource-room model has an advantage pensatory learning-skills instruction, personal over the teacher-consultant and itinerant-teacher management and independence-skills training, and models in that it provides instruction or assistance information counseling concerning blindness. immediately and according to the needs of the stu- The residential-school model is superior to dent. However, because of its availability, it may many other models in its attempts to meet all lev- foster dependence and restrict growth toward inde- els of student educational needs on an immediate pendent working within a self-contained class- basis. However, because students may return home room. only on a weekly or monthly basis, some students The self-contained classroom is a classroom in a may suffer from a lack of familial contact or inter- public school that is specially equipped and staffed action with sighted peers. with special-education teachers for the visually The basic curriculum for the visually impaired impaired. All the students in the class have visual student is identical to that of the nondisabled stu- electroretinography 77 dent. However, special education may include ERIC Clearinghouse on Handicapped and Gifted Chil- instruction or counseling in the areas of social- dren. Research and Resources on Special Education: emotional development, living skills, orientation Abstract 14. Reston, VA: ERIC, 1987. and mobility, communication, and vocational ERIC Clearinghouse on Handicapped and Gifted Chil- counseling: dren. Research and Resources on Special Education: Abstract 19. Reston, VA: ERIC, 1988. • Social-emotional development skills work to Mitchell, Joyce Slayton. See Me More Clearly. New York: Harcourt, Brace, Jovanovich, 1980. improve self-adjustment to vision impairment Scholl, Geraldine, ed. Foundations of Education for Blind and improve social skills. These may include and Visually Handicapped Children and Youth. New York: family counseling, sex education, and prepara- American Foundation for the Blind Inc., 1986. tion for marriage and family life. Scott, Eileen P. Your Visually Impaired Student. Baltimore: • Daily living skills center on grooming, hygiene, University Park Press, 1982. eating, dressing, and home management skills. These skills may include basic safety measures Education of the Handicapped Act (EHA) See and skills for using the telephone and identifying INDIVIDUALS WITH DISABILITIES EDUCATION ACT. money. • Orientation and mobility skills are those that con- electronic travel aids (ETA) Visually impaired cern orienting the body and moving within the persons receiving orientation and mobility training environment. Students are taught the sighted may be instructed in the use of electronic travel guide technique, cane traveling methods, and aids (ETA). These aids are prescribed by an other mobility skills. Physical and recreational optometrist or ophthalmologist and include canes, skills may be taught to ensure participation in hand-held devices, chest-mounted devices, head- physical education courses and recreational mounted, spectacles or control boxes, and devices activities. designed to be mounted on wheelchairs. They • Communication skills include those needed for require specialized training to use. learning and for interpersonal interaction. Stu- Electronic travel aids send out light beams or dents learn reading, listening, writing, and ultrasonic waves that come into contact with speaking skills that may include reading and objects in the path. When the beam or waves hit an writing braille or use of low-vision aids. object, the device responds by vibrating or emitting • Interpersonal communication skills center on con- a sound. The newest ETAs use radio frequency tri- versation, interviewing, small-group communi- angulation via timing signals from the worldwide cation, and appropriate language and listening global positioning system, coupled with a digital skills. Nonverbal communication skills are intro- map database and digital compass. duced that cover facial expressions, touching and Electronic travel devices are used by approxi- body language, personal space, and distracting or mately 1 percent of all visually impaired persons unattractive behaviors such as rocking. and are usually not designed to be used with a dog guide. (See ORIENTATION AIDS.) A listing and • Vocational counseling and prevocational counseling presents types of vocations and careers possi- description of available ETAs can be found on the ble for the individual. Prerequisite skills are Internet at www.noogenesis.com/eta/current/ analyzed and introduced at appropriate stages. html.

The study of the Barraga, Natalie C. Visual Handicaps and Learning. Bel- electroretinography (ERG) mont, CA: Wadsworth Publishing Company Inc., function of the RETINA when stimulated by light. An 1976. electroretinogram is a test often performed to diag- ERIC Clearinghouse on Handicapped and Gifted Chil- nose RETINITIS PIGMENTOSA and other eye diseases. dren. Research and Resources on Special Education: Retinitis pigmentosa (RP) is a group of progres- Abstract 13. Reston, VA: ERIC, 1987. sive, hereditary diseases that cause retinal dystrophy 78 employment or degeneration. First the rods, and then the cones, peers. An additional 25 percent of the employers of the retina stop functioning. Early symptoms said there was no difference in safety between include night blindness and progressive loss of the two groups. peripheral vision. • Employer’s group health insurance rates do not The electroretinogram may be necessary to con- increase when a visually impaired person is firm the diagnosis of RP. The test measures the hired. Nor do worker compensation rates electrical activity of the retina when exposed to increase. light stimulus. Each eye is tested separately. One • The Harris poll revealed that 39 percent of eye is first patched to exclude all light. Next, drops employees felt their employees with disabilities are administered to dilate the pupil of the other were more dependable than their employees eye. Anesthetic drops are administered and a con- without disabilities. Another 42 percent said tact lens attached to electrodes is placed on the there was no difference between the two groups. cornea of the eye. The chin is placed on a chin rest, and the patient looks into the test machine. Lights • Equipment necessary for visually impaired peo- that stimulate the retina are flashed into the eye in ple to do their jobs normally is comparable in both dark and light environmental conditions. The cost to that used by workers with normal vision. electrodes on the contact lens record the responses If special equipment is needed, a state rehabilita- of the retina and produce a graph that is inter- tion agency will offset the costs. preted by the ophthalmologist. Because of inequities in the public labor mar- employment The American Foundation for the ket, some visually impaired employees may work Blind estimates that there are approximately 4 mil- in a protected or sheltered workshop or business lion working-age, adult Americans who report enterprise. A sheltered workshop is any protected some type of vision loss that cannot be corrected. employment. Many are highly industrialized, Fewer than 50 percent of visually impaired adults produce a variety of goods and pay competitive are successfully employed. And of those who are wages. Sheltered workshops sell the goods to employed, one-third feels that they are underem- governmental agencies, including the military, ployed and have a monthly pay that is 37 percent through programs outlined and enforced by the less than that of nondisabled workers. Blind and Javits-Wagner-O’Day Act. visually impaired people have the highest unem- A business in the Business Enterprise Program ployment rate of any social or economic group in (BEP) consists of a vending stand or short order, the country. This disparity of unemployment rates cafeteria-style stand. These businesses are given a between disabled and nondisabled persons may be priority for placement in federal buildings and are due to prejudice and misunderstandings concern- administered by the State Vocational Rehabilitation ing the abilities of disabled workers. Disabled work- Agency under the Randolph-Sheppard Act. ers may be perceived by management as high in With the advent of new technology that adapts absenteeism, difficult to supervise, and a safety job tasks to the needs of those with limited sight, risk; however, studies show that this is not true. and in response to recent legislation, visually This is primarily due to misconceptions and lack impaired employees are increasingly seeking work of understanding concerning the blind and visually in the competitive marketplace. As stated in federal impaired among employers. Efforts are underway law, discrimination in hiring due to disability is to make employers aware of facts such as the fol- prohibited in companies that receive federal funds. lowing: While federal agencies and agencies that receive government funds are prohibited by law from dis- • A national poll by Louis Harris & Associates criminating against disabled people in employ- showed that half the employees who hire dis- ment, private businesses are encouraged to abled workers believe those workers have fewer consider hiring disabled workers, including those accidents on the job than their non-disabled with vision disorders. employment disincentives 79

The American Foundation for the Blind recom- she should be permitted to consult with vocational mends that employers interested in hiring visually rehabilitation resources to determine methods and impaired workers take the following steps to locate devices that will allow the employee to continue in such employees and make the work environment the same job. conducive for their success: If that is determined to be impossible, the employee and company should work with the • Perform reasonable accommodations to the rehabilitation resources to locate another job work place. These may include making changes within the company that relates to previous work, in the lighting, using e-mail or voice-mail mes- requires equal skill, and is of equal status, without sages among employees instead of written notes resorting to stereotyping. Stereotyping involves and memos, and acquiring software programs placing a visually impaired employee into one type that convert the print on a computer screen to of job that has proven successful for other disabled large print, Braille, or speech. workers, regardless of the employee’s skills, train- • Do not assume that a visually impaired worker ing, and background. cannot do what other workers can. For instance, Experts agree that employment of disabled if a particular job entails travel, do not assume workers benefits all parties involved. Disabled that a visually impaired employee would not be workers who are given the opportunity for em- able to handle that position. Canes, guide dogs, ployment are able to be self-sufficient and do not and electronic travel aids make travel possible have to rely on federal assistance. Businesses ben- for blind and visually impaired employees. efit by gaining efficient workers and getting a tax credit, and society benefits by the state and federal • Make the job application process accessible to blind and visually impaired potential employees. income taxes contributed by the employee. You can do this by posting the job on your com- Blind prospective employees can get help from pany’s Internet site, as well as in a newspaper the National Federation of the Blind, which oper- classified ad. If the application must be com- ates a program called Job Opportunities for the pleted on site, have someone record or transcribe Blind (JOB) Targeted Jobs Initiative. The program the visually impaired worker’s responses to the is run in conjunction with major national employ- questions. ers to provide pathways for blind people to find jobs with good salaries and benefits. • Focus on the blind person’s ability to fulfill the Other agencies, such as the Lighthouse for available position, and reflect that focus during the Blind and the National Industries for the the interview process. Do not worry about a Blind, also provide training programs designed to visually impaired person being able to locate the help blind people find and succeed at employ- rest room or operate the microwave oven in the ment. (See REHABILITATION ACT, VOCATIONAL REHA- lunchroom. BILITATION.) There are three federal tax credits available to American Foundation for the Blind. Employment: An Intro- help employers cover the cost of special equipment duction. www.afb.org/info_document_view, 2001. necessary for a handicapped worker, or to making National Federation of the Blind. Job Opportunities for the www.nfb.org/states/ the workplace accessible to a handicapped worker. Blind: Targeted Jobs Initiative. newjob.htm, 2000. The tax credits for which you may qualify are: the Work Opportunity Tax Credit, the Small Business Tax Credit, and the Architectural/Transportation employment disincentives Disincentives to Tax Deduction. More information about these tax employment exist within the disabled community credits is available by contacting the Internal Rev- as a result of the structure of federal benefits sys- enue Service. tems. Many disabled American workers receive If an employee becomes visually impaired or federal benefits from the Social Security Disability blind while already employed by a company, he or Insurance (SSDI) program and, of them, a majority 80 Enabling Technologies Company do not rejoin the workforce for fear of penalties The company offers a variety of equipment, associated with self-sufficiency. including braille printers, embossing, devices, sign Reforms, however, are under way to encourage makers, and Braille translation software. An on- disabled workers to rejoin the workforce. In 1986, line catalogue is available, or one can be ordered by revisions to the SSDI program allowed the recipi- calling the company. ents of SSI benefits to work and continue to receive Contact: limited benefits. In 1989, the Social Security Work Enabling Technologies Company Incentive Act was instituted, which provided 1601 NE Braille Place greater opportunities for disabled people to work Jensen Beach, FL 34957 and still receive some benefits. 800-777-3687 (ph) In December 1999, the Ticket-to-Work and Self- 561-225-3299 (fax) Sufficiency Program was established with the aim www.brailler.com of providing SSI recipients more choices of employment services. The program calls for SSI beneficia- ries to receive tickets, which they can then use to Employment Assistance Referral Network obtain vocational rehabilitation services, employ- (EARN) A national toll-free telephone and elec- ment services, or other support necessary to find tronic information referral service created in 2001 and keep a job. by the U.S. Department of Labor. The service The Ticket-to-Work program is being phased in matches up employers seeking to hire workers over a three-year period. The first states in which with disabilities with qualified employees. It takes disabled workers received tickets are: Arizona, Col- into account employee qualifications, job require- orado, Delaware, Florida, Illinois, Iowa, Massachu- ments, and geographic area. setts, New York, Oklahoma, Oregon, South EARN also offers assistance to employers in areas Carolina, Vermont, and Wisconsin. such as tax credits, disability laws, personal-assis- More information about the Ticket-to-Work tance devices, interviewing potential employees, program is available from Maximus, Inc., a private and recruitment and hiring strategies. Interested firm that has been contracted by the Social Security employers can call EARN Monday through Friday Administration to serve as the program manager. between 9 A.M. and 9 P.M. Eastern Standard Time. Contact: Contact: Maximus, Inc. Employee Assistance Referral Network 866-968-7842 (toll free) 888-695-8289 (ph) 866-833-2967 (TTY) (toll free) 703-820-4820 (fax) [email protected] Johnson, Kurt L. Incentives and Disincentives in the Voca- www.earnworks.com tional Rehabilitation Process. Washington, D.C.: National Rehabilitation Information Center, 1983. National Institute of Handicapped Research. Rehab Brief: endophthalmitis A condition in which inflam- Work Disincentives. Washington, D.C.: NIHR, 1980. mation in the posterior chamber of the eye extends Roth, Wendy Carol. “Let Us Work!” Parade Magazine, 17 into the center of the globe. This is often the result September 1989, pp. 16. of severe posterior UVEITIS (inflammation of the Social Security Administration, Office of Employment CHOROID), which involves the RETINA and VITREOUS. Support Programs. The Work Site, www.ssa.gov/work/ Severe posterior uveitis may be caused by infec- index2.html, 2001. tions such as TOXOPLASMOSIS and TOXOCARIASIS or by infections following injuries or surgery. Infec- Enabling Technologies Company Enabling tions such as toxoplasmosis and toxocariasis may Technologies Company manufactures adaptive be treated with steroids, and those that result from equipment for the blind and visually impaired. injuries or surgery may be treated with antibiotics. It was founded in 1969 by three recent college Surgery may be necessary to completely remove graduates. the infection. enophthalmos 81

Once the infection and inflammation spread to weatherizing the homes of low income, elderly, the anterior section of the eye, the condition is and disabled individuals, including those with termed PANOPHTHALMITIS. This condition usually blindness. results in the permanent loss of vision, and possibly The act provided up to $400 per home and stip- to removal of the eye. ulated the use of public-service employees and volunteers and trainees under Comprehensive endothelial cell count An endothelial cell count Employment and Training Act to install the insula- is a measurement of the number of endothelial tion materials. The amount was later increased to cells remaining in the CORNEA. An endothelial cell cover material and labor costs, program support count is often performed prior to CATARACT surgery and administration costs. In the fiscal year 2001, to determine the health of the cornea. $15.3 million in federal funds were allocated for Endothelial cells line the inside of the cornea this program. and protect it from the AQUEOUS FLUID of the eye. U.S. Department of Education. Summary of Existing Legis- Loss of endothelial cells through aging or cataract lation Affecting Persons with Disabilities. Washington, surgery could cause a clouded cornea. The cornea D.C.: USDE, 1988. requires enough endothelial cells prior to surgery US Department of Energy, Weatherization Assistance to allow for cell loss during the procedure. Program News Release www.eren.doe.gov/build- A presurgical cornea requires approximately ings/weatherization, 2001. 1,000 endothelial cells to function properly after surgery. The cells are counted by an endothelial cell enophthalmos An inward displacement of the camera, which is similar to a slit lamp or biomicro- eye within the orbit. The condition appears as scope. The test is painless and accurate. sunken or deep-seated eyeballs. The opposite con- A low endothelial cell count may require surgi- dition is exophthalmos or proptosis (bulging eyes). cal techniques to minimize cell loss. In addition, it Enophthalmos may be unilateral or bilateral. It may prohibit the possibility of an intraocular LENS may be caused by injuries, tumors, or aging. In- implantation, a procedure that causes some cell juries may cause orbital fractures that result in loss. enophthalmos. Aging may cause enophthalmos as fatty tissue within the orbit is absorbed and fails to endothelium The protective inner lining of the support the eyeball at the former level. In cases CORNEA. It is made up of a single layer of endothe- that involve continuous DIPLOPIA (double vision) lial cells. The cells prevent the AQUEOUS FLUID of the and cosmetic deformity, surgery may be required. anterior chamber from penetrating the cornea. A Tumors that cause enophthalmos are usually reduction of endothelial cells could allow seepage metastatic, or malignant tumors that originate in into the cornea resulting in swelling, loss of trans- other places in the body but spread to the orbit parency and loss of vision. Endothelial cells are lost through the blood stream. Metastatic scirrhous car- through the natural process of aging and through cinomas are a common cause of enophthalmos. CATARACT surgery procedures. The cells are gener- These fibrous tumors often originate from breast ally not regenerated by the eye. carcinoma in women and bronchogenic carcinoma The cornea requires a minimum of approxi- in men. Such tumors may be treated with radiation mately 1,000 endothelial cells to maintain ade- or chemotherapy. quate vision. The cells can be accurately counted by Degrees of enophthalmos may be measured an endothelial cell camera during an ENDOTHELIAL with an exophthalmometer. As the instrument is CELL COUNT. (See FUCH’S ENDOTHELIAL DYSTROPHY.) held up to the eyes, mirrors on the device super- impose a millimeter scale over a side view of the Energy Conservation and Production Act The eye. This enables the examiner to measure the dis- Energy Conservation and Production Act of 1976 tance from the lateral orbital rims to the corneal established a program to assist in insulating and apices. 82 entropion

Measurement differences between the eyes are muscles that hold it in place. The vessels are cau- often given most importance since general mea- terized to stop internal bleeding. The membrane surements of exophthalmos vary greatly due to and muscles are tied together and the conjunctiva individual anatomy. A variance of 2 millimeters is stitched closed. between the eyes is considered serious and worthy After a period of two or more days, the con- of further investigation. junctiva-lined socket of the eye is fitted with a plastic shell in preparation for an artificial eye or entropion A disorder of the eyelid in which the prosthesis. The prosthetic eye is fitted three to four lid turns inward. The lashes of the lid scrape against weeks later. A prosthetic eye is generally undetectable from a natural eye. the CORNEA and irritate it. The condition is generally associated with aging but may occur as the result of an injury, burn, conjunctival scarring, or esophoria A condition of STRABISMUS, or mis- TRACHOMA. aligned eyes. Often termed squint or crossed-eyes, Entropion usually affects only the lower lid and strabismus may cause visual problems or loss of is most common in those over 50. The disorder vision. Esophoria is a type of convergent strabismus may be seen in newborns, but this condition often in which the eyes tend to turn toward each other. rectifies itself without treatment during the first Esotropia is a condition in which one eye turns few months of infancy. Entropion can be tempo- inward. rary or chronic. In temporary cases, it usually As in all strabismus, the eyes view two differing begins in response to something else, such as itchy subjects. The brain received the two images and eyes due to an allergy. The sufferer blinks hard to double vision results. Often, in an effort to recon- get rid of whatever is causing the irritation, causing cile the two pictures, the brain may suppress the it to become worse. message received from one eye, reducing the vision The condition sometimes respond to a treatment of that eye. This results in a condition called ambly- as simple as a piece of adhesive tape placed on the opia. skin of the lower eyelid to prevent it from turning Strabismus is associated with high amounts of in. Eyelid surgery is performed to correct entro- myopia (nearsightedness), hyperopia (farsighted- pion. The surgery may be performed on an outpa- ness), and ASTIGMATISM. It can develop after a tient basis with a local anesthetic. The procedure major illness or injury, and some forms of strabis- may involve the removal of sections of the lid or mus may also be hereditary. excision of scar tissue with accompanying skin Treatment may include the prescription of eye- grafts. A TARSORRHAPHY, the placement of stitches to drops, eyeglasses or bifocals, or exercises. Exercises keep the lid in a permanent position, may be per- or eye patching may be prescribed if amblyopia is formed to hold the lid in an outward position. present. Surgery may be necessary to completely align the eyes. enucleation Enucleation is the surgical removal of the eyeball. Enucleation is performed when the esotropia See ESOPHORIA. eye contains a malignant tumor such as a melanoma, when the eye is blind and causes pain, and when the eye is nearly blind and sympathetic etiquette Courtesy when dealing with visually ophthalmia (an inflammation that occurs in both impaired persons differs little from that involving eyes as a result of injury to one eye) is a risk. fully sighted persons. Common sense and sensitiv- Enucleation is performed under general anes- ity should be the most important factors in decid- thetic. An incision is made in the limbus, the place ing what to do. where the SCLERA meets the CORNEA, and the CON- Many visually impaired persons, even those JUNCTIVA is opened. The eye is severed and who are legally blind, retain some usable vision. removed from the optic nerve and the six extrinsic Because of this, a visually impaired person may Eustis, Dorothy 83 appear to be sighted, especially in familiar sur- Do not assume that all blind and visually impaired roundings. Do not assume that the visually people use braille. Many do, but others do not. impaired person is totally without sight, and do not If a visually impaired person appears in need of assume that because he moves with accuracy and help, speak directly to him and ask if he wants grace that he has abundant vision. assistance. When giving directions, be concise. Tell When approaching a visually impaired person the number of blocks and turns, right or left, or on entering a room, identify yourself to him. If according to the direction he is facing. Do not inter- others are present, use his name when talking to rupt when someone else is giving him directions. him. Unless the visually impaired person has a Do not stop to pet or talk to a working dog hearing impairment as well, talk in a normal tone guide. The dog needs to concentrate on the job and and volume level. Do not avoid using visual words should not be distracted. or phrases such as “Do you see what I mean?” or When you take leave of a visually impaired per- “Look at it this way.” Avoid conversations that son or leave a room, tell him you are leaving. If dwell only on blindness. Keep the conversation as indoors, ask if you should turn out the lights. If varied as the individual. outdoors, let him know whether he is at the curb When walking with a visually impaired person, or near the stairs. do not pull, push, or take his arm. Let him take In all situations, keep in mind that the visually your arm or elbow, then walk naturally. He will fol- impaired person is a unique individual who just low the motion of your body. Alert him to obstacles happens to have a loss of sight. in the path or overhead. American Foundation for the Blind. What Do You Do When When living or working with a visually impaired You See a Blind Person? New York: AFB, 1970. person, replace furniture and objects to the original Braille Institute. How to Help a Blind Person. Los Angeles: resting place. Return doors to their original posi- BI, 1980. tion, either fully shut or open. Keep pathways clear Helen Keller National Center for Deaf-Blind Youths and and alert him to any changes or additions to the Adults. Guidelines for Helping Deaf-Blind Persons. Sands furniture arrangement. When entering new sur- Point, N.Y.: HKNC, 1988. roundings, place his hand on the back of the chair National Federation of the Blind. Do You Know a Blind Per- where he is to sit. Familiarize him with the envi- son? New York: NFB, 1988. ronment. National Federation of the Blind. What is the National Fed- In a restaurant, allow the visually impaired per- eration of the Blind? New York: NFB, 1988. son to order his own meal. If the visually impaired San Francisco Lighthouse for the Blind. At Ease. San Francisco: SFLB, 1982. person reads braille, request a braille menu. If not, offer to read the menu items and prices to him. Tell him the positions of the food on his plate and offer Eustis, Dorothy Dorothy Eustis, born Dorothy to cut his meat, if applicable. If he is to pay for the Leib Harrison in 1886, founded the first dog-guide meal, guide him to the cashier, but allow him to training school in the United States. The daughter pay and receive his change. of a prosperous owner of a sugar refinery, she was When taking an order or purchase from a visu- educated in Philadelphia and Eastbourne, England. ally impaired person, speak directly to him. Do not In 1906, she married Walter Abbott Wood Jr., who communicate through a third party. When return- died in 1915. ing change from a purchase, count the money back In 1923, she married George Eustis and moved to the visually impaired person and identify the to Switzerland to establish a breeding and training denomination of the bills. If necessary, allow time kennel to improve the working qualities of the for the customer to fold each denomination of the German shepherd breed. She was joined in her bills before moving on to the coins. work in 1924 by Elliot S. (“Jack”) Humphrey, an If you hand more than one item at a time to a authority on breeding and genetics. visually impaired person, tell him what they are, in Dog-guide schools had been established in Ger- the order in which they are placed or stacked. many in answer to the need for German shepherd 84 Everest Expedition guides for blinded World War I veterans. Eustis Treatment may include the prescription of eye- became interested in dog-guide training and wrote drops, eyeglasses or bifocals, or exercises. Exercises an article about it for a 1927 edition of the Saturday or eye patching may be prescribed if amblyopia is Evening Post. present. Surgery may be necessary to completely The article elicited interest in the project, and in align the eyes. 1929 Eustis returned to the United States to found the Seeing Eye, a dog-guide training facility in Nashville, Tennessee. At the time, attitudes in the exophthalmos Exophthalmos, or proptosis, United States were generally negative toward dog refers to a protruding forward of the eyeballs. The guides but changed toward acceptance as news condition is usually accompanied by a retraction of spread of successful use of the dogs. Today, Seeing the eyelids and infrequent blinking. The condition Eye Inc. is located in Morristown, New Jersey. may be unilateral, involving only one eye, or bilateral, affecting both eyes. Unilateral exophthalmos may be the result of muscle palsy, a vascular con- Everest Expedition An event held in 2001 to pro- dition, tumors, cysts, edema, or trauma and its mote the attempt of blind mountaineer Erik Wei- accompanying hemorrhage and infection. henmayer to reach the top of Mount Everest, the Bilateral exophthalmos is usually caused by highest spot on Earth. Sponsored by the National hyperthyroidism, or Graves’s disease. This disease Federation of the Blind, the NFB 2001 Everest is a disorder of the autoimmune system. It causes Expedition is intended to let the public know that the thyroid to overproduce hormones that over- blind people can overcome limits, and should stimulate the body’s metabolism. Over half of those never be considered helpless or dependent. The who develop Graves’s disease develop Graves’s expedition began in March and the team of ophthalmopathy, a condition in which the tissues climbers reached the summit of Mount Everest on and muscles of the eye are affected. May 25. Pseudoproptosis (the false appearance of exophthalmos) occurs when the other eye has become exophoria Exophoria is a condition of STRABIS- sunken due to a fracture or trauma. The normal MUS, or misaligned eyes. Often termed squint or eye appears to bulge forward in comparison. An crossed-eyes, strabismus may cause visual prob- overly large eye, as in the case of unilateral high lems or loss of vision. Exophoria is a type of latent MYOPIA (near-sightedness) may also appear to be strabismus in which the eyes tend to turn out- exophthalmic. ward, away from each other. Exophoria occurs The amount of exophthalmos can be measured when binocular vision is lost due to patching of with an exophthalmometer. This instrument deter- one eye or when the individual is tired. Exotropia is mines the degree of protrusion and symmetry condition in which either eye turns outward con- between both eyes. Readings beyond the normal stantly. range of 12–20 millimeters may indicate exoph- As in all strabismus, the eyes may fail to con- thalmos. verge on an object and view two differing subjects. Other tests may determine the underlying The brain receives the two images, and double cause. X rays may illuminate a tumor, fracture, or vision results. Often, in an effort to reconcile the erosion within the orbit. A CAT scan or biopsy may two pictures, the brain may suppress one com- detect a pathology within the eye or orbit, and a pletely. This negation may result in a condition culture of any discharge may identify an infection. called AMBLYOPIA. Treatment of exophthalmos must include ther- Strabismus can be associated with high amounts apy for the underlying cause. This may include of myopia (nearsightedness) hyperopia (farsighted- antibiotics, steroids, radiation, chemotherapy, radi- ness), and ASTIGMATISM. It can develop after a ation iodine treatments, or surgery such as TARSOR- major illness or injury, and some forms of strabis- RHAPHY, a stitching of the eyelid, or removal of the mus may also be hereditary. mass causing the proptosis. eye 85 exotropia See EXOPHORIA. body that focuses the light that enters the eye through the pupil. The lens is held in place by thousands of fibers called ZONULES. These fibers are See CATARACT. extracapsular extraction attached to the ciliary muscle and work with the muscle to help the lens to change shape. eye The eye is one of the most complex, special- The lens changes shape to correctly focus the ized organs in the body. It is responsible for up to light of images at varying distances. To focus on a 80 percent of the awareness information we near object, the lens must bulge forward. To do process. The eye can distinguish images, determine this, the ciliary muscle contracts, giving the fibers distance and depth of those images, and detect more slack and allowing the lens to bulge into the their shape, tone, and color. Amazingly, the light- needed focusing shape. To focus on a distant object, dependent eye can do its job in a brightness range the muscle expands, pulling the fibers taut and flat- fluctuating from candlelight to brightest sunlight. tening the lens. The large area behind the lens is filled with a Structure clear, gel-like matter called VITREOUS. The vitreous The eye is a globe measuring about one inch long. gives the eye its form and substance. Its structure has many parts. The front of the eye is The RETINA, the inner layer of the back of the a transparent tissue called the CORNEA. The cornea eye behind the vitreous, contains over 125 million bends and focuses entering light rays. Surrounding light-sensitive cells that give the retina information the cornea is the SCLERA, the tough, protective, about the image. Among these cells are the RODS white portion of the eye. The CONJUNCTIVA, a thin AND CONES. layer of membrane, covers the sclera. The cornea The more numerous (by a margin of five to one) and sclera work together to shield the eye much as rod-shaped cells react to faint light, darkness, shape, a watch crystal and case protects a watch. and movement. They are located throughout the Just behind the cornea is the ANTERIOR CHAMBER, retina and are responsible for peripheral vision. The a space filled with the AQUEOUS FLUID, a clear liquid. cones distinguish color and detail but require high The aqueous fluid brings nutrients to the cornea levels of light to be effective. The cones are concen- and LENS, and carries away waste. trated into an area called the MACULA. The IRIS is a thin circle of membrane suspended The macula is in the central section of the retina. just behind the anterior chamber and in direct line It is responsible for straight-ahead or central vision. to the cornea. The iris is the part that gives the eye It is a highly sensitive area of the retina packed its color. The hue depends on the amount of pig- with cones. The macula has a small hollow, called ment contained in the iris. Brown eyes contain the the FOVEA, in which the greatest numbers of cones most pigment, blue the least. reside. Light is focused directly on the fovea, mak- In the center of the iris is the PUPIL, a tiny hole ing it the site of greatest visual acuity. through which light passes into the eye. The pupil The CHOROID is a dark tissue layer between the changes size to accommodate different light retina and the sclera. Blood circulates through the extremes. In bright sunlight, it closes down to choroid to nourish the eye. The choroid is a part of screen out excess light, in low light it opens up to the UVEA, the pigmented structures of the eye that allow the maximum amount to enter into the eye. also include the iris and the ciliary body. The uvea The pupil is black because the inside of the eye is a vascularized, pigmented tissue layer that sup- showing through it is dark. Any change in pupil plies blood to the eye. color is an indication of disorder within the inside The OPTIC NERVE is a cord made up of a collection of the eye. of nerve cells and fibers. The optic nerve connects The iris and pupil are positioned in front of the each eye to the brain and supplies blood to the POSTERIOR CHAMBER, which, like the anterior cham- retina. The blood enters at the back of the eye and ber, is filled with aqueous. Behind the posterior is diverted through vessels over the complete sur- chamber is the CRYSTALLINE LENS, a transparent, soft face of the retina. The blood vessels in the retina 86 eye bank are easily viewed through an ophthalmoscope and replaces the damaged cornea with a healthy one to are the only vessels in the body that can be exam- restore sight. ined in their natural, unhampered state. Eyes are donated anonymously from people The place where the nerve fibers exit to the who die. Donors may make their intention to retina is called the OPTIC DISC. Since the optic nerve donate their eyes known before death by a donor contains no light-sensitive cells, it is blind and ren- card or the section about organ donation on some ders the optic disc blind as well. This is responsible state driver’s licenses. The Uniform Anatomical Gift for the eye’s blind spot in the field of vision. Act allows relatives of the deceased to donate the The eyes are protectively placed within the bony eyes if the donor has not provide written intention. depressions of the skull called ORBITS. Each eye is Eye donors are not limited by age or degree of eye- held in place and moved by six extrinsic muscles. sight and pay no fee to donate their eyes. Eyelids keep foreign matter out of the eye, close to The eye is enucleated (removed) from the donor protect the eye from unwanted light, and blink to as soon as possible after death. It is usually stored encourage tear production. The tears are necessary in special solutions or fixatives, or in some cases, it to maintain a layer of moisture over the cornea. may be quickly frozen and stored at low temperatures. Tissue deterioration may occur if the eye is How the Eye Works not treated within six to eight hours after death. The eye requires light to see. Light falling on an The eye bank evaluates the donor’s general object is reflected to the eye. It passes through the health, medical history, and the health of the eyes cornea where it is bent and focused to approxi- according to strict medical standards. After this mately 60 percent of what is needed. The light then evaluation, the cornea is distributed to the corneal enters the lens through the pupil. The lens bends surgeon who makes the final determination as to the light the additional 40 percent and focuses a whether the cornea is suitable for transplantation. sharp image onto the retina. Tissue and blood typing and matching normally are The retina transforms the light messages not necessary in corneal transplantation, except in received by the eye into electronic impulses that it rare instances, such as cases of major chemical sends through the optic nerve to the brain. Since burns or graft rejection. the retinas of each eye receive slightly different Corneas that qualify for transplantation are dis- images, the impulses sent to the brain vary some- tributed to recipients according to fair, just, and what. The brain translates and matches the equitable standards. Distribution is made without impulses received into a single image, creating a regard to age, sex, religion, race, creed, color, or sense of depth. national origin. If the corneas are not suitable for transplan- eye bank Eye banks are organizations that tation, or the sight-restoring procedure of epike- acquire, evaluate, and distribute eyes from eye tophakia, the eyes are used for research and donors. The eyes are used for CORNEAL TRANS- education. Because many sight disorders can not be PLANTS, medical research, and educational pur- simulated, donated eyes are valuable in the poses. research of glaucoma, diabetes, retinal diseases, Donated eyes are necessary for corneal trans- and other eye disorders and conditions. plantation, or keratoplasty. According to the Eye Bank Association of America, more than 46,000 Eye Bank Association of America (EBAA) The corneas were replaced by transplants in 2000, 90 Eye Bank Association of America (EBAA), located percent of which successfully restored vision. in Washington, D.C., was established in 1961 by The CORNEA is the clear, curved portion of the the Committee on Eye Banks of the American eye over the colored IRIS. The cornea bends or Academy of Ophthalmology. It is a nonprofit orga- refracts light to focus vision. When the cornea nization that includes more than 100 member eye becomes clouded or damaged due to injury or dis- banks in 45 states, as well as Canada, Taiwan, ease, vision is decreased. Cornea transplantation India, England, and Saudi Arabia. eye drops 87

The association develops and maintains quality Other eye drops used to treat glaucoma are beta- control in eye banking. It develops research pro- blockers, such as brand names Timoptic, Betoptic, grams, professional education and training pro- OptiPranolol, Ocupress, Betagan, and Carteolol. grams, and public awareness materials. The These drugs lower pressure within the eye by organization cooperates with other organ and tis- blocking beta adrenergic receptors in the eye. sue transplant organizations and represents mem- When those receptors are blocked, not as much ber eye banks in legislative and legal matters. aqueous fluid is produced. The effectiveness and The EBAA compiles statistics concerning eye potentially serious side effects of these various banks, transplants, and organ donation, and main- beta-blockers vary, and each patient’s case must be tains a speakers bureau. It publishes a newsletter thoroughly evaluated before a decision on which and holds an annual conference. one to use is made. Contact: Another type of drop, alpha-adrenergic agonists, also is used to treat glaucoma. Sold under brand The Eye Bank Association of America names such as Iopidine, Propine, Epifrin, and 1015 18th Street, NW Alphagan, these drugs lower eye pressure by treat- Suite 1010 ing both aqueous production and outflow. There Washington, DC, 20036 can be side effects to both the eyes and the cardio- 202-775-4999 (ph) vascular system from these types of drops. 202-429-6036 (fax) A newer class of drugs that is used in drops to treat glaucoma is called alpha-adrenergic agonists, eye drops Eye drops are commonly prescribed and includes the brand names Iopidine, Epifrin, in the treatment of eye disorders but may be used Propine, and Alphagan. They work by decreasing to treat diseases relating to other organs as well. the amount of fluid that is produced and may also Eye drops may be used to constrict the pupils help with the drainage of fluid from the eye. They in the treatment of diseases such as GLAUCOMA. may cause some eye discomfort, as well as some Such constricting or miotic drops include pilo- systemic side effects. carpine eye drops. Pilocarpine is a cholinergic Prostaglandin analogs, a new type of drug sold medication that constricts the pupils and helps under the brand name Xalatan, work differently to regulate or reduce intraocular pressure. Its most treat glaucoma. Instead of decreasing the amount common side effect is miosis, which is a decrease of fluid produced in the eye, Xalatan, which was in the size of the pupil. This can cause some loss approved for use in the United States in 1996, of sight. increases the rate at which eye tissue is able to Other eye drops dilate the PUPIL or have a my- absorb the fluid. This works to get the fluid out of driatic effect. These are used during eye examina- the eye, and reduces pressure. While Xalatan is tions. One class is cycloplegic drops that relax the noteworthy in its effectiveness, and because it has pupil and CILIARY BODY (parasympatholytics) and to be administered only once a day, there is a side are used to treat disorders such as acute IRITIS. effect that has prevented it from being more widely Atropine, cyclopentolate, and homatropine are used than it is. The drops cause the color of the eye common cycloplegic drops. The other class of to darken, turning those that are blue, green, hazel, mydriatic drops are sympathomimetics that stimu- or yellowish to brown. Long-term effects of this late the dilator muscle of the pupil. pigment change are not known. Eye infections are often treated with antibiotic These are not the only medicines used to treat drops. Steroids are occasionally used but usually glaucoma, but are those commonly found in eye for short periods of time only. ANTIVIRAL DROPS are drops. used to treat viral infections such as HERPES SIMPLEX Before administering eye drops, the hands or HERPES ZOSTER. Idoxuridine, trifluridine, ARA-A, should be washed. The patient should sit or lie acyclovir, and vidarabine are commonly prescribed down and tilt the head back. The lower lid should antiviral drops. be gently pulled down to form a hollow. A finger 88 eye examination can be placed next to the nose to apply pressure into them. By evaluating the lights and shadows and close off the draining tear duct. The dropper moving on the retina, the examiner can determine should be held close to, but not touching, the eye- whether the eyes are nearsighted, farsighted or lid. The prescribed number of drops can then be astigmatic. The examiner also tests for color per- squeezed into the hollow of the lid. After adminis- ception, depth perception and the ability of the tering the drops, the eye should be closed for sev- eyes to move freely and work together. eral moments. The dropper or applicator should An external examination of the eyes is included. not be wiped or washed, and the cap should be A small flashlight is used to check for abnormalities immediately replaced and tightly shut. of the lids, eye muscles and position of the eyes. The same medications found in eye drops may The light is shined directly into the eyes to test be prescribed in ointment form. Ointments are pupil response. administered in a similar manner to the drops. A An OPHTHALMOSCOPE, a hand-held lens light line of ointment is squeezed into the hollow of the shaped like a flashlight, is used to view the inside eyelid. Once the eyelid is closed, the eye should be and back of the eyes. The ophthalmoscope lights rolled to spread the medication. and magnifies the RETINA, blood vessels, and OPTIC Regardless of what type of eye drop you use, it NERVE of the eye. This is the only place in the body is important to know that the eye can only hold where an examiner can view the nerves and blood about one-fifth of one drop. If more than one drop vessels in their active state. is prescribed, you’ll need to wait at least three min- A BIOMICROSCOPE (slit lamp) is used to examine utes between applications for the drops to absorb the front of the eye. The machine is positioned in properly. Waiting between applications also helps front of the patient who places his chin on a chin to avoid the possibility of washing one drop from rest. A bright, vertical beam of light is directed the eye with another drop. through the CORNEA. The reflected light supplies an illuminated, magnified cross-section of the cornea, eye examination A general annual eye exam IRIS, and LENS. consists of several examinations of the parts of the A TONOMETER is attached to the biomicroscope. eye and tests to determine the health and compe- After the cornea is anesthetized, it checks the level tence of the eyes. Through examination of the of intraocular pressure or fluid within the eye eyes, diseases of the body including hypertension, when gently, painlessly placed on the cornea. arteriosclerosis, and diabetes can also be detected. After the battery of tests is completed, the exam- First, a health history is taken, including ques- iner can prescribe new lenses or treatment. If any tions about general health, medications taken or abnormalities are found, a referral may be made to a treatments given, visual history, current visual specialist or the patient’s physician. (See SCREENING.) complaints, and visual needs required by occupation or hobbies. Visual acuity and refraction are eyeglasses Eyeglasses, or spectacles, are devices tested next. Acuity is tested by reading an eye chart that improve sight. They correct the refracting both with and without current prescription lenses. errors of the eye’s lens and enable the wearer to see A refraction test to determine which lenses will more clearly. best correct vision is then given using a PHOROPTOR. Eyeglasses contain a frame and a pair of lenses. A phoroptor is an apparatus that contains hun- The plastic or metal frame holds the lenses in place dreds of lenses within a large base. The patient in front of the eyes. Side pieces of the frame that fit looks at a wall chart through lens openings in the along the sides of the head and over the tops of the base. The examiner changes the lenses with a dial ears are called temples. The section of the frame to correct the patient’s vision. The patient is asked between the two lenses that rests on the nose is to decide which lenses work best. called the bridge. The examiner inspects the refractive power of The lenses are specifically prescribed to correct the eyes while shining the light of a RETINOSCOPE the individual needs of the wearer. They can eyelids 89 improve nearsightedness, farsightedness, astigma- wearers may notice that objects seem sharper but tism, and PRESBYOPIA. Lenses to correct nearsight- larger. Those with an astigmatism may feel off bal- edness, or MYOPIA, are concave in shape. Those ance because the world looks temporarily slanted prescribed for farsightedness, or HYPEROPIA,are or curved. Bifocal wearers may need to develop convex. Cylindrical lenses are incorporated into the additional head or eye movements to accommo- concave or convex lenses to correct an astigmatism, date the needs of two lenses. a nonspherical shape in the eye’s lens that causes distortions. eyelids Eyelids are the eyes’ protection from Presbyopia (aging of the eye) results in the environmental injuries. They shut automatically inability of the eye’s lens to change shape to focus when an object threatens to enter the eye and pro- on near objects. Bifocals are eyeglasses that correct vide protection from unwanted light. They blink to this problem. They contain two lenses within each produce cleansing tears and have lashes that filter lens frame so that the wearer can adjust to near out dust and small debris. and distant objects without changing glasses. Trifo- The eyelids are subject to several conditions. cals add a third lens designed to help see distances BLEPHARITIS is an inflammation of the margin of the of two to three feet. lid. The disorder is associated with allergies or dan- Another type of lens, called progressive addition druff. The lids become red, swollen, and crusty at lenses, also contain different prescriptions within the base of the lashes. In less severe forms of the the same lens. They do not, however, have seams, disorder, temporary loss of lashes may occur. as bifocals and trifocals do, which allow your eye to Severe blepharitis destroys the lash follicles and make a smooth movement from one part of the results in permanent lash loss and deformity of the lens to another. lid margin. Lenses may be made of glass or plastic and are A HORDEOLUM or sty is an infection of a lash fol- required by federal law to be shatter resistant. licle. A spot on the lid margin becomes red, painful, Additional coatings or filters may be added to the and swollen with pus. The sty eventually ruptures, lens to screen out light or reduce unwanted glare drains, and heals itself if not treated. and reflection. CHALAZION is a swelling of the lid glands. The Eyeglasses are prescribed by an OPHTHALMOLO- enlargement grows slowly and painlessly. It may be GIST or an OPTOMETRIST. The type of lenses needed associated with an inflammation and can become a are determined by an eye examination and vision chronic condition. test. The shape and width of the lenses is set by the PTOSIS is a sagging of the upper eyelid. It may shape and size of the frame, the length of the occur as a result of aging or a neurological problem, bridge, the weight of the lenses, and the shape of such as lid muscle paralysis. the head. ENTROPION is a turning inward of the margin of The eyeglass frame must be carefully fitted to the the eyelid. As a result, the lashes often scrape wearer to ensure optimal correction by the lenses. against the CORNEA and inflame it. Entropion may The center of the lenses must be directly in front of occur after an injury or burn or as a result of aging. the eye, which may not necessarily be in the center ECTROPION is a turning outward of the margin of of each lens frame. To center each lens, the distance the eyelid. The inner lid is exposed to the elements, between the pupils of the eyes is measured and which results in tearing and irritation. Ectropion is recorded. The distance is also measured from the top commonly caused by aging. of the ear to the place where each temple is attached Tumorous growths may develop anywhere in to the frame. This measurement plus two inches is the eyelids. Benign cysts and tumors include papil- the amount needed for each temple. loma, a viral tumor, “strawberry nevus,” a reddish New eyeglasses often require adjustment time. tumor, cyst of gland of Moll, a watery, clear cyst, Nearsighted wearers may find that things look and xanthelasma, a fatty tumor. Malignant tumors sharper but smaller with the new lenses. Farsighted most often develop on the lower lid but may be 90 eyelids found elsewhere on the lids. These include basal TRICHIASIS occurs when the eyelashes grow cell carcinoma, squamous cell carcinoma, keratoa- inward. This may cause a corneal irritation. canthoma and malignant melanoma. DACRYOCYSTITIS is an inflammation of the tear TRACHOMA is a viral disease that infects the drainage sac caused by an infection. Symptoms inside of the eyelids, causing scarring of this area, include redness, swelling, and pain. and eventually of the cornea. It is a common cause of blindness in developing countries with limited eye care and sanitation. F

facial expressions See NONVERBAL COMMUNICA- Fair Labor Standards Act The Fair Labor Stan- TION. dards Act of 1938 sets the federal standard for minimum wage, work hours, overtime, recordkeeping, facial vision See SENSES. and child labor conditions. As amended, the act contains guidelines regarding disabled workers who work in special circumstances such as shel- Fair Housing Act An act that prohibits housing tered workshops. discrimination on the basis of race, color, religion, Section 14 of the act issues minimum wage cer- sex, disability, familial status, and national origin. tificates to those learning a job, including disabled Most housing, including private housing, state workers, apprentices and students. The certificates housing, local government housing, and that are based on individual productivity but require which receives federal financial assistance, is cov- that wages paid to disabled workers must corre- ered by the act. spond to those paid to nondisabled, certificated The act requires owners of housing facilities to workers producing comparable work. make reasonable exceptions to their policies and Employers must review the disabled worker’s operations to afford people with disabilities equal wages every six months and must adjust wages housing opportunities. For instance, a landlord yearly in compliance with those paid to nondis- who has a no pets policy may be required to abled employees in the same position. The disabled change the policy for a person who uses a dog worker may request a review of wages by the Sec- guide. The act also requires landlords to allow ten- retary of Labor. The secretary names an adminis- ants with disabilities to make reasonable access- trative judge to hold a hearing in which the related modifications to their private living and employer must show that the current wage rate is common-use spaces. necessary to continue offering the job. Anyone who feels they have been denied hous- Amendments to the act in 1966 authorized the ing on the basis of race, color, religion, sex, disabil- wages of employees of public or private institu- ity, familial status, or national origin may file a tions that serve the handicapped to be included complaint with the U.S. Department of Housing and governed by this act. In 1976, the Supreme and Urban Development’s Office of Program Com- Court ruled that such institutions run by federal pliance and Disability Rights. or state agencies were exempt from this ruling. Contact: That decision was overturned in a 1985 Supreme Office of Program Compliance and Disability Rights Court decision that determined that federal U.S. Department of Housing and Urban Develop- and local governments must comply with federal ment standards. Because of the extreme cost of im- 451 7th Street, SW plementation, the Fair Standards Act was Room 5242 amended to allow federal and state governments Washington, DC 20140 to offer, instead of wages, one and one-half hours 800-669-9777 (ph) of compensatory time for each hour of overtime 800-927-9275 (TTY) worked.

91 92 Federal-Aid Highway Act

The act was last amended in 1996, when the may work for the employee at the normal work minimum wage was set at $5.15 per hour. The station and on business trips. The assistants may increase went into effect September 1, 1997. include interpreters for the deaf and readers for the blind. U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, U.S. Department of Education. Summary of Existing Legis- D.C.: USDE, 1988. lation Affecting Persons with Disabilities. Washington, Welfare Information Network, Making Wages Work. D.C.: USDE, 1988. “Minimum Wage Legislation and Living Wage Cam- paigns.” www.makingwageswork.org/2000. federal resources A myriad of federal agencies exist for the purpose of providing services to indi- Federal-Aid Highway Act The Federal-Aid viduals with disabilities. These agencies are admin- Highway Act of 1973 approved the use of high- istered under the U.S. Departments of Education, way improvement program funds to improve Health and Human Services, and Labor, plus the accessibility to physically disabled people. The Veterans Administration and other agencies. (See funds may be used to correct curbs and pedestrian Appendix for addresses.) crosswalks and provide accessibility to rest-stop The U.S. Department of Education encompasses facilities. the Center for Libraries and Educational Improve- U.S. Department of Education. Summary of Existing Legis- ment, which grants funds to states for library ser- lation Affecting Persons with Disabilities. Washington, vices for the blind and physically disabled and D.C.: USDE, 1988. administers the Library Services and Construction Act. The Clearinghouse on the Handicapped provides information to the public concerning disabil- Federal Aviation Act The Federal Aviation Act of ities. 1958 as amended by the Air Carrier Access Act of The Division of Blind and Visually Impaired 1986 banned discrimination against disabled per- administers the Randolph-Sheppard Act and aids sons who use air transportation. The Act called for state rehabilitation agencies in development of the promulgation of regulations to be issued by the methods, standards and procedures. The National Department of Transportation to ensure nondis- Council on the Handicapped develops policy and crimination “consistent with the safe carriage of all plans for the National Institute on Disability and passengers on air carriers.” Rehabilitation Research. The National Institute on The act came under scrutiny in 1999, when a Disability and Rehabilitation Research awards con- report from the National Council on Disability tracts and grants for research and demonstration showed that disabled persons were still experienc- projects concerning disabilities and directs training ing discrimination when using air transportation. and research centers. The National Council on Disability recommended The Office of Special Education and Rehabilita- ways to better enforce the act. tive Services supervises the offices of Rehabilitation U.S. Department of Education. Summary of Existing Legis- Services Administration, Special Education Pro- lation Affecting Persons with Disabilities. Washington, grams and National Institute on Disability and D.C.: USDE, 1988. Rehabilitation Research. The Office of Special Edu- National Council on Disability. “Enforcing the Civil cation Programs administers the Education of the Rights of Air Travelers with Disabilities.” www.ncd. Handicapped Act, provides funding to the states for gov/newsroom/publications/acaa, 1999. the education of disabled students and funds personnel training, research, special program grants, Federal Employees Personal Assistants A 1980 demonstration grants, and scholarships. amendment to the Federal Advisory Committee The Rehabilitation Services Administration Act allowed federal agencies to hire personal assis- assists state agencies in vocational rehabilitation tants for disabled federal employees. The assistants programs by providing leadership, grants, and de- financial aid 93 monstration and training programs. It awards inde- Other agencies outside these departments pendent-living grants for the disabled. include the Office of Civil Rights, which enforces The Department of Health and Human Services laws prohibiting discrimination on the basis of race, contains the Administration for Children, Youth color, national origin, sex, age and disability. It pro- and Families, which operates the Head Start protects the rights of disabled individuals and investi- gram and advises the secretary of Health and gates cases of discrimination due to disability. Human Services on issues and programs concern- The Library of Congress administers the Na- ing early childhood education. The Administration tional Library Service for the Blind and Physically on Aging aids states in developing programs for Handicapped, which provides free library service aging citizens and administers the Older Americans to those unable to use standard print materials. Act of 1965. The service provides braille and recorded maga- The Health Care Financing Administration is zines and books, talking book players, and cassette responsible for the Medicare program and awards players. state grants for Medicaid. The Health Services The President’s Committee on Employment of Administration/Division for Maternal and Child People with Disabilities is a partnership of national Health Bureau of Health Care Delivery and Assis- and state organizations and individuals that work tance controls state block grants for disabled chil- to increase opportunities for the employment of dren’s services and maternal and child health disabled persons. services. The National Institutes of Health/National The Architectural and Transportation Barriers Eye Institute funds eye disease and disorder Compliance Board enforces the Architectural Bar- research and training of researchers. riers Act of 1968. The Committee for Purchase The Office of Human Development Services from the Blind and Other Severely Handicapped administers the social services programs of the administers the purchase of products and services Social Security Act and supervises various agencies, from nonprofit workshops as legislated under the including the President’s Committee on Mental Javits-Wagner-O’Day Act. Retardation and the Administration on Develop- The Equal Employment Opportunity Commis- mental Disabilities. The Social Security Administra- sion monitors and enforces laws that prohibit dis- tion dispenses Social Security benefits, including crimination on the basis of disability in the federal disability insurance and Supplemental Security government. The U.S. Office of Personnel Manage- Income (SSI). ment Governmentwide Selective Placement Pro- The Department of Labor controls the Employ- grams Division sets policy for the employment of ment Standards Administration Branch of Special disabled individuals within the federal government. Employment, which enforces laws concerning dis- The Small Business Administration makes loans to abled workers in sheltered workshops and indus- small businesses owned and operated by disabled try. The Office of Federal Contract Compliance individuals as legislated by the Small Business Act. monitors affirmative action as legislated by the Contact information for these agencies can be Rehabilitation Act of 1973. The U.S. Employment found in an appendix in the back of this book. Service controls the federal-state service program. The Veterans Administration operates the Blind Rehabilitation Service, which administers pro- financial aid Financial aid is available to visually grams for blinded veterans at Rehabilitation Cen- impaired individuals to meet the costs of daily liv- ters and Clinics. The Department of Medicine and ing, medical evaluation, public transportation, and Surgery furnishes outpatient and hospital treat- rehabilitation and vocational training. ment and nursing-home care in Veterans Adminis- To qualify for many types of financial aid, an tration facilities. The Department of Veterans individual must be recognized as legally blind. Legal Benefits administers compensation and pension blindness is a term for conditions of visual impair- programs and provides vocational rehabilitation ment that include either visual acuity of 20/200 or services and counseling. less in the better eye, after correction, or a visual 94 financial aid

field of 20 degrees or less, in the better eye, regard- abled people can use to obtain rehabilitation and less of visual acuity. Those who are legally blind employment services at an approved employment qualify for two programs of financial aid under the network. The ticket program was active in 13 states Social Security Administration. These are termed in 2001, with more states expected to be added in disability insurance benefits and Supplemental 2002. The first 13 states to be included in the pro- Security Income (SSI). gram are: Arizona, Colorado, Delaware, Florida, Disabled individuals are those who have a phys- Illinois, Iowa, Massachusetts, New York, Okla- ical or mental disability that is permanent or long- homa, Oregon, South Carolina, Vermont, and Wis- term (12 months or longer) or one that may result consin. in death. The 1999 act also encourages disabled workers Disability insurance benefits are authorized to find employment by providing work incentives, under the Social Security Act. They are paid to peo- including cash benefits in addition to Medicare ple who have contributed to the Social Security during employment, help with extra expenses System but who have become disabled before incurred as a result of the disability, financial assis- reaching retirement age. Disability insurance bene- tance with education or training, or rehabilitation fits are not affected by financial circumstances or necessary to work. Some of these incentives also need. Applicants must be unemployed or apply to people receiving Supplemental Security employed but earning less than a determined Income or Medicaid. For more information about amount, and must have a qualifying medical dis- the ticket program and work incentives, contact ability according to the ruling of the Disability the Social Security Administration at its toll-free Determination Service. An applicant must have number: 800-772-1213 and ask for the fact sheet contributed to the Social Security fund for approx- called “The Ticket to Work and Work Incentives imately half of the years since turning 21. Depen- Program of 1993.” dents and spouses of an eligible disabled person Supplemental Security Income provides a mini- may also qualify for up to 50 percent of the appli- mum income to low-income elderly and disabled cant’s rate. In some cases, a divorced spouse also individuals. SSI requires that recipients meet may be eligible for benefits. requirements of financial need and, unlike Social The benefits are paid in cash monthly to eligible Security Disability Insurance, does not base eligibil- people and their dependents. The age of the ity on the amount of taxes paid into the Social worker when he became disabled, his earned Security fund. SSI benefits are funded by general income, and the length of time he was employed tax revenues, not Social Security taxes, and are determine the amount of the benefit. The amount available for blind children, as well as adults. may be decreased if the worker is a recipient of Needy individuals or couples disabled or aged 65 other state or federal benefits. or older may qualify for SSI benefits if financial After receiving disability benefits for 24 months, needs requirements are met. the recipient is eligible for Medicare health insur- Monthly cash benefits are paid directly to recip- ance benefits. ients. The amount of payment is based on a Con- A national policy encourages disabled people sumer Price Index figure. receiving Medicare health insurance benefits to try The Work Incentives Improvement Act of 1999 to get back into the workplace, if at all possible. To increases the amount of money a disabled person accomplish this, the government has established can earn while still receiving benefits. laws to provide work incentives and protect dis- MEDICAID is the main source of medical-services abled people from discrimination in the workplace. funding to severely disabled individuals. It allows In 1999, Congress passed the Ticket to Work and states to offer coverage not only to those who Work Incentives Improvement Act of 1999. This receive public assistance, but also to eligible needy act provides more opportunities and benefits for people who do not qualify for welfare or Medicare. disabled people who want to return to work, Medicaid eligibility is determined by financial including a program that provides tickets that dis- need. Recipients generally fall into one or more financial aid 95 of the three qualifying categories: categorically In order to qualify for the deduction, an indi- needy, medically needy, or qualified severely vidual must be LEGALLY BLIND. The individual impaired. must attach to the tax return a statement from an The categorically needy receive AID TO FAMILIES OPHTHALMOLOGIST or doctor confirming legal WITH DEPENDENT CHILDREN (AFDC) benefits or Sup- blindness. plemental Security Income (SSI) benefits or qualify Some medical expenses may be deducted from under specific regulations for their state. income if itemized. Under the Internal Revenue Medically needy persons may have incomes too Code, a deduction is allowed for medical expenses high to qualify for AFDC or SSI benefits yet cannot that are above 7.5 percent of the individual’s afford to pay for necessary medical treatment. adjusted gross income. Items that are deductible States determine a different qualifying income include special equipment and its installation costs, level for those who are medically needy. necessary home improvements or renovations, Qualified severely impaired individuals are special education tuition, dog guides, and personal those under 65 who receive SSI benefits because of items, including prosthetic eyes. blindness or disability and are able to be employed Individuals with disabilities may be eligible for but do not have incomes that allow them to pay for special home loans and rent assistance programs. healthcare coverage. The Title I Home Improvement Loan is a federally MEDICARE offers health insurance benefits to insured loan that can be used to renovate a home qualified disabled and elderly individuals. Gener- to meet the needs of the disabled owner. The loan ally, those eligible are 65 years or older and qualify can be used to finance the removal of architectural for Social Security benefits. Disabled people may be barriers or to make necessary improvements. The eligible to qualify for Medicare after a two-year U.S. Department of Housing and Urban Develop- waiting period. ment (HUD) insures the loans, which are available Children’s Rehabilitative Services (CRS) is a fed- from banks and other lending institutions. eral/state program that supplies medical services to Low-income disabled individuals may qualify disabled children up to age 21. Medical diagnosis for housing assistance from HUD. Eligible tenants and evaluation is free in each state. Additional pay approximately 30 percent of their adjusted treatment or hospital costs vary by state but all gross income for rent. HUD pays direct subsidies to accept Medicaid, Blue Cross, Blue Shield, and other the rental unit owners to compensate for the dif- medical insurance. The program formerly was ference between payment and normal rental fee. called the Crippled Children’s Services. Legally blind individuals may mail materials free The Early Periodic Screening, Diagnosis, and of postage through a program called Free Matter for Treatment Program (EPSDT) medically screens the Blind or Handicapped. To become eligible, the children from poor families to determine whether individual must present written certification of legal medical treatment or related services are necessary. blindness by a competent authority such as a doc- The program provides remedial and preventative tor, ophthalmologist, or OPTOMETRIST, to the post medical care. office where mailings will be sent and received. Families receiving state Aid to Families with Material eligible for mailing includes books, Dependent Children benefits and those in which magazines, musical scores, braille material, 14- parents or guardians are receiving Medicaid or point SIGHTSAVING TYPE, records, or cassette local public-assistance benefits qualify for EPSDT tapes. Equipment and parts of equipment used for services for children up to 21 years old. writing or educational purposes, sound playback Tax deductions are available to legally blind indi- equipment for use by visually impaired individuals, viduals, as well. Married individuals over age 65 and and equipment designed or adapted for use by married blind individuals may deduct an additional visually impaired persons, such as braille watches $850. An elderly or blind spouse also qualifies for and white canes, are also eligible. the $1,100 deduction. Single elderly or blind indi- Reduced telephone rates may be available to the viduals are eligible for a $1,100 deduction. legally blind. Offerings differ from state to state, but 96 fluorescein angiography written verification of legal blindness by a doctor or In the procedure, fluorescein dye is injected into ophthalmologist may in some cases be used to a vein in the patient’s arm. As the dye passes obtain reduced monthly service rates for touch through the retinal vessels and capillaries a spe- tone dialing and speed calling. Telebraille devices cially filtered camera takes photographs every few may be offered to those who are deaf/blind and can seconds to record the flow. Analysis of the resulting read braille. Those with low vision may be eligible angiogram can determine the presence of tumors to receive free 411 information or large-number or clogged or leaking blood vessels, diabetic overlays for the telephone dial. retinopathy, or macular edema. Fluorescein Interstate bus lines and Amtrak offer reduced angiography may be used after photocoagulation fares to legally blind people as do many city public (sealing of blood vessels with laser treatments) to transportation systems. Identification cards may be determine the results of the procedure. necessary to obtain the reduced fare and are often issued by the individual transportation agency. An fluorescein eye staining Fluorescein eye staining identification card verifying legal blindness can also is a procedure performed to examine the CORNEA, be obtained from the American Foundation for the the transparent covering of the eye. The test allows Blind. the examiner to look for suspected scratches, irrita- Legally blind individuals are eligible for state tions, or infections. rehabilitation services. Each state supports an The examiner applies fluorescein dye into the agency for the blind under various names such as eye by touching the lower eyelid with a fluores- Department of Rehabilitation, Commission for the cein-laden paper strip. The dye covers the cornea Visually Handicapped, State Services for the Blind and settles into any cuts or scratches of the surface. and Visually Impaired, and Bureau of the Blind. The excess dye is washed from the cornea with the Services differ from state to state, but most natural tearing process. provide home-management skills, orientation The examiner observes the eye under an ultra- and mobility instruction, braille instruction, com- violet light. The fluorescein dye glows bright green, munication skills, personal-management skills, illuminating any irregularities such as cornea abra- vocational rehabilitation, counseling services, and sions, ulcers, burns, or overexposure to light. adaptive-aids evaluation and selection. Rehabilitation services are available at little or no cost to the individual. Some aspects of the reha- Food Stamp Act The Food Stamp Act of 1967, as bilitation program may require financial contribu- amended, authorizes food coupon allotments to tion by the individual. In some states, services such low-income families and individuals. The food as psychological counseling, equipment purchase, stamps can be used to buy food in retail stores, to transportation to school, or school tuition may be pay for the delivery of prepared meals to elderly or financed by the state or a combination of the state, disabled people or to purchase meals or food served the individual, and grants or loans. in small, group-living residences by disabled persons Disabled individuals may be eligible for low-cost receiving Social Security or SSI benefits. Allotments loans or financial assistance to start a small busi- are made based on net income and family size. ness. Eligibility is determined by the administering The current food-stamp program was initiated agency, the Small Business Administration. by President Kennedy in 1961 in a few low-income areas of the country and was expanded in 1964 as a formal Food Stamp Act. Its roots, however, go fluorescein angiography Fluorescein angiogra- back to 1939, when the food stamp plan was phy is a type of ophthalmologic photography used started to help needy depression-era families. In to examine the RETINA and CHOROID inside the back 1973, amendments were made to encompass section of the eye. The procedure, which is also numerous regional and federal food programs called fundus photography, allows a more detailed and to expand the program to include the entire examination than the ophthalmoscope. country. fovea 97

The Food Stamp Act of 1977 revised the program dation that was founded in 1971. It was formerly to regulate eligibility and to issue the stamps at no known as the RP Foundation Fighting Blindness charge to qualified recipients. It further expanded Retinitis Pigmentosa Foundation, Inc. on the program by lifting restrictions on certain The goal of the Foundation Fighting Blindness is elderly people living in federally subsidized hous- to find the cause, treatment, cure and prevention ing, institutionalized persons and those completing for retinitis pigmentosa (RP), Usher’s syndrome, drug or alcohol residential treatment programs. and other associated retinal degenerative diseases. The act simplified the application process by The organization is the largest voluntary non- allowing some governmental assistance agencies to governmental sponsor of research to cure RP, mac- qualify applicants for food stamps. This allowed ular degeneration and other retinal disorders. Since applicants the opportunity to apply for food stamps 1971, the foundation has raised $150 million for while applying for other benefits such as Aid to retinal degenerative disease research. Families with Dependent Children, Social Security In 2000, it formed a cooperative agreement with or SSI. The act directed state Food Stamp Program the National Eye Institute that devotes a larger per- agencies to alert SSI recipients to the Food Stamp centage of NEI budget increases to research in reti- Program and launched a system in which food nal degenerative disease. stamp values could be paid in cash to families The Foundation Fighting Blindness serves as a whose members are all 65 years or older or who all clearinghouse of information for RP specialists, receive SSI benefits. professionals, patients and families. It compiles sta- Amendments made in 1979 increased the tistics, directs extensive public education and spending limit for the program and eliminated human services programs and maintains a national some housing and medical deduction constraints. and international membership. Among its pro- They allowed disabled persons, including the blind, grams are a national registry and retina donor pro- receiving Social Security or SSI benefits and living gram. The foundation also publishes a newsletter in nonprofit group-living residences of no more and provides free information about retinal dis- than 16 people to be eligible for food stamps. The eases. stamps could be used to buy food or to pay for pre- Contact: pared meals. The Foundation Fighting Blindness In 1982, the Omnibus Budget Reconciliation Act Executive Plaza I, Suite 800 authorized certain disabled individuals over 60 liv- 11350 McCormick Road ing in a household to be regarded as a separate Hunt Valley, MD 21031-1014 household and eligible for food stamps. The Food 888-394-3937 (toll free) Security Act of 1985 continued the cash payment 800-683-5551 (TDD) program and redefined disabled persons to include www.blindness.org those receiving SSI and other federal or state disability benefits. The food stamp program served 17.2 million fovea A small hollow or indentation in the mac- people each month during fiscal year 2000, at a ular section of the RETINA. The retina is an inner cost of $21.2 billion. The all-time high in program layer of the eye behind the VITREOUS. The retina participation occurred in 1994, with 27.97 million contains millions of light-sensitive cells, including people served. RODS AND CONES. These cells give the retina image information that it sends to the brain. U.S. Department of Education. Summary of Existing Legis- The MACULA is the central section of the retina, lation Affecting Persons with Disabilities. Washington, which is packed with cones, the cells that distin- D.C.: USDE, 1988. guish detail and color. The fovea is in the center of the macula. It contains the highest concentration of Foundation Fighting Blindness The Foundation cones. Light is focused directly on the fovea, mak- Fighting Blindness is a national eye research foun- ing it the site of greatest perception. 98 Freedom Scientific Inc.

Freedom Scientific Inc. A company that offers a free matter for the blind and handicapped See variety of assistive technology products for people MAILING PRIVILEGES. with sensory impairments and learning disabilities. It was formed in April 2000 when Henter-Joyce, freezing method See CRYOSURGERY. Blazie Engineering, and Arkenstone merged. Henter-Joyce was a leading software company specializing in products for blind people. Blazie Fresnel prism See PRISMS. Engineering was a manufacturer of Braille computers, software, and embossers. Arkenstone was a Fuch’s endothelial dystrophy Fuch’s endothelial nonprofit organization that provided techni- dystrophy is a hereditary disease in which the cal solutions to visually and reading-impaired indi- corneal endothelium is destroyed. It is a leading viduals. cause of corneal transplantation in the United States. Freedom Scientific continues to design, produce, The endothelium is the protective inner lining of and market the products and services for which the CORNEA made up of a single layer of endothelial Henter-Joyce, Blazie, and Arkenstone were known. cells. The cells prevent the AQUEOUS FLUID of the Among those products is an extremely popular ANTERIOR CHAMBER from penetrating the cornea. A screen reading software called Job Access With reduction of endothelial cells allows seepage into Speech (JAWS). The user moves the JAWS cursor the cornea, resulting in swelling, loss of trans- anywhere on the screen to activate a speech syn- parency, and loss of vision. thesizer. Another product is Braille ’n Speak, a com- The disease usually becomes apparent when a pact computer with a Braille keyboard that can be person is in his or her 40s or 50s. It is more com- used as a talking computer terminal, a Braille-to- mon in women than in men. It is diagnosed from a print transcriber, a word processor, a talking clock slit-lamp examination by dystrophic spots in the and calendar, and a talking calculator. endothelium. As the condition progresses, CORNEAL The product is extremely popular because it EDEMA or fluid retention and swelling develops, the allows blind users to take notes, keep an address cornea thickens and vision is lost. In later stages, book, and update a personal calendar without the blisters form on the epithelium, resulting in painful use of pen and paper. There are now five different ruptures. models of the Braille ’n Speak. Early treatment of Fuch’s endothelium dystro- Freedom Scientific has its corporate headquar- phy may include CORNEAL TRANSPLANTATION (ker- ters in Carlsbad, California, and facilities in St. atoplasty), or replacement of a disk of healthy Petersburg, Florida. About 30 percent of the com- cornea for a disk of diseased cornea. Keratoplasty is pany’s work force is visually impaired. In January not effective for later-stage dystrophy. Severe, 2001, the company acquired the accessibility divi- painful forms of this disease are treated with sion of OMNI PC Systemintegration, GmbH, a Ger- cryotherapy; a cryoprobe is applied to the sclera of man PC software distributor and consulting the CILIARY BODY to alleviate the pain. company. The new division of Freedom Scientific will oversee the distribution in Europe of all the Washington Academy of Eye Physicians and Surgeons. company’s products. Fuch’s Corneal Endothelial Dystrophy. On the Inter- net at: www.wa-eyemd.org, 2001. Contact: Freedom Scientific, corporate office fundus The term for the back section of the inner 760-602-5232 eye. It contains the RETINA, the CHOROID, and the www.hj.com OPTIC NERVE. Freedom Scientific Blind/Low Vision Group The retina is the section of the eye where light 11800 31st Court North information is processed and sent to the brain St. Petersburg, FL 33717 where it is transformed into an image. The choroid www.freedomscientific.com is the pigmented layer behind the retina that sup- fundus photography 99 plies the eye with blood. The optic nerve is the cord disorders within the eye and to determine other of nerve fibers that acts as a conduit to transmit diseases of the body, such as hypertension, dia- information from the eye to the brain. betes, and arteriosclerosis. The fundus can be viewed with an instrument called an OPHTHALMOSCOPE. This handheld instru- fundus photography See FLUORESCEIN ANGIOGRA- ment lights and magnifies the fundus for examina- PHY. tion. Examination of the fundus, called funduscopy or ophthalmoscopy, allows the examiner to detect

G galactosemia A rare, congenital disease that pre- and roughly one of every 80 persons carries the vents infants from metabolizing galactose, a sugar recessive gene for RP. The disease most often is found in milk. Galactosemia occurs in about two of diagnosed during childhood or young adulthood every 100,000 births. As a result of the inability to and may lead to blindness or severe visual impair- process the galactose, it accumulates in the blood ment. and lens of the eye. The galactose in the lens USHER’S SYNDROME occurs when those with RP absorbs water and disrupts the lens fibers forming are also born deaf. Usher’s syndrome is the leading vacuoles, or pockets of liquid in the tissue. Bilateral cause of deaf-blindness and accounts for more than CATARACTS form from these vacuoles. half of all adults seeking rehabilitative services for Cataracts may be avoided or reduced in severity deaf-blindness. by early removal of milk and milk products from There is no treatment or cure for RP or Usher’s the diet. Dense opacities may be surgically syndrome. Low-vision aids may be helpful, and removed within the first month. Early extraction genetic counseling may help define the risks to rel- limits the possibility of developing amblyopia. atives and future offspring. Inherited MACULAR DISEASE, also called macular genetics the study of genes, segments of DNA dystrophy, is almost always a genetic disorder that located on the chromosomes that carry informa- appears at birth or up to age six. This disorder tion for all inherited characteristics. Genetics destroys the MACULA, or center of sharpest vision of explores the heredity and variation of organisms the RETINA. Although the disorder blurs and even- and the conditions that affect them. Genetic disor- tually may eliminate central vision, most patients ders are diseases caused by gene abnormalities or retain some peripheral vision. There is no medica- irregularities. Genetic disorders may be evidenced tion or cure for macular degeneration but a small at birth as congenital diseases or may surface as a number of patients may benefit from laser treat- disease or disorder later in life. ments. Over 3,000 major and minor hereditary disor- Genetic CATARACTS appear at birth or later in ders have been identified, 30 percent of which childhood as infantile or juvenile cataracts. The affect the eye. Hereditary and congenital diseases lens may be partially or completely opaque at birth. cause one in every five cases of blindness in the Surgery to remove dense cataracts may occur fol- United States. Thousands more are affected by lowing the neonatal period, but it is often post- these visual disorders to a less severe degree. poned until the density threatens to affect the Genetic factors are the major cause of blindness for child’s performance at school or home. After children from birth to six years. The cost of health surgery, patients may develop AMBLYOPIA or RETI- care, aid to disabled persons, and lost income due NAL DETACHMENTS. to visual disorders, many of which are genetic dis- Some corneal dystrophies are genetic and may eases, is in the billions of dollars. appear early in life or in middle age. Corneal dys- RETINITIS PIGMENTOSA (RP), a retinal degenerative trophies lead to the formation of opacities and may disease, is the most common of all inherited retinal result in blindness or vision impairment. Treatment disorders. It affects approximately 100,000 persons may include corneal transplantation.

101 102 glaucoma

SICKLE-CELL DISEASE is a single cell disorder that Impaired. Vol. 2 Alexandria, VA: Association for Edu- affects one in every 400 Americans of African cation and Rehabilitation of the Blind and Visually descent. The trait is present in one of every 10 Impaired, (1984, 1985): pp. 46–49. Americans of African descent. Sickle-cell disease Maumenee, Irene. “Discoveries in Genetic Eye Disease.” Sight-saving vol. 53, no. 4 (1984–85): 14–15. may cause blockage of the blood vessels in the CON- JUNCTIVA, CHOROID, or RETINA. Sickle-cell retinopathy and vision loss may result. There is no cure for glaucoma Glaucoma is group of eye diseases sickle-cell disease. Visual complications are treated responsible for over 8.5 million cases of blindness with varying results using scleral buckling and in the world. It is estimated that 3 million Ameri- photocoagulation therapy. cans have glaucoma, and about 67 million people Tumors may be genetic and congenital. worldwide. It is the second most common cause of RETINOBLASTOMA is the most common intraocular blindness in the United States and the most com- tumor in children. The malignancy is usually pre- mon cause among African Americans. According to sent at birth and may be inherited. It may occur in Prevent Blindness America, approximately one of one or both eyes. Treatment often involves enucle- every seven blind Americans is blind as a result of ation, or removal of the eye, but in less severe cases glaucoma. may include radiation, chemotherapy, or cryother- The disease affects roughly 1 percent of people apy treatments. over age 40. Those at most risk of developing glau- Color blindness is a single gene disorder pre- coma are those with a family history of glaucoma, dominant in males. The inherited characteristic is those over 40, blacks, diabetics, extremely near- transmitted by the male chromosome. The disorder sighted individuals, and those with undersized, far- does not affect the visual field or visual acuity. sighted eyes. Other diseases and conditions that result in Glaucoma is characterized by an abnormal rise visual impairments or blindness are genetic in in intraocular pressure, a condition affected by the nature. These include albinism, galactosemia, Mar- AQUEOUS FLUID. The ANTERIOR CHAMBER of the eye is fan’s syndrome, and Down’s syndrome. Diabetes filled with aqueous fluid, a watery fluid that brings may also be linked to genetic defects that react to nutrients to the avascular CORNEA and LENS and environmental or other factors. removes waste material. Genetic research with an emphasis on the eye The ciliary epithelium constantly produces new and vision continues. Recombinant DNA technol- aqueous that circulates through the anterior cham- ogy is producing new knowledge about gene func- ber and drains from the eye at the anterior angle. tion, diseases and treatments of the eye. The The aqueous passes through a meshwork grill research strives to identify and confine the under- called the trabecular meshwork, into the lying genetic defects in cataracts, retinal degenera- Schlemm’s canal, and out of the eye. When the eye tions, color vision disorders, and inherited ocular overproduces aqueous or the drainage systems of tumors. the eye inhibit the drainage of the aqueous, the Genetic counseling may determine the risk of pressure inside the eye increases. disease for future children by determining the As the pressure builds, it affects the function of chances for recurrence. Genetic counselors also the RETINA and OPTIC NERVE. The blood supply to describe methods of diagnosis (such as amniocen- these organs is reduced, nerve cells and fibers are tesis) and recommend reproductive options. (See destroyed and blindness results if not treated. CONGENITAL DISORDERS.) There are many types of glaucoma, but the two most common forms are open angle (also called Galloway, N. R. Common Eye Diseases and Their Manage- ment. Berlin: Springer-Verlag, 1985. wide-angle or chronic glaucoma) and angle closure Kaiser-Kupfer, Muriel I., and Julian Morris. “Advances in (also called narrow-angle or acute glaucoma). Human Genetics—The Long Range Impact on Blind- Open-angle glaucoma accounts for approxi- ness and the Visually Impaired.” Yearbook of Association mately 70 percent of all cases of glaucoma. It occurs for Education and Rehabilitation of the Blind and Visually when the angle of drainage is open, but the aque- glaucoma 103 ous fluid is unable to percolate through the mesh- Perimetry is a test that measures and maps the work. It is bilateral, may be inherited and rarely field of vision. The patient looks into a bowl- affects those under age 40. shaped device. Points of light are flashed into the The disease progresses slowly, painlessly, with bowl and the patient indicates when the lights few, transient symptoms. As the disease develops, it appear. destroys the optic nerve, constricts peripheral Glaucoma can be controlled but not cured. vision, which causes tunnel vision, forms scotomas, Treatment of glaucoma may include medication, or blank spots, in the field of vision and eventually surgery or laser therapy. Open angle glaucoma may destroys central vision. be treated with drops that reduce the size of the Angle-closure glaucoma accounts for roughly 5 pupil, inhibit production of aqueous or increase the percent of all glaucoma cases and occurs when the outflow of the drainage system. drainage angle is blocked by the IRIS. Angle-closure Medications used to treat glaucoma may be top- glaucoma usually develops in small, farsighted ical, such as eye drops or ointments, or oral. Med- eyes, which tend to have shallow anterior cham- ications that increase the outflow of aqueous from bers. Angle-closure glaucoma may be occasionally the eye are called miotics, and include Isopto Car- brought about by dilating drops. pine, Ocusert, Pilocar, and Pilopine. Other drugs Angle-closure glaucoma happens suddenly, that increase the outflow of aqueous fluid from the reducing vision and often producing pain. Symp- eye are called epinephrine compounds. These toms of angle-closure glaucoma include pain, red- include Epifrin and Propine. ness, pupil distortion, blurred or clouded vision, Beta-blockers and carbonic anhydrase inhibitors and halos around lights. help reduce the amount of aqueous produced in The disease may progress to rapid and perma- the eye. Beta-blockers include Betagan, Betimol, nent vision loss. Although the condition is not Betoptic, Ocupress, Optipranalol, and Timoptic. always bilateral, approximately half of patients Carbonic anhydrase inhibitors include Alphagan, with angle-closure glaucoma affecting one eye will Iopidine, and Trusopt. develop the condition in the unaffected eye with- In 1996 the U.S. Food and Drug Administration out preventative surgery. approved a new glaucoma medicine called lata- Glaucoma may be diagnosed during a routine noprost. Marketed as Xalatan, it works near the ophthalmologic examination by symptoms of drainage area of the eye to increase the secondary raised intraocular pressure, cupping of the OPTIC route of aqueous outflow. DISC, and visual field loss. Three tests—tonometry, Oral medications used to control glaucoma GONIOSCOPY, and perimetry—may be performed in include Daranide, Diamox, and Neptazane. These the screening, diagnosis, and treatment of glau- are carbonic anhydrase inhibitors, which work to coma. slow the production of aqueous fluid in the eye. Tonometry is a simple, painless method of mea- Surgery is indicated if the medication fails to suring intraocular pressure. An instrument called a correct the increase in intraocular pressure of TONOMETER is gently touched to the open eye and open-angle glaucoma, and in cases of angle-closure records the amount of pressure that is within the glaucoma that cannot be corrected with medica- eye. It is recommended that all individuals over 40 tion. Two major forms of surgery are IRIDECTOMY be screened for glaucoma with tonometry on a and filtering surgery called TRABECULECTOMY. yearly basis. An iridectomy is a surgical procedure in which a Gonioscopy is a test to examine the angle of the portion of the iris is removed with a laser to elimi- anterior chamber. The examiner looks through a nate the blockage of closed-angle glaucoma and mirrored lens called a gonioscope to estimate the prevent further attacks. It may be performed pre- angle of the chamber. The procedure indicates ventively on an unaffected eye that is predisposed abnormalities or changes in the angle of the cham- to the condition. ber and assists the examiner in prescribing treat- A trabeculectomy is performed when the dam- ment. age to the drainage angle has occurred due to 104 gonioscopy angle-closure or open-angle glaucoma. It bypasses gonioscopy Gonioscopy is a test to determine the the damaged meshwork and creates a new width of the angle of the eye’s ANTERIOR CHAMBER. drainage tract to allow the aqueous to flow from This angle, formed by the CORNEA and the IRIS,is the eye. the place where fluid drains from the eye. If the Laser therapy may be employed in a laser tra- angle becomes narrow or blocked, the fluid cannot beculoplasty, which opens the drainage area drain effectively, pressure builds up within the eye located where the cornea meets the iris. A series of and GLAUCOMA may develop. 100 laser burns are placed in the drainage area, The angle of the chamber is examined with a which causes scarring and opens the meshwork of gonioscope, sometimes called a gonioprism. This drainage channels. The fluid drains more easily instrument is a mirrored lens, which the examiner from the eye, and intraocular pressure is reduced. holds up to the patient’s eye. Gonioscopy is per- A fairly new program called seton placement is formed during glaucoma screening and the routine being used to treat glaucoma, and involves placing eye examination of a person with glaucoma. The a tube-like device into the eye, allowing fluid to procedure detects abnormalities or changes in the drain. angle of the chamber and assists the examiner in Secondary glaucoma may occur as a result of prescribing treatment. another disease or disorder such as vascular eye Gonioscopy is a routine part of a presurgical eye disease, UVEITIS, tumors, trauma, eye surgery, or in examination for those undergoing CATARACT reaction to drugs such as local or systemic steroids surgery. The surgeon may administer cycloplegic or or dilating drops. dilating drops prior to surgery, which could further Congenital glaucoma is a rare and often inher- restrict a narrow angle and cause complications. In ited condition. The raised intraocular pressure level addition, if an anterior chamber INTRAOCULAR LENS may be present at birth or develop some months (IOL) implant is planned, the gonioscopy could after. This type of glaucoma is caused by a defective indicate the amount of space, or lack of space, development or formation of the angle of the ante- available to accommodate the implant. rior chamber. Gonioscopy may be performed on any patient Symptoms of congenital glaucoma include prior to the application of cycloplegic drops. During bulging eyes, photophobia, and CORNEAL EDEMA. an examination or other procedure, cycloplegic The treatment involves goniotomy, a surgical pro- drops may be used in a patient with a narrow angle cedure that opens the trabecular meshwork. (See if care is taken to ensure that the PUPIL has returned LASERS.) to normal size after the procedure.

American Foundation for the Blind. Understanding and Living with Glaucoma, New York: AFB, 1984. gonorrhea A type of venereal or sexually Blacker, M. M., and D. R. Wekstein, eds. Your Health after transmitted disease. It is the most frequently Sixty. New York: E.P. Dutton, 1979. reported communicable disease in the United Cooley, Donald G. After 40 Health and Medical Guide. Des States. Approximately 1 million cases of gonor- Moines, Iowa: Better Homes and Gardens Books, rhea are reported each year, a ﬁgure that the Cen- 1980. ters for Disease Control estimates to be roughly International Association of Lion’s Clubs. Glaucoma. Oak only half of all cases contracted in the United States Brook, Illinois: IALC, 1987. annually. Medem Medical Library. “Important Facts About Glau- Gonorrhea is caused by the gonococcus bacteria coma.” www.medem.com, 2000. and may result in blindness when contracted con- Prevent Blindness America. Glaucoma: Sneak Thief of Sight. genitally. The disease is passed from mother to New York: NSPB, 1985. Reynolds, James D. Glaucoma. HealthNet Library. Colum- child during birth. As the child moves through the bus: CompuServe, 1989. birth canal the eyes come into contact with the Reynolds, James D. Glaucoma Surgery. HealthNet Library, gonococcus bacteria growing in or near the cervix Columbus: CompuServe, 1989. and become infected. Graves’s disease 105

The infection, called gonococcal ophthalmia, or various consolidated programs, general guidelines ophthalmia neonatorum in the case of newborns, of percentages are usually set. causes severe conjunctivitis. Early symptoms Discretionary grants are distributed to state and include swelling and redness of the CORNEA, CON- local governments and dispersed to other institu- JUNCTIVA, and eyelids. Without treatment, the con- tions, including universities and private organiza- dition may progress to damage the cornea and tions. Unlike formula or block grants, discretionary result in blindness. grants fund small, undiversified programs. They are Adults may contract gonococcal ophthalmia by administered by a federal agency and often include exposing the eyes to anything carrying the bacte- grants for training, research, experimentation, ria. Adults exhibit more severe signs and symptoms demonstration, evaluation, planning, construction, than newborns, including a copious pus-like dis- fellowships, and scholarships. charge. Blindness can result from untreated cases. The Office of Management and Budget pub- Gonorrhea in adults may be diagnosed from a lishes the Catalog of Federal Domestic Assistance, which Gram’s stain or a cervical culture. describes federal programs, projects, and services Treatment for gonococcal ophthalmia involves that provide public assistance or benefits. The cata- use of local antibiotic drops or ointments such as log lists goals, guidelines, eligibility requirements, penicillin or tetracycline. Systemic or injected application process, and specific interest location antibiotics may also be prescribed. indices. The catalog is available from the Superin- At one time, congenital gonorrhea was the lead- tendent of Documents, U.S. Government Printing ing cause of blindness in children. The passage of Office, Washington, DC 20402 (202-783-3238). It laws in all states requiring the administration of sil- can also be accessed on the Internet at the Catalog ver nitrate drops, or comparable antibiotics, to the of Federal Domestic Assistance website at www. eyes of all newborn infants has drastically reduced cdfa.gov. its incidence. Many doctors also recommend that The Federal Register is a daily periodical that pregnant women be tested for gonorrhea before informs the public of all federal agency regulations, giving birth. funding information, and policy changes. It provides information concerning federal grant background data, eligibility requirements, and funding grants Grants are available from the federal gov- information. ernment to disabled individuals and agencies serv- The Federal Register is available in public ing the visually impaired. The grants may be in the libraries and in many organizations that serve the form of formula grants, block grants, or discretion- disabled. It can be obtained through the Superin- ary grants. tendent of Documents for subscription and is Formula grants are funds allocated to local and available on DIALOG Information Services and state governmental agencies rather than individu- System Development Corporation. It can also be als or institutions. They provide support for estab- found online at the National Archives and Records lished major state programs concerning the Administration website at www.access.gpo.gov/ disabled. The amounts of the grants are determined su_docs/aces/aces. by criteria such as population, per capita income, unemployment rate, and percent of population made up of disabled individuals or disabled veter- Graves’s disease Graves’s disease or hyperthy- ans. roidism is a disorder of the immune system. The Block grants also provide ongoing support for Irish doctor Robert Graves first described the dis- programs for the disabled but are specially designed ease in 1835. to fund programs that have been consolidated into The disease is hereditary and affects approxi- another program and were formerly separately mately one of every 1,000 people. It is often diag- funded. Although states are allowed great discre- nosed among young women and teenage girls or tion in dividing the block grant funds among the among late-middle-aged persons of either sex. 106 Guide Dog Foundation for the Blind, Inc.

The disease was once thought to be caused by If the symptoms are mild, the disease may be stress but is now recognized as a disorder of the treated with antibiotic ointments for keratitis and autoimmune system. In this disorder, the immune tarsorrhaphy, a stitching of the lids, to improve lid system produces antibodies against cells in the thy- retraction. In more severe cases, steroids may be roid gland causing it to overproduce hormones. prescribed to reduce swelling. Muscle surgery and The hormones, which regulate the body’s metabo- surgery for decompression of the orbits may lism, increase the metabolism in many of the become necessary. body’s tissues causing the symptoms of nervous- It is recommended that people with Graves’s ness, weight loss, sensitivity to heat, and tremors. ophthalmopathy care for their eyes by applying cool Graves’s disease is treated with medication or compresses to sooth them. Also, wearing sunglasses radioactive iodine treatments. Drugs such as methi- protects vulnerable eyes from ultraviolet light and mazole, pills that block thyroid hormone produc- bright light, which can be uncomfortable. Lubricat- tion, may be prescribed. As a side effect, they may ing eyedrops may relieve dry, scratchy sensations rapidly destroy the body’s white cells and are on the eyes. And elevating the head to keep the therefore generally used for short periods only. head higher than the body reduces the blood flow Radioactive iodine treatments involve drinking to the head and may relieve pressure on the eyes. a liquid solution containing radioactive iodine. The iodine treatments destroy the thyroid gland after Guide Dog Foundation for the Blind, Inc. Guide two to three months. After the thyroid gland ceases Dog Foundation for the Blind, Inc., founded in to function, a daily hormone supplement pill is 1946, is a nonprofit organization that breeds and taken to sustain appropriate hormone levels. The trains dog guides for qualified blind clients. radioactive iodine treatments have been used suc- Qualified clients must be legally blind, physically cessfully for 40 years and have relatively few side ambulatory, and in good physical health and a effects. In some cases, surgery to remove most of minimum of 16 years old. The applicant must be the thyroid gland is performed. able to provide adequate food, housing, and care In some cases, Graves’s disease may also develop for the dog. into Graves’s dermopathy or Graves’s ophthal- The organization breeds golden retrievers and mopathy. Graves’s dermopathy is a rare condition Labrador retrievers. The dogs and their new own- in which the skin becomes inflamed due to a dys- ers receive training together over a 25-day in-resi- function in the immune system. dence instruction period. Over half of all patients with Graves’s disease The dog, training in its use and care, and in- develop Graves’s ophthalmopathy. It is a condition residence services are provided free of charge. The in which the immune system attacks the muscles foundation receives no governmental aid but relies and tissues of the eyes. on corporate and private contributions. Symptoms of Graves’s ophthalmopathy may Contact: include mild conjunctivitis, tearing, eyelid retrac- Guide Dog Foundation for the Blind, Inc. tion, protruding eyeballs, and impaired or con- 371 E. Jerico Turnpike stricted vision. Eyelid retraction and protrusion of Smithtown, NY 11787 the eyeballs may lead to exposure keratitis, an 631-265-2121 or 1-800-548-4337 (ph) inflammation of the cornea and corneal ulceration. 631-361-5192 (fax) Symptoms of Graves’s ophthalmopathy may be exhibited in the absence of other symptoms of The organization can be located on the Internet at Graves’s disease. It may be seen in patients previ- www.guidedog.org. ously treated with radioactive iodine or in those who are without thyroid dysfunction. The condition is Guide Dogs for the Blind, Inc. A nonprofit orga- serious, and although it may spontaneously resolve nization founded in 1942 that provides trained dog itself after three or four years, it can cause blindness guides for use by qualified blind individuals. The before resolution if the condition is not treated. school breeds and trains German shepherds, guide horses 107

Labrador retrievers and golden retrievers and pro- Contact: vides in-residence training for blind individuals in Guiding Eyes for the Blind, Inc. the use of dog guides. It has placed more than 611 Granite Springs Road 7,500 dogs with people since its start. Yorktown Heights, NY 10598 Licensed instructors from the school provide 800-942-0149 or 914-245-4024 (ph) dog-guide recipients with a 28-day training course 914-245-1609 (fax) in dog-guide use, grooming and care and provide www.guiding-eyes.org follow-up services to clients. Qualified recipients must be legally blind, over age 16, and physically Founded in 1999 by and temperamentally suited to use a dog guide. Guide Horse Foundation Janet Burleson, a former horse trainer, the Guide Guide Dogs for the Blind, Inc. is supported by Horse Foundation trains small horses known as voluntary contributions in the form of member- dwarfed, or pigmy, horses to assist visually im- ships, memorial and honorary gifts, grants, and paired people with travel. bequests. Clients are not charged a fee for the dog, Burleson decided to begin training small horses to the in-residence training in the dog’s use, trans- assist blind people after she and her husband, Don, portation to and from the school, dog handling rented and rode standard-size horses during a visit to equipment, or follow-up services. The organization Central Park in New York City. They were extremely has training facilities in San Rafael, California, and impressed with the horses’ ability to remain calm Boring, Oregon. Its headquarters are in San Rafael. even in heavy traffic and with how they understood Contact: that they could turn right on a red light. When Guide Dogs for the Blind, Inc. Burleson returned to her home in Kittrell, North P.O. Box 151200 Carolina, she taught her pet dwarfed horse, Twinkie, San Rafael, CA 94915 to lead a blind woman through the local mall. 415-499-4000 or 800-295-4050 The program is still very new, and horses are just www.guidedogs.com beginning to be placed with visually impaired people. The foundation depends on volunteers to donate, train, and deliver trained horses to those Guiding Eyes for the Blind (GEB) A nonprofit who need them and has a waiting list of more than training school and breeding farm of dog guides. 30 people who would like to have a trained horse Founded in 1954, GEB breeds and trains Labrador for assistance. retrievers, German shepherds and golden retriev- Contact: ers, and provides in-residence training to qualified blind clients from around the world. It has matched Guide Horse Foundation more than 5,000 dog/people teams. 2729 Rocky Ford Road Dog-guide applicants must be 16 years of age, Kittrell, NC 27544 legally blind, ambulatory, self-motivated, and phy- 252-433-4755 sically and psychologically able to care for a dog. www.guidehorse.com GEB accepts applications from those with multiple handicaps, and there is no maximum age limit. guide horses Used in much the same way as Dog-guide recipients receive in-residence training guide dogs, guide horses are a mobility alternative over a 26-day period. Services are provided at no for visually impaired people. They typically are charge. small horses, known as dwarfed or pigmy horses. Students provide their own transportation to Although horses have been recognized for their and from the school, but GEB may pay transporta- ability to guide and lead for many years, they only tion costs or find a sponsor to pay if the applicant recently have been trained to assist visually cannot afford to do so. GEB receives no govern- impaired people. mental funding and is supported by corporate and The Guide Horse Foundation, located in North personal contributions. Carolina, trains horses that meet the criteria to be 108 guide horses a guide horse and provides the animals free of situations when trained to do so. Because their charge to visually impaired people who qualify. eyes are located on the sides of their heads, they The horses must pass a physical examination by an have a very wide range of vision. They also have equine veterinarian and are tested for intelligence. very good night vision. They are trained to wear They must be no more than 26 inches high at the special sneakers so they do not skid on smooth sur- withers, must have structurally sound legs, and faces. demonstrate good stamina. The Guide Horse Foundation reports that Guide horses are recommended for rural or sub- dwarfed horses are very clean and can be house- urban use. They are popular among blind people broken. They do not get fleas, and horses shed only who are allergic to dogs or afraid of dogs, those twice a year. Although the organization recognizes who love horses, and those who want an animal that guide horses are not right for everyone, it with a longer life span than a dog has. Dwarfed claims that many people do extremely well with horses typically live to be between 25 and 35 years the small animals and are able to move very confi- old and have been known to live to be 50. Advo- dently with them. More information about guide cates say that horses are easier for people who have horses can be obtained by contacting: physical disabilities to use than dogs are, due to the docile nature of the dwarfed animals. And, some Guide Horse Foundation people prefer using horses because they can be 2729 Rocky Ford Road housed outside. Horses are natural guide animals, Kittrell, NC 27544 have good memories, and remain calm in difficult 252-433-4755 H

Hadley School for the Blind The Hadley School The word handicap stems from “cap in hand,” a for the Blind, founded in 1920 by William A. reference to beggars. Because of this negative con- Hadley, offers over 100 accredited home-study notation, the word disability is often the preferred instruction courses for blind and visually impaired term. When the term visually handicapped is applied individuals throughout the world. Courses range to a child it usually refers to the requirement for from those for high school diploma and college special educational provisions due to the sight loss. preparation to adult-education courses. The courses cover six categories of education, Hansen’s disease See LEPROSY. including academic, vocational, personal enrichment, parent/child, compensatory, and rehabilitation and technical. Course materials are available haptic sense The haptic sense refers to the sense in braille or cassette textbook form by mail or tele- of touch. It is used extensively by blind and visually phone. Some also are available online. impaired individuals to gather information. The Hadley School courses are available tuition free other senses of hearing, taste, smell, and sight are to legally and functionally blind individuals, those associated with a central organ to receive the infor- with a hearing impairment with prognosis of visual mation and transmit it to the brain. The haptic loss, and sighted professional, paraprofessional, or sense is not centrally located but receives informa- family members interested in assisting blind and tion throughout the body via the skin. deaf-blind students enrolled at Hadley. Students The haptic sense defines temperature, shape, must be able to read and understand course mate- size, texture, moisture and consistency, movement, rial written at high school level. and presence. It is used as a compensation for sight, Contact: as in the performance of tasks, or perceptually, as Hadley School for the Blind in reading braille or using an abacus. Early stimu- 700 Elm Street lation of the haptic sense is especially important to Winnetka, IL 60093 blind infants and children. It helps to link the 800-323-4238 (ph) infant to the surrounding world and indicate the 847-446-0855 (fax) presence of a protective or loving person. www.hadley-school.org Blind infants and children rely heavily on the haptic sense for developmental progress. Since the handicap There is no complete consensus on lips and hands of the body have large concentra- terms concerning the topic of blindness and vision tions of sensitive haptic receptors, blind children impairment, since experts in the field (educators, tend to mouth and handle objects longer than rehabilitation specialists, doctors) define the TERMI- sighted children in an effort to gain information. NOLOGY according to their own preferences and Blind and visually impaired children rely on the viewpoints. In recent years, those involved in the haptic sense for aid in movement and exploration, field of blindness and vision impairment have essential developmental activities. Tactual expe- made efforts to standardize terms such as handicap riences such as fondling a stuffed animal may to eliminate confusion or misinterpretation. be stimulating for a blind child and alleviate the

109 110 heat cautery need to develop self-stimulating behaviors such as The agency surveys the causes and rates of rocking. blindness in an area and maintains data on the Factors such as the ability to move the hands, effectiveness of the treatment provided. Recent finger dexterity, wrist flexibility, and motor control studies by the organization have concluded that may affect the effectiveness of the haptic sense. If vitamin A distribution has not only alleviated the haptic sense itself is impaired, information blindness due to malnutrition, but has also helped gathering may be impaired. Those who have lost to improve child survival rates. sensitivity of touch in the fingertips due to diabetic Contact: neuropathy may be unable to feel the detail neces- Helen Keller International sary to read braille, and those with motor-control 90 West Street, 2nd Floor problems may be unable to direct the hands in New York, NY 10006 place to gather information. 212-766-5266 (ph) 212-791-7590 (fax) heat cautery See PHOTOCOAGULATION. www.hki.org

Helen Keller International (HKI) An Ameri- Helen Keller National Center for Deaf-blind can, nonprofit, voluntary organization that works Youths and Adults (HKNC) A comprehensive with foreign countries to prevent blindness, treat rehabilitation, research and training facility estab- eye disorders and assist those who are perma- lished in 1967 by an act of Congress. HKNC is nently blind. It was founded in 1915 by Helen funded by annual Congressional appropriations Keller and others to assist European servicemen and is operated by Helen Keller Services for the blinded in World War I. It has since offered aid to Blind, under supervision of the Rehabilitation Ser- 80 nations but now works exclusively in develop- vices Administration. ing countries. The HKNC program consists of training and HKI provides aid to countries developing eyeresearch headquarters in Sands Point, Long Island, care components to basic health services. It works New York, 10 Regional Offices, and extensive Affil- with governments and voluntary organizations to iated Agency Programs. The residential school at improve blindness-prevention programs by provid- the headquarters offers instruction in orientation ing managerial and material aid. and mobility, communication skills, speech, audi- The agency trains and sends eye-care profes- tory and low-vision training, basic education, sionals to rural areas and eye surgeons to urban work-experience programs, psychological and hospitals. The personnel diagnose and treat eye dis- medical services, industrial arts, daily living skills, orders and refer patients for additional care. home management, industrial arts, creative arts, The organization distributes vitamin-A capsules leisure activities, and horticulture. to fight blindness resulting from malnutrition. It The Regional Offices support state and local conducts programs that offer nutritional education agencies serving deaf-blind persons by offering and food fortification to alleviate vitamin A defi- assistance and consultation services. Regional Rep- ciency in the diet. resentatives locate and refer deaf-blind persons to HKI works to integrate permanently blind chil- appropriate services, aid in resettlement, assist in dren and adults into the activities of their families, finding employment opportunities, and serve as an villages, and towns. The organization trains coun- advocate for services to the deaf-blind population. selors, fieldworkers, and schoolteachers in the HKNC provides temporary financial support to development of community-based education and Affiliated Agency Programs, public or private agen- rehabilitation programs. Programs include counsel- cies that work to develop or expand services to deaf- ing parents of blind children, education of school- blind individuals throughout the country. The age children, daily living skills training, and adult center acts as a clearinghouse and resource center of vocational training. information for the deaf-blind, their families, and herpes simplex 111 professionals working in related fields. It maintains brain and eye, the vision may be lost and then may a National Register of deaf-blind individuals to pro- suddenly return in a matter of minutes. Usually, vide statistics concerning the deaf-blind population the vision lost due to these attacks is completely that are used in planning appropriate services. recovered within 24 hours. HKNC designs and improves sensory aids, maintains a National Training Team that works in the A virus that causes most corneal field, offers training seminars to rehabilitation herpes simplex blindness due to infection in the United States. workers, and sustains a Community Education Program to educate the public as to the needs and According to the National Institutes of Health, abilities of deaf-blind persons. 500,000 cases of ocular herpes simplex are diag- Contact: nosed each year. Herpes simplex is the most common virus found in humans. Helen Keller National Center for Deaf-Blind Herpes simplex is one of four types of herpes Youths and Adults virus that also include HERPES ZOSTER, cytomega- 111 Middle Neck Road lovirus, and Epstein-Barr virus. Herpes simplex may Sands Point, NY 11050 infect the genitals, skin, brain, and eyes. All herpes 516-944-8900 (ph) viruses contain a central core of DNA, the genetic 516-944-8637 (TTY) code of the organism, enveloped by a layer of pro- 516-944-7302 (fax) tein. The organism cannot reproduce itself but must www.helenkeller.org/national obtain reproduction molecules from a healthy host human cell. The virus invades a healthy cell and helping blind people See ETIQUETTE. uses its molecular properties to reproduce. After prolific reproduction, the host cell may burst. hemianopsia A loss of vision in one-half of the Herpes simplex virus cells usually enter the body eye. This results in a loss of the right or left half of through the mouth, genitals, or eyes. In the past, the field of vision. Objects or people in the field of those infections that occurred above the waist were vision may appear to be cut in half. commonly referred to as Type I, and those below Hemianopsia is a common symptom of migraine the waist were referred to as Type II. However, the headaches. It occurs during the preheadache or above and below the waist categorizations are used prodrome stage. The loss of vision may be accom- less commonly since Type I herpes is now fre- panied by shimmering zigzag light patterns and quently seen below the waist and Type II is increas- blind spots called scotomas. Hemianopsia accompa- ingly diagnosed above the waist. nying migraines usually lasts from five minutes to Approximately 90 percent of the population has one hour. The lost vision generally returns with the been exposed to and infected by herpes simplex. onset of the headache. Most first infections are generally Type I and usu- Retinal migraine occurs when a spasm occurs in ally infect the mouth. The symptoms of fatigue and the blood vessels in the retina of one eye. One half a low-grade fever may go unnoticed. Others may of the vision of the affected eye is lost but the unaf- have a more severe infection that is called primary fected eye retains full vision. The condition is tem- herpes. In each case, the infection appears to run porary and abates with the migraine. its course, and the symptoms disappear. Hemianopsia is also associated with strokes. As a After the symptoms subside, the virus has not result of a stroke, vision may be blurred or lost in been killed. Herpes simplex Type I passes through one half of the field of vision, or the entire vision nerves in the mouth or skin to deep nerve tissue in one eye may be lost. Recovery of this visual loss centers, called ganglia, located the base of the brain depends on the damage done during the stroke and and upper spinal cord. Herpes Type II travels the progress made during recovery. through nerves to the ganglia at the base of the As a result of a focal transient ischemic attack, a spinal cord. Here the virus lies dormant. The virus temporary disruption of the flow of blood to the may remain dormant or reactivate and reinfect the 112 herpes zoster body. During latency, healthy host cells are not Most patients do not experience a recurrence infected, and the virus cannot be passed to others. after an initial recurrent attack. A patient has a 25 Herpes simplex may infect the eyes in one of percent chance of a new recurrence within five three ways: congenitally, primarily, or recurrently. years of the first and the possibility of additional Congenital herpes is contracted by infants during recurrences increases with each attack. However, birth. If the mother has active genital herpes, the the virus is unpredictable, and the recurrences may infant may become exposed to the virus when the suddenly discontinue for no known reason. water breaks or when traveling through the birth Herpes keratitis is treated with the drugs vidara- canal. It is estimated that 1 of every 7,000 births bine, trifluridine, idoxuridine, acyclovir, and anti- involves infection of the newborn from the mater- viral eye drops or ointments. These drugs are not a nal reproductive system. cure for herpes. They stop the reproduction of viral Congenital herpes is a serious disease that car- cells but cannot rid the body of the virus. During ries a fatality rate of 50 percent. Survivors may periods of dormancy, the drugs are ineffective in retain permanent damage to the eyes, brain, liver, fighting the virus. or kidneys. Damage to the eyes usually concerns Severe scarring is treated with cortisone eye the retina but may also entail the CONJUNCTIVA, drops. Cortisone is a steroid that may actually OPTIC NERVE, LENS, and CORNEA. worsen the herpes infection and is therefore used If the mother is aware of an active case of geni- only for short periods of time. Severe vision loss tal herpes, a Caesarean section delivery may avoid due to scarring may in some cases be corrected newborn infection. However, mothers are often with a CORNEAL TRANSPLANT, or keratoplasty. unaware of the infection when the symptoms are U.S. Department of Health and Human Services. Vision mild or hidden, or when the virus is a first infec- Research: Report of the Corneal Diseases Panel. vol. 2, part tion. In these cases, congenital herpes may be 2, NIH Publication No. 83-2472 (1987) Washington, unpreventable. D.C.: USDHHS. Primary herpes infection of the eyes is rare in Review of Optometry Online. “Handbook of Ocular Dis- adults and generally occurs only in children or ado- ease Management, Herpes Simplex Keratitis.” lescents. The symptoms include fever, fatigue, www.revoptom.com/handbook/sect3m: 2001. swollen eyelids, CONJUNCTIVITIS, and a blistering rash around the eyes. The infection is usually mild herpes zoster Herpes zoster, or shingles, is a and short-lived. It can be treated with antiviral eye painful skin disease that may involve the eye. It is drops or ointments. caused by the same virus that causes chicken pox Recurrent ocular herpes is an eye infection, usu- or varicella. According to the National Institutes of ally involving only one eye, which happen as a Health, it is responsible for roughly 7 percent of all result of a reawakening of the herpes virus. The skin disorders, a substantial amount of which affect virus, which may have first infected the mouth, the eye. If you have shingles on your face to any travels to the fifth nerve ganglion, the trigeminal, extent, it is extremely important to see your eye where it remains dormant. The fifth ganglion has doctor promptly. connecting fibers to the upper part of the face, Generally, only one eye is affected. Complica- including the eyes. On reactivation, the virus trav- tions may include corneal ulcers, scarring and els back up these fibers and infects the eye. cataracts, which can cause loss of vision. Additional A recurrent infection is typified by redness, pain conditions may include recurrent KERATITIS and a watery discharge of the eye. Herpes keratitis, (corneal inflammation), increased eye pressure or corneal infection, iritis, an infection of the iris, resulting in GLAUCOMA, UVEITIS, secondary infec- glaucoma, and cataracts may result from this infections, and eye-muscle paralysis. tion. As the eye attempts to heal itself, corneal scar- Treatment of eye disease caused by zoster is ring may develop, followed by loss of vision. Each problematic. Corneal ulcers are often treated with recurrence increases the possibility of scarring and soft contact lenses that remain on the affected eye vision loss. for a period of months until the ulcers heal. Hoover, Richard E. 113

Keratitis is treated with antiviral drops or oint- and colleges, could be canceled after the student’s ments. These drugs are effective only when the graduation if the student entered a public-service virus is active. During periods of latency, they are field. These fields included teaching full time in a impotent. Since the virus is not destroyed, it may public or nonprofit school for disabled students. A become active again and the keratitis may recur. portion of the loan is canceled for each year of pub- Glaucoma is treated with medication or eye lic service. Loans awarded through the National drops and CATARACTS may eventually be removed. Defense Student Loan Program are also eligible for Eye muscle paralysis is not treatable with medica- cancellation by these amendments. tion or therapy but usually heals itself in time. Under Title VII, the act addresses accessibility Zoster scarring causes unique problems. Vision and usability of university and college buildings by loss caused by zoster scarring cannot be corrected disabled students. The Rehabilitation Act of 1973 by corneal transplantation. The scarred cornea and the Architectural Barriers Act of 1968 prohibit becomes vascularized, a condition in which blood discrimination toward disabled people in federally vessels invade the cornea and interfere with post- funded programs, including barring access to insti- transplantation healing. In addition, there may be tutions or buildings. Title VII funds reconstruction lid abnormalities and epithelial or tear function dis- or renovation grants that can be used to correct orders as a result of the scarring, which further barriers in existing buildings or to construct new complicate a transplant. An unsuccessful cornea buildings in accordance with the Architectural Bar- transplant may develop complications during heal- riers Act of 1968. ing that could result in the loss of the eye. U.S. Department of Education. Summary of Existing Legis- U.S. Department of Health and Human Services. Vision lation Affecting Persons with Disabilities. Washington, Research: Report of the Corneal Diseases Panel, vol. 2, part D.C.: USDE, 1988. 2, NIH Publication No. 83-2472 (1987). Washington, D.C.: USDHHS. Hoover, Richard E. Richard E. Hoover is credited with developing the long cane foot travel system, a Herplex See IDOXURIDINE. method of independent traveling using a long cane as an aid. Higher Education Act Enacted in 1965 to Born in 1915, Hoover began as a teacher and encompass and expand existing federal laws such physical training coach at Maryland School for the as the Morrill Act, the GI Bill, and the National Blind. At the time, there was no comprehensive Defense Education Act. system for teaching blind people how to use the Originally, the act provided grants and guaran- existing cane of the time, the white cane. Hoover teed loans for tuition and financial aid for instruc- found the white cane too short, heavy, and awk- tional materials or equipment. Additionally, the act ward for efficient mobility use. supported college libraries and community support As an army sergeant (and later lieutenant) in services, founded the Teacher Corps, and included World War II, he was transferred to the Valley policy-making language that increased accessibility Forge General Hospital in Phoenixville, Pennsyl- of handicapped and educationally disadvantaged vania, to work as the eye center’s director of phys- students to higher education. ical reconditioning, orientation, and recreation. Amendments made in 1972, 1976, 1980, and Convinced that the men needed a lighter, longer 1998 to revise the act included the creation of new cane, he experimented with several adaptations of grants and loans. Some of the accompanying con- the white cane until he developed the prototype ditions and stipulations of the loans aided disabled for the long cane. The new cane was made of students. metal with a plastic tip and a crook at the top. It Under Part E, Title IV, low-interest Perkins loans was up to 10 inches longer than the white cane, were authorized for students lacking financial half the diameter, and weighed only seven means. These loans, awarded through universities ounces. 114 hordeolum

Hoover developed a series of techniques for are established under Section 515 and Section 521 using the long cane in sweeping arc movements, of the act. low, in front of the body, rather than by the side. Section 515 offers guaranteed or insured loans The techniques were incorporated into the orienta- to owners of rural property rented by elderly or dis- tion and mobility program that was then trans- abled persons. The loans may be used to purchase ferred to the Veterans Administration Hospital at or construct new property, to improve existing Hines, Illinois, where word of its achievements property, to add special designs or equipment such spread. as ramps or grab bars to aid the elderly or disabled, Today, the Hoover methods and the long cane or to fund recreational or related services or facili- are universal components of orientation and ties. The loans are disallowed for nursing homes or mobility programs. Hoover entered medical school special-care institutions. after World War II and became a distinguished oph- The loans may be granted to individuals, part- thalmologist. He died in 1986. nerships, cooperatives, nonprofit organizations or trusts. Loan recipients must have sufficient security hordeolum An infection on the outside or inside and income to repay the loan and be able to accept of the eyelid, also called a sty. An external horde- all related loan obligations. olum is an infection of an eyelash follicle. As the Section 521 of the act establishes direct rent sub- sty begins to form, the entire lid swells and sidies for low-income families, including disabled becomes painful. A localized area on the lid margin or elderly persons. The families must live in rural then becomes red and swollen with pus. If un- rentals, rural cooperative housing, or farm-labor treated, the sty eventually bursts, drains, and heals housing. Families pay up to 30 percent of their net itself. income toward rent. A subsidy payment is made to An internal hordeolum is a sty on the inside of the landlord to compensate for the difference be- the eyelid. It is the result of an infection of a gland. tween this payment and comparable rental hous- If untreated, the hordeolum becomes inflamed and ing prices. swollen, and is called a chalazion. These chalazia The Housing Act of 1949 was celebrated and normally do not affect vision unless they are commemorated on its 50th anniversary. Cere- located in the middle of the upper eyelid, where monies were held November 3, 1999, at the Na- they can flatten the central cornea and distort tional Building Museum in Washington, D.C., to sight. Sties can be treated by holding a warm, damp mark the anniversary. cloth over the site for 20 minutes, three or four U.S. Department of Education. Summary of Existing Legis- times a day. Most sties and chalazia go away on lation Affecting Persons with Disabilities. Washington, their own, without medication. D.C.: USDE, 1988.

Housing Act of 1949 As amended, the Housing Housing Act of 1959 The Housing Act of 1959, Act of 1949, Title V, allows direct, insured loans for Section 202, establishes direct long-term federal the establishment and renovation of rural housing. loans to build, renovate, or manage rental housing The Housing and Community Development for disabled and elderly people. The loans are Amendments of 1977 allowed people with disabili- granted to private nonprofit organizations or cor- ties to participate in the program. A “handicapped” porations and consumer cooperatives at below- person, as described in Title V, is anyone with a per- market interest rates. The funds may be used to manent or long-term impairment that obstructs construct basic housing units or related facilities independent living and whose ability would be such as cafeterias, recreation halls, or medical-ser- improved by better housing. Those with develop- vices buildings. mental disabilities are considered eligible by the act. Families are eligible for such housing if their Two major programs offered by Title V affect dis- household consist of one or more persons who abled people. These housing-assistance programs are disabled or 62 years of age or older. Rent- Howe Press 115 al subsidies described under Section 8 of the Under Title I of this act, cities and urban counties Lower Income Housing Program of the United may apply for entitlement grants. A formula based States Housing Act of 1937 are available for this on the population, income level, and availability of housing. housing in the area is used to determine qualifica- The Supportive Housing Demonstration Pro- tion. Title I funds may be used to improve condi- gram is also described and funded by this act. The tions for disabled people by financing improvement program contains transitional and permanent of access to buildings, removal of architectural bar- housing projects for homeless disabled people. A riers, and renovation or construction of facilities, homeless disabled person is described by the act as including public centers for disabled persons. one who has a handicap and is homeless or at risk The funding application outlines area housing of becoming homeless or is living in a transitional and development needs and specifies long- and home. short-term goals to meet these needs. A list of nec- The transitional program supplies temporary essary actions, their locations, the resulting costs, housing and assistive services for homeless people. and contributing resources is included. Maps are The program strives to find permanent housing for added to show areas in which ethnic groups or residents within 18 months. Services of this pro- low-income families are concentrated. gram include housing location, medical and psy- The application requires a Housing Assistance chological care, child care, vocational training, Plan that outlines the area’s available housing and transportation, and other support. evaluates future housing-assistance needs for low- The permanent housing program provides long- income families. From these figures, one-year and term community-based housing and assistive ser- three-year housing assistance goals are determined vices. Homes must not exceed the resident limit of and listed. The plan suggests locations for construc- eight disabled persons. tion of new facilities or renovation of existing facil- Assistance for both programs fund the purchase, ities. rehabilitation, or renovation of existing facilities, Title I outlines nonentitlement grants as well. grants for modest renovation, transitional program These grants fund urban community-development operating costs and HUD technical support. and housing projects for non-entitlement areas. Section 232 of the Housing Act establishes fed- The funds may finance a variety of services, includ- eral mortgage insurance to finance or renovate ing the construction or purchase of public works board-and-care homes, intermediate-care homes, facilities, urban or economic renewal projects, and or skilled-nursing facilities. This loan insurance may housing renovation or code enforcement. be used to fund construction or rehabilitation of The act was amended in 1999 to establish and facilities sheltering 20 or more people who need sustain affordable housing in rural and remote skilled-nursing services or who require limited, areas affected by very low income levels and exces- continuous services by skilled or licensed personnel. sive outmigration. U.S. Department of Education. Summary of Existing Legis- U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, lation Affecting Persons with Disabilities, Washington, D.C.: USDE, 1988. D.C.: USDE, 1988.

Housing and Community Development Act of Howe Press The Howe Press of Perkins School 1974 The Housing and Community Develop- for the Blind was established as a printing department Act of 1974 authorized block grants as federal ment of the Perkins School for the Blind in 1835. It aid to urban areas. The grants are administered was renamed the Howe Memorial Press in 1879 under a program called the Community Develop- after the founding director, Dr. Samuel Gridley ment Block Grant program or CDBG. The grants Howe, and is commonly called the Howe Press. finance a variety of projects, including those that The goal of the Howe Press initially was to pro- benefit people with disabilities. duce books for the blind in Boston line type, a 116 Howe, Samuel Gridley raised and enlarged Roman alphabet. As braille Bridgman, a deaf-blind girl who became his stu- became the standard medium for books for the dent in 1837. blind, the Howe Press began to produce books in Howe founded a school printing department in braille. 1831 to produce reading materials for the students. The Howe Press began producing braille writing In 1879, three years after his death, the printing machines (braillers) in 1900. The Perkins Brailler department was named the Howe Memorial Press was developed in 1939 by David Abraham, a in his honor. Perkins shop teacher. The Howe Press began pro- Throughout his 44 years as director of Perkins ducing the Perkins Brailler after World War II, and School, he maintained an activism in the abolition it now concentrates on the manufacture of approx- of slavery and reform of public schools, prisons, imately 5,000 Perkins Braillers per year. and treatment of the insane. In 1843, he married The Howe Press sells the braillers, brailler acces- Julia Ward, author of the words for “The Battle sories, brailling slates, slate accessories, handwrit- Hymn of the Republic.” He died in 1876. ing aids and games, mathematical aids, music, maps, and braille paper by mail-order catalog. Contact: HumanWare, Inc. HumanWare Inc., formerly Sensory Aids Corporation, is a company that man- Howe Press of Perkins School for the Blind ufactures products and tailors services for use by 175 North Beacon Street both disabled and nondisabled individuals. The Watertown, MA 02172-2790 goal of the company is to make technology more 617-924-3490 (ph) accessible to the nontechnical person while provid- 617-926-2027 (fax) ing features attractive to those with highly developed technical skills. Howe, Samuel Gridley Samuel Gridley Howe Located in Loomis, California, the company is a was born in 1801 in Boston. He graduated from unit of Arianne Beheer B.V. of the Netherlands. Harvard Medical School in 1824 and offered his Arianne Beheer is owner of several companies services for six years as a soldier and surgeon to that together make up the world’s largest manu- Greece during the Greek War of Independence facturer of low-vision devices. HumanWare is a against Turkey. He continued to raise money for major distributor of print-access products for peo- relief shipments after his return to America in ple who are blind or have reading and learning 1831. disabilities. It works closely with the Overbrook In 1829, the New England Asylum for the Blind, School for the Blind in Philadelphia to implement the first school for the blind in the United States, advanced classroom technology for Overbrook was incorporated. In 1831, the state of Massachu- students and staff. setts hired Howe to serve as director. Howe jour- HumanWare print-access products include neyed to Europe to study prototypes and returned braille terminals, braille printers, CCTVs, talking in 1832 with two teachers. He opened the school in palmtop organizers, specially configured talking his home with six pupils. The school was renamed computers, scanners, and reading systems. The the New England Institution for the Education of firm also provides reading and writing software the Blind and finally the Perkins School for the and self-contained reading systems incorporating Blind after a wealthy philanthropist, Thomas Han- speech synthesis for people with learning difficul- dasyd Perkins, who donated a mansion to house ties or low reading competency. The company the school. recently introduced Braille Note and Voice Note, Howe developed new methods and devices for new Windows CE-based personal note takers, and instruction of the blind, including a variation of Braille Voyager, a new kind of braille terminal. raised-letter printing and textbooks on geography, A complete listing, descriptions, and prices of grammar, and spelling. He became internationally HumanWare’s products are available on the com- renowned for his successful instruction of Laura pany’s website at www.humanware.com. hyphema 117

Contact: sue-cell destruction due to lack of oxygen. In severe cases, the damage to the retina may destroy vision. HumanWare, Inc. Hypertension tends to run in families and may 6245 King Road be hereditary. It is also associated with obesity, Loomis, CA 95650 smoking, and lack of exercise. Many cases of 800-722-3393 or 916-652-7253 (ph) hypertension and the accompanying retinopathy 916-652-7296 (fax) exhibit few outward symptoms of the condition. The patient may be unaware of the hypertension hyperopia Hyperopia is farsightedness. This and may be first alerted to it during a routine med- occurs when the CORNEA and LENS cannot clearly ical or ophthalmologic exam. Since hypertensive focus an image onto the RETINA. This is the result of retinopathy has few symptoms in the early stages, weak focusing power or eyes that are too “small” or the condition rarely requires therapy. The underly- “short” for their refracting capabilities. ing cause of hypertension is treated with medica- Farsighted people generally see far objects more tion, diet and exercise. clearly than near objects. Convergent or convex corrective lenses are usually prescribed for either hypertropia A condition of STRABISMUS, or mis- eyeglasses or contact lenses. In some cases, surgery aligned eyes. Often termed squint or crossed-eyes, can be performed to correct farsightedness. strabismus may cause visual problems or loss of Babies are often born farsighted because of their vision. Hypertropia is a type of strabismus in which small eyes. They maintain strong focusing power to one eye turns upward. Hypotropia is condition in offset the problem, and seldom require correction which one eye turns downward. As in all strabis- except in severe cases or in the presence of addi- mus, the eyes fail to converge on an object and tional eye disorders. view two differing subjects. The brain receives the two images, and double vision results. Often, in an hypertensive retinopathy The name given for effort to reconcile the two pictures, the brain may the effects of hypertension on the eye’s RETINA. The suppress one completely, causing partial vision loss. retina is the light-sensitive layer in the back of the This results in a condition called AMBLYOPIA. eye that receives light and encodes it into electrical Strabismus is associated with high amounts of MYOPIA (nearsightedness), HYPEROPIA (farsighted- impulses. The impulses travel from the OPTIC NERVE to the brain, where they are translated into an ness) and ASTIGMATISM. It can develop after a major image. illness or injury, and some forms of strabismus may Hypertension is a term for high blood pressure. also be hereditary. It is a condition commonly associated with aging Treatment may include the prescription of eye and occurs when the small arteries of the body lose drops, eyeglasses or bifocals, or exercises. Exercises elasticity and become clogged, a condition called or eye patching may be prescribed if amblyopia is present. Surgery may be necessary to completely ARTERIOSCLEROSIS. The blocked arteries become smaller in diameter, and the blood flows slower align the eyes. and less smoothly. As the blood supply is decreased to vital organs, hyphema A bleeding into the ANTERIOR CHAMBER serious consequences may result. Heart attacks and of the eye. Hyphemas may occur as a result of an heart failure, strokes, angina, kidney disease, and injury or following intraocular surgery such as poor circulation are often attributable to hyperten- CATARACT removal. Hyphemas may appear sponta- sion and arteriosclerosis. neously due to diabetes-related neovascularization, Hypertension and arteriosclerosis can affect the tumor, juvenile xanthogranulomatosis, or previous blood vessels in the retina. The vessels may become vascular occlusions. constricted, causing bleeding or fluid leakage. The Hyphemas due to injury are caused by damage condition may lead to infarcts, localized areas of tis- to blood vessels in the IRIS or CILIARY BODY. In most 118 hypotropia cases, the bleeding slows and then ceases, and the of the need to physically resolve an emotional blood is reabsorbed within the eye over a period of upset or shock. It also is called psychogenic or psy- a week. Secondary bleeding that starts one to five chic blindness. days following the injury may fill the anterior The blindness is usually bilateral and often chamber and elevate intraocular pressure. occurs suddenly. Often the blindness is not total The raised intraocular pressure of secondary and is restricted to a particular field. Additional bleeding may cause secondary glaucoma, a serious symptoms of hysterical blindness include lack of result for which children are particularly at risk. regard for the loss of sight, ability to travel within The CORNEA may also become permanently blood- surroundings, and normal blink response. stained, causing an opacity or clouded area. An eye examination is necessary to diagnose Hyphemas due to surgery are common but hysterical blindness. The examination reveals that much less likely to result in secondary bleeding. the pupils react normally, and the fundus (back of The bleeding generally recedes within days, and no eye) appears normal, discounting damage to the further treatment of hyphema is necessary. optic nerve, cortical blindness, chiasmal lesions, or Hyphemas are treated initially to prevent sec- other ocular disease. The condition is usually diag- ondary bleeding and its consequences. Treatment nosed in light of information gathered through the varies according to the practitioner. Patients may eye examination and study of the patient’s psycho- be admitted into the hospital, confined to bed rest logical history. for several days, treated with cycloplegics, which Treatment of hysterical blindness may include widen the pupil, or with steroids or undergo patch- reassurance to the patient that the condition will ing of the eyes. right itself, presentation to the patient of ability to Secondary bleeding may be treated surgically. see, and placebo medicine therapy. The patient Medication is given to reduce intraocular pressure. may recover from the hysterical blindness only to The hyphema may be removed or flushed out of replace it with another physical illness. Psychiatric the eye with a saline solution. counseling is often recommended to address the underlying emotional problem. hypotropia See HYPERTROPIA. Hysterical blindness is not to be confused with malingering, a condition of feigned blindness often hysterical blindness An emotionally caused con- undertaken as an attempt to receive continued dition of blindness. The blindness occurs as a result compensation for an accident or injury. I

IBM International Business Machines Corpora- guages: English, French, Italian, German, Spanish, tion (IBM) has established itself as a leader in pro- Japanese, Chinese, Portuguese, and Finnish. viding information, training, and assistive devices IBM has developed other products for visually for people with vision, hearing, speech, and mobil- impaired users, such as the Screen Reader, the Page ity impairments; learning disabilities; and mental Scanner, Book Manager, and TextReader. More retardation. In January 2000 the company opened information about these and other products is the IBM Accessibility Center and the IBM Accessi- available on the company’s website at www. bility Research Institute, both based in Austin, ibm.com/able. The website also contains informa- Texas. Previously, IBM operated the IBM National tion for human resource professionals who are Support Center for Persons with Disabilities, responsible for making information more accessible located in Atlanta. That organization was inte- to employees with disabilities. grated with the Accessibility Center, and the Contact: Atlanta facilities closed. IBM Accessibility Center The goal of the Accessibility Center is to enable 11400 Burnet Road people with disabilities to compete equally in Building 901, Room 5D-014 today’s electronic society by making sure they have Austin, TX 78758 equal access to information, e-business services, and education. The center has facilities and opera- idoxuridine An antimetabolite drug used in the tions in Austin, Japan, and Europe. The IBM treatment of ocular HERPES. It is also called IDU, Accessibility Research Institute was created to Herplex, Stoxil, and Dendrid. It was one of the first explore emerging technologies and ongoing drugs developed for the treatment of herpes kerati- research generated by IBM’s research laboratories tis, a disorder involving corneal inflammation. and to refer any applicable technology to the Idoxuridine is activated by enzymes contained Accessibility Center. The Accessibility Center will in healthy human cells and cannot differentiate continue to invest in new technology for assistive between viral and healthy cells. Therefore, while it devices and will focus on the development of tools is effective in destroying viral cells, it unfortunately that generate accessible applications and middle- may attack and destroy healthy cells. Because of ware software, which could be integrated with IBM the toxicity, idoxuridine cannot be taken intra- products to enhance accessibility. It also will con- venously; possible side effects could cause poten- tinue working to improve existing assistive devices, tially dangerous disorders. such as the Home Page Reader. The Home Page Idoxuridine is available in ointment or eye-drop Reader is a talking web browser, which allows form. Normal dosing for the ointment is to apply it users who are blind or visually impaired to fully five times per day. The eye drops normally are explore the Internet and take advantage of e-busi- administered every hour during the day and every ness opportunities. The Home Page Reader soft- two hours during the night. The period of use for ware provides JavaScript support, which enables it either form is roughly two to three weeks. Dosing to speak all information contained on a webpage. varies from patient to patient, however, so the doc- The software recognizes and speaks nine lan- tor’s instructions should be followed.

119 120 illumination

Idoxuridine is not a cure for herpes keratitis. It fuseness of light, and a smooth, reflective surface is only effective once the virus is active. During may increase glare. periods of latency, the drug is ineffective against Diffuseness is the distribution of light. Shadows the virus. Its ocular side effects include redness and and spotlights may decrease visibility. Glare results swelling of the conjunctiva and possible irritation from an excess of light, a concentration of light, or of the cornea. an uneven distribution of light, and may decrease visibility. Illumination may be controlled or manipulated illumination The density of light falling on a sur- by making changes in the environment as well as face. Illumination is a factor in visibility, and con- the light source. Light transmission, reflection control of illumination may result in improved vision trol, and contrast enhancement may be used to for those with impairments. maximize available illumination. To properly control illumination, type of light Light transmission is improved through lenses, source, intensity of the light source, distance from filters, and absorptive lenses that reduce glare and the light source, surface the light falls on, diffuse- highlight contrast for those with light sensitivity, or ness, the amount of glare, and environmental photophobia. Lenses, filters, and absorptive lenses changes must be considered. The best lighting situ- are available in a wide range of degrees of protec- ations involve properly intense, diffuse light from tion from simple filters that reduce glare to pho- overhead (or the side of usable vision if reading tochromic lenses that use gray, green, and amber with one eye only) that causes the least amount of filters to block all ultraviolet light. shadows and glare. Reflection is controlled by visors, side shields, Light sources commonly include daylight, specially treated lenses, and typoscopes. Visors may incandescent light, and fluorescent light. Daylight be supplied by the brim of a hat or can be a filter- varies according to time of day and weather condi- ing visor lens attached to the spectacle frame. tions. Incandescent lights simulate daylight but in a Sideshields are filters that attach to the sides of constant, steady flow. Fluorescent lights may spectacle lenses to control the light on the sides of flicker but can be linked and adjusted to eliminate the eyes. the flicker. A typoscope is a slit reading device that isolates Specially designed lights may be used to maxi- one line of type at a time, thus reducing glare from mize residual vision. The BLBS (Better Light Better the light reflected from the page. Typoscopes are Sight) lamp is a study lamp constructed according especially helpful for those with cataracts. to requirements of the Illuminating Engineering Contrast is enhanced by using highly contrasting Society of America and incorporates ideal lighting colors near one another such as black ink on white components. or yellow paper or fluorescent strips on stair risers. Tensor-type lamps are intense lights that can be Contrast for reading pale or bluish print may be adjusted for maximum illumination with limited improved by using pale yellow tinted lenses or by glare. Small clip-on lamps are available that attach placing a clear yellow or amber sheet over the to the sides of spectacle frames. page. The intensity of light is measured in footcandles. Lighting requirements vary according to the age One footcandle equals the intensity of light that of the individual and the cause of the visual impair- falls on one square foot of a surface located one ment. As the eyes age, they need greater amounts foot from one international candle. of illumination to function properly. Sixty-year-old The intensity of light on an object is controlled eyes need twice as much light to complete a task as by the distance from the light to the object. A lamp 20-year-old eyes. two feet from the reading page has four times the Eye disorders and conditions may create a need light intensity as a lamp four feet away. for either reduced or increased light. Those who The surface the light falls on affects the visibility. function best in low light include persons with An uneven surface may contribute to uneven dif- ALBINISM, ANIRIDIA (lack of IRIS), CATARACT, and Individuals with Disabilities Education Act 121 corneal opacities. Those who function best in max- These services may include counseling to de- imum light include those with GLAUCOMA, OPTIC termine the individual’s need for independent liv- ATROPHY, surgical aphakia (lack of natural lens), ing services, individual counseling, referrals and MYOPIA, COLOBOMA, and MACULAR DISEASE. counseling regarding attendant care, and peer counseling. impairment There is no complete consensus on An independent living center may offer atten- terms concerning the topic of blindness and vision dant care and training, advocacy services, legal impairment. Educators, doctors, rehabilitation spe- services, independent living skills training, job- seeking skills training, equipment training, and cialists, and other leaders in the field define TERMI- housing and transportation referral and assis- NOLOGY according to their own preferences but have recently made efforts to standardize terms tance. such as impairment to eliminate confusion or mis- The center may provide community group-liv- interpretation. ing arrangements, health-maintenance programs, An impairment refers to a recognizable defect or education and training for living in the community malfunctioning of an organ or any part of the body, and participating in community activities, social such as an eye. The defect or malfunction can be and recreational activities, interpreter services for diagnosed and defined by a medical doctor. A visu- deaf and deaf-blind individuals, and reading ser- ally impaired person may include an individual vices for blind individuals. with no sight as well as someone with low vision. independent living skills See DAILY LIVING SKILLS. independent living aids See ADAPTIVE AIDS. Individuals with Disabilities Education Act Independent Living Aids, Inc. A mail-order com- (IDEA) Formerly known as Public Law 94–142, pany that provides adaptive aids and devices for dis- this law guarantees that all children between the abled persons, including visually impaired ages of three and 21 who need special education individuals. Through its catalog, the company offers and services due to a disability will have access to a watches, magnifiers, braille items, canes, writing free and appropriate public education. The law pro- guides, medical and health related items, adaptive vides money to assist states in providing an indi- tools and appliances, cooking aids, adaptive games vidualized education program (IEP) for each and toys, large-print books, talking items, and student. The IDEA was formerly known as the portable electronic magnifying viewers. Education of the Handicapped Act (EHA). The orig- Contact: inal act—EHA—was implemented in 1975 and changed to IDEA in 1991. IDEA was amended in Independent Living Aids, Inc. 1997. 200 Robbins Lane Before 1975, about 1 million disabled child- Jericho, NY 11753-2341 ren did not have access to public schools, and 800-537-2118 thousands more did not receive appropriate edu- www.independentliving.com cation in the schools. Ninety percent of children with serious disabilities used to be housed in independent-living center A program of services state institutions and did not attend public or a facility that provides a variety of independent schools. living services for persons with disabilities. The ser- IDEA states that school administrators, teachers, vices are directed to provide resources, training, and parents should be involved with developing an counseling, and assistance to promote the indepen- individualized education program for each student dence, productivity, and quality of life of persons who needs one. The 1997 amendments to the act, with disabilities. They may be supported by federal, signed into law by President Bill Clinton on June state, local, or private funds. 4, include the following: 122 injuries

• Changes in the formula for distributing federal lumber, and any other building matter. Home money to states products are those used to maintain a household • Instruction in braille and the use of braille for and include bleaches, chemicals, glues, and acids. visually impaired students, unless braille is not Personal products consist of items such as contact considered by the IEP team to be in the best lenses, sun lamps, combs, and brushes. Home interests of the child workshop materials encompass tools and machin- ery, wet cell batteries, and welding gear. • More freedom for school districts to serve dis- In order of severity, the most hazardous materi- abled children who attend private schools als are metal debris, contact lenses, and auto- • Requirement for a state to set performance goals mobiles, followed by batteries, sun lamps, and for disabled children and a means for mapping adhesives or glue. Among children aged five to 14, progress most accidents involve metal debris, baseball gear, • More flexible, but more frequent re-evaluations workshop apparatus, and adhesives. Injuries for of children with individualized programs those aged 15–24 most often involve contact lenses, metal debris, sun lamps, automobiles and batteries. • Changes in the way in which disputes between Injuries for those 25–64 generally include metal the parents of a disabled child and the local edu- debris, automobiles, and contact lenses. cation agency are handled Sports or recreational injuries are responsible for • Changes in the way in which discipline problems nearly 40,000 eye treatments in hospital emer- involving disabled students are to be handled gency rooms each year according to the National • Children with disabilities must be included in Society to prevent blindness. The society estimates statewide and district-wide assessments as many as 100,000 such injuries each year, • Regular education teachers must be included in although not all are reported. Nearly one third of IEP teams if there is any possibility that a dis- those treated are children five to 14 years of age. abled child will participate in regular class Generally, baseball and basketball account for most injuries, followed by racquet sports and football. • Children with disabilities must be given access to It is estimated that 90 percent of all injuries can the regular curriculum be prevented if proper precautions are taken to wear protective safety goggles and to store harmful Office of Special Education and Rehabilitative Services, chemicals and spray cans. When a chemical or acid the U.S. Department of Education. IDEA ’97 Amend- ments, Final Regulations. www.ed.gov/offices/OSERS, injury occurs, the National Society to Prevent 2001. Blindness suggests gently flushing the eyes with water for 15 minutes and immediately obtaining a medical examination. Do not use an eye cup or injuries According to the National Society to Pre- bandage the eye. vent Blindness, nearly 1.3 million people suffer eye When specks or debris enter the eye, lift the injuries each year in the United States. Injuries are upper eyelid outward and down over the lower lid. responsible for 4 percent of all cases of blindness If the tears do not wash out the particle, do not rub and 3 percent of all new cases of blindness in the the eye, keep it closed, bandage it lightly and see a United States each year. Currently, approximately doctor. 1 million people have sustained some vision loss When an impact to the eye occurs, apply cold due to injuries. Nearly half of these injuries compresses for 15 minutes and each successive occurred in or around the home in product-related hour until pain and swelling are reduced. If the eye incidences. becomes discolored, see a doctor. Four product groups—construction materials, In the case of a puncture or cut to the eye, do home products, personal products, and workshop not wash with water or try to remove a foreign tools—account for more than half of these injuries. body. Bandage the eye lightly and see a doctor Construction materials include nails, metal parts, immediately. IOL surgery 123

National Society to Prevent Blindness. Vision Problems in depends on the level of nearsightedness present in the U.S.: Facts and Figures. New York: NSPB, 1998. the patient. The greater the degree of nearsightedness, the thicker the implant needs to be. Two seg- Internal Revenue Code See TAX BENEFITS. ments are implanted into each eye. The ICR segments, which recently were approved by the U.S. Food and Drug Administration, reduce near- International Guiding Eyes, Inc. (IGE) A non- sightedness by reshaping the cornea without having profit dog-guide training facility founded in 1948. to cut or remove tissue from the central optical The organization breeds and trains dog guides and zone. provides in-residence training in dog-guide use and The central optical zone is the most critical area after care for qualified blind individuals. The orga- for clear vision. The segments can be removed if nization also is known as, and conducts business as necessary or desired, leaving the eye in the same Guide Dogs of America. state it was before they were implanted. So far, ICR IGE breeds and trains male and female Labrador segments can only be used to treat mild to moder- retrievers, German shepherds, and golden retriev- ate cases of myopia. They cannot be used at present ers. The school has graduate dog-guide users work- to treat farsightedness, astigmatism, or high levels ing in 24 states and four foreign countries. of nearsightedness. The procedure of implanting an Recipients of the dog guides must be 16 years ICR segment is performed under topical, numbing old, physically healthy and able to walk freely, and eye drops. A normal implantation on one eye typ- desire independence. An applicant must be able to ically would take between 10 and 15 minutes, with afford food for the dog and have received orienta- only a tiny incision made at the base of the cornea. tion and mobility training before qualifying. Recip- Recovery time generally is rapid, with vision ients attend a one-month in-residence course of improving in a short time. Few side effects or com- instruction with the dog guide at the facility. The plications have been noted, although a small per- dog guide, dog harness, and in-residence training centage of ICR segment patients have experienced are provided without cost to the recipient. problems, including decreased night vision, glare, IGE receives no government or state funding. It halos, and blurry vision. is supported by corporate and private contributions. Eyesearch.com, Inc. “Intrastromal Corneal Ring Seg- Contact: ments (INTACS) are the first FDA-Approved Non-Laser Surgical Technique for Correcting Near- International Guiding Eyes, Inc. sightedness,” 1999. 13445 Glenoaks Boulevard Sylmar, CA 91342 IOL surgery Intraocular lens implants, or IOL 818-362-5834 (ph) surgery, is the implantation of a small, clear plastic 818-362-6870 (fax) lens in the eye to replace the section of natural lens www.guidedogsofamerica.org lost in CATARACT removal surgery. As a permanent substitute for the lens, it enables the CORNEA to intracapsular extraction See CATARACT. focus light onto the RETINA and produce a distinct image. The intraocular lens is made up of two parts. The intraocular lens See IOL SURGERY. optic is the center portion of the lens that does the job of focusing. It is approximately one-quarter of Intrastromal Corneal Ring (ICR) Segments Thin, an inch long and is made of PMMA plastic. The crescent-shaped segments that can be implanted portion called the haptic holds the lens in place. into a patient’s cornea in order to reduce myopia The power of the IOL is determined by two tests. (nearsightedness). The segments are made of a spe- KERATOMETRY is a test that determines the curva- cialized polymer, and the thickness required ture of the cornea. More curved corneas require 124 iridectomy incrementally weaker implants. An ultrasonic A- malleable, the incision allows a peripheral portion scan determines the length of the eye. The longer of the iris to prolapse out of the eye. The prolapsed (more nearsighted) the eye, the weaker the section is held with forceps and excised with scis- implant needed. An A-scan may determine that an sors. The iris bombe sinks backward into the eye. IOL is unnecessary. Often, the condition or blockage requires only a cut Intraocular lens implantation can be performed to be made rather than a removal of the iris. The in either intracapsular or extracapsular cataract cut is called an iridotomy. The cut or incision may removal. Significant advances have been made in be made surgically or with an argon laser, which the technology of IOLs. They are smaller than they burns a hole in the iris through the closed eye. Iri- used to be and can be folded and placed into the dectomy or iridotomy is usually performed at the eye through a tiny incision. There are three initial attack of narrow-angle glaucoma after treat- implantation methods: ANTERIOR CHAMBER, POSTE- ment with medication has begun. It is used as a RIOR CHAMBER, and IRIS supported. The lens is treatment and as a prophylactic measure to prevent placed in front of the iris in the anterior method recurrent attacks of narrow-angle glaucoma. behind the iris in the posterior method and is clipped or sewn to the iris in the almost obsolete iridocyclitis A condition of the IRIS and ciliary iris-supported method. Most ophthalmologists pre- body in which these two portions of the eye fer the posterior method, claiming the lenses are become inflamed. Because of the close proximity of more secure there and in a better position to help the CILIARY BODY to the iris, inflammation and restore eyesight. IOLs provide constant, immediate infection pass easily from one body to the other. improvement in vision and require no ongoing Since the iris and ciliary body are located in the care. Patients may require normal glasses or bifo- front portion of the uveal tract, which also includes cals as a supplement. the CHOROID, the condition is also called anterior IOL surgery is often restricted to older patients UVEITIS, or inflammation of the uveal tract. since long-term side effects are unknown. It is rec- Symptoms of iridocyclitis may include pain, ommended that the surgery not be repeated if an especially when focusing on near objects, redness, implant was unsuccessful in one eye or in the pres- light sensitivity, and changes in the appearance of ence of other serious eye problems. the pupil. The inflammation irritates the sphincter muscle of the pupil, which causes it to constrict, iridectomy The surgical removal of part of the appear misshapen, or develop spasms. As a result SYNECHIAE eye’s IRIS. The procedure is often performed as of iridocyclitis, posterior may occur. This treatment for narrow-angle GLAUCOMA, a condition is a condition in which the pupil adheres to the in which AQUEOUS FLUID builds within the eye due underlying lens. to a pupillary block and causes a rise in intraocular Iridocyclitis may be caused by IRITIS, which in pressure. turn is caused by injuries, viruses, HERPES ZOSTER, The removal of the section of iris creates a pas- funguses, parasites, arthritis, and sinus or tooth sageway between the posterior and anterior cham- infections. The condition may be treated with bers of the eye and eliminates an iris bombe, a cycloplegic, or dilating, drops, local steroids, and condition in which the iris is abnormally bowed medications for underlying causes. The condition forward due to the increased intraocular pressure. may last for two weeks or more and carries a ten- The procedure allows aqueous fluid to pass from dency to recur. Several recurrences may raise the possibility of CATARACT development. the posterior to ANTERIOR CHAMBER and thus reduces intraocular pressure. The surgery is performed under general or local iridodonesis A trembling of the iris. This condi- anesthetic. Traditionally, a small incision is made at tion is frequently seen with a subluxated (dis- the limbus through the CORNEA and SCLERA, into placed) lens or following CATARACT surgery. It also the anterior chamber of the eye. Since the iris is is associated with MARFAN’S SYNDROME. itinerant teacher 125 iris The thin circle of membrane suspended Because the iris is part of the uveal tract, iritis behind the ANTERIOR CHAMBER and in front of the may be present in UVEITIS. Other causes may CRYSTALLINE LENS. As a part of the uveal tract (the include injuries, viruses, HERPES ZOSTER, funguses, IRIS, CILIARY BODY, and the CHOROID), it is pig- parasites, arthritis, and sinus or tooth infections. mented and gives the eye its color. The hue When the inflammation of iritis spreads to the depends on the amount of pigment in the iris. adjoining CILIARY BODY, the condition is termed IRI- Brown eyes have the most pigment, blue the least. DOCYCLITIS, or anterior uveitis. The PUPIL is the black dot in the center of the iris. Iritis is most often treated with cycloplegic, or The pupil is a hole through which light passes into dilating, drops and local steroids. The condition the eye. The iris opens the pupil wider in low light may last for two weeks or more and carries a ten- and shuts it down in bright light. dency to recur. Several recurrences may increase The iris is subject to several conditions or disor- the possibility of CATARACT development. ders. Iritis is an inflammation of the iris and often involves the adjacent ciliary body. Symptoms Ishihara Test See COLOR BLINDNESS. include pain, redness, and sensitivity to light. The pupil may become misshapen or constricted, as well. Iritis may be caused by injuries, viruses such Isopto Carpine An ophthalmic solution used in as HERPES ZOSTER, funguses, parasites, or arthritis. the treatment of GLAUCOMA. The main ingredient, When iritis spreads to the adjoining ciliary body, pilocarpine hydrochloride, is also contained in the the condition is termed IRIDOCYCLITIS, or anterior equivalent products known as Adsorbocarpine, uveitis. Iritis is present in the condition uveitis, an Adarpine, Almocarpine, Akarpine, Ocusert Pilo-20, inflammation of the uveal tract. Ocusert Pilo 40, Pilocar and Pilopine HS. The med- SYNECHIAE is a condition that often follows icine causes the pupils to constrict and lowers pres- iritis in which the iris bonds to the crystalline sure within the eye. lens. Symptoms include pain and a misshapen The dosage is administered in drops. Some pupil. The iris may also become attached to the patients may suffer side effects. Minor side effects CORNEA as a result of an injury or ophthalmologic may include headache or aching in the brow, loss surgery. of night vision, blurred vision, and twitching eye- COLOBOMA is a defect in which the iris is missing lids. Major side effects may include diarrhea, nau- a part. This can be due to a birth defect, eye sea, difficulty urinating, stomach cramps, sweating, surgery, or an injury. palpitations, shortness of breath, muscle tremor, Cysts or tumors may grow in the iris. They may nearsightedness, or other changes in vision. be benign or malignant. Isopto Carpine should not be taken by those IRIDODONESIS is a condition in which the iris with a pilocarpine allergy. It should be used with trembles uncontrollably. It is caused by a missing or caution by those with a history of heart disease, displaced crystalline lens. asthma, thyroid disease, peptic ulcer, gastrointesti- Heterochromia is a harmless condition in which nal spasms, urinary tract blockage, Parkinson’s dis- one iris differs in color from the other. The iris may ease, or seizures. change color through contraction of iritis, but generally the condition is due to a birth defect. itinerant teacher The itinerant-teacher form of education or model is a model of education com- iritis An inflammation of the IRIS. Symptoms of monly used for visually impaired students. Other iritis may include pain, especially when focusing education models include the residential-school on near objects, redness, light sensitivity, and model, teacher-consultant model, resource-room changes in the appearance of the pupil. While the model, and self-contained classroom model. CORNEA remains clear, the pupil may appear con- An itinerant teacher is one who travels to public stricted or misshapen and develop spasms. schools to provide special education modifications 126 itinerant teacher to the instructional program of visually impaired The success of the itinerant-teacher program is children. The visually impaired student lives at dependent on the attitude of the regular classroom home and spends most of the instructional day in a teacher and his willingness to adapt regular teach- regular classroom. ing practices to the mainstreamed visually impaired The itinerant teacher normally visits every two child. The model is most effective for students who or three days to work with the student in a section are self-directed and independent in learning skills of the classroom, the library, the hall, the office, or and least effective for students who lack academic any available space. The itinerant teacher provides learning skills and lag in social development in special equipment, training, and materials adapted comparison with their peers. to the student’s learning needs, and consultation services to the regular classroom teacher. J

Javits-Wagner-O’Day Act The Javits-Wagner- JAN counsels employers, rehabilitation profes- O’Day Act of 1971 was enacted as an amendment sionals, and individuals with disabilities seeking to the Wagner-O’Day Act of 1938. The Wagner- job-accommodation solutions. It provides addi- O’Day Act mandated a program in which federal tional information on accessing available programs agencies may buy specific products from qualified such as the Job Training Partnership Act, Projects workshops for the blind in an effort to improve with Industry, Supported Employment, Targeted employment opportunities. Jobs Tax Credit, and Barrier Removal incentives. In 1971, the Wagner-O’Day Act was renamed Employers with questions or concerns about job the Javits-Wagner-O’Day Act and amended to accommodation may call JAN. A Human Factors include severely disabled workers and add services Consultant takes the information request, includ- as well as products. The products for sale to the fed- ing details about functional requirements of the eral government are approved by the Committee specific job, functional limitations of the worker, for Purchase from the Blind and other Severely and environmental factors involved. The consul- Handicapped, a presidentially appointed committee tant accesses the computer for information based that oversees the act. on these facts and provides matching or similar sit- A study in 1998 concluded that the Javits- uation solutions. Additional addresses and phone Wagner-O’Day Act contracts have the potential to numbers of resources are provided. provide significant cost savings to the federal gov- The service is free, but the user is requested to ernment. provide information about resulting accommoda- The committee is composed of 15 members; 11 tions for the computer files. are representatives of federal agencies, three are Contact: representatives of the general public, and one is a private citizen representative of the disabled com- Job Accommodation Network munity. The committee determines and lists the West Virginia University, 809 Allen Hall products and services reasonable for purchase from P.O. Box 6080 qualified workshops, decides the fair market price Morgantown, WV 26506-6080 for such products and services and sets the rules 1-800-JAN-PCEH (526-7234) (voice and TDD) and regulations to execute the act. http://janweb.icdi.wvu.edu U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, Job Training Partnership Act (JTPA) The Job D.C.: USDE, 1988. Training Partnership Act (JTPA) of 1982 was designed to revise the existing Comprehensive Job Accommodation Network (JAN) An inter- Employment and Training Act (CETA). Its purpose national information clearinghouse and consulting is to set up programs that will prepare youth and resource established by the President’s Committee unskilled adults to enter the workforce, and to pro- on Employment of People with Disabilities. It provide job training. The new act eliminated federal vides guidance on practical methods of job accom- funding for public-service employment, involved modations. the private sector through a series of incentives,

127 128 juvenile retinoschisis transferred additional administrative authority to and encourage job training and related aid to those the state, demanded improved accountability, disadvantaged in the employment market, includ- included community organizations, targeted spe- ing persons with disabilities. Additional research cific populations, and extended the program by grants in Title IV fund training and job market broadening the eligibility requirements. studies used to develop improved training methods The act established vocational training and and placement programs. placement programs for economically disadvan- Title IV, Part B, establishes the Job Corps pro- taged people, including those with disabilities. The gram, a national education, job training, and coun- term “economically disadvantaged” includes those seling program. Job Corps centers, both residential who qualify for or receive welfare payments or and nonresidential, provide trainees with the skills food stamps, live within a family whose income is necessary to become employable. Trainees are most below the poverty level, or receive local or state often between the ages of 14 and 22 but older, dis- payments as a foster child. abled individuals may be allowed to participate in Although income is the chief criterion for quali- the program. fication, the JTPA program may fund handicapped U.S. Department of Education. Summary of Existing Legis- individuals, regardless of economic means, so long lation Affecting Persons with Disabilities. Washington, as the percentage of such recipients does not D.C.: USDE, 1988. exceed 10 percent of the total. According to the act, the term handicapped includes physical and mental juvenile retinoschisis An inherited disease that disabilities that form a barrier to employment. causes progressive loss of central and side vision The act is divided into five titles. Title I describes due to degeneration of the retina. Loss of sight usu- structure and planning guidelines. Title II estab- ally occurs at about age 13. The condition, which lishes conditions for adult and youth training pro- also is known as X-linked retinoschisis, almost grams. Title III approves funding for training and always occurs in males. employment services through formula or discre- The condition begins at birth, but there usually tionary grants. Title IV authorizes human services are no symptoms until about the age of 10, when a research and development programs, the Job decline in vision begins. Other early signs of the Corps, and Veterans’ Employment Programs. Title disease include involuntary eye movements and V contains stipulations pertaining to other federal the loss of ability to focus both eyes on an object. laws. Blindness sometimes occurs within three years of Title II-A establishes a grant program to main- diagnosis, while other people with the disease tain training services. The program is administered retain some vision into adulthood. by the state and executed through agreements Juvenile retinoschisis is genetically passed along between local and state governmental agencies and by the X-linked pattern of inheritance, because the the private sector. These formula grants support 28 gene for the disease is located on the X chromo- services, including vocational counseling and train- some. There is no treatment or cure at this time for ing, transitional counseling and training, custom juvenile retinoschisis, but surgery can be per- job development or training with the agreement to formed to repair retinal detachments, which often hire, and postemployment follow-up services. occur as part of the disease. People with the disease Title IV provides grants for national pilot- may benefit from the use of low-vision aids, orien- demonstration programs. These programs support tation and mobility training, and so forth. K

Keller, Helen Helen Keller is perhaps the best- Fund (later named the American Braille Press, the known figure in history associated with blindness. American Foundation for Overseas Blind and Born sighted in 1880 in Alabama, she contracted a Helen Keller International) in 1915. fever at 18 months, which left her deaf and blind. She was a member of the staff for the Founda- The infant grew into a wild and unruly child with tion of the Blind from 1924 until her death in few methods for communication with others. Her 1968, serving as an adviser on national and inter- father, Captain Arthur Keller, editor of the North national relations. In 1924, she founded the Helen Alabamian, sought advice from Alexander Graham Keller Endowment Fund to benefit the founda- Bell in his search for help for his daughter. Bell sug- tion. She established the foundation’s special- gested that Captain Keller write to the Perkins service program for deaf-blind individuals in 1946. Institution for the Blind to request a teacher for In 1946, when the American Braille Press Helen. became the American Foundation for Overseas In 1887, Anne Mansfield Sullivan arrived to Blind, she became a counselor on international teach the child. Sullivan taught her to fingerspell relations for the organization. She embarked on the words for objects, but Keller showed no under- speaking tours that covered 35 countries on five standing of the connection between the spelling continents between 1946 and 1957. Her last speak- and the object. The breakthrough came one day at ing tour, at age 75, covered over 40,000 miles in the well when water gushed onto Keller’s hand as Asia. Sullivan spelled W-A-T-E-R. Keller continued to Keller received honors during her lifetime for study with Sullivan, mastering the alphabet in both her work benefiting blind persons. Honorary manual and raised print. degrees include those from Temple University, Har- Keller entered the Cambridge School for Young vard University, and the Universities of Glasgow, Ladies in 1898 in preparation for Radcliffe College. Berlin, Delhi, and Johannesburg. Awards bestowed She enrolled in Radcliffe in 1900 and graduated on her include the Presidential Medal of Freedom, with a bachelor of arts degree cum laude in 1904. Brazil’s Order of the Southern Cross, Japan’s Sullivan remained at Keller’s side throughout Sacred Treasure and the Philippines’ Golden Heart. Keller’s studies, translating lectures and textbooks. She was elected to the National Institute of Arts Keller began a writing career while studying at and Letters and named a Chevalier of the French Radcliffe. In 1902, her autobiography, The Story of Legion of Honor. My Life, was published. The book was written with Versions of Keller’s life have been the subject of the assistance of John Macy, a critic and socialist stage and film productions. The documentary Helen reformer. When Sullivan married John Macy in Keller in Her Story and the play and movie The Mir- 1905, Keller went to live with the couple. acle Worker all chronicle the events of her life. Keller worked for the interests of blind and deaf- Sullivan, long separated from Macy, died in blind individuals throughout her life by appearing 1936. Polly Thomson, who joined the two in 1914 before legislatures, writing articles and books, and when Sullivan’s eyesight deteriorated, continued to lecturing. She became a member of the first board serve as Keller’s interpreter and companion. In of directors of the Permanent Blind Relief War 1961, Keller retired from public life to her home,

129 130 keratitis

Arcan Ridge, in Westport, Connecticut. She died in It is a chronic, progressive disease. The exact 1968 at the age of 87. cause of kertatoconus is not known, but it is thought that there is a genetic predisposition to the disorder. Most researchers agree that there proba- keratitis An inflammation of the CORNEA caused by viruses, bacteria or, infrequently, fungi. Keratitis bly is more than one factor involved in the cause in can occur as a result of a corneal abrasion caused the disorder, and there is a “trigger” that sets off a series of events in the tissues of the eye that even- by CONTACT LENSES or by an injury. Elderly persons, diabetics, those with poor tear functions, and those tually result in keratoconus. It is most often diag- treated with corticosteroid drugs may be more nosed in children or adolescents and usually likely to develop keratitis after an abrasion. presents symptoms when they are near 10 years of Keratitis is a serious infection and should be age. The National Keratoconus Foundation esti- treated by a physician. Symptoms of keratitis in- mates that one of every 2,000 people will develop clude redness, sharp pain, tearing, impaired vision, the disorder. light sensitivity, and dulled or milky corneal sur- Keratoconus may be diagnosed during the rou- face. tine ophthalmologic exam. Examination with the Simple viral keratitis is generally the least seri- BIOMICROSCOPE, or slit lamp, will reveal thinning of ous type. Patients are usually treated with medica- the central cornea or presence of the Fleischer ring, tion on an outpatient basis. However, herpes a narrow, greenish-brown ring in the cornea. Later keratitis is a very serious viral infection that can stages of keratoconus, in which the cornea has result in scarring and permanent visual impair- markedly bulged forward, can be seen without ment. benefit of examination instruments. Bacterial keratitis is more dangerous than viral This disorder progresses slowly and affects both types and often must be treated in a hospital. The eyes. Milder forms of the condition are often cor- infection is treated with antibiotics and cortisone- rected with spectacles or special CONTACT LENSES based steroid drugs. Bacterial keratitis can perma- that cover the cornea and part of the SCLERA. More nently scar the cornea and cause vision loss. serious and advanced forms are corrected surgically Bacterial keratitis may be contracted congenitally or by a CORNEAL TRANSPLANT, called keratoplasty. as in syphilis. Keratoconus is a prime reason for keratoplasty The most common forms of fungal keratitis are in the United States. It is a highly successful proce- caused by yeasts. Fungal keratitis may require hos- dure since, in cases of keratoconus, the cornea pitalization and treatment with antibiotics. Scar- remains vessel free. ring frequently results, despite treatment, and causes vision impairment. Another type of keratitis keratometer See KERATOMETRY. is exposure keratitis. This sometimes occurs when the eyelid cannot cover the eye because of bulging, keratometry Measurement of the curvature of as found in some thyroid conditions. Exposure ker- the CORNEA with an instrument called a keratome- atitis can vary from mild dry spots to ulcers on the ter. The exact keratometer measurement is used to cornea. determine the power of an INTRAOCULAR LENS to be implanted during CATARACT surgery. keratoconus A degenerative disorder of the The greater the degree of corneal curvature, the CORNEA in which the central part of the cornea more nearsighted is the eye. Higher degrees of thins and bulges forward into a cone shape. As the nearsightedness require weaker implants. The cur- cornea thins, vision becomes distorted. As a result vature measurement and the length of the eye, of further stretching, the cornea may break at the measured with an ultrasonic A-scan, are analyzed peak. The cornea will heal itself, but scar tissue will by a computer that determines and prescribes the form at the break, causing vision loss. precise power of the implant. Kurzweil Educational Systems Group 131 keratoplasty See CORNEAL TRANSPLANT. The cornea heals slowly after keratotomy is performed, and there may be side effects such as fluc- keratotomy A procedure in which incisions are tuating vision, a weakened cornea, infection, made in the cornea to change its curvature over temporary pain, or difficulty in getting contact the pupil. There are two kinds or keratotomies: lenses to fit. Rarely, patients develop cataract, seri- radial and astigmatic. Radial keratotomy, done to ous infection, or experience rupture of an incision. reduce myopia (nearsightedness), was introduced In extreme cases, loss of vision may occur. in North America in 1978. During the procedure, American Academy of Ophthalmology. Radial and Astig- the surgeon makes several deep incisions in the matic Keratotomy. www.eyenet.org, 1997. cornea to change the curvature of the cornea over the pupil. The incisions are made in a spokelike, or Kurzweil Educational Systems Group A com- radial, pattern. No cuts are made in the optical pany that develops reading software for people zone, which is the portion of the eye that you see who are blind or visually impaired, have learning through. The surgeon measures the thickness of disabilities, or difficulty with reading, such as with the cornea to determine how deep to make the dyslexia. Kurzweil Education Systems Group is a incisions, then, under a microscope and using a cal- division of Lernout & Hauspie, an international ibrated diamond blade, the surgeon will make the company based in Belgium that specializes in precise cuts. speech and learning products. Normal pressure within the eye causes the areas The Kurzweil company was first known for its around the incisions to bow, which results in a flat- Kurzweil Reading Machine, which was introduced tening of the center of the cornea. The flattened in 1977. It now offers two new products for blind area reduces the refractive power of the cornea and or visually impaired users. The Kurzweil 1000 is an allows light rays to focus on the retina, thus reduc- advanced scanning and reading tool that scans doc- ing nearsightedness. Radial keratotomy is an out- uments into a computer and converts them to patient procedure that normally takes no more speech. The MagniReader is a scanning and reading than 30 minutes to perform. Approximately 85 software package designed for people with low percent of people who have this type of surgery can vision. It displays scanned documents on a compass a standard driver’s license exam that requires puter screen in large print. The print can either be 20/40 vision without corrective lenses. scrolled for reading, or converted into speech. Astigmatic keratotomy is a similar procedure Contact: that is used to reduce astigmatism. The incisions used in astigmatic keratotomy are made in a Lernout & Hauspie Customer Support Center curved, rather than a radial, pattern. Astigmatic 3984 Pepsi Cola Drive keratotomy sometimes is used in combination with Melbourne, FL 32934 radial keratotomy to reduce myopia with astigma- 888-483-6266 (toll free) tism. www.lhsl.com

L large print Large print is a low-vision aid that The laser cane requires from 30 to 40 hours of benefits visually impaired individuals who have training with a qualified instructor to operate. (See some usable vision but cannot read conventional ELECTRONIC TRAVEL AIDS.) print. Large print, 18-point type is roughly 3/16 of an inch high and therefore easier to read than stan- laser in situ keratomileusis (LASIK) A proce- dard print. dure that combines the vision-correcting tech- In the United States, large print originated in niques of automated lameller keratoplasty (ALK) 1913 in sight-saving classes. In order to help their and photorefractive keratectomy (PRK) to correct students who could not read conventional print, moderate to extreme nearsightedness, farsighted- teachers began to hand-print enlarged text. In ness, and astigmatism. Sometimes referred to as 1914, the early large-type books were printed, and laser assisted in situ keratomileusis, the name by 1935 the American Printing House for the Blind refers to the use of a laser to reshape the cornea began to publish large-print textbooks for children. without affecting surrounding cells. In situ is from Today, large-print books, magazines, and litera- the Greek, meaning “in the natural or normal ture are available through publishers, visual-aids place.” In medical terms, “in situ” refers to the site catalogs, and public libraries. There also is compu- of origin without invasion of neighboring tissues. ter software available to get large print on a com- Kerato is the Greek word for cornea, and mileusis puter screen. means “to shape.” LASIK surgery has become increasingly popular laser cane An electronic traveling device. It is since it was first performed in U.S. clinical trials in prescribed by an ophthalmologist or optometrist, 1991. It is now the most commonly performed and it requires specialized training from an orienta- refractive procedure in the United States. The pro- tion and mobility instructor. cedure has been done internationally for more The laser cane is a long cane that sends out three than 10 years. While LASIK is relatively new, oph- thin beams of invisible infrared light. The beams thalmologists have been reshaping the cornea for detect objects within 20 feet at face level, waist more than half a century. So, while the LASIK pro- level, and ground level. It can detect changes in the cedure is new, the concept of it is not. terrain of the path, including drops down to five In the LASIK procedure, a MICROKERATOME is inches below surface, such as curbs and potholes. used to make a thin, shallow incision in the cornea. When the laser light hits an obstacle, it sets vibrat- The incision is made from the side and produces a ing pins into motion and/or sends out an auditory hinged flap. During surgery, the flap is opened, and signal. an EXCIMER LASER is used to remove small amounts The signal is pitched according to the height of of corneal tissue. The flap is then removed, gener- the obstacle. When the beam touches an obstacle at ally eliminating the need for a protective contact face level, the auditory signal is a high-pitched lens to be worn after surgery. The excimer laser is beep. When it hits a center or waist-high obstacle, extremely accurate and does not disturb surround- the beep is pitched lower. When it hits a ground- ing tissue. LASIK surgery normally is performed level obstacle, the pitch is low. using only topical drops to numb the eye. In some

133 134 lasers cases, patients may be given a mild sedative to help Patients with a strong desire to be less depen- them relax. The procedure does not take very dent on glasses or contacts they must wear due to long—only 15 to 30 minutes for both eyes. nearsightedness, farsightedness, or astigmatism, While some surgeons perform the procedure on are considered candidates for LASIK, provided they both eyes during the same visit, others prefer to fully understand the potential risks of surgery. operate on one eye and then wait for anywhere Also, people who are bothered by wearing glasses between a few days and several months before but cannot tolerate contacts are considered to be doing the other. If you are considering LASIK good candidates. Patients considering LASIK surgery, you should discuss this matter with your should have no eye diseases and should have had doctor. Some patients prefer having both eyes done stable vision for at least two years. at the same time because they feel it is more con- While the effects of LASIK do not wear off, venient than having to return for a separate proce- changes that may affect vision can still occur within dure. Others like a waiting period between the individual. For this reason, LASIK is not rec- procedures. If the procedure is done on only one ommended for patients under the age of 18, whose eye, it may be uncomfortable to use both eyes eyes are still undergoing many changes. Perform- together until the vision in the other eye is cor- ing the procedure after internal eye changes have rected. If both eyes are not operated on at the same slowed down or stopped increases the chances for time, the patient may need to wear a contact lens long-term, continuing correction. in the uncorrected eye in order for it to be able to Possible side effects of the LASIK procedure work in concert with the corrected eye. include temporary glare, scratchiness, and mild Because the eye’s natural surface is merely discomfort. In some cases, overcorrection or pulled away and then returned to its original posi- undercorrection could occur, meaning that the tion after surgery, there is generally less discom- procedure would have to be redone in order to fix fort than with photorefractive keratectomy, the problem. Infection also is a remote, but a pos- during which the surface layer of the eye is sible side effect. Because LASIK is considered to removed. Some patients report a mild burning be elective surgery, the procedure is not covered sensation in their eye following surgery. For this by most insurance companies. Some U.S. compa- reason, patients often are encouraged to sleep for nies, however, will offset or cover the cost of the several hours following the procedure, after which procedure. Also, the cost may be able to be time most of the discomfort will have abated. deducted from your federal income taxes as a Patients may experience blurred vision for several deductible health expense. The cost varies greatly, hours following the procedure, but most are able depending on patient circumstances, the surgeon, to return to work and drive a car the following and the area in which the procedure is being con- day. ducted. LASIK surgery is widely recognized and the The LASIK Institute, Boston, MA. LASIK Surgery. quality of the procedure continues to improve. www.lasikinstitute.org, 2000. Most patients who undergo the LASIK procedure Florida Eye Institute. Laser In Situ Keratomileusis (LASIK), enjoy improved vision as a result. More than 90 www.fleye.com/laser/lasik, 2000. percent of those with low to moderate nearsight- EyeSearch. Lasik. www.eyesearch.com/lasik/lhtm, 2000. edness achieve at least 20/40 vision, which is con- Federal Trade Commission in cooperation with the sidered good enough in most states to drive American Academy of Ophthalmology. Basik Lasik: without wearing corrective lenses. Many patients Tips on Lasik Eye Surgery. www.ftc.gov/bcp/conline/ achieve 20/20 vision or better as the result of pubs/health/lasik.htm, 2000. LASIK. Those with more severe cases of nearsightedness, however, or with severe farsightedness, lasers The word laser stands for Light Amplifica- may not achieve the same results. Although LASIK tion by Stimulated Emission of Radiation. Lasers is generally considered to be very safe, it is not rec- use natural oscillations of atoms to amplify or gen- ommended for everyone. erate electromagnetic waves of visible light. The lasers 135 light energy produced by a laser contains great LOPATHY (ARM), a major cause of blindness associ- power since the photons (units of light) are all the ated with aging. ARM produces scarring of the same wavelength and are moving in the same MACULA, the region of the retina that allows for direction. This allows the light to be concentrated sharpest vision. Subretinal neovascularization is into a very bright, focused beam. caused by a break in the pigment epithelium, a The first laser, which used a ruby as its active layer below the retina. A collection of blood vessels medium, was built by Theodore Mainman and below the retina bleeds into the retina through the introduced in 1960. Later lasers included the break and causes scarring. argon, the CO2 or carbon dioxide, the krypton and An argon or krypton laser is used to treat the the neodymium: yttrium-aluminum-garnet or ND- disorder. The blue-green light of the argon laser is YAG laser. absorbed by the pigment of the inner retina. The Lasers affect living tissues in one of three ways: red krypton laser is absorbed only in the melanin to burn, cut, or destroy tissue. Laser light directed pigment of the deepest layers of the retina where into and absorbed by tissue causes energy to be the neovascularization occurs. Treatment with the released in the form of heat or a burn. Lasers are krypton laser is preferred because it allows the used to create an acoustical wave that disrupts or inner, unaffected retinal layers to remain cuts tissue and can be directed to break down or untouched while treating only the deep, affected vaporize tissue. All three laser techniques are used layers. surgically. Low-level laser energy is used in imag- A laser treatment called photodynamic therapy ing tissue and is nondestructive. is used for some patients with the wet form of Laser therapy is often used to treat DIABETIC ARM. This therapy, which was approved by the RETINOPATHY, a leading cause of blindness in the Food and Drug Administration in April 2000, United States. A complication of diabetes, diabetic involves a special dye that is injected into the retinopathy occurs as a result of damage to retinal patient and absorbed by the abnormal blood vessels blood vessels that leak or hemorrhage. The retinal in the eye. Once the dye has been absorbed, a low- tissue loses oxygen normally brought by the vessels level laser is used to activate it, causing the dye to and develops new vessels (neovascularization) that block the abnormal blood vessels. This can be done tend to be weak and bleed. Continuous leaking and without damaging other areas of the eye, which the formation of retinal scars may lead to blind- makes it a significant breakthrough in the treat- ness. ment of ARM. Lasers such as the ARGON are used to treat dia- Another use of lasers in ophthalmology is to betic retinopathy in a process called photocoagula- repair retinal holes, which, if left untreated, can tion. The laser is directed into the eye with a special cause retinal detachment. A laser can be used to lens. The light passes through the transparent seal a hole in the retina before detachment occurs. structures of the eye and is stopped when it reaches If the retina does detach, a retinal reattachment the pigmented layer of the retina. The energy of operation would be performed, and a laser may be the laser is converted to heat that coagulates or used to secure the retina. congeals the tissue. Several burns are placed in the Laser therapy may be an alternative to surgery tissue surrounding the bleeding vessel. The tissue in the treatment of GLAUCOMA, a disease in which develops scars that form a ring to enclose the ves- the intraocular fluid fails to properly drain from the sel and stop the bleeding. eye, accumulates, and causes elevated intraocular If neovascularization has occurred, unhealthy, pressure. The procedure is called laser trabeculo- oxygen-deprived tissue is treated with the laser. plasty. The directed energy of the laser causes scarring When medication fails to lower the intraocular and prohibits the tissue from forming new, weak pressure, laser trabeculoplasty is often used to open vessels. the drainage area located where the CORNEA meets Lasers are used to treat subretinal neovascular- the IRIS. A series of laser burns are placed in the ization, a disorder caused by AGE-RELATED MACU- drainage area, which causes scarring and openings 136 laser trabeculoplasty within the meshwork of drainage channels. The All laser treatments are administered in a simi- fluid drains more easily from the eye, and intraoc- lar manner. The therapy is usually performed ular pressure is reduced. without anesthesia but a topical anesthetic or Lasers are used postoperatively in CATARACT dilating drops may be administered. A contact lens extraction. After a cataract is removed in an extra- may be placed on the eye to aid in properly focus- capsular procedure, the capsule of the lens remaining the beam. The patient sits in a dimmed room ing in the eye opacifies in approximately 20 with the chin placed on the chin rest in front of percent of all cases and impairs vision. In the past, the slit lamp or biomicroscope. The patient may be a second intraocular operation, a posterior cap- asked to direct his vision to a specific point in the sulectomy, was required to remove the capsule. room. That surgery has been replaced by a procedure per- The surgeon focuses the laser and then adminis- formed by the ND-YAG laser. ters several bursts to the affected area. The patient The physician focuses the YAG LASER to a fine may see flashes of colored light. The procedure is point on the capsule and releases a series of usually painless, but some mild discomfort or short, 500,000 watt explosions of energy that destroy the intense painful moments may occur. The proce- capsular matter. Because the laser can be so dure may take from five to 30 minutes. After the minutely focused, the physician can aim the beam procedure, some discomfort may be felt for a day. If accurately and avoid surrounding tissue or an a local anesthetic was applied, the vision may be intraocular lens resting on the opaque capsule. blurred for a few hours. If the eyes were dilated, it The YAG laser is unique in its ability to perform may take several hours for the PUPILS return to nor- this procedure since, unlike other lasers, it is not mal size. The patient should be able to walk or dependent on pigmented tissue to be effective. The drive home. After a week, the patient may have a argon and other lasers depend on pigment such as follow-up examination. that found in the iris of the eye or in blood flowing Complications due to laser therapy include dam- through blood vessels in retinal tissue. The pig- age to surrounding healthy tissue, loss of focus, mented tissue absorbs the energy from the argon bleeding, cataract, neovascularization, opacifica- laser and is destroyed. However, cataracts or their tion of the VITREOUS, inflammation, temporary remaining capsules contain no pigmentation and intraocular pressure elevation, and vision loss. are immune to the power of the argon laser. While lasers have many uses and great promise A relatively new type of laser—the excimer for more uses and applications in the future, doc- laser—also is being used in ophthalmology. Excimer tors warn that they should not be viewed as a laser light is a beam that is produced when two means of miracle cures. Lasers are tools that doc- gases—argon and fluorine—are mixed. It is referred tors can use to work more precisely and effectively. to as a “cold” laser. The beam has the ability to They are not, however, cures in themselves. remove tiny layers of tissues with very little or no Berland, Theodore, and Richard A. Perritt. Living With heat damage to the surrounding tissue. The excimer Your Eye Operation. New York: St. Martin’s Press, 1974. laser is important because of its precision, and it is Eden, John. The Eye Book. New York: Penguin Books, being considered for new uses and applications. 1978. The excimer laser currently is used in photore- Krames Communications. The Retina Book. Daly City, Cal- fractive keratectomy (PRK) to permanently ifornia: KC, 1987. reshape the cornea by removing tiny amounts of Reynolds, James D. “Lasers in Ophthalmology,” Health- tissue. It also is used in LASIK surgery and in pho- Net Library. Columbus: CompuServe, 1989. totherapeutic keratectomy (PTK). PTK is another Shulman, Jules. Cataracts. New York: Simon and Schus- surgical procedure that is used to remove cloudy ter, 1984. scar tissue from the cornea. Lasers also are used to Wavikar, C. M., M.D. “Lasers in Ophthalmology.” help manage tumors within the eye and for cos- www.exicom.org, 1999. metic surgery involving the eye or area surrounding the eye. laser trabeculoplasty See LASERS. leprosy 137 legally blind Legally blind or legal blindness are tion fares and telephone rates, heating and insula- terms used by the Internal Revenue Service and tion reductions, as well as other benefits that vary other governmental agencies to determine by state are available to the legally blind. whether an individual is eligible for federal or state American Macular Degeneration Foundation. AMDF benefits. This classification is determined by mea- Bulletin Board, Re: Legally Blind. www.macular.org, suring visual acuity (how much detail one sees at a 2001. specific distance) and visual field (the area of vision). A person is classified as legally blind if the visual Legal Services Corporation A nonprofit organi- acuity of the better eye, with correction, is 20/200 zation established by Congress in 1974 to provide or less. This involves a loss of central vision. funding for a variety of legal services to needy in- One may also be termed legally blind if the dividuals including representation, advice and re- visual field of the better eye, even with 20/20 ferral. The Legal Services Corporation Act vision, is limited to 20 degrees or less. An individ- amendments of 1978 allowed disabled persons to ual with loss in the visual field may experience become eligible for these services. peripheral or central vision loss. Loss in the periph- Under the new amendments, the corporations eral, or side, vision may result in tunnel vision. were directed to consider the needs of potential Loss in the central, or straight-ahead, vision may clients to determine priorities, giving particular pri- result in difficulty in seeing an object in the center ority to those most needy, including those with dis- or direct line of sight. Because the classification abilities and the elderly. However, Congress involves measurement of the better eye only, peo- restricted the powers of the legal service corpora- ple who are blind in one eye are not considered tions in 1981 when it reauthorized the Legal Ser- legally blind. vices Corporation. It prohibited participating Legally blind people should not necessarily be attorneys from bringing a class-action suit against considered totally blind. The term includes a wide any government agency. range of visual abilities. Two individuals with The Legal Services Corporation does not provide 20/200 visual acuity or 20 degree visual fields may services directly but provides grants to independent have vastly different vision levels. local programs. In 1997 grants went to 269 such Current statistics show that there are approxi- programs. mately 500,000 legally blind people in the United U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, States. Of these, over 75 percent have some re- D.C.: USDE, 1988. maining vision. They are often able to utilize their Legal Services Corporation. What is LSC? www.lsc.gov, remaining vision to work, read, travel, and con- 1999. tinue their daily routine by using adaptive devices or by developing accommodating body or head movements. lens See CRYSTALLINE LENS. Individuals who are classified as legally blind may be eligible for financial aid. The Social Security leprosy A disease with complications that causes Administration offers two programs authorized by between 50,000 to 100,000 cases of blindness Titles 2 and 16 of the Social Security Act. The first throughout the world. In 1997 there were esti- program offers assistance based on contributions mated to be 1.2 million leprosy patients in the made to the Social Security System. The second, world, as reported by 91 countries. About half a also called Supplemental Security Income, or SSI, million new cases are detected each year. is based on financial need. Benefits vary according Leprosy is widespread in 60 countries. The 16 to one’s income and financial resources. rated “most endemic,” which account for 90 Medicare programs available to legally blind percent of all leprosy cases throughout the world, people provide assistance with medical and hospi- are Bangladesh, Brazil, Cambodia, Ethiopia, Guinea, tal bills. Tax deductions, reduced public transporta- India, Indonesia, Madagascar, Mozambique, 138 Lernout & Hauspie

Myanmar (Burma), Nepal, Nigeria, Philippines, Library Services and Technology Act (LSTA) Sudan, Tanzania, and Democratic Republic of the An act passed by Congress on September 30, 1996, Congo (formerly Zaire). India, and Nepal account for to replace the Library Services and Construction nearly 70 percent of all cases. Act. The act provides federal funding for libraries in Leprosy is a chronic infectious disease caused by the United States and guidelines for library pro- Mycobacterium leprae, a bacillus that reproduces very grams and services. slowly and mainly affects the skin, nerves, and The goal of the LSTA is to enhance technology in mucous membranes. If untreated, it leads to pro- America’s libraries, including that which will bene- gressive damage of the skin, eyes, and limbs. Visi- fit people who are blind or visually impaired. Some ble symptoms might not appear for five to 20 years of the aims of the LSTA are to establish or enhance after a person has contacted the disease. electronic link-ups among or between libraries; Advances are being made in controlling leprosy, link libraries electronically with educational, social, and public health officials are hopeful that the or information services; help libraries access infor- disease will soon be eliminated. A combination of mation from electronic networks; buy computers drugs has been found to be effective in treating and telecommunications equipment for libraries leprosy. that do not have them; provide library services in World Health Organization. A World Without Leprosy. areas that do not have them; and provide services www.who.int/lep/index.html, 2000. for everyone who wishes to use them, including blind, visually impaired, and learning impaired persons. Lernout & Hauspie One of the world’s largest The original act to fund libraries in the United providers of speech- and language-technology States was the Library Services Act, which went products. Headquartered in Belgium, Lernout & into effect in 1956. It was replaced by the Library Hauspie has offices in Massachusetts, Connecticut, Services and Construction Act in 1964. In 1966, and Florida. the act was amended to authorize special library- Founded in 1987 by Jo Lernout and Pol Haus- access programs and services, including those that pie, the company provides advanced speech and benefit blind or visually impaired people. language technologies to industries, individuals, Contact: educational facilities, government agencies, and other customers. Its products include the Kurzweil The American Library Association. Highlights of 1000, an advanced scanning and reading tool that the Library Services and Technology Act. scans documents into a computer and converts www.ala.org.washoff/lstahigh.html, 2000 them to speech. Lernout & Hauspie’s products and service stem from four technologies: automatic Lions Clubs International A service group speech recognition, text-to-speech, digital speech founded in 1917 by Melvin Jones, a Chicago busi- and music compression, and text-to-text (transla- nessman. The goals of the organization are to pro- tion). vide service to the community and around the Contact: world. The group has a membership of 1.3 million business and professional men and women. The Lernout & Hauspie World Headquarters organization operates over 39,000 clubs located in Flanders Language Valley 50 164 countries and geographical areas. 8900 Ieper, Belgium In 1925, Helen Keller challenged the Lions to +32-57-228-888 (ph) promote the cause of the visually impaired. As a +32-57-208-489 (fax) result, Lions Clubs established GLAUCOMA screening www.lhsl.com and detection centers, eye research foundations, eye banks, dog-guide training facilities, rehabilita- Library of Congress See NATIONAL LIBRARY SER- tion centers, and other service enterprises for the VICE FOR THE BLIND AND PHYSICALLY HANDICAPPED. visually impaired. The organization runs the Lions low vision 139

Recycle for Sight program, which collects used eye- experts. The user learns to employ all the senses in glasses that are sent around the world to people conjunction with cane techniques to travel safely. who need them. The organization is also involved in drug-aware- Low Income Home Energy Assistance Act The ness programs, environmental health, interna- Low Income Home Energy Assistance Act of 1981 tional understanding, diabetes research and is a state block-grant program of the Omnibus Bud- education, international youth camps, educational, get Reconciliation Act of 1981. The grant estab- recreational, social and citizenship programs, and lished a program in which tax credits and the Leo Clubs, a young adult organization. emergency federal payments are made to states The American Council of Blind Lions, an orga- and individuals to compensate for the rise in home nization made up of legally blind members of the heating costs. Lions Clubs International, was established in 1970. Individuals receiving SSI or AFDC benefits, Food The group informs the public about the abilities Stamps, and specific income-related veterans bene- and needs of blind people. fits are eligible for the assistance. Also eligible are Lions Clubs International issues four publica- those whose household income is less than 150 tions, the Lions Magazine, Club President’s Update, percent of the federal poverty level or 50 percent of District Governor’s Update, and Lions Club Com- the state median income. In fiscal year 2000, 84, munity Activities Bulletin. The organization holds 122 U.S. Households received an average of $414 an annual convention. each in energy assistance grants. long canes The long cane or prescriptive cane is U.S. Department of Education. Summary of Existing Legis- the travel aid most commonly used by visually lation Affecting Persons with Disabilities. Washington, impaired people. The American Foundation for the D.C.: USDE, 1988. U.S. Department of Health and Human Services. Low Blind estimates that about 109,000 people in the Income Home Energy Program. www.acf.dhhs.gov, United States use long canes to get around. The 2001. lightweight fiberglass or aluminum shaft of the cane is roughly one-half inch in diameter. The length of the cane is individually prescribed by an low vision A term generally used to describe a orientation and mobility expert according to the level of vision that is below normal after correction. user’s height and length of stride. It is a serious vision loss that cannot be corrected The cane is usually white and covered in one with lenses, surgery, or treatment and that inter- section with a reflective material. The tip of the feres with the performance of daily activities at shaft is red and made of steel or nylon. The handle home or work. A person with low vision is also of the cane is usually a rounded crook shape sometimes referred to as partially sighted, partially underneath which is a rubber grip. seeing, visually impaired, visually limited, or visu- The cane is also available in collapsible folding ally handicapped. or telescoping models. These are made of fiberglass, According to the American Foundation for the aluminum, or wood, and have crook, rounded, or Blind, there are approximately 11 million adults straight handles with a rubber grip, or wrist loop. and children in the United States who have vision Collapsible canes are often shorter and less durable below normal, even with correction. Of these, than the prescription length but are used in the almost 1.5 million can be classified as having low same manner. vision. Unless their vision loss is severe enough to The cane user swings the cane in front of his enable them to be classified as legally blind, they do body in wide sweeping arcs. The tip of the cane not qualify for federal or state benefits. touches the ground and alerts the user to obstacles Although there is no legal term for low vision, or changes in terrain. Cane use cannot alert the ophthalmologists and other eye care professionals user to obstacles overhead. The user is taught cane define low vision by visual acuity and visual field use techniques by trained orientation and mobility measurements. Visual acuity is the amount of 140 low-vision aids detail a person can see at a set distance, and visual with low vision to enhance their sight. A low- field is the amount of area, measured in degrees, vision aid may be as simple as a stronger lightbulb that a person can see. to better illuminate the subject or as complex as a A person with a visual acuity measurement of talking computer. Emerging technologies promise 20/50 or less and a visual field of 20 to 40 degrees even more exciting and complex aids, such as elec- or less in the better eye, with correction, is consid- trodes that can be implanted to transmit signals ered to have low vision. Someone with a visual from a video camera directly to the brain. However, acuity of 20/200 and a visual field of 20 degrees or most aids either enlarge the image of the object, less in the better eye, with correction, is termed enlarge the object itself, illuminate or improve con- legally blind. trast or enhance an object or task. Most legally blind people have some usable Many aids magnify the image of an object. An vision. Because of this, and since the word “blind” enlarged image spread out over the RETINA helps is involved in the legal classification, a misconcep- the viewer to overcome any blind spots in the field tion exists about what blind people can actually of vision. Those that magnify the image include see. Therefore, many agencies for the blind suggest MAGNIFIERS, telescopic devices, and electronic that the word “blind” be used to describe only devices. those with no usable vision and that the words Magnifiers improve close vision for reading and “low vision,” “visually impaired,” and “partially writing tasks. These aids range from the inexpen- sighted” be used to describe people with some sive dime-store magnifying glass to sophisticated, remaining usable vision. expensive video equipment. Hand-held or stand Low vision may be caused by injury, birth magnifiers are available in a wide range of sizes and defects, disease or aging. The most common vision- strengths and come with or without built-in illu- limiting diseases or disorders are GLAUCOMA, AGE- mination. RELATED MACULOPATHY, CATARACT, OPTIC NERVE A loupe, or spectacle magnifier, is a convex lens ATROPHY, and DIABETIC RETINOPATHY. A stroke also that clips onto an eyeglass frame. The lens is can result in low vision. attached to the frame by a thin, metal arm and Some conditions limit the vision by blurring or swings down into position just in front of the eye- clouding the general or central vision. Others block glass lens. Two or more loupes can be simultane- out or blur specific areas within the entire field of ously mounted on the frame to accommodate work vision. In the latter, a person might experience tun- or reading done at different distances. nel vision, the illusion of looking through a straw, Telescopic devices increase distance vision. They or randomly blocked vision, giving the illusion of can be used with one or both eyes and may be looking through a web or tree branches. hand-held or spectacle mounted. Telemicroscopic Those with low vision may seek low-vision ser- lenses or reading telescopes improve intermediate vices. Low-vision programs provide specialists who distance vision. These lenses are clipped or examine the patient’s eyes, evaluate how the mounted onto one or both of the eyeglass lenses. patient uses his vision and how it affects his daily Other lens systems include filters and prisms. activities, provide specific counseling and training, Filter shields worn over eyeglasses reduce glare and and prescribe low-vision aids or devices. ease bright lights for those with light sensitivities. Cockerham, Paul. Low Vision Questions and Answers. New Prisms incorporated into spectacle lenses adjust the York: American Foundation for the Blind. 1987. image to a different section of the retina to take National Society to Prevent Blindness. Vision Problems in advantage of functional vision and avoid blind the U.S. New York: NSPB, 1980. spots. American Foundation for the Blind. What Is Low Vision? Electronic magnifying systems are more com- www.afb.org/info, 1999. plex and expensive. Video magnifiers such as CLOSED-CIRCUIT TELEVISION (CCTV) enlarge an orig- low-vision aids Low-vision aids or devices are inal print image up to 60 times and display the optical lenses or nonoptical devices that help those image on a large viewing screen. LS&S Group, Inc. 141

A low-vision aid that magnifies the object, may be asked about general health, living condi- rather than its image, is LARGE PRINT. This enlarged tions, traveling needs, and job tasks. print enables some people with low vision to read Next, the eye examination is performed by an with or without additional magnifying aids. optometrist or an ophthalmologist. The examiner Many low-vision aids adapt or enhance an uses specifically designed eye charts and carefully object to compensate for the loss of vision. These monitored light levels to assess the patient’s dis- ADAPTIVE AIDS include communication and writing tance vision. Powerful lenses and magnifiers are aids, household devices, and health-care instru- used to evaluate the patient’s near vision and read- ments. Low-vision aids for computers also are ing skills. The examination may take many sessions available. to complete, and each session may last up to an Low-vision aids are available through low- hour in length. vision clinics and adaptive aids catalogs. Many of After the eye examination, the patient receives the magnification aids should be prescribed by a training in visual techniques and/or the use of low- low-vision specialist through the services offered at vision aids. The instruction is given by a rehabilita- low-vision clinics. tion counselor or professional low-vision clinician. During the lesson, the patient is taught skills for using his vision efficiently and is introduced to low-vision clinics Low-vision clinics provide spe- appropriate devices or aids. These may include opti- cial services to people with low vision. They may be cal lenses such as magnifiers, clip-on loupes, and located in clinics or hospitals or medical, rehabilita- telescopic devices or nonoptical aids such as lamps, tion or optometric centers. Many ophthalmologists reading stands, filters, or large print. The patient and optometrists specialize in low-vision services may take the aids home for a trial period. The half- and offer them through private practice. hour lesson may be repeated until the proper pre- Low-vision services vary. Most offer vision scription can be made. An additional recheck assessment, low-vision eye examinations, training examination is usually scheduled after six months. in techniques to help maximize remaining vision, A patient may be referred to other professionals and prescription of aids or devices to enhance in the field such as an orientation and mobility vision. instructor or a vocational rehabilitation counselor Some low-vision clinics extend this basic pro- for additional training. These specialists may direct gram and offer pediatric low-vision exams, genetic the patient back to the low-vision clinic at any time counseling, and contact lens evaluation and dis- during training to reevaluate the patient’s vision or bursement. Others add rehabilitation experts to aids. train patients in orientation and mobility instruction and counsel them in vocational and financial matters. LS&S Group, Inc. A mail-order company that A standard low-vision eye exam includes an specializes in products for the visually impaired. assessment interview, specialized examination of Through its catalog, the company offers adaptive the eyes, assessment of remaining vision use, eval- aids and electronic equipment. uation of vision needed to complete daily tasks at Items offered include talking and braille watches work and home, counseling, and prescription for and clocks, large-print, braille, and speech com- and training in the use of adaptive devices or aids. puter systems; reading machines; personal com- The assessment interview may be conducted by puters; talking calculators; large-print and braille a social worker, rehabilitation or mobility instruc- translation software; speech synthesizers; closed- tor, psychologist, counselor, nurse, or other profes- circuit television systems (CCTV); recorders; sional worker in the low-vision field. The telephones and answering machines; timers; mag- oral-assessment interview consists of questions that nifiers; lamps; mobility aids; canes; health aids; determine how the patient feels about loss of vision glasses; security devices; kitchen aids; recreation and how it interferes with daily living. The patient aids; and toys and games. 142 lupus

Contact: UVEITIS, an infection in the eye’s IRIS, can be caused by lupus. It is treated with cortisone drugs. LS&S Group, Inc. Unfortunately, the drug therapy of lupus P.O. Box 673 patients may contribute to their eye disorders. Northbrook, IL 60065 Many lupus patients are treated with cortisone and 708-498-9777 or 1-800-468-4789 (ph) other steroids, which may cause cataracts or GLAU- 847-498-1482 (fax) COMA in those predisposed to glaucoma. www.lssgroup.com Plaquinil, an antimalarial drug used in the treatment of lupus, can cause glaucomalike symptoms, lupus Lupus or lupus erythematosus (LE) is the such as the loss of peripheral vision. This drug may name for a series of chronic autoimmune diseases also be damaging to the eye’s macula. in which the body’s immune system attacks its own tissues. The Lupus Foundation of America esti- lutein A nutrient in the carotenoid family that is mates that between 500,000 and 1.5 million Amer- thought by some people to reduce the risk of devel- icans have been diagnosed with the disease. Lupus oping age-related macular degeneration. While occurs more frequently in women than in men, most researchers and doctors agree that good nutri- and its more prevalent in people of African-Amer- tion is important to overall eye health, there is lit- ican, Indian, or Asian origin. It is a lifelong illness tle scientific evidence to support the theory that but is not considered life threatening. lutein can prevent macular degeneration, despite Lupus attacks collagen, the support material for recent publicity to the contrary. The National Eye tissue. As a result, it can affect the kidneys, skin, Institute (NEI) in March 2000 issued a statement joints, blood, heart, eyes, and virtually any other concerning the value of taking lutein supplements. organ in the body. Since its symptoms of skin rash, The NEI advised that claims concerning lutein and painful swelling of the joints, fever, headache, and eye health should be regarded cautiously and exhaustion mirror those of other disorders, lupus stated that the possible benefits of lutein are uncer- can be difficult to detect immediately. tain. The cause of lupus is unknown, but heredity, Foods that are rich in carotenoids include green, viruses, exposure to ultraviolet or sunlight, leafy vegetables such as kale and cabbage. While extreme stress, and various drugs may play a role. the NEI recognizes that these lutein-rich foods are There is no cure for lupus, but treatment can con- beneficial to overall health, it questions that direct trol and relieve symptoms and often result in a relationship between lutein and eye health. remission. Since collagen is found in every part of the eye, many eye disorders can result as a complication Lyme disease An infection caused by Borrelia of lupus or its treatment. Hypertension associated burgdorferi, a spirochete bacteria spread by the bite with lupus can swell the blood vessels of the of an infected tick carried by deer, mice, birds, rac- OPTIC NERVE, causing hemorrhaging. When this coons, chipmunks, and domestic animals. Lyme occurs, the blood vessels of the brain and eye disease has a worldwide prevalence and has been become protectively constrictive, shutting off nec- recorded in six continents, 20 countries and 48 of essary oxygen to the eye and causing permanent the United States. More than 100,000 U.S. cases damage. have been reported to the Centers for Disease Con- Vasculitis, swelling of the blood vessels, can cen- trol and Prevention. States most affected by Lyme ter in the eye, causing blockage of the eye’s main disease are New York, Connecticut, Pennsylvania, artery. Sudden, severe vision loss may occur. and New Jersey. Optic neuritis, swelling of the optic nerve, can Symptoms of Lyme disease include a circular or cause retinitis and an accompanying vision loss. oblong rash, headache, stiff neck, fever, muscle Cortisone treatment may reverse the damage aches, fatigue, and other flulike discomforts. The caused by optic neuritis. symptoms usually subside, only to reappear later or Lyme disease 143 give way to more serious problems such as infec- the infecting spirochete but is not completely reli- tions of the eye, muscles and joints, brain, heart, able. Those who test negative to the disease may be skin, liver and lung, skin tumors, gastrointestinal infected. disorders, birth defects, and loss of nerve conduc- Lyme disease is treated with oral antibiotics in tion. the early stages and with intravenous antibiotic Early stages of Lyme disease are manifested in treatments in later stages. The antibiotic treatment the eyes as conjunctivitis, episcleritis, and photo- is not a cure. Although some individuals remain phobia. Later, cranial nerve palsies may result and symptom free, others experience recurrences and cause exposure keratitis and corneal abrasion. require long-term antibiotic treatment. There is a Lyme disease may cause papilledema, optic neuri- vaccine against Lyme disease called Lymerix, but it tis, and loss of vision. Ocular disorders may be is not always effective. Scientists and doctors are transmitted from an infected mother to the unborn working to improve the vaccine. fetus. Diagnosis of the disease is problematic. A blood test can measure the immune system response to

M macula The macula is the central section of the Macular diseases of the eye that cause deteriora- RETINA responsible for clear central vision. It is tion to the macula, or central part of the RETINA. located in direct line of sight with the PUPIL. This results in a loss of vision in the central field. The retina, which contains the macula, is filled The macula is centered in the retina, a light-sensi- with RODS AND CONES. These light-sensitive cells tive layer in the back of the eye. Light reflected off supply information to the eye about the image an object is focused onto an indentation of the seen. The rods react to faint light, movement, and macula, called the FOVEA. The fovea is the point of shape. The cones distinguish color and detail but clearest sight. require higher light levels to be effective. The mac- Cones in the fovea interpret the light into infor- ula contains the greatest number of cones. mation about the object. This information is Within the macula is an indentation called the encoded into electrical impulses by the retina and FOVEA. The fovea contains the greatest concentra- sent to the brain via the OPTIC NERVE. The brain tion of cones and is the site of sharpest vision. translates the impulses into an image. Because the cones require light to work, incoming There are two major types of macular disease. light is focused by the eye onto the macula, center- The first, inherited macular dystrophies, usually ing on the fovea. occur before the age of 20. These inherited diseases The macula is subject to degeneration. Macular are rare and usually incurable. disease may be caused by heredity, other diseases The more common form of macular disorder is such as arteriosclerosis, or aging. ARM, or age- called age-related maculopathy, or ARM. It is most related maculopathy is the most common type of common in people who are over 60, but can appear degeneration. It is a disease in which the macula as early as age 40. deteriorates, causing a loss of central vision. The It is thought that the disorder is caused by a disease may involve hemorrhaging from fragile breakdown in the blood supply to the retina. It blood vessels beneath the retina. ARM is a progres- may also develop due to an infection, ocular sive disease that may worsen over time. It may trauma or injury, drugs, other diseases such as dia- effect one or both eyes. The disease is seldom betes, or heredity. responsible for total blindness since the patient ARM may fall into one of two categories: wet usually retains some peripheral vision. type or maculopathy. The wet type occurs when new delicate blood vessels form in the CHOROID,a vascular layer of tissue beneath the retina. When macular disease Macular disease is the leading these abnormal vessels break or leak into the mac- cause of new cases of blindness. The Macular ula, healthy cells are destroyed and vision loss Degeneration Foundation, an educational and occurs in that central area. Maculopathy does not research organization founded in 1989, estimates involve fluid leakage. that more than 1.2 million American are affected ARM is a progressive disease that may worsen by this disease and that a new case of adult macu- rapidly or slowly over time. The onset usually takes lar disease is diagnosed every three minutes in the place in one eye first, to be followed by an occur- United States. rence in the other eye, two or three years later. The

145 146 macular edema condition may first present itself as a blurring of the infection treated before further damage can vision. Printed type may look blurred, vertical lines occur. Photocoagulation is most successful in the may look wavy, and central vision may appear early stages, since it becomes impossible once the blocked or distorted. vessels develop near the center of the macula or Age-related maculopathy can be detected during once the infusion of blood conceals the vessels. the normal ophthalmological examination. Those over 50 years of age are routinely screened for the macular edema A condition of the macula stem- disease. During the exam, the ophthalmologist ming from retinal edema. The macula is an inden- looks for changes within the retina and choroid. tation of the retina that contains an abundance of The presence of new blood vessels beneath the cones, light-sensitive cells that are responsible for retina may be signs of possible degeneration devel- discerning color and detail. Light is focused directly opment. The presence of drusen, small whitish on the macula by the eye, making it the center of spots of waste material scattered on the posterior sharpest sight. pole may indicate a propensity for development of Retinal edema occurs when the capillaries of the the disease. retina bleed, filling the spaces between retinal cells The patient may also be tested for age-related with fluid. Retinal edema may be present through- maculopathy with the Amsler grid. This is a grid out the retina and involve the macula, or it may with a dot in the middle of two intersecting lines. contained in a general area that spares the macula. With one eye covered, the patient looks at the dot. If the macula is spared, vision may be relatively If the patient is unable to see some of the lines or if unaffected at first. However, the macula tends to some lines appear wavy or kinked, ARM may have accumulate the fluid. In this case, macular edema occurred. occurs. The condition is characterized by inflam- Fluorescein angiography may be performed to mation of the macula and blurred or impaired view the retinal blood vessels. This is a test in vision. If untreated, macular fluid collects in small which a fluorescent vegetable dye is injected into a pockets of space and forms cysts, a condition called vein in the arm. As the dye travels throughout the cystic macular edema. The condition leads to body and into the retina, a series of photographs degeneration of the macula in which central vision are taken. The photographs point out any irregu- may be permanently lost. larities within the retinal vascular system. Macular edema is caused by diabetic retinopa- Doctors and scientists have been working hard thy, hypertension, retinal vein obstruction, traction to learn more about ARM. A new drug, Visudyne, of the vitreous, inflammations such as UVEITIS and was recently approved for treatment of the wet RETINITIS, and CATARACT surgery. It is diagnosed form of ARM. Physicians are hopeful that this drug with fluorescein angiography, a procedure in will begin a series of advancements in the treat- which fluorescein dye is injected into a vein in the ment of this disease. But since the peripheral field arm and monitored as it passes through the veins of vision remains unaffected, it is possible to learn of the retina. Macular edema may right itself spon- to use the remaining vision to the best advantage. taneously or persist. Treatment of the condition Special viewing techniques and optical aids such as varies according to the cause. Cases due to inflam- telescopic lenses may be prescribed. mation are treated with corticosteroids. In approximately 10 percent of cases, laser pho- Those conditions of edema caused by vascular tocoagulation treatments can improve the condi- problems and diabetes may be treated with photo- tion. These treatments use LASERS to cauterize and coagulation, a treatment that uses a laser to seal seal the abnormal leaky vessels of wet type ARM. It leaking blood vessels. There is no treatment for is usually a painless procedure, performed on an edema due to traction or cataract surgery. out-patient basis. Early diagnosis is critical to the treatment of macular degeneration. If the disorder is caused by magnifiers Magnifiers and other optical aids are drugs or infection, the drugs can be discontinued or used to increase the size of an image. Magnifiers magnifiers 147 improve close vision for reading and writing tasks. Telescopes are commonly used optical aids. They These LOW-VISION AIDS range from the inexpensive may be hand held, fused into spectacle frames, dime-store magnifying glass to sophisticated, incorporated into prescription lenses, or worn on a expensive video equipment. headband. Binocular hand-held telescopes are used Placement-type, hand-held, and stand magni- for distance magnification and are available in var- fiers are available in a wide range of sizes and ious magnifications. Hand-held binocular tele- strengths and come with or without built-in illu- scopes are adjustable and may be used with one or mination. Bar magnifiers are plastic bars that are both eyes. They are used with both eyes for view- placed on one line of print to double the original ing sports events, television, and street signs. When size. Page magnifiers are sheets of plastic placed used with one eye, binoculars produce a smaller over a page to magnify the print. Both are available field of view and are used for near and intermedi- without prescription. ate distance viewing in tasks such as reading or Hand-held magnifiers range from 3X to 10X writing. magnification. Some are modeled after a flashlight Binocular telescopes may be fused into spectacle and include illumination. These are used for near- frames for convenience of use. These are used for vision tasks such as short-term reading. Hand-held distance viewing of sports events, television, stage magnifiers are not suitable for long periods of read- productions, etc. They produce a small field of view ing and writing due to unsteadiness of the hand. and are available in 3X magnification. Binocular Stand magnifiers are available in 3X to 10X spectacles are available without a prescription but magnification and are mounted on a stand that is cannot be used if a prescriptive correction is neces- placed over the document to be read. The stand sary. places the magnifier the proper distance from the Hand-held monocular telescopes are available material and frees the hands. Stand magnifiers are for use with one eye in magnifications up to 10X. generally used with reading glasses. They are used for distance of viewing sports or tele- A loupe, or spectacle magnifier, is a convex lens vision or in school but are not recommended for that clips onto an eyeglass frame. The lens is walking. Variations of the hand-held monocular attached to the frame by a thin, metal arm and telescope may be attached or fused onto prescrip- swings down into position just in front of the eye- tive lenses. Attached versions are available in mag- glass lens. Two or more loupes can be simultane- nifications up to 3X, and fused versions up to 4X ously mounted on the frame to accommodate work magnification. or reading done at different distances. Bioptics are optical aids that consist of small Electronic magnifying systems are more com- telescopes fused onto the upper portion of specta- plex and expensive. Video magnifiers, such as cles, on one or both lenses. The bottom portion of closed-circuit television or CCTV, enlarge an origi- the spectacles contains the individual’s corrective nal print image up to 60 times. The image is dis- prescription. The bioptics involving both eyes played on a large viewing screen. These devices can enables the user to view distances when walking or change the dark letters on a white field of the orig- driving or to view closer objects or material if mag- inal to white letters on a dark field to increase con- nification is needed. The bioptics that involve one trast and visibility. Many users can use the CCTV to eye only are used for near and intermediate dis- write, type and operate a computer. tance viewing for reading material. Bioptics are High-powered, portable magnifying devices are prescribed by an ophthalmologist or low-vision rapidly becoming available. Small and lightweight, expert and must be properly centered to the eyes of these aids are powered by rechargeable battery the wearer. Magnification may extend to six times packs. They scan print information with a camera normal size when used for distance viewing. Wide- mounted on rollers and magnify the image four to angle and zoom lenses may be incorporated into 64 times the original size. The image is projected the device. onto a display monitor in either orange print on a Near telescopes are fused onto the lower portion black background or the reverse. of the spectacle frames, with the prescriptive lenses 148 mailing privileges in the upper portion of the frame. They are avail- ally or physically disabled individuals. The mail is able up to 8X magnification and are effective for subject to inspection by the Postal Service. five to 40 inches. The telescopes are angled to be Noncommercial agencies or organizations, indi- used by both eyes and are used for intermediate viduals, and libraries serving eligible persons may distance tasks such as reading or typing. mail the material to an eligible person or organiza- Headband telescopes are attached to a headband tion free of charge. The eligible person may ex- and free the hands for work. They can be worn change or return material postage free to other over prescriptive lenses and are used for near view- eligible persons or organizations. Commercial pro- ing up to one foot or less. They afford a wide field ducers of this material may mail it free of postage of vision and are most effective for those with to an eligible individual or organization so long as equal sight in both eyes. the fee, charge, or rental does not exceed the cost Some new systems combine the camera and dis- of the material. play screen in a hand-held housing. A vacuum-flu- Eligible persons may send letters in braille, orescent display makes a magnified image appear large print, or recorded form. Handwritten or typed as the camera is moved across the reading material. letters are subject to postage when mailed to or There also are some new systems that use head- from an eligible person. Letters must remain mounted displays, providing portability and a new unsealed to allow inspection by the Postal Service. way of viewing. More information and reviews of All mailed material must be stamped, printed, or various CCTV systems are available by contacting handwritten with the words. “Free Matter for the the National Technology Program: Blind or Handicapped” in the space reserved for postage. Free international delivery of some mate- 212-502-7642 (ph) rials also is included. Special services, however, 212-502-7773 (fax) such as Express Mail or Certified Mail, are not [email protected] included. mailing privileges Materials may be mailed free of mainstreaming A term used to describe the prac- postage by legally blind individuals or those unable tice of educating disabled students, including those to read or use conventionally printed materials as a with visual impairments, in a standard, public result of a physical disability. The program is entitled classroom for non-disabled children. “Free Matter for the Blind or Handicapped.” Federal law requires that all disabled children be In order to become eligible, the individual must given a free, appropriate public education in the present written certification by a competent least restrictive environment. This environment authority to the post office where mailings will be has often been equated with mainstreaming. sent and received. An authority may include a The mainstreaming movement grew out of a licensed doctor, ophthalmologist, optometrist, reg- need for the education of a large population of istered nurse, or professional staff member of a visually impaired children who were blinded by hospital or other agency or institution. retrolental fibroplasia during the early 1950s. At Material eligible for mailing includes books, that time, the most popular form of education, res- magazines, musical scores, braille material, 14- idential schooling, was unable to immediately pro- point Sightsaving Type, records, or cassette tapes. vide for the influx of students. Equipment and parts of equipment used for writing Parents organized to insist that their children be or educational purposes, sound play-back equip- allowed into public schools and that special educa- ment for use by the visually impaired, and equip- tion be provided according to their needs. Today, ment designed or adapted for use by visually although residential schools still provide vital edu- impaired persons, such as braille watches and cation and training services, the American Founda- white canes are also eligible. tion for the Blind estimates that nearly 90 percent The material must be free of advertising and of disabled students receive all or part of their edu- must be specifically designed for and used by visu- cation in local public schools. malignant melanoma 149

Students may be mainstreamed into a public IRIS, or CILIARY BODY. Also called an intraocular school program through several models of delivery, melanoma. According to the U.S. Department of including the itinerant-teacher model, and the Health and Human Services, malignant melanomas teacher-consultant model, and the resource-room account for up to 80 percent of all eye malignan- model. cies, making them the most common primary The ITINERANT TEACHER is one who travels every (originating in the eye) inner-eye tumor. The two or three days to each public school in the dis- tumor may develop from a mole or spontaneously trict to provide special education modifications to and is usually slow to grow and spread. It generally mainstreamed visually impaired children. The affects one eye only (unilateral), may appear at any teacher provides special equipment, training, and age and is more common in whites than blacks. materials adapted to the student’s learning needs Symptoms include redness of the eye, inflamma- and consultation services to the regular classroom tion, vision loss, and the presence or development teacher. of GLAUCOMA. Melanomas of the iris may distort The TEACHER-CONSULTANT is a special educator the shape of PUPIL. who advises regular classroom teachers, teacher A melanoma can be detected in the ophthalmo- aides, administrators, and other school personnel logic examination. It may first appear to be a in methods that will meet visually impaired stu- choroidal hemorrhage, but can be identified fur- dents’ needs. The greatest proportion of the work is ther by FLUORESCEIN ANGIOGRAPHY or ULTRASONOG- consultative, rather than instructive. RAPHY. The RESOURCE ROOM is a specially equipped Three types of treatment are commonly used for room staffed with special education personnel intraocular melanomas. They are: surgery, radia- trained to work with disabled students, including tion therapy, and photocoagulation. Surgery is the those with blindness or visual impairments. The most common treatment. It can involve removing students live at home and attend public school in a portion of the diseased eye, or enucleation, which regular classrooms taught by teachers who provide is the removal of the entire eye. Radiation uses X general curriculum instruction. Students visit the rays and other high-energy rays to kill cancer cells resource room at regularly scheduled intervals or and shrink tumors. It can be used by itself, or in when needed. combination with surgery. Photocoagulation treats Students may be technically mainstreamed into the melanoma by destroying blood vessels with a a public school system through a school’s SELF-CON- tiny beam of light, usually from a laser. Destroying TAINED CLASSROOM for the disabled. This is a class- the blood vessels kills the tumor. room in a public school that is specially equipped Clinical trials to test other treatment methods and staffed with special education teachers for the are ongoing. More information about the trials can disabled. All the students in the class have visual be obtained by calling (toll free) the National Can- impairments or other disabilities. cer Institute’s Cancer Information Service at 800- Many children, often those with low vision or 422-6237. If the diagnosis is uncertain, a period of other disabilities that do not interfere with educa- observation may be prescribed, possibly including tional progress, attend their local public schools chemotherapy or radiation treatments. without special-education support. Little is known concerning the cause of malig- Scholl, Geraldine, ed. Foundations of Education for Blind nant melanomas. Unlike skin or conjunctiva and Visually Handicapped Children and Youth. New York: melanomas, sunlight exposure is not related to American Foundation for the Blind Inc., 1986. these tumors. Limited data exists concerning Scott, Eileen P. Your Visually Impaired Student. Baltimore: metastatic rates (growth or spread of tumor) and University Park Press, 1982. spontaneous regression rates

National Cancer Institute. “What is Intraocular Mela- malignant melanoma A tumor of the eye that noma?” NCI website: www.cancernet.nci.nih.gov, grows from melanin-laden cells in the CHOROID, 2000. 150 Marfan’s syndrome

Marfan’s syndrome Marfan’s syndrome (arach- funds for states under the Maternal and Child nodactyly) is a rare genetic disease. It is character- Health program and the Crippled Children’s pro- ized by long, thin bones, elongated limbs, especially gram. of the extremities, tall slender figure, lack of sub- The Social Security Act Amendments of 1965 cutaneous fat, nonelastic ligaments, congenital extended and improved health-care services for heart disorders, high infant-mortality rate, malfor- mothers and children. Project grants were estab- mations of the spine, joints, and ears, and ocular lished to develop maternal and children’s health- disorders. care programs and comprehensive training services Ocular disorders include dislocation or subluxa- for specialists working with disabled children. Pro- tion of the LENS, serious refractive errors (near- ject grants were authorized to support and improve sightedness, far-sightedness, etc.), GLAUCOMA, health-care services to low-income school-age and CATARACT, and uveal COLOBOMAS. IRIDONESIS, or a preschool-age children. trembling of the iris, also associated with Marfan’s In 1967, amendments to the Social Security Act syndrome. The most common symptom, sublux- combined the separate Crippled Children’s Service ated lens, is a condition in which the lens becomes grants and Maternal and Child Health Services displaced in an up and out direction. grants into one authorization. One-half of the The subluxated lens may increase myopia and funding was allotted to formula grants; the other cause ASTIGMATISM or cataracts. Often, the dis- half was divided 40 percent for project grants and placed lens blocks or narrows the angle of the 10 percent for training and research. In 1981, this ANTERIOR CHAMBER and causes secondary glau- grant authority was consolidated with those for all coma. If glaucoma cannot be treated successfully the programs established in Title V into one state with medications or surgical procedures, the lens block-grant authority by the Omnibus Budget Rec- may be removed. In some cases, aphakic (without onciliation Act. lens) patients may experience corrected vision with The words “crippled children” were removed aphakic spectacles or contact lenses. from the wording of the Act in 1985 and the For more information contact: words, “children with special health-care needs” was substituted. In 1986 and 1987, appropriations The National Marfan Foundation were raised for the Maternal and Child Health 382 Main Street program. Port Washington, NY 11050 Block grants awarded to the states may be used 800-8-MARFAN (ph) to provide health-care services, and fund develop- 516-883-8040 (fax) ment, administration, training, education and eval- www.marfan.org uation of the programs. According to the Office of Special Education and Rehabilitative Services, the Maternal and Child Health Services Program law authorizes the states to use MCH block-grant The Maternal and Child Health block-grant pro- funds to: gram evolved from the original Sheppard-Tower Act of 1921. Also known as the Maternity and • Assure mothers and children access to quality Infant Act, it was the first national health services health services grant program. In 1935, the act was amended and • Reduce infant mortality, preventable diseases, revised by Title V of the Social Security Act to and disability conditions among children include services for disabled children. • Reduce the need for in-patient and long-term Amendments to Title V in 1963 authorized a care services grant program to improve health and prenatal care for low-income women. The effort was • Increase appropriate child immunization designed to reduce preventable mental retarda- • Increase health assessments and follow-up diag- tion and birth defects. The legislation provided nostic and treatment services for low-income funding for research studies and additional grant children Medicaid legislation 151

• Provide preventative and primary-care services Mills medical-aid program for low-income blind for children and prenatal, delivery, and postpar- and disabled individuals and dependent children. tum services for low-income mothers The new program became known as Medicaid. • Provide rehabilitation services for blind or dis- Unlike Medicare, it allowed states to offer coverage abled children under 16 who receive Supple- not only to those who receive public assistance, but mental Security Income benefits also to eligible needy people who did not qualify for welfare or Medicare. The program varies from • Provide information services regarding diagnosis, state to state. hospitalization, and after-care for children who Although the original legislation of 1965 made have disabilities or conditions that may lead to no specific reference to disabilities, Medicaid has disabilities become the main source of medical services fund- • Provide for Special Projects of Regional and ing to severely disabled individuals. In 1992, U.S. National Significance (SPRANS), research and federal and state budgets included $118 billion in training for genetic disease testing, counseling, Medicaid benefits. This may be because later and information dissemination amendments added specific benefits for mentally • Provide grants relating to hemophilia and sud- ill and mentally retarded institutionalized indi- den infant death syndrome viduals, and because the funding targets low- income groups where the incidence of disability is U.S. Department of Education. Summary of Existing Legis- greater. lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. Medicaid eligibility is determined by financial need. Recipients generally fall into one or more of the three qualifying categories: categorically needy, Maxi Aids Inc. Maxi Aids is one of the largest medically needy, or qualified severely impaired. suppliers of adaptive living aids in the United The categorically needy receive AID TO FAMILIES States. Formerly known as Seeing Technologies WITH DEPENDENT CHILDREN (AFDC) benefits or SUP- Inc., the company has an extensive on-line catalog PLEMENTAL SECURITY INCOME (SSI) benefits or qualify and also offers traditional catalogs of its products. under specific regulations for their state. It offers products including alarm vibrators, Medically needy persons may have incomes too adaptive calculators, canes, CCTVs, computer prod- high to qualify for AFDC or SSI benefits yet cannot ucts, games, personal need devices, glasses, kitchen afford to pay for necessary medical treatment. and cooking adaptive devices, mobility devices, States determine a different qualifying income magnifiers, radios and recorders, paging devices, level for those who are medically needy. sensory products, talking products, and telephones. Qualified severely impaired individuals are Contact: those under 65 who receive federal SSI benefits Maxi Aids because of blindness or disability and are able to be 42 Executive Blvd. employed but do not have incomes that allow Farmingdale, NY 11735 them to pay for health-care coverage. Medicaid provides hospital services, both inpa- 631-752-0521 or 1-800-522-6294 (to place an tient and outpatient, as well as laboratory tests or order) X-ray services. Special nursing facility services and, 631-752-0738 (TTY) for those over 21 years old, home health services 631-752-0689 (fax) are also provided. www.maxiaids.com The benefits cover the recipient’s doctor services and diagnostic tests such as those classified as Medicaid legislation In 1965, amendments to EPSDT, or early periodic screening, diagnosis and the Social Security Act added Title XIX, a grants treatment services, for those under 21. Addition- program that allowed states to establish medical- ally, some rural health-clinic care and family-plan- assistance systems. Title XIX extended the Kerr- ning services are also provided under the plan. 152 Medicare legislation

States must arrange to transport recipients to • People with childhood disabilities who qualify and from medical services if needed; they must for Social Security benefits allow the recipient to choose the medical caregivers • Disabled widowed persons, 50 years of age or and must provide health-care services statewide. If older adequate medical care is provided, states may limit • Diagnosed as having an end-stage renal condi- the quantity, extent, and range of these services. tion If listed in the state plan, the state may provide any optional services that are allowed under state In 2001, nearly 40 million people in America law and permitted by the Secretary of Health and were eligible for some Medicare health coverage. Human Services. Since each state designs a pro- Medicare has two parts: Part A is hospital insurance gram to meet the specific needs of its citizens, cov- and Part B is medical insurance. Part A helps pay erage differs greatly from state to state. for necessary in-patient and limited home services The optional services may include private nurs- including hospital or emergency-room care, nursing, health-clinic, and dental services. Physical and ing facilities, hospice services, and some home- occupational therapy and rehabilitation services health care. may be covered, as well as hearing, speech, and Part B of the insurance plan helps pay for doc- language therapy or treatment. tors, services, outpatient hospital care, and other The plan may include prescriptions such as medical treatment not covered by Part A. Services drugs, eyeglasses, dentures, prosthetics, and pros- covered by the plan are paid according to reason- thetic aids. Other services may include those not able costs and fee schedules. Any eligible individual covered specifically under federal law in such areas may register for Part B benefits. Although the indi- as diagnostic screening, inpatient hospital proce- vidual is required to pay a monthly premium, some dures, nursing or intermediate-care facility ser- states or other agencies may pay the premium for a vices, in-patient psychiatric treatment for those disabled person. under 21 or over 65, and case-management ser- At the end of March 2001, a bill was pending in vices for specific categories of eligible people. Congress that would make orientation and mobil- U.S. Department of Education. Summary of Existing Legis- ity specialists, rehabilitation teachers, and low- lation Affecting Persons with Disabilities. Washington, vision therapists eligible providers under Medicare. D.C.: USDE, 1988. U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, Medicare legislation Title XVIII of the Social D.C.: USDE, 1988. Security Act authorizes the Health Care Financing Health Care Financing Administration. “Medicare Administration, a division of the Department of Basics.” www.medicare.gov, 2001. Health and Human Services, to offer Medicare health-insurance benefits to qualified handicapped migraine A migraine is a type of recurrent and elderly individuals. Generally, eligible individ- headache. It differs from the normal tension uals are those 65 years or older who qualify for headache in that it usually affects one side of the Social Security benefits. Disabled individuals may head only and is often accompanied by visual disqualify for Medicare after a two-year waiting turbances, nausea, and vomiting. period if they are: Migraines are thought to be caused by a sudden dilation of the arteries in the brain and scalp • No longer able to work and their pre-disability following a period of spasm or narrowing. The contributions to the Social Security FICA meet sudden expansion of the arteries causes the blood the required limit to surge against the artery walls and surrounding • People with severe childhood disabilities who are tissues. The dilation and constriction may occur dependents of eligible Social Security recipients when the body over-produces serotonin and nor- who are retired or have died epinephrine, amines or biological substances that migraine 153 dilate and constrict blood vessels of the body and light to block out vision. Scotomas may appear brain. anywhere in the field of vision and may move dur- Migraine attacks tend to run in families and may ing the course of the prodrome stage or during the be triggered by a variety of causes. It is estimated headache stage. that between 11 and 18 million Americans suffer Fortification spectra is a shimmering, glittering from migraines, most of them women. In addition, pattern of bright or colored lights in the field of it is estimated that up to 38 million Americans have vision. The lights form shapes such as auras or the genetic propensity for migraines. The following semicircles and appear in zigzag formations much have been linked to migraine attacks: intense like a prism. They may block vision or lie atop it. direct, reflected, or flickering lights; rapidly chang- Hemianopsia is a decrease or loss of vision in ing images, sudden or persistent noises; reaction to one half of each eye. The entire right or left half of stress; strong odors; allergies; hypertension; hor- the field of vision may be obliterated or may be monal changes; nitroglycerin; anesthetic; drugs; blocked by fortification spectra. alcohol; cheese; chocolate; cured foods; MSG; poor Distorted vision may result from migraine. ventilation; change in barometric pressure; exer- Objects or people may appear elongated or cise; tight clothing; steam; motion; dental prob- stretched out of shape as by a funhouse mirror. lems; a shock or blow to the head; and too little or This phenomenon is sometimes called the Alice in too much sleep. Wonderland syndrome in reference to the distorted The two major categories of migraine headaches figures pictured in Alice’s Adventures in Wonderland. are common and classic. Each is preceded by a pre- The author, Lewis Carroll, was said to have suf- headache state, called the prodrome stage, which fered migraines and collaborated closely with the may last from five minutes to an hour. During this illustrator to produce illustrations that captured the stage, symptoms of the oncoming migraine may be visual effects he experienced. noted. They include nausea, vomiting, weakness or The visual effects of the prodrome stage may dis- tingling on one side or section of the body, mental appear with the onset of the headache or my over- confusion, fatigue, irritability, dizziness, pallor, lap. When the visual symptoms occur, but a euphoria, water retention, and lack of coordination. headache does not follow, the condition is known Common migraines are associated with light, as a migraine equivalent. noise or odor sensitivity, and vomiting or nausea. The migraine headache itself is often severe. It Classic migraines may include these symptoms but usually affects only one side of the head and may are further characterized by visual disturbances. include the face, extending as far as the jaw. Patients Patients may experience blurred vision, TUNNEL may experience light sensitivity, head, neck, and VISION, double vision, SCOTOMAS, scintillating sco- scalp sensitivity or tenderness, nausea and vomit- tomas, fortification spectra (angled, shimmering ing. The headache may last from one to 24 hours. In lines), HEMIANOPSIA, or distorted vision. rare cases, the headache may last for days. Blurred vision is common to migraine attacks Migraines can occur at any time of life. They and may be accompanied by tunnel vision, the loss may appear in children as recurring attacks of of peripheral or side vision. Tunnel vision has been headache and vomiting or as migraine equivalents. described as vision seen when looking through a The attacks may disappear or return later in middle straw. Double vision, or DIPLOPIA, may result during life. Migraines can occur for the first time in middle a migraine if ophthalmoplegia, paralysis of the eye age and may decrease in regularity as time goes muscles, occurs. When a muscle is paralyzed, one on. Women are more likely to suffer from eye moves out of alignment and the brain receives migraines, but the problem tends to improve with two images instead of one, or double vision. menopause. Scotomas are blind spots in the field of vision of At present, there is no cure for migraines. Anal- one or both eyes. The vision in the scotoma may be gesics such as aspirin and acetaminophen or either blurred or completely obliterated. Scintillating sco- compound with codeine may be taken to ease pain tomas are blind spots that shimmer with bright at the first sign of the headache. Severe pain is 154 mobility often treated with vasoconstricting agents such as the user’s path. The sensor vibrates if an object is ergotamine. These drugs constrict the blood vessels present and increases the vibration rate as the user of the scalp to reduce the flow of blood. Ergota- nears the object. The sensor has a short range for mine must be taken during the early stages of the objects less than one meter away and a longer headache and cannot be taken in conjunction with range for objects up to four meters away. drugs for hypertension. Approximately the size of a flashlight, the device Migraines may recur. Patients may reduce may be hand held or carried in a pocket or purse. recurrences by avoiding triggering factors and A model for those with poor tactual sensation pro- managing stress and tension. Drugs to prevent duces an audible signal heard through an earphone migraine attacks may be prescribed in cases in attachment. Other similar devices are manufac- which the severity or frequency of migraine attacks tured under various names, including the Bliss Pas- has not been affected by the elimination of trigger- sive Detector. ing factors. The drugs, such as Bellergal, Pizotyline, The device is designed to be used with a long Propranolol, Elavil, and Sansert, have varying cane or dog guide. Several hours of practice and/or degrees of effectiveness, side effects, and safety. training with a qualified instructor are required for New treatments for migraines are being developed proficient use. (See ELECTRONIC TRAVEL AIDS.) and tested. Migraines can be very upsetting and distressing multiple sclerosis (MS) A chronic disease of to those who suffer from them and to their families the central nervous system. According to the and friends. Also, there are many misconceptions National Multiple Sclerosis Society, approximately about migraines, including the theory that a 333,000 Americans have been diagnosed with MS migraine is not a bona fide physical illness. or MS-related diseases, and approximately 200 Joel R. Saper, M.D., director of the Michigan new cases are diagnosed each week. Head-Pain & Neurological Institute, explained the The disease attacks the body’s myelin, a fatty problem of misconception as it relates to migraines. substance that coats and insulates nerve fibers of “There is no condition of such magnitude that is the brain and spinal cord. As the myelin is dam- shrouded in myth, misinformation, and mistreat- aged, sclerosed or hardened tissue, called plaques, ment as is this condition, and there are few condi- form. The plaques interrupt or obstruct the tions which are as disabling during the acute impulses transmitted along the nerves. attack,” Saper said. Symptoms of MS include tingling in the limbs or There is a support group for migraine sufferers extremities, numbness, blurred or double vision, called Migraine Awareness Group: A National nystagmus, impaired sensation, fatigue, weakness, Understanding for Migraineurs, or M.A.G.N.U.M. dizziness, slurred speech, tremor, spasticity, and Contact: bladder, bowel, or sexual function problems. M.A.G.N.U.M., Inc. Half of all those who are diagnosed with MS 113 South Saint Asaph, Suite 300 may experience visual disturbances. The three Alexandria, VA 22314 most common disorders are optic neuritis, DIPLOPIA, 703-739-9384 and NYSTAGMUS. www.migraines.org Optic neuritis, or inflammation of the OPTIC NERVE, often results in a condition termed retrobulbar neuritis. It may first appear as a loss of vision in mobility See ORIENTATION AND MOBILITY. one eye, blurring of vision, color blindness, or blind spots. The disruption of vision usually first occurs Mowat Sensor The Mowat Sensor is a mobility in the central field of vision and progresses to aid designed for use by visually impaired persons peripheral fields. and developed by HUMANWARE. The device uses Optic neuritis may be treated with steroids or high-frequency sound waves to detect objects in the drug ACTH. Recurrence is possible, but remis- myasthenia gravis 155 sion of the visual impairment is good. Most cases Although there is no cure for MS, it may be respond to treatment in three months. treated with medications to reduce the symptoms. Diplopia, or double vision, may occur if the eyes Muscle relaxants may reduce spasticity and med- do not move together to focus on an object. ications may be prescribed to reduce pain, tension, Diplopia occurs when the myelin along nerve fibers bowel and urinary distress. controlling coordination of the eye movement is The drug ACTH or steroids such as prednisone damaged. Diplopia is treated with steroids and may shorten the duration and lessen the intensity of ACTH or by patching one eye. The condition usu- exacerbations. ACTH is usually administered by ally improves within several weeks but may recur. injection and monitored for effects on the body in Nystagmus is an involuntary, jerky movement the hospital. Steroids are given orally or by injection of the eyes that makes focusing difficult. It may but also require monitoring. Side effects of these cause dizziness and blurred vision. The condition is medications may include weight increase, fluid treated with steroids, ACTH, and Meclizine for retention, mood alteration, and tendency toward symptoms of dizziness. Within a few weeks the the development of ulcers. Since 1993, three new symptoms may subside, although recurrences are medications to treat relapsing forms of MS have possible. been approved by the Food and Drug Administra- The symptoms and progression of MS are tion. They are: Betaserona, Copaxonea, and unique to the individual. Although an initial attack Avonexa. These medicines have been shown to may never be followed by a recurring incident, lessen the severity and frequency of MS attacks. most people experience periods of exacerbation, in They also help to reduce accumulations of lesions on which symptoms of the disease are most pro- the brain and to slow the progression of disability. nounced, and remission, symptom-free periods. Since increasing evidence links MS to disorders The degree of disability varies by individual but within the body’s immune system stemming from two thirds of all those with MS remain ambulatory a viral infection, current areas of research include over their lifetimes. The disease is rarely fatal and virology and immunology. Some researchers studies indicate that life expectancy is only reduced believe that MS is associated with physical trauma, by 15 percent or less. but that theory is controversial. MS usually first appears between the ages of 20 Frames, Robin. “Insight into Eyesight.” MS: Facts and and 40. Women, whites, and those who live in Issues. New York: National Multiple Sclerosis Society, colder climates are more likely to develop the dis- 1985. ease. Twice as many women as men have MS. National Multiple Sclerosis Society. Living with MS. Studies suggest that where one was born and lived HealthNet Library, CompuServe, 1988. for the first 15 years of life affect the risk of devel- National Multiple Sclerosis Society. What Is Multiple Scle- oping the disease more than later places of resi- rosis? New York: NMSS, 2001. dence. The cause of MS is unknown. It is not conta- myasthenia gravis Myasthenia gravis is an gious or inherited, although certain genetic condi- autoimmune disease in which abnormal antibodies tions within individuals may make them more in the blood disrupt transmission of impulses from receptive to MS. These factors include exogenous the nerve endings to muscle tissue. This condition (outside the environment) factors such as viruses results in severe or fatal (in the case of respiratory and endogenous (inside the environment) factors failure) fatigue of the muscle. It is estimated that such as body immunity. there are about 36,000 cases of the disease in the Because families tend to share similar exoge- United States, with a prevalence of 14 in every nous and endogenous factors, susceptibility to the 100,000 people. Women are affected more often disease may run in families. Four percent of all and earlier in life than men. families with an incidence of MS have an addi- The disease may affect one group of muscles or tional case of MS. those of the entire body. Approximately 75 percent 156 myopia of all initial myasthenia cases involve the ocular ated by modern attitudes toward, and stereotypes muscles, and nearly 90 percent develop some ocu- of, blindness. lar involvement over time. Those cases that involve Some commonly held myths surrounding blind- only the ocular muscles for a period of two years ness include the concept of all forms of blindness as will probably be limited to the ocular muscles and darkness, the concept of blind as dependent, the not progress systemically. Ocular myasthenia cases connection between blindness and punishment as account for approximately 20 percent of all cases. in the Oedipal legend, the belief that the other Ocular symptoms of the disease include PTOSIS senses compensate for a loss of sight, and that peo- (drooping eyelid), lid twitch or quiver, and NYSTAG- ple who have a vision loss have ESP or musical tal- MUS (uncontrollable movement of the eyes). Ptosis ent. may be absent at the start of the day but becomes Being blind does not necessarily mean seeing more pronounced as the day progresses. nothing, or being in darkness. Of the half million Myasthenia gravis is diagnosed with a Tensilon people who are legally blind in the United States, test. The drug Tensilon is injected to stimulate most retain some usable vision. Only a fraction nerve transmission. Muscle strength is measured have no light perception or usable vision. Because before and after the injection. Those who show a darkness is so closely associated in society with temporary gain in strength or improvement of ignorance, evil, and fear, the concept of blindness symptoms after the injection test positively for as darkness also links it to these negative traits. myasthenia gravis. The lack of understanding about visual abilities Myasthenia gravis is generally treated by a neu- of the blind fosters the perception of blind persons rologist. Treatment may consist of oral drugs and as dependent. Throughout history, blind persons corticosteroids. Removal of the thymus gland may have been seen as liabilities to the social group, produce an improvement in symptoms. wards of society, or beggars. This myth disregards the abilities of blind individuals to work and be self-supporting and exists today in the unwilling- myopia Nearsightedness, occurring when the ness of employers to hire blind persons. refractive power of the eyes is too great in relation The evil-eye myth stems from ancient times to the length of the eyes. Myopic eyes are too when blindness was perceived as a sign of evil or a “long” for their refracting capabilities. Myopic peo- punishment from God for some evil-doing or sin. ple see close objects more clearly than distant Those with the evil eye were thought to be able to objects. Corrective concave lenses in the form of kill with it, and were therefore shunned. contacts or eyeglasses are prescribed to correct the The Oedipal legend supports the myth that problem. blindness is equated with evil. Oedipus blinded High myopia is a condition in which the eye is himself as a punishment for wrong-doing. The leg- extremely long or large, producing extreme near- end supports blindness as a just punishment for sightedness. In very large eyes, the structures with- sins and suggests that blind persons may have in them are stretched, causing the retina to become brought the condition on themselves. thin and weak. Tears or detachments that impair A commonly held myth about blindness con- vision can develop as a result. cerns the compensation of senses. It is falsely Myopia usually occurs from the preteen to believed that once eyesight is gone, nature height- teenage years. As the child grows, the myopia may ens the other senses to compensate for the lack of worsen with each growth spurt. Once the child sight. In reality, the blind person may learn to use reaches maturity, it generally levels off and stabi- the other senses in more efficient ways to gather lizes for many years. information, but the senses remain unchanged. Blind persons are often believed to have extra- myths Myths about blindness have existed for ordinary abilities or talents, as well. It is commonly centuries and grew from ignorance about the con- held that blind individuals develop extrasensory dition and nature of blindness. Myths are perpetu- powers, or ESP, as a compensation for the sight myths 157 loss. Perhaps because of some popular blind per- ety who happen to lack some degree of sight. (See formers, the myth exists that blind persons are ATTITUDES, EMPLOYMENT.) innately musically talented. Carroll, Thomas J. Blindness, What It Is, What It Does, and Curiously, the reverse situation is also widely How to Live With It. Boston: Little, Brown, 1961. believed. It is held that blind persons lose sense Goldberg, Maxwell H., and John R. Swinton. Blindness abilities, especially hearing, with the loss of sight. Research: The Expanding Frontiers. University Park: This myth prompts people to shout questions to a Pennsylvania State University Press, 1969. blind person with normal hearing. Haskins, James. Who Are the Handicapped? New York: As blind and visually impaired persons become Doubleday, 1978. more widely integrated into social, vocational, Jernigan, Kenneth. Disability and Visibility: Uncle Tom, and education situations, myths may dissipate. Blind Tom, and Tiny Tim. Baltimore: National Federa- Through personal experiences, society can discover tion of the Blind, 1970. that blind persons are not condemned or blessed as Mitchell, Joyce Slayton. See Me More Clearly. New York: Harcourt, Brace, Jovanovich, 1980. a group, but rather, are individual members of soci-

National Alliance for Eye and Vision Research community groups, and individuals interested or (NAEVR) A nonprofit advocacy organization affected by visual impairment. made up of a coalition of professional, consumer, The organization offers encouragement and and industry organizations involved in research in emotional support to families and provides infor- eye and vision disorders. The organization works to mation to parents on care, treatment, education, provide the best vision possible for all Americans and services available to visually impaired children. through education, advocacy, and vision research. NAPVI communicates its expectations to service Its goals are supported by the National Institutes of agencies at the local, state, and federal levels to Health, the National Eye Institute, and other fed- obtain and ensure quality services to visually eral research organizations. impaired and blind children. NAEVR was founded in 1997 as an afﬁliated NAPVI awards the annual Outstanding Contri- organization of the ALLIANCE FOR EYE AND VISION bution Award to a Professional Working in the RESEARCH. Its purpose is to carry out the advocacy Field of Blindness. It publishes a quarterly newslet- activities of that coalition. It is particularly con- ter called Awareness that provides resource infor- cerned about maintaining federal funding for the mation for parents. NATIONAL EYE INSTITUTE to allow the NEI to carry out The organization disburses fact sheets, bro- its extensive research programs. NAEVR actively chures, and a publications list and holds a biennial lobbies for NEI funding. It also is working to raise National Parent Conference. government awareness of the connections between Contact: tobacco use and eye disease, and the devastating National Association for Parents of the Visually effects of macular degeneration on many elderly Impaired people. NAEVR hopes to convince Congress of the P.O. Box 317 need for intensive, focused research in these areas. Watertown, MA 02471 Contact: 800-562-6265 (ph) National Alliance for Eye and Vision Research 617-972-7441 (fax) 426 C Street, NE www.spedex.com/NAPVI Washington, DC 20002 202-544-1880 (ph) National Association for Visually Handicapped 202-543-2565 (fax) (NAVH) A nonproﬁt, national voluntary health www.eyeresearch.org agency. It serves the partially sighted, those not completely blind but who lack adequate vision National Association for Parents of the Visually even with the best possible corrective lenses. Impaired (NAPVI) An association that serves Founded in 1954, the organization was formerly as a source of support, information, and service to known as Aid to the Visually Handicapped or families of the visually impaired. Founded in 1980, National Aid to the Visually Handicapped. the association membership consists of parents and NAVH produces and distributes large-print families of the visually impaired, agencies and books, texts and reading materials free on request

159 160 National Braille Association to partially sighted persons. It serves as a large- the materials, blind and visually impaired people, print consultant to commercial publishers and teachers, librarians, educators, publishers, profes- maintains a free, large-print lending library. sional workers and volunteers for the blind, and The organization offers counseling and advice parents of the blind or visually impaired. services to young adults, seniors, and families of The organization maintains request registries for the partially sighted. It cooperates with senior citi- those seeking texts in braille, large print, or on zen centers, hospitals, and institutions and offers tape. The Reader-Transcriber Registry receives adult discussion groups and teenage cultural, requests for nontextbook or nontechnical material social, and educational group activities. transcription. The Braille Textbook Assignment NAVH maintains public and professional educa- Service accepts requests for college textbooks and tion programs addressing the needs of the partially other technical materials. sighted. It serves as a public clearinghouse on ser- In 1963, the NBA established the Braille Book vices for the partially sighted and disseminates Bank (BBB) in Rochester, New York. The BBB is a information on available commercial aids. It coop- nonprofit organization maintained by volunteers erates with commercial manufacturers of aids in and is partially underwritten by donations. The field testing. It offers a large variety of visual aids Braille Book Bank is a major source of textbooks for sale. Visual-aid counseling is offered to all and career materials in braille for visually impaired clients who visit a facility. college students. It maintains over 1,800 titles in Publications include In Focus, an annual chil- master copies for immediate thermoform duplica- dren’s newsletter, Update, a large-print, quarterly tion. Each year, more than 36,000 volumes of newsletter, Seeing Clearly, an annual newsletter for paper braille are added to the collection as books adults, the Program Report Annual Bulletin, the bien- are transcribed by request. The Braille Book Bank nial Catalog of Large Type Publications, and pam- offers three catalogs for ordering material under phlets, brochures, and manuals. NAVH holds an the titles The Textbook Catalog, The Music Catalog and annual convention in New York City. The General Interest Catalog. The catalogs are free on Contact: request to the Braille Book Bank, 422 South Clin- National Association for Visually Handicapped ton Avenue, Rochester, New York 14620. 22 W. 21st Street The NBA established the first volunteer elec- New York, NY 10010 tronic library in the United States. Volunteers tran- 212-889-3141 (ph) scribe materials with computers. The finished 212-727-2931 (fax) transcriptions are sent on diskettes to the NBA Or, contact the San Francisco site of NAVH at: Braille Book Bank for storage or reproduction onto embossed paper braille or as paperless cassette 3201 Balboa Street braille. The transcriptions are available by request San Francisco, CA 94121 to individuals, schools, agencies or businesses. 415-221-3201 (ph) Electronic methods reduce costs allow the NBA to 415-221-8754 (fax) provide materials in braille comparable to the print www.navh.org cost. The NBA publishes the journal Bulletin four times a year. It holds a biennial national confer- National Braille Association (NBA) The ence. National Braille Association (NBA), founded in Contact: 1945, is an organization that produces and distributes braille, large print, and taped reading materi- National Braille Association als for the visually impaired. The NBA offers 3 Townline Circle transcription workshops and collects and studies Rochester, NY 14623 improvements to transcription techniques. 716-427-8260 The membership numbers over 2,500 and 716-427-0263 (fax) includes volunteers and professionals who produce www.nationalbraille.org National Federation of the Blind 161

National Eye Institute (NEI) The National Eye publication. These and other publications can be Institute (NEI) was established by Congress in 1968 ordered on-line at www.nei.nih.gov/publications. as a part of the federal government’s National Insti- Contact: tutes of Health. Funded by Congressional appropri- National Eye Institute ations, the NEI funds approximately 80 percent of National Institute of Health all vision research supported by the federal govern- 2020 Vision Place ment agencies and national private philanthropic Bethesda, MD 20892 organizations. 301-496-5248 The goal of the NEI is to conduct and support www.nei.nih.gov research relating to ocular disease and disorder treatments and cures, training concerning blind- ing eye diseases and disorders, research and train- National Federation of the Blind (NFB) The ing in health concerns and requirements of the National Federation of the Blind (NFB), founded blind, and clinical sciences regarding the mecha- in 1940, is the largest organization of the blind nisms of visual function and sight preservation. in the United States. Membership includes The NEI funds grants for research concerning more than 10 percent of the nation’s blind per- the prevention, diagnosis, and treatment of blind- sons. The organization is dedicated to the coming and visually disabling disorders and diseases. plete, equal integration of blind persons into All research is classified under one of five major society. programs: retinal and choroidal diseases; corneal The NFB serves as a public clearinghouse on diseases; cataract, glaucoma, and strabismus; am- information concerning blindness, directs and con- blyopia; and visual processing. Special considera- ducts research, produces and disseminates infor- tion is given to projects relating to visual mation to blind persons, and researches and impairment and the rehabilitation process that can monitors legislation concerning the blind. be related to the major programs. It advises and refers blind individuals to ser- The NEI distributes its plan, which outlines the vices, provides assistance to blind persons with dis- major needs and opportunities within the vision crimination concerns, consults with congressional research field, to members of the vision research committees and state legislatures, serves as an community, scientists, government officials, and advocate for the rights of blind individuals, and the public. It encourages coordination among pri- evaluates and promotes new technology. NFB vate and governmental agencies that support offers over 26 scholarships to blind students and vision research. grants an award for the greatest contribution to The NEI works with individual investigators to welfare of the blind. encourage submission of grant applications in tar- With the United States Department of Labor, geted priority areas, presents plan recommenda- NFB developed Job Opportunities for the Blind tions to scientific meetings, organizes workshops (JOB), a program that matches qualified blind and symposia on plan-identified topics, and estab- workers with employers. JOB directs seminars on lishes research resources, such as animal colonies. career planning for unemployed blind people and In January 2001, Dr. Paul A. Sieving was named educational seminars concerning blindness for director of the NEI, replacing acting director Dr. employers. Ruth L. Kirschstein. Sieving was with the Kellogg In 1990, the NFB opened the International Eye Center of the University of Michigan before Braille and Technology Center at the National Cen- joining the NEI. ter for the Blind in Baltimore, Maryland. The The NEI compiles and publishes research results center is a comprehensive facility, offering train- in the National Advisory Eye Council Report, enti- ing, evaluation, and demonstration of various tech- tled Vision Research. nology. It also offers a variety of free brochures, posters, Staff at the International Braille and Technology Spanish-language materials, and a school program Center is available to answer any kind of question 162 National Industries for the Blind about assistive technology for the blind. The center Contact: can be accessed through the NFB’s phone number, National Industries for the Blind which is listed below. 1901 N. Beauregard Street, Suite 200 Publications include The Braille Monitor, a Alexandria, VA 22311 monthly journal, Future Reflections, a bimonthly 703-998-0770 (ph) magazine and numerous pamphlets, brochures and 703-998-8268 (fax) materials in print, braille, and on records and cas- www.nib.org settes. NFB holds an annual conference. Contact: National Keratoconus Foundation (NKCF) A National Federation of the Blind nonprofit agency founded in 1986 to increase 1800 Johnson Street awareness and understanding about KERATOCONUS Baltimore, MD 21230 and support research concerning the disorder. The 410-659-9314 (ph) organization began with a grant from Jane Neely 410-685-5653 (fax) and her husband, Norman, who had keratoconus www.nfb.org and was frustrated by how little information was available. National Industries for the Blind (NIB) A pri- The mission of NKCF is to provide information vate, nonprofit organization that develops indus- and support about the condition to patients, their trial employment for blind and multihandicapped families, and eye care professionals, and to encourage research and new technology for treatment of blind Americans. It includes 108 associated indus- the disorder. tries in 36 states, Puerto Rico and the District of NKFC provides educational materials, support Columbia. groups and programs, a newsletter, links to other NIB allocates federal government orders and keratoconus-related sites, a patient registry, an out- offers grant programs, management training pro- reach program, a referral service, and patient edu- grams, technical expertise in new product and ser- cation seminars. It also oversees a research vice development, industrial engineering, contract program and a corneal tissue collection program. administration, purchasing, quality assurance, and Contact: production maintenance to its associated industries. National Keratoconus Foundation The organization was developed in 1938 follow- 8733 Beverly Boulevard, Suite 201 ing the passage of the Wagner-O’Day Act, which Los Angeles, CA 90048 mandated that federal agencies purchase products 800-521-2524 from workshops for the blind meeting specific www.nkcf.org qualifications. In 1971, the Wagner-O’Day Act was renamed the Javits-Wagner-O’Day Act and National Library Service for the Blind and Physi- amended to include severely disabled workers and cally Handicapped This act was originally legis- services as well as products. The products for sale to lated in 1904 by Congress to permit free braille the federal government are approved by the Com- books to be mailed to blind adults. The Pratt-Smoot mittee for Purchase from the Blind and other Act of 1931, and further amendments in 1934, Severely Handicapped, a presidentially appointed authorized the Library of Congress to establish a committee. national library service that provided free braille The first products included mops and brooms and talking books to blind adults. but have since expanded to include 1,300 quality In 1952, an amendment to the act deleted the blind-made products such as components for the word “adult,” thus allowing the service to expand Army’s Kevlar helmet, tracheotomy kits, and vari- and include visually impaired children. Further ous kitchen gadgets stocked in commissaries for amendments in 1962 extended the program to sale to military families worldwide. include braille musical scores, textbooks, and National School Lunch Act 163 related music instructional information. In 1966, funding and food donations necessary to serve free the act was amended to include other physically or reduced fee lunches to eligible children. Children limited people among those who qualify for the qualify according to their family income and the service. These may include people with paralysis, number of children participating in the program. missing limbs, chronic weakness, or muscle-coordi- The participating schools, child-care centers, and nation problems. residential-care centers are reimbursed for the Currently, the Library of Congress offers free lunches that must meet nutritional guidelines braille and recorded matter under the Books for the determined by the Department of Agriculture. The Blind and Physically Impaired Program. Full-length rate of reimbursement is set by the states according braille books and magazines and cassettes, records, to figures in the Consumer Price Index. or discs (talking books) are distributed through a The Commodity Distribution Program, as out- nationwide cooperative library system. Books, lined in Section 6 of the act, allows donations of materials, and play-back machines are sent and re- food bought by the federal government under turned through the mail, postage-free. price-support or surplus-removal programs. For- The network began serving 19 libraries. In 2000 it mula grants to state agencies are used to distribute has expanded to 56 regional and 81 subregional the food to eligible schools, institutions, child and libraries throughout the United States. In 1999 more elderly nutrition programs, nonprofit summer than 22 million recorded and braille books and mag- camps, families, and individuals. azines were circulated to more than 764,000 read- Section 13 of the act provides for the Summer ers. The program is funded by Congress. In the 2000 Food Service Program, a nonprofit summer meal fiscal year it received $47,984,000. program for children in summer camps or institu- The service is available at no cost to patrons who tions, including those that serve the disabled. The cannot read or use conventional print materials program awards formula grants to states that in- due to permanent or temporary physical or visual troduce, support, or extend the program and pay impairments. according to the number of meals served. The Contact: meals must meet nutritional criteria set by the National Library Service for the Blind and Physi- Department of Agriculture. cally Handicapped The Child-Care Food Program, Section 17 of the The Library of Congress Act, provides grants-in-aid to states maintaining 1291 Taylor Street NW nonprofit meal programs for children in nonresi- Washington, DC 20542 dential day care. The programs serve meals, includ- 202-707-5100 (ph) ing breakfast, lunch, snack, and dinner, to eligible 202-707-0712 (fax) children. Qualified nondisabled children under 12 202-707-0744 (TDD) years of age or disabled children of any age are [email protected] (e-mail) entitled to two meals and one snack per day under www.loc.gov/nls the program. The meals must meet the Department of Agriculture’s nutritional requirements. The states distribute the funds to facilities such National School Lunch Act As amended, the as public or private nonprofit institutions or orga- National School Lunch Act of 1946 offers assistance to public and private institutions, schools, camps, nizations, day-care and recreation centers, and and day-care centers, including those that serve other day-care services. Grants are awarded ac- handicapped or mentally retarded students, to pro- cording to how many meals are served based on vide meals to eligible children. The assistance out- reimbursement rates set by the federal govern- lined in the act includes grants, reimbursements, ment. and commodity donations. U.S. Department of Education. Summary of Existing Legis- The School Lunch Program, as authorized under lation Affecting Persons with Disabilities. Washington, Section 4 of the act, provides institutions with the D.C.: USDE, 1988. 164 night blindness night blindness The inability to see clearly at DISEASE, ALBINISM, RADIAL KERATOTOMY patients, night or in low light. The condition results from contact lens wearers, and monochromatic persons. damage or defect in the rods of the RETINA. Preoperative cataract patients may wear glasses The retina receives reflected light from an with light-amber colored lenses and a 40 percent object. Light-sensitive cells called RODS AND CONES total light transmission (TLT) rate to provide glare translate the light into electrical impulses that the protection and increased visual acuity. Postopera- retina sends to the brain through the OPTIC NERVE. tive cataract patients may wear 10 percent TLT The brain changes the impulses into an image. amber lenses or 18 percent TLT gray-green lenses. The cones, packed into the center (or macular These lenses absorb ultraviolet and infrared rays section) of the retina, discern detail and color and that were formerly absorbed by the eye’s natural require bright light to work effectively. The rods lens, removed in cataract surgery. function in dim light and are responsible for detect- Individuals with retinitis pigmentosa may wear ing movement and shape. Any dysfunction of the 2 percent TLT dark-amber or 10 percent TLT amber rods may cause damage to night vision. Any lenses. These enhance vision and protect the eyes peripheral vision loss that restricts the field to 5 from a maximum amount of visible light. degrees central vision results in night blindness Patients with macular disease may wear 40 per- because the usable foveal area contains no rods. cent TLT light-amber lenses to provide a high qual- Damage to the rods may occur as a result of ity of visible light, and those with albinism may nutritional deficiency or disease. Vitamin-A defi- wear 1 percent TLT dark grey-green lenses to pro- ciency may cause night blindness since the pres- vide maximum protection from light. ence of vitamin A is necessary for proper rod Individuals undergoing radial keratotomy functioning. Vision impairment due to vitamin-A surgery may wear 10 percent TLT amber lenses or deficiency is common in developing countries. A 18 percent TLT grey-green lenses. Contact-lens resulting disease, XEROPHTHALMIA, is the second wearers may use 10 percent TLT amber or 18 per- major cause of blindness in the world. cent TLT grey-green lenses, and monochromatic or Xerophthalmia causes changes in the CORNEA, color-blind persons may wear 90 percent TLC red CONJUNCTIVA and anterior segments of the eye. In lenses. acute cases, the cornea can perforate, the IRIS may Contact: adhere to the cornea, and the eyeball may be NoIR Medical Technologies destroyed. A common and early symptom of P.O. Box 159 xerophthalmia is night blindness. The condition South Lyon, MI 48178 can be detected with an electroretinogram or a 734-769-5565 or 800-521-9746 (ph) thorough corneal examination. The condition is 734-769-1708 (fax) treated with megadoses of vitamin A given orally. www.noir-medical.com Night blindness is also a first symptom of RETINI- TIS PIGMENTOSA (RP), a degenerative disease of the Congress has enacted rods and cones. RP first affects the rods, decreasing nondiscrimination laws legislation that entitles individuals with disabilities, vision in the peripheral fields and causing night including blindness and vision impairment, to free- blindness. RP is a hereditary condition for which dom from discrimination on the basis of disability. there is no cure or treatment. The laws guarantee the right to a free, appropriate education, the right to medical treatment for NoIR Medical Technologies A company that infants born with disabilities, the right to protec- produces plano medical sunglasses, which chemi- tion from harm in institutions, the right to protec- cally absorb ultraviolet (200–400nm) and near tion from discrimination in federally conducted infrared (800–1400) rays. The glasses may be pre- programs, the right to access to federally supported scribed in cases of preoperative CATARACT, postop- or operated facilities and programs, and the right to erative CATARACT, RETINITIS PIGMENTOSA, MACULAR access to advocacy and protection programs or ser- nondiscrimination laws 165 vices for developmentally disabled or mentally ill The Developmental Disabilities Assistance and Bill of individuals. Rights Act ensures the rights of appropriate services, Eight major bills were passed during the 1970s treatment, and rehabilitation to those with devel- and 1980s that aimed to ensure these rights. They opmental disabilities. include the Rehabilitation Act of 1973, the Educa- The Protection and Advocacy for Mentally Ill Individ- tion of the Handicapped Act, the Architectural Bar- uals Act of 1986 establishes a formula-grant program riers Act, the Civil Rights of Institutionalized to states to provide mental-health advocacy pro- Persons Act, the Child Abuse Prevention and Treat- grams and services. The Fair Housing Act, as ment and Adoption Reform Act, The Civil Rights amended in 1988, prohibits housing discrimination Commission Act Amendments of 1978, the Devel- on the basis of a variety of factors, including dis- opmental Disabilities Assistance and Bill of Rights ability. Act, and the Protection and Advocacy of Mentally In the spring of 1990, a landmark disability Ill Individuals Act. rights bill called the Americans with Disabilities Act The Rehabilitation Act of 1973 provides assurances passed in the United States Senate and House of that disabled individuals are protected from dis- Representatives. The bill bars employment discrim- crimination in acceptance to, or benefits from, fed- ination for qualified applicants with disabilities and erally funded or operated programs. Sections of the calls for changes in the workplace if needed to act protect against employment discrimination by accommodate the worker. It requires accessibility federal agencies or contractors. The act authorizes to all new businesses, trains, and buses, and re- grants to states to establish systems for protection quires telephone companies to provide operators to and advocacy for disabled rights. relay messages from deaf to hearing individuals. The Individuals with Disabilities Education Act, The National Voter Registration Act of 1993 is formerly known as the Education of the Handicapped intended to increase the number of registrations of Act, ensures the right of all disabled children to a people with disabilities and of minorities. Both free and appropriate public education. It supplies groups have historically had very low registration assistance to states to support this education and rates. offers grants to states that provide appropriate edu- The Rehabilitation Act prohibits discrimination cational programs to disabled students. on the basis of disability in programs conducted by The Architectural Barriers Act of 1968 required all federal agencies or supported by public funds. It buildings constructed or altered with federal funds also applies to employment in federal jobs and to after 1969 to be accessible to persons with disabili- the employment practices of federal contractors. ties, in compliance with accessibility guidelines The standards pertaining to employment discrimi- issued in 1969. The act was amended to include nation are the same as those used in the Americans public buildings and government-leased buildings with Disabilities Act. intended for public use. The Rehabilitation Act also sets requirements for The Civil Rights of Institutionalized Persons Act of electronic and information technology that is 1980 granted the right of the U.S. Department of developed, maintained, owned, or used by the fed- Justice to sue states for violation of rights of insti- eral governments. All technology that falls into tutionalized persons. those categories must be accessible to people with The Child Abuse Prevention and Treatment and disabilities, whether they are federal employees or Adoption Reform Act of 1978 includes a section pro- members of the public. To be considered accessible, hibiting the withholding of medically indicated an information technology system must be opera- therapy or treatment to physically or mentally dis- ble in a variety of ways and not be dependent on a abled infants. single sense or ability of the user. The Civil Rights Commission Act Amendments of The Architectural Barriers Act requires that 1978 expanded the jurisdiction of the Civil Rights buildings and facilities that are built with federal Commission to include protection from discrimina- money or leased by a federal agency comply with tion to disabled persons on the basis of disability. federal accessibility standards. These standards 166 nonoptical aids apply to new buildings, and those that have been placing a clear yellow or amber sheet over the remodeled or altered. U.S. post offices are included page. in this act. U.S. Department of Education. Summary of Existing Legis- nonverbal communication Nonverbal commu- lation Affecting Persons with Disabilities. Washington, nication involves ideas or emotions expressed by D.C.: USDE, 1988. the face and body. Components of nonverbal com- US Department of Justice. A Guide to Disability Rights Laws. munication include eye contact; facial expressions; www.usdoj.gov, 2000. head nodding or listing; shrugs; body posture; hand, arm, and foot gestures; touching; and regard nonoptical aids Nonoptical aids or environmen- for personal space. tal aids change, improve, or maximize residual A review of literature on communication skills vision by improving conditions in the environ- of the blind indicates that blind individuals present ment. Nonoptical aids include illumination, light different behaviors than sighted individuals. Indi- transmission, reflection control, and contrast. viduals who become blind after birth (adventi- Illumination is improved through use of brighter tiously) tend to exhibit more standard types of or dimmer room lighting, as needed according to behaviors than do congenitally blind individuals the cause of disability. Ideal lighting provides max- (Bonfanti, 1979). imum illumination and minimum glare. Lighting Nonverbal communication is generally learned may consist of standard lamps to small lamps that through observation. Because blind or severely attach to spectacle frames. impaired persons do not have the opportunity Light transmission is improved through lenses, to observe these gestures, they often do not filters, and absorptive lenses that reduce glare form a pattern of appropriate gestures. This lack and highlight contrast. These are especially help- of knowledge can result in inappropriate behav- ful for individuals with conditions such as albinism, ior or a lack of nonverbal feedback to the other CATARACTS, GLAUCOMA, and MACULAR DISEASE, party. The resulting awkwardness or confusion which result in light sensitivity, or photophobia. can impede communication with sighted individ- Lenses, filters, and absorptive lenses are available uals. in a wide range of degrees of protection, from sim- Blind people may show a lack of facial expres- ple filters that reduce glare to photochromic lenses sion, inappropriate voluntary or involuntary facial that use gray, green, and amber filters to block all expressions, distracting or unattractive physical ultraviolet light. behaviors such as rocking or eye rubbing, excessive Reflection is controlled by visors, side shields, blinking, lack of eye contact, overuse or underuse specially treated lenses, and typoscopes. Visors may of hand or arm gestures, and more intense touch- be supplied by the brim of a hat or can be a filtering techniques. ing visor lens attached to the spectacle frame. Blind individuals can be trained in nonverbal Sideshields are filters that attach to the sides of communication skills. The individual is made spectacle lenses to control the light on the sides of aware that such gestures or signals are received, the eyes. A typoscope is a slit-reading device that translated, and acted on by the receiving party. isolates one line of type at a time, thus reducing Instruction includes methods to improve eye glare from the light reflected from the page. Typo- contact, form appropriate voluntary facial expres- scopes are especially helpful for those with sions, improve posture and appearance, develop cataracts. appropriate, light touching behaviors, and correctly Contrast is enhanced by using highly contrasting judge personal space or territory. colors near one another such as black ink on white The training usually involves tactile props and or yellow paper, or fluorescent strips on stair risers. techniques. It may include instruction in the work- Contrast for reading pale or bluish print may be ings of the eye and explanations of clues received improved by using pale-yellow tinted lenses or by visually as opposed to tactually. Although results nystagmus 167 vary with the individual, training usually results in Pendular nystagmus is the less common form of some improvement of nonverbal skills. the disorder. The eyes move horizontally and equally quickly in both directions. Pendular nys- Bonfanti, Barbara H. “Effects of Training on Nonverbal and Verbal Behaviors of Congenially Blind Adults.” tagmus may be caused congenitally as in congeni- Journal of Visual Impairment and Blindness (January tal CATARACT or disorder of the OPTIC DISC. It may be 1979), pp. 1–7. acquired after birth as the result of ASTIGMATISM, Scholl, Geraldine, ed. Foundations of Education for Blind albinism, OPTIC ATROPHY, or corneal opacification or and Visually Handicapped Children and Youth. New York: cataracts. American Foundation for the Blind Inc., 1986. The underlying cause of nystagmus is treated to alleviate the symptom. If the cause is astigmatism, nutritional amblyopia See TOXIC AMBLYOPIA. prescription eyeglasses may be helpful. When the cause is a disease or disorder that can be treated, control of the disease usually results in control of nystagmus The term for an involuntary move- the nystagmus. In unmanageable conditions the ment of the eyes. The eyes may move vertically, patient may learn to hold the head or body in horizontally, in circles, or some combination of the accommodating positions or learn to focus with three. The condition causes focusing problems and one eye only. A nonprofit agency to serve people blurred vision. Nystagmus may be congenital or affected by nystagmus was formed in 1999. The acquired as a result of another disorder. American Nystagmus Network offers on-line sup- Jerking nystagmus is the most common form of port and discussion groups and provides informa- the disorder. The eyes move faster in one direction tion concerning the condition. than the other. It may be caused by lesions or It does not, however, offer medical advice. changes in the brain stem, cerebellum, or vascular Contact: system; overstimulation of the systems within the inner ear; hypertension; stroke; multiple sclerosis; American Nystagmus Network Ménière’s disease; labyrinthitis; drug or alcohol P.O. Box 45 toxicity; or brain inflammations, including menin- Jenison, MI 49429-0045 gitis and encephalitis. www.nystagmus.org

O object of regard The object of regard is the object just before retiring since the myopia induced by the on which the eyes are focused. drug will have stabilized by morning. The system must be stored in a refrigerator. oculist See OPHTHALMOLOGIST. Office of Disability Employment Policy (ODEP) Ocusert The trade name of a medication used in An office formed in 2001 within the U.S. Depart- the treatment of GLAUCOMA, a condition in which ment Labor that attempts to increase employment intraocular pressure builds within the eye. Manu- of persons with disabilities. This office was formerly factured by the Alza Corporation, which merged known as the President’s Committee on Employ- with Johnson & Johnson in the second half of ment of People with Disabilities. Programs and staff 2001, Ocusert is a thin membrane worn in the eye of the former President’s Committee on Employ- like a contact lens. The membrane rests in the con- ment of People with Disabilities were integrated in junctival cul-de-sac and continually dispenses pilo- the new office. carpine into the eye. The mission of ODEP is to improve and increase Pilocarpine is a parasympathomimetic drug that employment of persons with disabilities through constricts the PUPIL and facilitates an increased policy analysis, technical assistance, and develop- aqueous humor outflow from the eye, decreasing ment of best practices. It also stresses outreach, intraocular pressure. It also is available in drop and education, and constituent services, and promotes gel form. hiring of disabled persons. Ocusert may be prescribed in one of two The President’s Council on Employment of Peo- strengths: Ocusert Pilo-20, which releases 20 ple with Disabilities was founded in 1947 by Presi- micrograms of the drug per hour, or Ocusert Pilo- dent Harry Truman to encourage business and 40, which releases 40 micrograms of the drug per industry to offer employment opportunities to hour. The Ocusert is effective for one week, at the returning disabled veterans of World War II. Among end of which time it must be replaced. its goals and duties were to serve as an adviser to Ocusert may induce MYOPIA (nearsightedness) the president; attempt to improve public attitudes within the first few hours of insertion because it toward disabled workers through education and stimulates the CILIARY BODY. Ocusert should not be awareness programs; and serve as an advocate for used by those with a history of acute inflammatory policies and practices for disabled employment disease of the anterior segment of the eye because rights. It also advised disabled workers, sponsored a pupil constriction will occur and may exacerbate national resource and consultation service, com- the problem. It is also contraindicated for those piled and disseminated public information and with glaucoma who have had an extracapsular technical materials, and contributed to standardiz- CATARACT extraction because posterior SYNECHIAE ing guidelines and practices governing the employ- (adherence of the iris to the lens) may occur. ment of disabled persons. The President’s Council The Ocusert membrane may be placed in the on Employment of People with Disabilities also eye by the patient. Recommended insertion time is served as a public relations channel with the media.

169 170 onchocerciasis

The President’s Council worked in close alliance and Drug Administration in 1997. Stromectol is a with an organization of volunteers in each state to very effective antiparasite medicine, and can be conduct programs and activities that it initiated and used to treat onchocerciasis. It is available under developed. It also awarded prestigious prizes to dis- the name Mectizab in many parts of the world, abled persons who demonstrated outstanding including Africa and Central and South America. achievement, and sponsored scholarships. However, the treatment is very expensive and may ODEP has undertaken a cultural-diversity initia- not be affordable to all people. tive aimed at increasing job opportunities for Prevention of the disease may include insecti- minority disabled people. It also is working to cre- cides to rid the community of the worms, avoid- ate a better understanding among the public of, as ance of breeding sites such as rivers and open well as job opportunities for, people with cognitive waterways, wearing protective clothing, and excis- disabilities. ing of skin nodules that contain the worms. Contact: (See WORLD BLINDNESS.) Office of Disability Employment Policy Bath, Patricia E. “Blindness Prevention Through Pro- 1331 F Street, NW, Suite 300 grams of Community Ophthalmology in Developing Washington, D.C. 20004 Countries.” Ophthalmology, vol. 2. K. Shimizu and J. 202-376-6200 (ph) Oosterhuis, eds. Amsterdam: Excerpta Medica, 1979. 202-376-6205 (TTD) Center Watch. “Drugs Approved by the FDA.” www.cen- terwatch.com/patient/drugs, 2000. 202-376-6219 (fax) Cupak, K. “The Importance of Eye Camps in Underde- www.dol.gov/pcepd/index.htm veloped Countries.” Ophthalmology, vol. 2. K. Shimizu and J. Oosterhuis, eds. Amsterdam: Excerpta Medica, onchocerciasis One of four major causes of 1979. blindness in the world including TRACHOMA, Helen Keller International. Facts About Helen Keller Inter- national. New York: HKI, 1988. XEROPHTHALMIA and CATARACT. The disease occurs Phillips, Calbert I. Basic Clinical Ophthalmology. London: primarily in developing countries and is found Pitman Publishers Limited, 1984. mainly in West Equatorial Africa, Central America, World Health Organization. Available Data On Blindness and South America. According to Helen Keller (Update 1987). New York: WHO, 1987. International, it may have infected over 30 million people and blinded an estimated 1.5 million people. It is projected that 20 percent of all those opacification A cloudiness or lack of trans- infected will become visually impaired. In Africa, parency that blocks the transmission of light. This approximately 40,000 people become blind each usually refers to a clouding of the eye’s lens, which year due to this disease. leads to a CATARACT. Onchocerciasis, also known as river blindness Opacities in the lens are very common in aging due to association of the infection with vector persons and are not termed cataract until the breeding sites, is a systemic disease caused by the opaque lens fibers significantly interfere with filarial worm Onchocerca volvulus, a parasite trans- vision. Opacities often progress so gradually that mitted by the blackfly. Humans become infected the patient is unaware of the cataract until it with the disease when the worm infests the body becomes large or crosses the center of vision. Opac- through tainted water or direct contact. The worm ities that do develop into cataracts can be removed may live up to 15 years within the human skin, by surgery. Prognosis is excellent, and satisfactory kidneys, blood, or cerebrospinal fluid. The disease results are achieved in 90 percent of cases. causes corneal inflammation or KERATITIS, corneal scarring, and vision loss. It may be seen in con- ophthalmia neonatorum An inflammation of the junction with chronic IRIDOCYCLITIS and GLAUCOMA. eyes of newborn infants. The condition generally A drug called Stromectol, manufactured by affects the CORNEA and CONJUNCTIVA. Once a com- Merck & Co., Inc., was approved by the U.S. Food mon cause of blindness arising from unhygienic ophthalmoscope 171 conditions at birth, the infection is now successfully clinical setting. Graduates of the program are treated with antibiotics immediately after birth. required to take the certification exam issued by The condition is not hereditary but occurs dur- the Joint Commission on Allied Health Personnel ing birth. Bacteria such as gonococcus, staphylo- in Ophthalmology. Certification is not, however, a coccus, streptococcus, or pneumococcus and viral requirement for employment in all cases. infections such as chlamydia are present within the maternal birth canal. The inflammation is trans- ophthalmologist An ophthalmologist (or oculist, ferred from the mother to the infant’s eyes as the the term used in Europe) is a medical doctor (MD) child passes through the birth canal. who has completed college, four years of medical A herpes infection is the most common infection school, a year of internship, and a minimum of transmitted at birth, affecting approximately 1 in three years of specialized residency training con- 5,000 births, according to the International Herpes cerning diseases and surgery of the eye. Many Alliance. Gonococcus or staphylococcus germs and receive additional training in one or two years to other bacteria may cause ophthalmia neonatorum subspecialize in areas such as CORNEA TRANSPLANT also. Symptoms of the infection are apparent surgery, retinal surgery, or low-vision services. shortly after birth when the cornea, conjunctiva, Ophthalmologists test vision, prescribe correc- and eyelids of the infant begin to inflame. The eyes tive lenses, diagnose and treat eye diseases and may be treated with local antibiotics such as peni- defects, prescribe medications, and perform sur- cillin, streptomycin, or tetracycline administered at gery. They are subject to the licensing practices and one hour intervals. Systemic antibiotics may be requirements outlined by state and professional prescribed if the cornea is involved. If not treated, organizations for physicians. Each state medical the condition can cause blindness and spread to board issues a license to an applicant after the other parts of the body. physician passes a comprehensive examination The standard postbirth therapy to prevent oph- covering general medical knowledge. Ophthalmol- thalmia neonatorum consists of the administration ogists may be certified as members of the American of silver nitrate, or comparable antibiotics, in eye- Board of Ophthalmology, a national organization drop or ointment form. In order to prevent blind- formed to ensure optimum ophthalmological care, ness from ophthalmic neonatorum, all states have after passing written and oral examinations accord- passed laws that require the routine application of ing to subspecialty. silver nitrate drops or antibiotic ointment to all newborn infants’ eyes. ophthalmoscope An instrument used to magnify and illuminate the inside of the eye. Examination ophthalmic technician A skilled assistant who of the eyes with an ophthalmoscope is a routine works with an ophthalmologist. Ophthalmic tech- part of the annual eye exam. nicians complete patient medical histories, perform The hand-held instrument shines a bright light simple vision tests, administer eye drops or oint- on the back of the eye, making it possible to view ments, change eye dressings, take optical measure- and evaluate the health of the RETINA, blood ves- ments, and assist in surgery. Under the supervision sels, and OPTIC NERVE. The examiner uses the oph- of an ophthalmologist, the ophthalmic technician thalmoscope to look for abnormalities of these eye may also aid patients in fitting contact lenses, parts, as well as indications of diabetes, hardening instruct patients in lens care, and perform some of the arteries, high blood pressure, and other dis- treatment procedures. eases. Since the blood vessels in the inside of the Ophthalmic technicians must have completed eye are the only ones in the body able to be viewed high school before entering the accredited training in their natural state, they provide a window to the programs offered by medical schools, hospitals, and general health of the patient. Routine examina- colleges. The two-year training program is followed tions with an ophthalmoscope often uncover disor- by two years of supervised work experience in a ders or diseases unsuspected in the patient. 172 Optacon

Another version of the ophthalmoscope, a binoc- Optic atrophy may be caused by glaucoma, an ular indirect ophthalmoscope, is used to evaluate the obstruction of a retinal vein or artery, a disorder of entire surface of the retina. The light is attached to the optic nerve such as optic neuritis, a tumor, a headband worn by the examiner. Examination of PAPILLEDEMA (swelling of the disc due to intracra- this kind can determine whether the retina is nial pressure), RETINITIS PIGMENTOSA, toxic-related healthy and functional enough to warrant causes, such as tobacco amblyopia, or injury. Treat- CATARACT surgery. ment of optic atrophy consists of therapy for the underlying cause with medication or surgery or withdrawal of toxic substances. Optacon A reading machine developed by Tele- sensory Systems Inc. that converts print into tactual letter configurations that are read with the optic disc The part of the RETINA where the OPTIC fingertips. The Optacon, which is no longer manu- NERVE meets the eye and the blood supply enters factured but still used by some people, is designed the eye. The optic disc contains no light-sensitive to increase access to print and not to replace rods or cones and is therefore unable to “see.” It is braille. responsible for the blind spot in the normal field of The Optacon user slides a miniature camera vision. across a line of print with the right hand. Simulta- Optic atrophy, a condition in which nerve tissue neously, the left hand rests on an electronic array has been lost from the disc, results in loss of visual consisting of 100 vibrating pins. The Optacon elec- field. This condition may be caused by GLAUCOMA, tronically converts each letter of print into a letter retinal vascular occlusion, PAPILLEDEMA, RETINITIS configuration formed on the array and read by the PIGMENTOSA, or injury. tip of the index finger of the left hand. The Opta- The optic disc is subject to swelling. Papilledema con can translate a variety of print styles and sizes. is a condition that occurs when the optic disc Adaptations to the machine include models that becomes swollen due to an obstruction to the cir- adapt to typewriters, computer terminals and elec- culation of blood within the eye or by increased tronic calculators. pressure within the cranium. Swelling may also be Individuals must be extensively trained to use caused by optic neuritis (swelling of the optic the Optacon effectively. The speed of the reading nerve), blockage of a central retinal vein due to machine is slower than voice synthesized models arterial disease, MULTIPLE SCLEROSIS, DIABETIC or sight reading. (See TELESENSORY SYSTEMS INC.) RETINOPATHY, and postoperative conditions following intraocular surgery. optical aids See MAGNIFIERS. optician An optician dispenses the lenses and low-vision aids prescribed by optometrists and optic atrophy Optic atrophy is a loss of nerve tis- ophthalmologists. Opticians grind and formulate sue on the OPTIC DISC, the place where the OPTIC the lenses and fit them to a frame. In many states, NERVE joins the eye. The optic disc is nonseeing and opticians also fit and administer contact lenses. corresponds to the blind spot in vision. Optic atro- They are not trained or licensed to examine the phy may cause a loss of visual field. Both central eyes or to prescribe lenses. and side vision may be lost, although visual acuity may remain unaffected. It can also cause abnormal optic nerve A cord of approximately 1 million color vision or blurred vision. Often called pale nerve fibers that connect the brain to the eye and disc, optic atrophy is characterized by pallor, or that supply blood to the RETINA. It sends blood from whiteness, of the disc. Because nearsighted eyes the back of the eye through blood vessels in the and those of children also have disc pallor, the con- retina to cover the entire surface. dition may be misdiagnosed or confused with other The optic nerve is a conduit of information from conditions. the retina to the brain. The retina receives reflected orbit 173 light that falls on an object. It evaluates the light bar neuritis, involves sudden loss of vision in one messages and transforms them into electrical eye accompanied by pain associated with eye impulses. The impulses travel through the optic movement. Blind spots, or SCOTOMAS, may appear nerve to the brain, where they are translated into within the field of vision as well as COLOR BLIND- an image. NESS and difficulty seeing in bright light. Vision The optic nerve is joined to the eye in the retina may be affected in the entire field or may begin in at a point called the OPTIC DISC. Since the optic the center of the field and progress to peripheral nerve contains no light-sensitive cells, it is “blind” areas. The condition is treated with steroids, and and renders the spot where it connects to the the prognosis is excellent. The vision loss may be retina, the optic disc, blind as well. This juncture partially or completely recovered after three where the nerve joins the retina is known as the months. blind spot in the normal field of vision. Optic neuropathy or neuritis unrelated to multi- The optic nerve is subject to several disorders. ple sclerosis may be caused by collagen disease OPTIC ATROPHY is the deterioration of optic nerve such as LUPUS; vascular disease such as arterioscle- fibers of the optic disc. As a result, both central or rosis, arteritis, or arterial hypertension; a viral, fun- side vision may be lost. Optic atrophy may be gal or bacterial infection; tumors or cysts; and caused by a blockage of a retinal vein or artery, alcohol or tobacco overuse and other toxic causes. an injury, a congenital or hereditary condition, There is also a hereditary form of optic neuropathy GLAUCOMA or RETINITIS PIGMENTOSA, or following a that is passed through the mother to her children. swelling or disease in the optic nerve. It affects males more than females, usually occur- TOXIC AMBLYOPIA is a condition related to optic ring in the mid-20s. This type of optic neuropathy atrophy in which the optic nerve is damaged due to is called leberis hereditary optic neuropathy. Symp- toxins such as alcohol or tobacco. Poisoning by toms may include loss of vision in one or both eyes. these substances results in loss of central vision. Treatment may consist of medication for the Optic neuritis (also called optic neuropathy) or underlying systemic cause and may include corti- swelling of the optic nerve, may result in condi- costeroids. Vision loss produced by neuritis unre- tions such as retrobulbar neuritis. Symptoms of lated to multiple sclerosis may be irreversible. retrobulbar neuritis include painful eye movements and loss of central vision. The condition is optometrist An optometrist has a degree of sometimes associated with MULTIPLE SCLEROSIS. optometry (OD), which is awarded after complet- Tumors may develop along the optic nerve path- ing college and four years of optometry school. An way. They may cause vision loss and bulging of the optometrist screens and diagnoses common eye eyeball. problems, assesses the efficiency and health of the For more information about condition affecting eyes, provides low-vision care, prescribes corrective the optic nerve, contact: eyeglasses, contact lenses, and low-vision aids. The International Foundation for Optic Nerve Optometrists are not physicians, and in the case Disease of disease or surgery, optometrists refer patients to P.O. Box 777 a physician or ophthalmologist. Cornwall, NY 12518 845-534-7250 orbit The bony socket lined with fatty tissue that www.ifond.org cradles and protects the eye. The globe of the eye is held in place in the orbit by six extrinsic muscles. optic neuropathy Optic neuropathy or neuritis is The orbit is subject to several conditions. The a swelling of the OPTIC NERVE. The condition is seri- fatty tissue surrounding the globe may become ous and may result in permanent vision loss. inflamed due to bacterial infection. The infection Optic neuropathy is often associated with MULTI- may spread to the globe. Tumors may also form PLE SCLEROSIS. This form of neuritis, called retrobul- within the orbit. 174 orbital cellulitis

Hemangioma, a common tumor of the orbit Orbital cellulitis may be the result of an infec- most often seen in children, is benign and rarely tion of the sinuses that spreads to the bony orbit requires surgery. Dermoid cyst is a growth that socket. Symptoms include forward displacement of appears at the level of the eyebrow in the upper the eye, restricted ocular motility, fever, and red, portion of the orbit. The cyst may be removed for swollen eyelids. Movement of the eye also may be cosmetic reasons and for biopsy. Pseudotumor is an limited. Treatment involves admission to the hospi- inflammatory mass of the orbit without known tal where antibiotics are administered in intensive cause. This tumor is treated with steroids to reduce therapy. Surgery may be performed to drain an the inflammation. abscess. If treatment is timely, the prognosis for the Other rare tumors include glioma of the OPTIC eye and vision are excellent. NERVE and rhabdomyosarcoma. Glioma of the optic nerve is a slow growing tumor that causes OPTIC orientation aids Maps, scale models, or verbal ATROPHY. It may be linked with Von Reckling- descriptions of a building or site that enable visu- hausen’s disease. Rhabdomyosarcoma is a rare ally impaired persons to navigate independently. tumor of the orbit seen in children. It is highly Orientation aids are particularly appropriate to malignant and rapid growing but may be con- large public facilities, such as airports, train sta- trolled by radiation therapy if treated in the earliest tions, hospitals, hotels, or universities. stages. Tumors originating from diseases of the Orientation aids may be visual, verbal, or sculp- body may metastasize to the orbit. tural. Visual types include diagrams or maps and Tumors of the orbit often cause DIPLOPIA (double may include raised lines or features. TACTILE MAPS vision) or EXOPHTHALMOS, bulging of the eyes. with visual information are beneficial to both visu- Exophthalmos, also known as proptosis, is also ally impaired and sighted users. caused by thyroid dysfunction, muscle palsy, injury, Verbal aids are spoken or written descriptions of and infection. ENOPHTHALMOS, the appearance of the site or descriptions of routes to travel the site. sunken eyeballs, may occur due to an injury that Verbal aids may be recorded onto cassette or tape displaces the fatty tissue lining of the orbit. or printed. Many verbal aids are designed to be Injuries to the orbit may result in vision-limiting used en route. conditions. A common injury, the blow-out frac- Sculptural aids are three-dimensional models of ture, occurs when the globe is forced back into the the environment or site. If made to scale, models orbit. A fracture forms on the orbital floor and give the most information about spatial relation- bone is forced downward. Such an injury often ships and concepts. causes damage to the rectus muscle and infraorbital Orientation aids are recommended for inclusion nerve. The injury may be treated with placement of in standardized locations in all public facilities or a plastic implant in the orbital floor and return of sites by the Committee on Architectural and Envi- the displaced tissue to its correct position. ronmental Concerns of the Visually Impaired, a Fractures of the skull may extend into the orbit standing committee of the American Association of and cause cranial nerve palsy or optic nerve dam- Workers for the Blind. (See TRAVEL AIDS.) age. A blow to the eye may result in OPTIC DISC atrophy. Such conditions resulting from injuries The term used to may affect vision or result in vision loss. orientation and mobility describe methods to navigate safely, gracefully, and confidently in an environment. Orientation and orbital cellulitis An inflammation of the orbit. mobility skills are taught as a part of the rehabilita- The infection is considered an emergency and must tion and education program for the blind and visu- be treated promptly. If untreated, the OPTIC NERVE ally impaired. may become damaged and vision permanently lost. Formal orientation and mobility programs came If allowed to spread to the brain, the infection into existence after World War II. In response to could cause meningitis. the need for rehabilitation-skills training for orientation and mobility 175 blinded veterans, the United States military estab- Concept development is essential for those con- lished rehabilitation programs at four hospitals. genitally blind and includes learning spatial con- Richard E. Hoover, an ophthalmologist working as cepts such as perpendicular and parallel, and a director of physical reconditioning, orientation, understanding fundamental structures such as and recreation at Valley Forge General Hospital in compass directions, the layout of a building, or the Phoenixville, Pennsylvania, developed a long cane design of a city block. and a set of methods for using the cane that are Motor skills include proper posture and body the basis of today’s orientation and mobility pro- movement and the maintenance or improvement grams. of coordination. These skills may be enhanced or As word of the benefits of Hoover’s program developed through exercise, such as walking, skip- grew, a demand for mobility training developed. ping rope, jumping, or running. In 1959, at a conference cosponsored by the Orientation training may include skills using American Foundation for the Blind and the Of- landmarks and shorelines, squaring off, and trail- fice of Vocational Rehabilitation, guidelines for ing. Landmarks are objects in specific areas used to mobility instructor criteria were outlined. Train- orient oneself in the environment. Shorelines are ing programs were established in universities, places where two different surfaces meet, such as and by 1960 Boston College established a gra- where the floor meets the wall or where the floor duate Peripatology Program, to be followed in meets the rug. 1961 by the establishment of the Center of Orien- Squaring off uses landmarks as guides for deter- tation and Mobility in Western Michigan Uni- mining direction, such as lining up with the edge of versity. the curb to cross the street. Trailing involves lightly Current programs in universities require course trailing the back of the hand to follow a shoreline work in education, physical and behavioral sci- such as a table edge, a hedge, or a wall. The back of ences, sensory training and awareness, preventive the hand is used to avoid injuring the fingers. and restorative resources, and field training. Qual- Self-protection includes teaching protective ified orientation and mobility instructors are certi- body techniques. Upper-body protective tech- fied by the American Association of Workers for niques involve using the arm to protect the upper the Blind. body and face from obstacles. The user carries one Orientation and mobility skills instructors indi- arm horizontally in front of the body with the vidualize the program to the needs and abilities of elbow bent at a 90 degree angle. The arm then the user. It is important for blind children to have comes into contact with impeding objects before orientation and mobility training early, in order to the body. If the head or face is the area most likely develop confidence in their surrounding and their to come into contact with obstacles (such as when ability to negotiate their environments. Although horseback riding) the arm is held up vertically to programs vary, orientation and mobility courses the side of the body with the hand held slightly usually include sensory training, concept develop- ahead, protecting the face. The upper- and lower- ment, motor skills, orientation to surroundings, body protective technique combines the horizon- self-protection, long-cane skills, and use of a tally held arm with the other arm held in front of human guide. the body, below the waist, at a 45-degree angle. Sensory training involves learning to use and Long-cane skills are taught once the preceding sharpen the SENSES, including remaining vision, to skills are mastered. Training involves correct grip, their greatest abilities. The senses are used to deter- movement of the cane, and use of the cane while mine landmarks, orient oneself to surroundings, walking to identify and circumvent obstacles. and maneuver safely within an environment. The Although use of a human guide is the least inde- training may include development of echo percep- pendent form of travel, it is sometimes necessary. tion or echo location, listening to the echo of self- The training in use of a human guide includes mas- emitted sounds to determine objects or surfaces in tery of the SIGHTED GUIDE TECHNIQUE, a method for the environment. traveling with a sighted person. 176 orthokeratology

Visually impaired persons receiving orientation The goal is to reshape the cornea to allow a visual and mobility training may be instructed in the acuity of 20/20 without correction. As this is use of optical or electronic travel aids prescribed achieved, the lens-wearing time is gradually by an optometrist or ophthalmologist. Optical aids reduced. include telescopes, magnifiers, and hand-held or After the process, the cornea may maintain its spectacle-mounted devices that improve or new shape for a period of time but eventually enhance remaining vision. reverts to its original shape. Retainer lenses may be Electronic travel aids include the laser cane, the prescribed to discourage regression. The retainer Pathsounder, the Sonicguide, and the Mowat Sen- lenses may be worn as little as once every month sor, all of which require specialized training to use. or as much as eight hours a day. Electronic travel aids send out light beams or Objective analysis of the procedure has revealed ultrasound waves that come into contact with the dangers of permanent damage to the cornea, objects in the path. When the beam or waves hit unimpressive and transient success rates, discom- an object, the device responds by vibrating or fort during the procedure and expense. Those with emitting a sound. Electronic travel aids are used mild myopia stand the best chance of success, but by approximately 1 percent of visually impaired those with severe myopia may benefit only in a persons and often cannot be used with a dog reduction of strength needed in the lens prescrip- guide. tion. Dog-guide training is not a part of a standard The procedure, although acclaimed by some orientation and mobility program. Only approxi- doctors, is not widely used. mately 1 percent of visually impaired persons use DOG GUIDES because restrictions of age, health, A skilled health-care worker who hearing ability, remaining vision, and temperament orthoptist diagnoses and treats people who have fused-vision, limit those who may qualify to receive a dog. Those eye-muscle, and crossed-eye disorders. Orthoptists who do qualify for a dog guide are trained with the work under the supervision of an ophthalmologist dog at the dog-guide school in specifically designed to teach patients vision exercises that enable the orientation and mobility programs. patient to accurately focus and coordinate the American Foundation for the Blind. How Does a Blind Per- movement of both eyes. They may also be trained son Get Around? New York: American Foundation for in GLAUCOMA and vision-field testing. the Blind, 1988. Orthoptists must complete a minimum of two Kelley, Jerry D., ed. Recreation Programming for Visually years of college or registered nurse’s training in Impaired Children and Youth. New York: American addition to the two years orthoptist academic pro- Foundation for the Blind, 1981. Scott, Eileen P. Your Visually Impaired Student. Baltimore: gram offered by hospitals, medical schools, or eye University Park Press, 1982. clinics. They may be certified by the American Skurzynski, Gloria. Bionic Parts for People. New York: Four Orthoptic Council, although this is not a require- Winds Press, 1978. ment for employment in every case. orthokeratology A procedure that uses contact Overbrook School for the Blind A private, not- lenses to reshape the CORNEA to reduce MYOPIA. The for-profit school geared toward students with curvature of the cornea is measured, and hard con- vision impairments and other challenges. It was tact lenses are prescribed at a slightly flatter degree. founded in 1832 by Julius Friedlander, a young As the cornea is flattened, new lenses are pre- teacher who moved to Philadelphia from Ger- scribed at increasingly flatter degrees. The process many for the purpose of starting a school for chil- may take up to three years to complete. dren with impaired vision or blindness. Overbrook The eyes are regularly measured and the visual is located on a 22-acre campus in West Philadel- acuity tested to determine the degree of correction. phia. About 200 students attend the school. Most Overbrook School for the Blind 177 commute, but there is some student housing to academics, the school offers life skills classes, a available. work experience program, and extracurricular Overbrook educates children between the ages activities. of three and 21 who are legally blind. Some have Contact: other impairments as well. There is no charge to Overbrook School for the Blind families of the children who attend the school. 6333 Malvern Avenue State funding and funding from the child’s school Philadelphia, PA 19151 district covers the cost. The school also provides 215-877-0313 (ph) services to children who do not attend Overbrook 215-877-2709 (fax) and initiated a campaign in 2001 to provide www.obs.org advanced technology in its classrooms. In addition

P panophthalmitis A painful condition in which intracranial pressure increase and is often accom- inflammation or infection affects the entire globe of panied by vomiting and headache, enlargement of the eye. This may result from the inflammation of the blind spot, and transient blurring or loss of posterior UVEITIS or an infection due to surgery or vision. It almost always is bilateral, and may injury. develop over hours to weeks. Panophthalmitis also occurs when an inflamma- Since papilledema may indicate a tumor, it is a tion or infection that affects the posterior chamber serious condition that requires prompt medical and center of the globe, a condition called endoph- attention. Papilledema may be diagnosed by a thalmitis, spreads past the center to involve the visual-field examination, ULTRASONOGRAPHY,com- ANTERIOR CHAMBER and the SCLERA. puterized TOMOGRAPHY, and FLUORESCEIN ANGIOG- The underlying condition is usually not treatable RAPHY, a test in which fluorescein dye is injected once it has reached the stage of panophthalmitis. into the body and observed as it travels through the Panophthalmitis usually results in complete, per- eye. manent loss of vision in the affected eye. The eye Pseudopapilledema is a degeneration or abnor- may begin to shrink and it may require surgical mality of the disc that exhibits the same symptoms removal. as those of papilledema. Pseudopapilledema may actually be a misshapen disc or multiple drusen, waste particles of the optic nerve. paperless braille Cassette braille, an information Papilledema is treated according to its cause. system that is stored on discs and accessed in Hydrocephalus is treated with a shunt to drain the braille. The system reduces the storage space nor- extraneous fluid. Tumors are surgically removed. mally needed for thick braille texts. Medication or surgery may be necessary for hyper- To use paperless braille systems such as Versa- tension or hematoma. Braille, the individual runs his fingers over display cells to read the text. The push of a button accesses the next segment of recorded material. The user can partially sighted See LOW VISION. produce, edit, and record braille with the system. Although it consists of several pieces of equip- pathsounder One of the ultrasonic ELECTRONIC ment, the system is portable. It can be adapted for TRAVEL AIDS designed for use by visually impaired use with computer terminals, calculators, and type- persons. The device is manufactured under several writers. names, including the Russell Pathsounder and the Polaron. papilledema A swelling of the OPTIC DISC due to The device consists of a small box that may be an increase in intracranial pressure. Intracranial hand held or worn at chest height from a strap pressure may be the result of cerebral tumor or around the neck. The box sends ultrasonic waves abscess, hypertension, subdural hematoma, or hy- into the path of the user to detect objects up to 16 drocephalus, an increase in cerebrospinal fluid feet away. The reflected waves are converted into within the cranial cavity. It is a symptom of an audible sound to warn the user.

179 180 peripatology

The device is designed to be used in conjunc- function in the detached area, and vision is lost. tion with a long cane, and some manufacturer’s Detached retinas are usually treated surgically. models may be used with a dog guide. Use of the GLAUCOMA is a disease that attacks and destroys Pathsounder requires training from a qualified peripheral vision. It is the leading cause of blind- instructor. ness among adults in the United States. It may be caused by heredity, aging or as a result of another eye condition. As the AQUEOUS FLUID in the ANTE- peripatology See ORIENTATION AND MOBILITY. RIOR CHAMBER of the eye fails to drain normally, the fluid builds within the eye, forcing the vitreous in peripheral vision The side vision of the visual the posterior chamber against the retina and optic field. It gives information about the area surround- nerve. The pressure cuts off the blood supply to ing central vision, where detail is perceived. nerve cells in the retina and optic nerve, damaging Peripheral vision is controlled by the rods, light- them and destroying vision. Since glaucoma first sensitive cells of the RETINA. The retina is the inner affects those cells that determine peripheral vision, layer between the CHOROID and the vitreous gel a loss of peripheral vision is a major symptom of that contains photosensitive RODS AND CONES. The glaucoma. Other symptoms include pain, blurred rods and cones provide information about the vision, the presence of halos around lights, and a shape, color, size, and movement of an object in loss of night vision. Without treatment, glaucoma view. The retina processes the information from causes increasing tunnel vision. Vision lost as a the rods and cones and encodes it into electrical result of glaucoma cannot be restored, but once impulses. The impulses are sent via the optic nerve diagnosed, glaucoma may be effectively treated to the brain where they are translated into an and controlled with medication or a combination image. of medication, laser treatments and surgery. The rods outnumber the cones by an average of five to one and are scattered throughout the retina. They react to faint light, shape, and movement. Perkins School for the Blind The Perkins School Because the rods do not require high levels of light for the Blind, established in 1829 as the New Eng- to function, they enable the eye to see at night. land Asylum for the Blind, was the first school for Because they are scattered throughout the retina, the blind in the United States. It was later referred unlike the cones which are concentrated in the to as the New England Institution for the Blind and center, they are responsible for peripheral vision. then finally renamed The Perkins School for the Diseases of the retina and other disorders of the Blind in honor of an early benefactor, Colonel eye may damage cones or destroy peripheral Thomas Handasyd Perkins. Both HELEN KELLER and vision. RETINITIS PIGMENTOSA (RP) is a hereditary ANNE SULLIVAN, her teacher, were students at the group of diseases that attack the retina and cause Perkins school. degeneration of the rods and cones. The rods are Under the directorship of Dr. Samuel Gridley affected first. As they are destroyed, night vision Howe, the school offered instruction for blind and deteriorates and peripheral vision is lost. As the dis- deaf-blind individuals. A printing department, later ease progresses, ever-increasing tunnel vision named the Howe Memorial Press, was added that results. Currently, there is no treatment for RP. produced books and materials in Boston Line Type, RETINAL DETACHMENT may cause a sudden loss of a raised and enlarged Roman alphabet, and in peripheral vision. A retinal detachment occurs braille. when the retina pulls away from the epithelial Today the school educates and trains children layer next to the choroid. This may be caused by and adult blind, visually impaired, deaf-blind, and holes or tears in the retina, by traction or by leak- multi-impaired individuals. The Adult Services Pro- age of the VITREOUS gel. The tears may result from gram provides community housing options, offering aging, injury, cataract surgery, or severe myopia instruction in independent-living skills and rehabil- (nearsightedness). As the retina detaches, it fails to itation programs for those 18 years and older. photocoagulation 181

The Severe Impaired Program offers individual- ing the procedure, a small incision (one-tenth of an ized instruction and residential care to severely or inch) is made in the eye. An ultrasonic, titanium multi-impaired individuals aged 10 to 22. The needle is then inserted into the incision. The sur- Deaf-Blind Program serves individuals aged five to geon presses a foot pedal to activate the needle. The 22 and provides academic education, vocational needle vibrates 40,000 times per second to break training, and daily living skills. down or emulsify the hard nucleus of the cataract. The Perkins School offers secondary services to The liquefied cataract is then sucked back up adolescents in high school or special educational through the needle and removed from the eye. The programs, a lower-school program of individual- posterior capsule is left intact, and one suture is ized instruction for children in elementary school, placed to close the incision. Recovery from surgery and a preschool program and infant-toddler pro- is almost immediate. Patients may often return to gram for assessment and training for children from work and routine activities the following day. birth to five years. When phacoemulsification was first introduced, The project with industry program explores it was associated with a higher complication rate employment opportunities for blind and visually due to the inexperience of the surgeons. As more impaired adults and provides job-placement ser- ophthalmologists gained expertise in the proce- vices, job analysis, adaptive engineering, and train- dure, the complication rate dropped and the ing support. method is no longer considered controversial. The school operates the Howe Press, which manufactures the Perkins Brailler, a braille type- phoroptor An instrument used in the ophthal- writing machine. The Howe Press offers the mologic examination. The phoroptor determines braillers, brailler accessories, brailling slates and the refraction errors, or the degree of inability to accessories, games, maps, mathematical aids, properly focus. music, and braille paper through its mail-order cat- It is a large butterflylike apparatus that has two alog. round sections affixed to a vertical base. The The school also runs the Hilton/Perkins Pro- patient faces the phoroptor, with one round section gram, aimed at improving the quality of life for centered in front of each eye. The patient places his multi-handicapped blind or deaf-blind children chin on a chin rest and looks through lenses in around the world by offering increased educational each round section to read a wall chart. opportunities. The phoroptor holds hundreds of lenses of vary- The Perkins School maintains the Samuel P. ing degrees in each round section. The examiner Hayes Library, the world’s largest collection of print uses a dial to change the lenses in front of each eye. material on the nonmedical aspects of blindness The patient is asked to determine which lenses pro- and deaf-blindness. The library contains 25,000 vide the clearest vision or image of the chart. volumes in print, braille or on recorded discs or From the information provided by the patient in cassettes. The school publishes a biannual newslet- response to the phoroptor lenses, the examiner can ter, the Howe Press Newsletter. prescribe the proper corrective lenses. Contact:

Perkins School for the Blind photocoagulation A procedure in which light is 175 North Beacon Street used to coagulate or congeal hemorrhages. Photo- Watertown, MA 02172-9982 coagulation is used routinely in ophthalmological 617-924-3434 (ph) therapy and as an alternative to surgery. 617-926-2027 (fax) Light was first used in the 1950s to coagulate www.perkins.pvt.k12.ma.us retinal detachments. The procedure used a German device that produced a powerful beam of light from phacoemulsification A type of CATARACT extrac- a xenon arc. In the 1960s LASERS were introduced tion invented in 1967 by Dr. Charles Kelman. Dur- and became the instrument of choice for photoco- 182 photophobia agulation because they generate less heat and can drive home afterward. Follow-up treatments may be focused more precisely. be necessary. The low energy, finely concentrated light of the Although photocoagulation may improve vision laser is directed into the eye where it is absorbed by in some cases, it is not always a cure. It frequently the tissue. The energy converts to heat, which cannot restore lost vision and may only serve to forms a burn. The burn develops into scar tissue, stop or impede the progression of a disease or dis- which congeals the hemorrhage. order. Photocoagulation is used to treat DIABETIC Berland, Theodore, and Richard A. Perritt. Living With RETINOPATHY. An ARGON LASER is directed into the Your Eye Operation. New York: St. Martin’s Press, 1974. eye where the light is absorbed into the pigmented Eden, John. The Eye Book. New York: Penguin Books, layer of the RETINA. The surgeon makes several 1978. “burns” around each leaking vessel of the retina. Krames Communications. The Retina Book. Daly City, Cal- The resulting scar tissue stops the leaking. ifornia: KC, 1987. Unhealthy tissue that is generating neovasculariza- Medem Medical Library. How is Diabetic Retinopathy tion (new, weak vessel growth) is treated with the Treated? www.medem.com/search, 1997. laser to destroy it and prevent the cycle of new Reynolds, James D. “Lasers in Ophthalmology.” Health- growth. Net Library, CompuServe, 1989. In much the same manner, photocoagulation is Schweitzer, N. M. J., ed. Ophthalmology. Amsterdam: Exerpta Medica, 1982. used to treat subretinal neovascularization, a com- Shulman, Jules. Cataracts. New York: Simon and Schus- plication of AGE-RELATED MACULOPATHY. A break in ter, 1984. the pigment epithelial layer beneath the retina causes the underlying vessels to bleed into the retina and cause scarring. The scarring destroys photophobia Photophobia, or fear of light, is a vision in the macula, the central section of the condition in which the eyes have little tolerance for retina responsible for sharpest sight. light. The eyes may experience pain as a result of This treatment utilizes a laser, which is absorbed exposure to light or may involuntarily squint or only in the deepest layers of the retina where such blink in response to light. damage occurs. The light passes through the upper, Photophobia is not a disease but, rather, a symp- unaffected layers and treats only the targeted areas tom or result of an ocular disease or disorder. Pho- below. tophobia is a first sign of congenital GLAUCOMA in Photocoagulation may be used in some infants. It may be caused by or seen in a multitude of disorders including IRITIS, corneal lesions, instances to treat GLAUCOMA. A laser may be used to create a series of burns that develop into scars ALBINISM, CATARACTS, BLEPHARITIS, MIGRAINE, TRA- and form openings in the meshwork of drainage CHOMA, UVEITIS, some types of drugs, and SYMPA- channels that allow fluid to flow more easily from THETIC OPHTHALMIA. Since photophobia is a result or the eye. symptom of disorder, its occurrence should prompt Photocoagulation is generally a painless proce- an ocular examination. dure, usually performed without anesthesia. The patient sits in front of a slit lamp or biomicroscope photorefractive keratectomy (PRK) A corneal in a dimmed room. Topical anesthetic drops, dilat- surgery that can reduce or correct mild to moder- ing drops or a contact lens may be placed in the ate myopia (nearsightedness), with or without eye. mild astigmatism. The surgery, which normally is The surgeon administers from 50 to several done on an outpatient basis, involves removing the hundred rapid bursts of energy to the affected areas epithelium, or surface layer, of the cornea. A spe- of the eye. The patient may see flashing lights and cial laser is then used to precisely reshape the may experience slight discomfort or brief, painful cornea. The actual surgery generally takes only moments. The procedure may last from five to 30 about a minute, although the overall procedure minutes, and the patient is usually able to walk or requires more time. posterior chamber 183

An ophthalmologist programs the PRK laser— The treatment consists of producing an af- an excimer laser—to specifically meet the needs of terimage on which the patient is taught to focus. each patient. The laser produces a highly concen- The macular region of the RETINA is stimulated trated beam of light that removes micro-thin layers with a bright or dazzling light. When the light is of tissue from the cornea. This results in a flatten- turned off, the patient fixates on the macula’s ing of the cornea’s front surface, which generally after-image, encouraging the individual to use the improves the condition of myopia. Much research MACULA. has been done to determine exactly how much Pleoptic treatment may last several weeks to laser is required to treat a particular amount of several years. Results of pleoptic treatment have myopia. been disappointing in light of early expectations, Most people who undergo PRK report that they and the methods are now more widely used in no longer have to wear glasses or contacts. Tests Europe than in the United States. show that about two-thirds of patients who undergo PRK can see 20/20 or better without cor- pneumatic retinopexy A fairly new procedure rective lenses. Nearly all—about 95 percent—can used to repair a RETINAL DETACHMENT. A retinal pass a standard driver’s license exam that requires detachment occurs when the retina becomes sepa- 20/40 vision without glasses or contacts. rated from the back of the eye. Some detachments PRK was first performed in the United States in are caused by retinal holes or tears, which must be 1996. The procedure still is used, but the newer surgically repaired. LASIK procedure has become more popular. PRK is With pneumatic retinopexy, freezing treatment normally without complications, but, as with all is placed around the retinal tear, after which an surgeries, there are some risks involved. These expanding gas bubble is injected into the eye. The include the possibility of infection or drug reaction, gas pushes against the area of the retinal tear and which, in extreme cases, could result in loss of closes it, eliminating the need for a SCLERAL BUCKLE. vision. Some people find they need reading glasses The procedure requires only local anesthetic and at an earlier age than average (about 40) after PRK, often can be done in a doctor’s office. It does not, even though they did not wear glasses before the however, work for all types of retinal detachments. procedure. Some PRK patients have experienced Pneumatic retinopexy was first introduced in the problems with night vision, and a small percentage United States in 1985. of patients realize a decrease in best corrected vision. People who have uncontrolled autoimmune or posterior chamber The posterior chamber of the vascular disease, are pregnant or nursing, have eye is the area between the IRIS and the LENS. It is KERATOCONUS, or have previously had a RADIAL the counterpart to the ANTERIOR CHAMBER located KERATOTOMY normally are not advised to consider between the CORNEA and the iris. Both chambers PRK. are filled with AQUEOUS FLUID, the clear liquid that nourishes the CORNEA and lens and carries away waste. pinguecula See CONJUNCTIVA. The aqueous is produced by the CILIARY BODY epithelium. The ciliary body also has a muscle Plaquinil See LUPUS. group that bends the lens of the eye to focus properly. The aqueous flows from the ciliary body into pleoptics Pleoptics or pleoptic methods are part the posterior chamber to bring nutrients to the of orthoptic training, the use of exercises to correct lens. It then flows through the PUPIL of the eye into or improve vision disorders. Pleoptic methods use the anterior chamber to reach the back of the flashing devices to improve macular and foveal ori- cornea. After the fluid has circulated, it leaves the entation and fixation in cases of AMBLYOPIA, a con- eye through the Schlemm’s canal, a drainage point dition of blindness in one eye due to disuse. at the junction of the cornea and the iris. 184 potential acuity meter

The posterior chamber is the site of surgery for near objects. The first symptoms usually arise after posterior intraocular lens implantations. As a part 40 years of age and include difficulty in reading or of CATARACT surgery, a plastic lens is often placed doing close work. either in front of, or behind, the iris to replace the Prescriptive convex lenses in reading glasses or portion of natural lens lost to surgery. Posterior bifocals may correct the problem. In addition, a lens implantation places the artificial lens behind Texas-based company called Presby Corp. has the iris. developed and is marketing a surgical technique Posterior is also a term used to describe the back called Surgical Reversal of Presbyopia. The proce- portion of the eye behind the lens. This area is dure uses a tiny device called a scleral expansion filled with the vitreous, a clear gel-like material band to expand the diameter of the sclera. This that makes up 80 percent of the volume of the eye. causes the distance between the scleral and the lens The vitreous gives volume to the eye and supports to increase, restoring the effective working distance the other organs within the globe. of the muscle, as in a younger eye. The company is The expanded definition or boundaries of the conducting investigational clinical trials at six uni- posterior area may include the RETINA, OPTIC NERVE, versities to test the procedure. and portions of the CHOROID and SCLERA, which are positioned in the back of the eye. This area may be President’s Committee on Employment of People injected with antibiotics or other medications in with Disabilities See OFFICE OF DISABILITY EM- the treatment of disease or infection. It may be the PLOYMENT POLICY. site of surgery as in RETINAL DETACHMENT operations, or vitrectomies. In retinal detachment surgery, the retina is reattached to the epithelial Prevent Blindness America The oldest national layer next to the choroid. During vitrectomy, the voluntary health organization working to prevent chamber behind the lens is drained of diseased vit- blindness. Founded in 1908, it has been formerly reous gel and filled with a sterile saline solution. known as the National Committee for the Preven- The posterior section behind the lens may be tion of Blindness, the National Society for the Pre- subject to floaters, bits of debris or blood in the vit- vention of Blindness, and the National Society to reous. Light passing through the vitreous casts Prevent Blindness. The goal of the organization is shadows of the debris onto the retina, causing to preserve sight and prevent blindness through images of the debris to float through the field of community-service programs, public and profes- vision. Floaters appear in normal vision and are not sional education, and research. considered as a symptom of disease unless they Prevent Blindness America activities include appear suddenly or in large numbers. preschool vision testing, distributing a family home eye test called “How’s Your Vision?,” local glaucoma screening and educational programs, and potential acuity meter (PAM) A slit-lamp promoting industrial and recreational eye-safety attachment used to assess the potential, usable programs. The organization also promotes cooper- vision of those with cataractous lenses or corneal ative public and educational programs with gov- opacities. ernmental and voluntary health and social-service The PAM uses a prism system and self-illumina- agencies, and sponsors the National Center for tion to project a small SNELLEN CHART through a Sight, a toll-free number for eye health and safety clear section of the cornea or lens and onto the information. The line is open from 8:30 A.M. to 5 retina of the person being examined. In by-passing P.M. Central time, and can be reached at 800-331- the opacities, the examiner can efficiently use the 2020. Prevent Blindness America also maintains a Snellen chart to measure visual acuity. website with extensive information and links to other eye care–related sites. In addition, it sponsors presbyopia Aging of the eyes. As the eye ages, research projects to find the causes and treatments the lens deteriorates and loses the ability to focus for eye diseases and disorders. prevention of blindness 185

Publications include Insight, an annual report, or biannual eye examination after the age of 35. and a wide range of pamphlets and brochures deal- Many diseases are easiest to control and have the ing with eye safety, home-vision screening, eye best success records when diagnosed and treated in health, and industrial and recreational eye safety. the early stages. The organization also publishes Prevent Blindness Injury-related vision impairments may be pre- News, a 12-page newsletter printed three times a vented by wearing protective eye wear and year. improving eye-safety practices, such as improving Contact: contact-lens hygiene and overwear time and wearing seat belts while traveling in the car. The mate- Prevent Blindness America rials and products most commonly associated with 500 E. Remington Road injuries to the eyes are metal fragments, contact Schaumburg, IL 60173 lenses, motor vehicles, and chemicals. 800-331-2020 Work-related accidents account for at least www.preventblindness.org 61,000 eye injuries each year. Prevention of blindness due to occupational hazards or injuries is prevention of blindness According to the Pre- closely monitored by the Occupational Safety and vent Blindness America there are currently more Health Administration (OSHA), which enforces than half a million legally blind people in the occupational health and safety standards, and the United States, and more than 50,000 people American National Standards Institute, which become blind each year. Prevent Blindness Amer- specifies manufacturing standards for protective ica estimates that 50 percent of blindness can be eyewear. prevented with current medical knowledge and Work-related injuries may be prevented by the techniques and that 90 percent of all accidental eye consistent use of appropriate eye-protection gear. A damage can be averted with proper eye-safety recent survey by the Bureau of Labor Statistics practices and appropriate eyewear. showed that three out of five workers who suffered The leading causes of blindness in the United an eye injury wore no eye protection. Of those States are GLAUCOMA, MACULAR DISEASE, CATARACT, who did, 40 percent wore the wrong kind. Protec- OPTIC NERVE ATROPHY, DIABETIC RETINOPATHY, and RE- tive eye-safety wear includes safety goggles or TINITIS PIGMENTOSA. These causes represent an esti- glasses, side shields, eye-cup side shields, ventilated mated 51 percent of blindness cases. The leading goggles, face shields, and helmets. Safety glasses or causes of new cases of blindness are macular degen- goggles are made of impact-resistant glass, plastic, eration, glaucoma, diabetic retinopathy, and cataract. or polycarbonate prescription or non-prescription There are approximately 11.4 million visually lenses. The glasses frames are reinforced more impaired persons in the United States, those who strongly than normal types and are heat resistant. have serious vision problems but who cannot be Side shields that attach to, or that are part of, the classified as legally blind. Of this group, 1.4 million safety goggle frame protect the eyes from flying have severe vision impairments that hinder them particles or objects from the front and sides of from reading ordinary newsprint even with the aid the wearer. Eye-cup side shields protect the wearer of corrective lenses. from flying objects from the front, side, top, and The most common causes of vision impairment bottom. are cataract, INJURIES, glaucoma, and CONGENITAL Goggles fitted with regular or indirect ventila- DISORDERS. Cataract is responsible for up to one- tion protect the wearer from chemical splashes, third of all new cases of vision impairment. Injury- dust, sparks, and flying particles. Face shields pro- related vision impairments number close to nearly tect from splashes, heat, glare, and flying objects 1 million, with an estimated 40,000 new cases and must be worn over safety goggles or glasses. caused by injury each year. Welding helmets with appropriate filter plates or The best defense against blindness or vision lenses protect the wearer from splashes of molten impairment due to disease or disorder is an annual metal, sparks and the intense heat and light of 186 prisms welding. The helmets are worn over safety glasses Prevent Blindness America. “Facts and Figures.” or goggles. www.preventblindness.org, 2000. Sports-related injuries account for more than 40,000 emergency room eye treatments annually. prisms Prisms are inexpensive optical additions Sports with the highest injury frequencies are base- to prescriptive lenses that maximize use of remain- ball, basketball, racquet sports, and football. More ing vision. They are used to improve ocular condi- than 90 percent of all eye injuries and resulting tions such as NYSTAGMUS, DIPLOPIA, macular disease, vision impairments may be prevented in sport- or peripheral-field defects. related activities by wearing safety eyeguards or Prisms are horizontally incorporated into frames industrial-quality safety glasses. for prescriptive lenses or noncorrective spectacles Over 420,000 persons in the United States have to treat nystagmus, an uncontrollable jerking of the lost some sight due to home eye injuries, nearly 45 eyes that impairs focusing on an object. The prisms percent of all injuries. Home injuries are usually may relieve symptomatic headache and improve product related and are due generally to home acuity and stabilization of vision. structure or construction materials such as nails Vertically applied prisms are used to treat and lumber, home-maintenance products such as diplopia, or double vision, due to retinal surgery. glues and bleaches, personal-use products includ- The prisms compensate for the impaired abilities of ing contact lenses and sun lamps, and home shop the extraocular muscles. equipment such as batteries and manual tools. Those with macular disease may be helped by Household products cause more than 32,000 seri- prisms. If the MACULA, or central section of sight, is ous injuries each year. impaired or destroyed, prisms can be placed to Home eye injuries can be prevented by wearing move the image from the FOVEA (central macular eye protection such as safety glasses (ANSI Z-87) region) to an area outside the fovea that is usable. when using hazardous materials or working with Prisms such as the Fresnel prism are used for tools. Safety goggles should be worn as a protection peripheral-field (side vision) defects. They are against battery fragments or acid when jump-start- incorporated into prescription lenses or pressed ing a car. onto noncorrective spectacles in sections above and Ultraviolet absorbing sunglasses should be worn below or to the sides of the usable central visual in sunlight, due to evidence that UV rays can dam- field. By moving the eyes or the head slightly, the age the eyes and contribute to the development of user can see through the prisms into the restricted various disorders, including macular degeneration and cataracts. field. Public education programs organized by nonprofit associations, state departments of education, progressive addition lenses Seamless, multifocal public health-care providers, and civic and service lenses that allow the wearer a smooth transition groups serve to prevent blindness by alerting and from the distance portion of the lens into the read- educating the public about eye care, eye safety, and ing portion. No line is visible, either to the wearer eye diseases. Many such organizations perform free or anyone else. The power of a progressive addition eye examinations, provide training and education lens gradually increases as the wearer looks from programs for professionals in the eye-care field, the distance portion to the reading portion, creat- support research into eye diseases, and work for ing an appropriate lens power for every distance. A legislation to enforce and extend existing laws for disadvantage of these lenses is that the sides tend to eye protection and safety. (See VITAMINS, WORLD become distorted, making side vision appear to be BLINDNESS.) wavy. Technology for creating these lenses, which Krames Communications. A Guide to Eye Safety. Daly City, first appeared in the late 1970s, continues to California: KC, 1987. improve, however, and wearers find the distortion Prevent Blindness America. “Safety.” www.preventblind- to be less troublesome as they get accustomed to ness.org, 2000. the lenses. prosthesis 187 proliferative retinopathy A retinal disorder that transparent tissues have become opaque due to occurs as a complication of DIABETES. It is a serious hemorrhage. disease that can result in permanent vision impair- Treatment consists of photocoagulation or laser ment or blindness. therapy. Originally, the treatment involved areas of Proliferative retinopathy is one of three types of the retina in which the neovascularization had DIABETIC RETINOPATHY, which also include exuda- occurred. Now, the photocoagulation is applied tive, or background retinopathy, and preprolifera- extensively in the retina in a method called pan- tive retinopathy. Diabetic retinopathy is a retinal photocoagulation (PRP). During this treat- circulatory disorder that causes the blood vessels ment, over 1,000 laser burns are placed on the that nourish the RETINA, a light-sensitive inner lin- retina, excluding the macular area. These areas are ing in the back layer of the eye, to weaken, disin- destroyed, allowing the limited blood supply to tegrate or become blocked. The vessels may leak reach and nourish the MACULA, or area of sharpest fluid, bleed, grow unnaturally, bulge, or stop func- sight. tioning completely. Vitrectomy may be necessary in cases of extreme Exudative retinopathy is a first stage of diabetic vitreal hemorrhage or traction detachment. A spe- retinopathy in which small hemorrhages occur cialized instrument is inserted into the vitreous from the retinal vessels. Hard exudates form rings where it breaks down blood deposits and scar tis- around the damaged vessels. This condition rarely sue. It then removes the matter and the diseased affects vision and may last indefinitely or progress vitreous fluid by suction. Simultaneously, a sterile to a more serious stage. The preproliferative stage is saline fluid is injected to replace the vitreous fluid. marked by an increasing number of hemorrhages, Approximately two thirds of those who undergo dilation of the retinal vein, and the occurrence of vitrectomy gain improved vision. soft exudates. Preproliferative retinopathy is a seri- Proliferative retinopathy may regress sponta- ous condition that may rapidly progress to the pro- neously. In cases of progressive proliferative liferative stage. retinopathy, early treatment of the ocular condition and the underlying diabetes may prevent or Proliferative retinopathy involves neovascular- limit vision loss. ization or development of abnormal blood vessels within the retina and VITREOUS. The vessels develop Galloway, N. R. Common Eye Diseases and Their Manage- as a result of ischemia, tissue anemia due to an ment. Berlin: Springer-Verlag, 1985. obstruction to the flow of blood. The new, weak Rhoade, Stephen J., and Stephen P. Ginsberg. Ophthalmic vessels grow between the vitreous and the retina, Technology. New York: Raven Press, 1987. Vaughn, Daniel, and Taylor Asbury. General Ophthalmol- near the OPTIC DISC. They leak and cause retinal and ogy. Los Altos, California: Lange Medical Publications, vitreal hemorrhages. The vitreous may shrink and 1977. pull the vessels with it, causing hemorrhaging, fibrous-tissue development, retinal tears, retinal detachment, and secondary glaucoma. At first, a proptosis See EXOPHTHALMOS. person with proliferative retinopathy may notice few symptoms of the disorder. As the condition prosthesis A prosthetic or artificial eye is used to progresses, floaters may be seen, and vision may replace an eye that has been enucleated, or surgi- become blurred or lost. cally removed. Prosthetic eyes have been in exis- Proliferative retinopathy is diagnosed by an eye tence for centuries. Ancient Egyptian cultures examination. FLUORESCEIN ANGIOGRAPHY may be fashioned wax, plaster- or precious-stone eyes to used to aid diagnosis and locate areas of greatest adorn their dead. proliferation. During this procedure, fluorescein Roman surgeon priests made artificial eyes for dye is injected into a vein in the arm and moni- the living out of wood, shells, bone, ivory, stone, tored as it flows through the retina. B-SCAN ultra- and precious metals. In the 16th century, Venetians sonography, or sonar vision, may be applied if the developed the first glass eyes, but the precursor of 188 pterygium the modern type of prosthetic was developed in the lateral and causing AMBLYOPIA. The surgery may be 17th century by French surgeons. performed under local anesthetic for adults and Before World War II, most prosthetic eyes were general anesthetic for children. The type of surgical manufactured of glass in Germany and exported to procedure used depends on the severity and under- other countries. After the war, plastic prosthetics lying cause of each case. were invented and manufactured throughout the Three surgical procedures are most commonly world. Modern prosthetic eyes are made from glass used. The Fansanella-Servat involves the removal of or plastic by ocularists. They are custom shaped to a portion of the lid from the inside. The outer skin match the eye socket of the individual and the col- is not incised. The shortened lid is lifted off the eye. oring of the natural eye. Prosthetic eyes are gener- This procedure is used to treat mild cases of ptosis. ally nondistinguishable from natural eyes. The levator resection is used to treat moderate cases. Two or more days after enucleation the eye During this procedure several incisions are made in socket is fitted with a plastic shell that will cradle the lid. A sling is placed inside the lid to perma- the prosthesis. Three or four weeks later, the pros- nently lift it. The frontalis suspension is reserved for thetic eye is fitted. The eye is attached to the severe cases of ptosis. A section of the muscle that remaining extrinsic muscles in the orbit to ensure raises the eyelid is removed. The surface skin of the natural movement. eyelid is usually involved in the incision. The short- The prosthetic eye is worn constantly to prevent ened muscle keeps the lid elevated. Complications contraction of the eye socket. It is cleansed daily from eyelid surgery may include infection, bleed- and may be lubricated with drops for this purpose. ing, scarring, and corneal drying. Over- and under- A slight mucous discharge is a normal characteris- corrections may occur. tic of prosthesis wearers, but profuse discharge Treatment of other forms of ptosis involves could indicate an infection. treating the underlying cause. Neostigmine may be Infection often stems from roughening of the prescribed in cases of myasthenia gravis. When prosthesis. The prosthesis should be polished once surgery is contraindicated, special spectacles with or twice a year to buff out scratches and reduce irri- an attached crutch to raise the eyelid may be pre- tation, and should be checked for wear by a spe- scribed. cialist at regular intervals. Most plastic prosthetic eyes last five years on average. pupil The small opening centered in the IRIS of the eye. It allows light to pass into the eye. The pterygium See CONJUNCTIVA. pupil can change size to accommodate different light extremes. The iris, or colored part of the eye, ptosis A sagging of the upper eyelid. It may be regulates the size of the pupil by using adjacent congenital or acquired and can affect one or both dilator and sphincter muscles to open and close it. eyes. The disorder may appear congenitally in In bright light, the pupil constricts to screen out children or in adults due to aging, nerve palsy, in- excess light. In low light, it opens up to allow the flammation, styes, tumors, cysts, MYASTHENIA GRAV- maximum amount of light to enter the eye. IS, oculomotor palsy, Horner’s syndrome, or use of The pupil may open wider in response to a stim- guanethidine eyedrops. ulus other than light. Emotions of fear, excitement Mild ptosis that does not affect vision may and delight, and loud noises may dilate the pupil. require no treatment. Severe forms of the condition Drugs may artificially dilate or constrict the pupil. may affect vision by obstructing the pupil or may be Cycloplegic drops dilate the pupil. Different types cosmetically unattractive. After careful diagnosis as such as tropicamide, cyclopentolate, or atropine are to the cause, ptosis may be corrected surgically in effective from three hours to seven days. The pupil some congenital, nerve palsy, or age-related cases. is dilated to examine the back of the eye and to Surgery may be performed on children of three treat conditions such as IRITIS and CYCLITIS. Occa- or four years of age or younger if the ptosis is uni- sionally, dilation of the pupils can bring about an pupil 189 attack of GLAUCOMA in eyes with narrow ANTERIOR or shape of the pupil may indicate a disorder within CHAMBERS. the eye or the body. A light-colored pupil, called Meiotic drops constrict the pupil. Pilocarpine, leukokoria, may indicate the presence of a tumor. ecothiopate, or phospholine iodide may constrict A constricted or misshapen pupil may be evi- the pupil from 4 to 12 hours. The pupils are con- dence of iritis. An enlarged pupil may indicate stricted to reduce intraocular pressure. glaucoma or increased intracranial pressure. Pupils The pupil is black because the inside of the eye of unequal size may also be the result of anisocoria, showing through it is dark. Any change in the color a congenital defect.

radial keratotomy (RK) A type of CORNEA eye to determine the surgical plan. The cornea is surgery developed in the Soviet Union by Dr. stamped with a trephine, a cookie-cutter-like Syvatoslav Fyodorov. The surgery is designed to instrument that marks an incision pattern that the improve myopia (nearsightedness). The ultimate surgeon uses as a guide. The pattern includes a cen- goal of the surgery is to restore the patient’s vision ter circular clear zone and a variable number of to 20/20 without the use of contact lenses or eye- incision lines radiating out from the clear zone. The glasses. The words radial keratotomy refer to the surgeon uses a diamond blade to cut from the clear radial cuts or incisions made on the cornea during zone circle outward. The procedure flattens or surgery. shortens the cornea, to produce better refraction Those with mild myopia can expect the best and improved vision. results from radial keratotomy. Possible candidates The surgery is done on an outpatient basis must require glasses or contact lenses to correct (without overnight hospitalization) and generally their vision. The best results are for those with a requires 30 minutes per eye. The eye is covered refraction between -2.00 to -4.00 diopters and a with a patch for 24 hours, and eye drops such as visual acuity level of 20/80 to 20/200. Those with pilocarpine hydrochloride are used for a week. high myopia (-5.00 or greater) will not achieve the After surgery the patient may experience pain, same results. sensitivity to light, tearing, decrease or fluctuation Although prospective RK patients must be of visual acuity, over- or undercorrection, and mildly myopic, people with very slight myopia are astigmatism. Patients may achieve from 20/20 discouraged from undergoing surgery for such vision to 20/200 vision, or experience no improve- minimal correction. Those with corneal disorders, ment at all. GLAUCOMA or pre-glaucomatous conditions, lentic- Studies indicate that radial keratotomy ular astigmatism, or other eye disorders are also improves vision in the majority of cases. However, often not considered good candidates for this the procedure remains a controversial one and the surgery. prospective candidate for RK is encouraged to re- The presurgical examination involves an exter- search the procedure, its risks and benefits and nal examination of the eye, a vision acuity test, and the surgeon involved to develop a reasonable a refraction test. Additional tests may include expectation. corneascope photographs, a slit-lamp examination, intraocular-pressure testing, motility studies, and Waring, A. O., et al. “Results of the Prospective Evalua- tion of Radial Keratotomy (PERK) Study on Year After cornea measurement and depth testing. Surgery.” Ophthalmology, vol. 92, no. 2 (February Approximately one hour before surgery, the 1985): 177. patient is treated with two or more sets of eye drops to dilate and anesthetize the eye. Many surgeons also administer an antibiotic such as gentam- radiation burns Burns caused by light. Ocular icin sulfate. radiation burns can be caused by ultraviolet rays, In the operating room, the surgeon takes a infrared rays, X rays, microwaves, laser beams, and number of exact readings and measurements of the gamma rays.

191 192 radio information services

Burns due to ultraviolet rays include SNOW of therapy that is exposed to the light for a specific BLINDNESS, welders’ flash, and sun-lamp injuries. amount of time. Industrial lasers can produce reti- Ultraviolet waves do not penetrate the globe and nal burns when viewed directly or by reflection off therefore deliver a burn to the CORNEA, or clear, other objects. outermost covering of the eye. Symptoms of these Gamma rays can produce cataracts and loss of burns are usually delayed two to nine hours and vision. The rays released by atomic bomb explo- include extreme pain, a sensation of sand in the sions resulted in mass amounts of cataract cases fol- eyes, and severe light sensitivity. The burns heal lowing the bombings of Hiroshima and Nagasaki themselves within two to three days but antibiotics during World War II. or steroid drops may be prescribed. Ultraviolet burns can be prevented by wearing protective eye- radio information services Radio channels and glasses or goggles. programs that provide news and information on Eclipse blindness is an ultraviolet burn caused community events. Many services read sections or by watching the sun during an eclipse. Although complete issues of local newspapers and offer infor- the ultraviolet rays of the sun do not enter the mation of interest to visually impaired listeners. globe, the heat generated within the eye during Radio services may be broadcast on open, freely prolonged exposure to these rays produces a accessible channels or on closed channels that burn to the MACULA. The macula is the area of require a reception box available to the user clearest sight within the RETINA, the light-sensitive through the broadcasting station. State radio infor- layer at the back of the eye. The damage to the mation services are often titled Radio Reading Ser- macula from an eclipse burn is irreversible and vice, Radio Talking Book, or Radio Information causes loss of central vision. An eclipse cannot be Service. (See Appendix for listing by state.) Local safely viewed directly. Sunglasses, photographic cable television stations may provide similar ser- film, or film negatives afford no protection to the vices. eyes. An eclipse may be safely viewed indirectly Television descriptive services such as Descrip- by observing the image of the sun projected onto tive Video Service (DVS) and Washington Ear pro- a flat surface through a small hole in a piece of vide narration describing various visual features of paper. dramatic television programs. During the program, Infrared rays can penetrate the eye and may the narrator supplies details of the costuming, cause CATARACTS. In the past, ocular infrared burns lighting and physical actions taking place. The were found among steel workers and glass blowers. service uses a separate channel accessible through The adoption of safety goggles and eyeshields has an adapter that is compatible with standard tele- virtually eliminated the problem. vision and video cassette recorders with stereo X rays may produce cataracts in threshold doses capabilities. of approximately 1,000 rad but may vary with Contact: exposure times. Simple dental or diagnostic X rays Descriptive Video Service, WGBH-TV will not endanger the eyes. X rays that are used 125 Western Avenue therapeutically to treat lesions near the eyes should Boston, MA 02134 be given only when the eyes are appropriately 617-300-5400 (ph) shielded. 617-300-1026 (fax) Microwaves may cause cataracts but only when http:\\main.wgbh.org the eye is in the direct line of the beam. According to current knowledge, microwave ovens constitute The Metropolitan Washington Ear, Inc. no threat to vision. 35 University Boulevard East LASERS are intense beams of light that can enter Silver Spring, MD 20901 the globe of the eye. They are used therapeutically 301-681-6636 (ph) in ophthalmology to heal hemorrhages in the 301-681-5227 (fax) retina. The beam is focused directly onto the point www.washear.org Recording for the Blind and Dyslexic 193

Rail Passenger Service Act The Rail Passenger The act amendments outlined procedures and Service Act, as amended by the Amtrak Improve- regulations to ensure fair treatment between blind ment Act of 1973, founded the National Railroad vendors, the licensing agencies, and the federal Passenger corporation. The corporation must government, and established greater control and ensure that no elderly or disabled person is denied participation by the Rehabilitation Services Ad- transit on any intercity passenger train operated in ministration. In cases in which vending machines connection with the corporation. directly compete with blind vendors, the amend- The corporation was instructed to renovate ments allowed the income from the machines existing facilities and equipment to make them to accrue to the vendor or to be used by the accessible to elderly or disabled persons, to ensure state licensing agency as a sick fund or vacation/ that new facilities or equipment comply with acces- retirement fund. (See BUSINESS ENTERPRISE PRO- sibility standards, to provide special employee GRAM.) training dealing with traveling needs or concerns of U.S. Department of Education. Summary of Existing Legis- the elderly and disabled, and to assist elderly and lation Affecting Persons with Disabilities. Washington, disabled passengers in the terminal and as they D.C.: USDE, 1988. board and alight the trains. Amtrak was instructed in 1990 to make access improvements at some stations that it shared with reading machines Machines that “read” printed a commuter authority. Those instructions were a material aloud via a voice synthesizer. They are result of the Americans with Disabilities Act of used by visually impaired and blind persons who 1990. They were noted in Amtrak’s 1997 Reform are unable to read with magnification. and Accountability Act. Most reading machines, such as the Kurzweil Reading Machine, employ a computer-controlled U.S. Department of Education. Summary of Existing Legis- camera that scans the lines of print and recognizes lation Affecting Persons with Disabilities. Washington, words from its programmed computer memory. D.C.: USDE, 1988. These machines can read textbooks, articles, and Amtrak Reform Council. “The Amtrak Reform and tests, as well as a user’s own written work. The Accountability Act of 1997.” www.amtrakreform- council.gov, 1997. voice synthesizer says each word aloud. The user puts the text on the glass plate of the scanner and pushes buttons on a control panel to activate the Raised Dot Computing (RDC) See DUXBURY voice synthesizer. On several models, the user can SYSTEMS, INC. control the speed, volume, and pitch of voice and can direct the machine to repeat material or to read raised-line drawing kit A tactual aid used to punctuation marks. make pictures or graphs. It consists of a board cov- The Optacon is an optical-to-tactual converting ered with a soft underlay of rubber. The user places reading machine. It translates print into letter con- a sheet of acetate over the board and draws on it, figurations that are read with the fingertips. The creating raised lines and an embossed picture. user slides a camera across a line of print with the right hand. Simultaneously, the left hand feels the Randolph-Sheppard Act The Randolph-Shep- letter configuration formed on an array of vibrating pard Act of 1938 established an employment- pins. The user must be extensively trained to use opportunities program in which blind individuals the machine. could operate vending facilities on federal property. Amendments to the act, legislated in 1974, ex- Recording for the Blind and Dyslexic (RFB&D) tended its scope to include federal property oper- A non-profit, national service organization that ated by all federal agencies or departments and records and lends educational books free of cost to added operational guidelines to be authorized by the blind and the physically or perceptually handi- state licensing agencies. capped. Based in New Jersey, the organization 194 reduced rates maintains 32 recording studios across the United Contact: States and circulated 238,543 titles in 2000. RFB&D The organization was founded in 1948 by Anne 20 Roszel Road T. MacDonald to provide books to blind World War Princeton, NJ 08540 II veterans completing their education on the GI 609-452-0606 Bill of Rights. The service has since expanded to www.rfbd.org make books available to anyone who is print handicapped (i.e., cannot read conventional printed material due to a visual, physical, or perceptual dis- reduced rates Reduced rates for telephone and ability). Because an increasing number of people transportation fares are frequently available to with learning disabilities were using the service, legally blind individuals. Legal blindness is a term the name of the organization was changed in 1995 describing visual conditions of either visual acuity to Recording for the Blind and Dyslexic. It formerly of 20/200 or less in the better eye, after correction, was known as Recording for the Blind. or a visual field of 20 degrees or less in the better Over 91,000 people of all ages are served by the eye, regardless of visual acuity. RFB&D. Although most are students, many are pro- Verification of legal blindness by a doctor or fessional people seeking work-related materials; oth- ophthalmologist may in some cases be used to ers are pursuing nonvocational interests or hobbies. obtain reduced monthly service rates for touch- In order to request a text, a borrower must be tone dialing and speed calling. Telebraille devices registered with the RFB&D. Registrants complete may be offered to those who are deaf/blind and can an application that includes verification of a visual, read braille. Those with low vision may be eligible physical or perceptual impairment by a medical or to receive free 411 information or large-number educational authority. The registered borrower overlays for the telephone dial. may then request a text by telephone or mail. If the Interstate bus lines and Amtrak offer reduced text has already been recorded, it is copied onto fares to legally blind individuals as do many city cassettes, checked for quality, and shipped to the public transportation systems. Identification cards borrower. If the book has not been recorded, the may be necessary to obtain the reduced fare and borrower sends two copies of the book to the are often issued by the individual transportation RFB&D. The book is recorded and sent in install- agency. An identification card verifying legal blind- ments as it is completed. When finished, the mas- ness can also be obtained from the American Foun- ter tapes remain in the RFB&D library. dation for the Blind. (See FINANCIAL AID.) The RFB&D maintains a Master Library of over 83,000 educational manuscripts ranging from elementary to postgraduate levels. In 2000, 4,300 new refraction A term used to describe the bending of titles were added, most as a result of borrowers’ light. The eye must refract light efficiently in order requests. Librarians also provide reference services to see clearly. and bibliographic searches drawing from a comput- When light falls on an object it is reflected to the erized data bank containing information from the eye. The light enters through the eye’s CORNEA,a Master Library and the National Library Service for thin, transparent covering. The cornea bends or the Blind and Physically Handicapped. refracts the light and focuses it toward the inner RFB&D has more than 5,700 volunteers. It is sections of the eye. working to introduce digital audio technology to its The refracted light enters the PUPIL, a tiny hole members. Members will soon be able to access in the center of the IRIS, the colored part of the eye. information on CD-ROM or on the Internet. The light is then further refracted by the CRYS- The RFB&D honors outstanding blind college TALLINE LENS of the eye. The lens focuses the light seniors with annual Scholastic Achievement onto the RETINA, a light-sensitive layer in the back Awards. The awards are presented to those chosen of the eye. The retina transforms the light into elec- for exceptional character and scholarship. trical impulses or information about the light rehabilitation 195 received. The impulses are sent to the brain by the tectomy (PRK) and laser in situ keratomileusis OPTIC NERVE. The brain translates the impulses into (LASIK) surgeries. an image. If there is any problem with the refract- Refractive keratology was developed mainly in ing or focusing of the light throughout this process, Russia. During the procedure, doctors use a special a distortion or blurring of the image will result. scalpel to score the surface of the cornea in order to reshape it. This type of surgery is most successful for mild cases of astigmatism and nearsighted- refractive error Refractive error, or ametropia, is an inability of the eye to focus properly. The ness. Treating more severe cases sometimes resulted in fluctuating vision, a persistent glare CORNEA and the LENS of the eye focus light on the and starbursts. RETINA, which transforms the light into electrical impulses. The impulses are sent to the brain, where they are interpreted and presented as an image. If REHABDATA A bibliographic database of disabil- the cornea and the lens are unable to effectively ity and rehabilitation literature produced by The focus the light onto the retina, a refractive error is National Rehabilitation Information Center present and blurred vision results. (NARIC). It includes citations to research reports, The four most common refractive errors are scholarly papers, journal articles, audiovisual mate- MYOPIA (nearsightedness), HYPEROPIA (farsighted- rials, and reference documents. ness), ASTIGMATISM (distorted image), and PRESBY- Each of the more than 50,000 entries in the OPIA (aging eyes). Refractive error is often caused computerized listing is described by one to five by the length of the eye. An average eye is approx- descriptor headings to assist the user in the infor- imately 24 millimeters long. The lens and cornea mation search. Each entry contains an abstract and are designed to work best with an eye this length. 10 information fields describing the entry. An eye that is longer or shorter than this length REHABDATA may be accessed through NARIC. creates focusing problems. A longer-than-average NARIC accepts search requests by telephone, mail, eye is myopic, or nearsighted. A shorter-than-aver- TDD (telecommunication device for the deaf), elec- age eye is hyperopic, or farsighted. tronic bulletin board, or in person. Search requests An eye that is too curved or flat presents a dis- are usually processed within two working days. Or, torted image and is termed astigmatic. The irregular the Internet can be used to reach NARIC’s Instant shape causes the light to focus onto two different Disability Information Center. That site contains points, rather than the one focusing point of nor- five databases to facilitate your search. It can be mal vision. Astigmatism may be present in myopic, accessed at www.naric.com/search. hyperopic, or presbyopic eyes. A presbyopic eye is Contact: one in which the lens has lost its natural elasticity REHABDATA—NARIC due to aging. The lens is unable to change shape to 1010 Wayne Avenue, Suite 800 focus on near objects. Silver Spring, MD 20910 Refractive errors are easily detected in the rou- 800-346-2742 (ph) tine eye examination. Contact lenses or eyeglasses 301-495-5626 (TDD) may be prescribed to correct the error and allow the 301-562-2401 (fax) eyes to see clearly, or refractive surgery may be rec- www.naric.com ommended. Although early diagnosis and treatment are encouraged because they produce clear rehabilitation Rehabilitation services are provision, refraction errors are not worsened or grams that provide training or support to disabled improved by the use of corrective lenses or glasses. individuals from federal, state, or private agencies. Rehabilitation may be offered through a public or refractive keratology The first type of refractive private residential school, within a program of spe- surgery to reshape the cornea, refractive keratology cial education in a public school (through an orga- has been widely replaced by photorefractive kera- nization for the blind), by a private rehabilitation 196 rehabilitation facility (through correspondence courses) or by ualized written plan that outlines the rehabilitation state rehabilitation agencies. goals, the individual’s skills and needs, and the All 50 states administer programs of VOCATIONAL process by which those needs will be met. REHABILITATION and DAILY LIVING SKILLS for the pur- The plan may provide for a medical examination pose of enabling disabled individuals to become to ascertain the extent and limitations of the independent, employed, integrated members of disability in order to assess suitable employment society. These agencies are listed under various possibilities. Medical treatment or equipment, names, such as Department of Rehabilitation, including surgery, psychiatric counseling, hospital Commission for the Visually Handicapped, State services, prostheses, and eyeglasses, may be pro- Services for the Blind and Visually Impaired, and vided to reduce or alleviate the disability and the Bureau of the Blind. improve productivity on the job. Each state program varies according to the range Guidance counseling may be suggested to assess of services and training available and the amount the individual’s potential for rehabilitation, inde- of financial assistance provided. Services may pendent living, and appropriate employment. Job include medical and vocational diagnostic services, training may be provided at home, rehabilitation physical restoration, home-management skills centers, trade schools, or on-the-job settings. Edu- training, orientation and mobility instruction, cational tuition and expenses may be supplied if braille instruction, communication-skills training, college is necessary to the vocational rehabilitation. personal-management skills instruction, books and The plan may furnish financial assistance during training supplies, transportation allowance, reader the rehabilitation process. services for the blind, vocational rehabilitation, Rehabilitation services may be provided by job-placement services, postemployment services, social workers, occupational therapists, therapeutic procurement of job-related equipment and occupa- recreation workers, vocational rehabilitation coun- tional licenses, adaptive aids evaluation and selec- selors, rehabilitation counselors, or orientation and tion, counseling, and family-member services. mobility teachers. Legally blind individuals may qualify for state Rehabilitation counselors or teachers are col- rehabilitation services if they can provide certifica- lege-trained specialists who provide daily living tion of disability and if the state has a reasonable skills training as well as communication-skills, expectation that such individuals will benefit from recreational-skills, and low-vision aids training. receiving the services. Vocational rehabilitation Daily living skills, also known as independent- services are provided if the disability results in a living skills, concern personal and home manage- substantial handicap to employment and if the ment and are frequently taught in the home or in state has a reasonable expectation that the recipi- a rehabilitation facility. They include methods for ent will get or hold a job as a result of vocational grooming and self-care, dressing, eating, precane training. mobility, handling and identifying money, personal Rehabilitation services are available at little or recordkeeping, labeling food and clothing, cooking, no cost to the individual. Some aspects of the reha- laundering, safety skills, household cleaning, bilitation program may require financial contribu- sewing, and home repair. tion by the individual. In some states, services such Communication skills may include listening as psychological counseling, equipment purchase, skills, handwriting, typing, telephoning, braille, and transportation to school or school tuition may procurement of large-print or recorded materials, be financed by the state or a combination of the and personal communication or nonverbal-com- state, the individual, and grants or loans. munication skills instruction. In all state programs, each individual’s case is Recreational-skills training includes instruction carefully evaluated by a rehabilitation counselor in leisure activities and exposure to adaptive for the blind and/or a vocational rehabilitation games, crafts, and hobbies. The availability of sup- counselor for the blind with input from the dis- port groups, sports groups, and other social activi- abled person. Everyone eligible is given an individ- ties may be explored. Rehabilitation Act 197

Low-vision evaluation is provided by an oph- California Department of Rehabilitation. Client Informa- thalmologist or optometrist who recommends spe- tion Booklet. Sacramento, California: CDR, 1987. cific aids and often provides training. Rehabilitation California Department of Rehabilitation. Rehabilitation is teachers can provide training in the use of other Here to Help. Sacramento, California: CDR, 1986. nonprescriptive adaptive low-vision aids and appli- Lions Clubs International. Rehabilitation of the Blind. Oak Brook, Illinois: LCI, 1984. ances such as bold-line writing paper, talking National Association for Visually Handicapped. The Adult clocks, or glare-free lighting. Partially Seeing. New York: NAVH, 1984. Orientation and mobility teachers are college- trained specialists who provide instruction that allows the visually impaired individual to move Rehabilitation Act The Rehabilitation Act was safely and efficiently in the environment. Skills created in 1954 to replace the outdated National provided in the instruction include auditory skills, Vocational Rehabilitation Act of 1920, which first tactual skills, olfactory skills, kinesthetic awareness, established the national system of state vocational- perpendicular and parallel alignment, search pat- rehabilitation agencies. The act was rewritten in terns, recovery skills, use of reference points, solic- 1973 to include emphasis on service to individuals iting assistance, time and distance estimation, with severe disabilities. It was amended in 1992 in sighted-guide technique, protective techniques, order to revise and extend the programs approved trailing, and use of the long cane and electronic in 1973, and again in 1998. travel aids. The 1973 amendments prohibited discrimina- Vocational rehabilitation enables the visually tion on the basis of physical or mental disability in impaired individual to continue employment or all areas of life affected by the federal government. train for new work. Vocational training may be They stated that no otherwise qualified disabled offered by the state rehabilitation agency, a reha- person could be discriminated against, or excluded bilitation facility, a residential or public school, an from participating in or gaining benefits from any organization for the blind, or a sheltered workshop. activity or program that receives federal financial College-trained vocational rehabilitation spe- support. cialists work with individual to evaluate existing The 1973 law established federal funding of skills and aptitudes, evaluate and recommend nearly $1.5 billion to support training and placing occupations, outline needed skills, provide voca- individuals with mental and physical disabilities tional skills training and education, and recom- into full- or part-time employment in the competi- mend and provide training of vocational aids or tive labor market. The act put into effect a variety devices. of services, demonstration programs, training and Vocational-rehabilitation training may result in research grant programs, and a federal-state grant- employment in the mainstream of industry, in-aid program. employment in a business enterprise program The act provides basic federal-state vocational (BEP), a vending, short order, or cafeteria-style grants that support state vocational-rehabilitation stand business program supported by the federal agencies, client-assistant programs (CAP) to inform funds, or employment in a sheltered workshop. and advise rehabilitation clients and other disabled The individual may also be employed at home as a persons, innovation and expansion grants that homemaker and family-care provider. expand state vocational-rehabilitation services to The success of rehabilitation training varies by those with severe disabilities, American Indian individual. The extent of the visual loss, the time in vocational-rehabilitation services, research and life when the loss occurred and the abilities and training grants, construction loans and grants for aptitude of the individual all affect the outcome. rehabilitation facilities, and grants to public and The length of time for rehabilitation services also nonprofit organizations for vocational training ser- differs and may continue six months or longer. vices for disabled persons. American Foundation for the Blind. Rehabilitation Services. The act further supports special projects and New York: AFB, 1988. supplementary services including severely disabled 198 rehabilitation center projects, disabled youth job-training programs and require each state to establish a state rehabilitation reader and interpreter services. The act establishes council in order to receive federal funding in this the National Council of the Handicapped, which area. reviews all federal statutes pertaining to those with A state that sets up an agency to handle funding disabilities and recommends legislative proposals to for vocational rehabilitation services provided for Congress and the president. blind people may still, under the 1998 amend- Employment opportunities projects are sup- ments, establish a separate state rehabilitation ported by the act through programs such as Pro- council. The latest amendments also strengthen the jects with Industry and other public/private electronic and information technology guidelines ventures that offer training or employment services that were approved in 1992. to disabled individuals. U.S. Department of Education. Summary of Existing Legis- The act provides formula grants for vocational- lation Affecting Persons with Disabilities. Washington, rehabilitation agencies to support independent-liv- D.C.: USDE, 1988. ing services and centers for independent living. It supplies independent-living services for visually A facility that provides impaired persons who are over age 55 and unem- rehabilitation center rehabilitation services to persons with disabilities. ployable. Rehabilitation services may include medical, psy- The Rehabilitation Act specifically addresses the chological, social, and vocational services. The pro- hiring and employment of the disabled. Section 501 gram is designed to offer reeducation and of the act prohibits discrimination in employment of restoration of the disabled individual to the great- qualified disabled persons by federal agencies. It est physical, social and economic level possible. instructs federal agencies to establish goals for hir- Rehabilitation centers may be supported through ing employees with severe disabilities, to recruit federal, state, local, or private funding. such individuals, and to encourage equal opportu- Programs offered may include testing, fitting, or nity in career development and advancement. training in the use of prosthetic and orthotic Disabled federal employees and those applying devices; prevocational or recreational therapy; for federal jobs are protected from arbitrary dis- physical and occupational therapy; speech and missal and other actions based on disability. The hearing therapy; psychological and social services; section states that disabled employees may qualify personal and work-adjustment counseling; voca- for reasonable accommodation, including aids and tional training; evaluation for control of a specific personnel that will enable them to perform their disability; orientation and mobility services for the jobs. blind; additional adjustment services for the blind; Section 503 of the act mandates affirmative and employment for those with disabilities who action by private organizations that do contract cannot be readily absorbed into the competitive work for federal agencies and further supports rea- labor market. sonable accommodations. Section 504 of the act requires federal agencies and private and public organizations that receive rehabilitation engineering center Rehabilitation federal funds to make facilities, programs, and engineering centers were first established in 1972 activities accessible to disabled employees. Com- as facilities to develop ways to apply advanced pany rest rooms, libraries, cafeterias, and other technology in medical, scientific, psychological, public areas must be accessible. and social areas for solving rehabilitation and envi- Among the changes to the act in 1992 was the ronmental problems of disabled persons. addition of the electronic and information technol- There are 15 rehabilitation engineering centers ogy accessibility guidelines, which are meant to in the United States. Each works within a core area assure that people with disabilities will have equal of research specialty. access to electronic and information technology The Smith-Kettlewell Institute of Visual Sci- within federal agencies. The 1998 amendments ences, located in San Francisco, is the center retina 199 devoted to the visual sciences. The center designs Scholl, Geraldine, ed. Foundations of Education for Blind and modifies sensory aids for the blind and offers and Visually Handicapped Children and Youth. New York: rehabilitation engineering services through collab- American Foundation for the Blind, 1986. oration with the Pacific Presbyterian Medical Cen- ter’s low-vision services. (See SMITH-KETTLEWELL resource room The resource-room model is one EYE RESEARCH INSTITUTE.) of five educational models or plans for the instruction of visually impaired students. The others are residential schools The residential-school model the ITINERANT-TEACHER model, TEACHER-CONSULTANT is one of five major educational models or plans for model, SELF-CONTAINED CLASSROOM model, and the instruction of visually impaired students. The oth- RESIDENTIAL SCHOOL MODEL. ers are the TEACHER-CONSULTANT model, ITINERANT- The resource room is a specially equipped room TEACHER model, SELF-CONTAINED CLASSROOM model, staffed with special education personnel trained to and RESOURCE ROOM model. work with blind or visually impaired students. The Residential schools are those in which visually students live at home and attend public school in impaired students live and receive educational regular classrooms taught by teachers who provide instruction. It is the oldest form of education for general curriculum instruction. Students visit the the visually impaired and is offered in nearly every resource room at regularly scheduled intervals or state. Many residential schools for the visually when needed. impaired share a campus or facilities with schools The resource-room teacher provides specialized for the deaf and are referred to as “dual” schools. skills instruction and information counseling relat- Residential schools may be either state operated ing to vision loss and academic remediation. Spe- or private. State-operated residential schools are cial instruction may take place individually or in funded by state legislatures and provide free small groups. tuition, room, board, and transportation. Private The resource room model has an advantage over residential schools charge fees that may be paid by the teacher-consultant and itinerant-teacher mod- the public school district of the student. els in that it provides instruction or assistance The campuses, schoolrooms, and educational immediately and according to the needs of the stu- programs of residential schools are designed and dent. However, because of its availability, it may equipped to meet the needs of visually impaired foster dependence and restrict growth toward inde- students. The educational materials and curricula pendent working within a self-contained class- can be designed, or the students may be grouped, room. to meet an individual’s instructional requirements. Barraga, Natalie C. Visual Handicaps and Learning. Bel- Trained staff, including houseparents, are on mont, California: Wadsworth Publishing Company, duty 24 hours a day to provide general curriculum Inc., 1976. instruction, academic remediation, compensatory- Scholl, Geraldine, ed. Foundations of Education for Blind learning-skills instruction, personal management and Visually Handicapped Children and Youth. New York: and independence-skills training, and information American Foundation for the Blind, 1986. counseling. The residential-school model is superior to many retina The light-sensitive nerve layer in the back other models in its attempts to meet all levels of stu- of the eye that lies between the VITREOUS and the dent educational needs as they arise. However, CHOROID. It is an information-gathering and pro- because students may return home only weekly or cessing portion of the eye and is necessary for sight. monthly, some students may suffer from a lack of As light is reflected from an object, it passes familial contact or interaction with sighted peers. through the LENS and is focused on the retina. Barraga, Natalie C. Visual Handicaps and Learning. Bel- Light-sensitive RODS AND CONES collect this light mont, California: Wadsworth Publishing Company, information. The cones, which are responsible for Inc., 1976. central vision and color, are found throughout the 200 retina retina but are most concentrated in a depression inherited condition involves the progressive degen- called the MACULA, the place of sharpest vision. eration of the retina’s rods and cones. The rods are Within the macula is the FOVEA, a central indenta- first affected, producing the symptoms of night tion packed with cones. The rods, which are blindness and limited peripheral field. In later responsible for night vision, are scattered through- years, the central field may be affected. out the retina. Often, progressive loss of vision due to vascular The retina transforms the information gathered disorders of aging are termed retinal degeneration, by the rods and cones into electrical impulses, as well. Vascular disorders include ARTERIOSCLERO- which it sends through the OPTIC NERVE to the SIS, a narrowing or blocking of the arteries associ- brain. The brain translates the impulses into an ated with hypertension and heart disease. image. Arteriosclerosis may block retinal arteries and The retina is subject to many serious conditions impair venous return, which may trigger neovas- that cause retinopathy, any change in the retina due cularization (formation of new, weak blood ves- to a disease or inflammation. RETINITIS is any con- sels), hemorrhaging and result in vision loss. dition in which the retina becomes inflamed. Hypertensive retinopathy is related to, and Retinitis is often linked to the choroid, the layer includes, arteriosclerosis, and also contains condi- that underlies the retina and that provides blood to tions of edema, exudates, and hemorrhaging. the eye. Any inflammation of the choroid may Severe damage may cause loss of vision. spread to the retina to become CHORIORETINITIS. DIABETIC RETINOPATHY, a leading cause of vision Chorioretinitis may be caused by toxoplasmosis, loss, is a condition of diabetes in that the retinal a parasitic infection carried by cats, toxocariasis, an blood vessels form aneurysms which swell and infection in dog feces, congenital syphilis, or other hemorrhage. Neovascularization, hemorrhaging, systemic diseases. The condition results in inflam- and scarring occur, which may cause retinal matory lesions. Lesions near the macula result in detachment and loss of vision. central-vision loss. ARTERIAL OCCLUSIONS are obstructions of the cen- Since the optic nerve joins the eye at the retina, tral retinal artery that block blood from reaching conditions of the optic nerve often affect the the retina. Retinal tissue is damaged due to lack of retina. PAPILLEDEMA is a swelling of the OPTIC DISC, oxygen, and sight is lost. Obstructions to retinal the place where the optic nerve and the retina veins cause hemorrhaging, retinal edema, and meet. The condition may block ocular venous cir- vision loss. culation and can result from a rise of intracranial SICKLE CELL RETINOPATHY is an inherited disease pressure. in which sickle-shaped hemoglobin cells replace Retinal degeneration is any condition in which the rounded red hemoglobin cells. The sickle-shaped retina is reduced to a lesser state of effectiveness. cells block the flow of blood, which leads to oxygen Macular degenerative disease may be caused by deprivation and vascular occlusions of the retina. heredity, systemic disease, drugs, infections, and RETINOPATHY OF PREMATURITY is a disease of pre- aging. Age-related maculopathy (ARM) is a condi- mature infants in which the proliferation of retinal tion of senility in which the Bruch’s membrane vessels may lead to hemorrhage. The resulting scar tends to thicken, neovascularization takes place tissue causes a vision loss due to RETINAL DETACH- and central vision is lost. MENT, a condition difficult to repair. Angioid streaks are dark brown streaks on the Retinal dystrophy is any condition or disease that retina near the optic disc. They are caused by destroys or damages the tissue of the retina. Com- changes in the Bruch’s membrane and are associ- mon dystrophies include juvenile retinoschisis, a ated with degeneration of the elastic tissue. Myopic dystrophy of the fovea, Stargardt’s disease, a individuals may experience myopic chorioretinal hereditary disease of the central retina, Best’s dis- degeneration. ease, a condition characterized by elevated macular RETINITIS PIGMENTOSA is a misnomer for a degen- regions, and cone dystrophy, in which color and erative disease that involves no inflammation. The central vision are progressively destroyed. retinal detachment 201

Retinal detachments occur when the retina form as a result of the hemorrhaging. As the vitre- becomes separated from its underlying epithelium ous membranes contract, they may cause detach- and choroid. They may be caused by holes or tears, ment of the retina. This contraction is known as fluid leakage, or traction. These conditions are traction. caused by injuries, infections, other ocular condi- Vitreous detachment can cause retinal holes or tions or disorders, and systemic diseases. tears. In this condition, the vitreous leaves its nor- Retinal detachments cause sudden loss of sight mal position against the retina and falls to the ante- that is often permanent. Some detachments can be rior cavity of the eye. A hole or tear may form as prevented and corrected by cryotherapy, a surgical the vitreous collapses from its position. procedure performed using a super-cooled cry- Rhegmatogenous detachments, or those associ- oprobe. ated with holes, are most often related to eye TUMORS of the retina may be malignant or injuries, trauma to the eye or head, aging, near- benign and include retinoblastoma, a hereditary sightedness, degenerative eye conditions, retinal tumor of childhood. This serious growth spreads degeneration, and vitreous detachment. Some peo- quickly and may metastasize along the optic nerve ple are prone to retinal detachment due to heredi- to the brain. Tumors may necessitate removal of tary conditions such as Stickler’s syndrome and the affected eye or cause retinal detachments. Wagner’s disease. Additionally, CATARACT surgery may be a leading factor in rhegmatogenous detachments. According retinal degeneration See RETINA. to the National Institute of Health, detachments ensue in one of every 50 cataract operations. Non- retinal detachment A retinal detachment occurs rhegmatogenous detachments are associated with whenever the RETINA is disconnected from the back diabetes, diabetic retinopathy, and retinopathy of layers of the eye. It is a serious condition that may prematurity. require immediate medical treatment. The most common symptom of retinal detach- The retina is the light-sensitive portion of the ment is a sudden loss of sight in either the central back of the eye that receives and encodes informa- or peripheral field. It is often described as a curtain tion about an object into electrical impulses. It or shadow cast on the field of vision. Symptoms sends the impulses through the OPTIC NERVE to the may also include flashes of light or the appearance brain. The brain then translates the impulses into of floaters, spots that seem to float across the visual an image. field. Floaters are bits of debris or blood in the vit- The retina, the pigment epithelium and the reous that cast shadows on the retina. These shad- CHOROID are located between the VITREOUS gel and ows appear as the floating spots. the outer SCLERA of the eye. The retina normally Treatment of retinal detachments may be pre- adheres closely to the pigment epithelium and is ventative or reactive. Prevention involves the cor- supported by the vitreous gel. When the retina rection of tears and holes that have not yet caused detaches or separates from the epithelial layer, a a detachment, or the treatment of an area of the retinal detachment occurs. retina that has degenerated. This type of treatment Retinal detachments are caused by tears or holes may be considered before cataract surgery. Since in the retina, fluid leakage, or traction. When the holes or tears do not always result in retinal retina becomes disturbed, as from a tear or hole detachments, this procedure is considered contro- resulting from an injury, space may open up versial. Each case is decided individually, according between the retina and the epithelium. Fluid from to the risk of possible future detachment. the vitreous may leak into the space, causing a fur- Surgery is needed to treat existing detachments. ther retraction or a detachment. In most cases, the surgeon forms a scar on the hole The vitreous may experience hemorrhaging or tear by thermal or cryotherapy (freezing treat- from vessels damaged by diabetes or injury. Inflam- ments) methods. The thermal method, called surgi- mation may develop and vitreous membranes may cal diathermy, utilizes a needle transmitting 202 retinal dystrophy high-frequency electrical current. The needle is Retinal edema is caused by DIABETES, hyperten- touched to the sclera and the resulting heat stimu- sion, retinal vein obstruction, traction of the vitre- lates scar tissue formation. ous, inflammations such as UVEITIS and RETINITIS In cryotherapy or CRYOSURGERY, a cryoprobe, an and CATARACT surgery. instrument with a tip cooled to between 30 and 70 Retinal edema is diagnosed with FLUORESCEIN degrees below freezing, is touched to the sclera. The ANGIOGRAPHY, a procedure in which fluorescein dye sclera remains unaffected, but the retina and under- is injected into a vein in the arm and monitored as lying choroid are frozen and stimulated to form it passes through the veins of the retina. adhering scar tissue. After the scar tissue has been Retinal edema may resolve spontaneously or stimulated, a hypodermic needle is then inserted persist. Persistent cases may cause permanent through the sclera to drain any accumulated fluid vision loss. Treatment of the condition varies under the retina. The surgeon may then make an according to the cause. Cases due to inflammation indentation in the back of the eye and place a sili- are treated with corticosteroids. Those conditions cone buckle or belt around the eye to indent the of edema caused by vascular problems and diabetes sclera inward and help reattach the retina. may be treated with photocoagulation, a treatment The surgery requires an incision but is per- that uses a laser to seal leaking blood vessels. There formed underneath the membrane that covers the is no treatment for edema due to traction or sclera. The inside of the eye is seldom breached. cataract surgery. The buckle remains permanently in the eye but is not seen or felt. retinitis See RETINA. The surgery is performed in the hospital or occasionally in an outpatient setting. It may last from one to several hours and may require a brief stay of retinitis pigmentosa (RP) A group of inherited up to six days in the hospital. Postsurgical eye diseases that causes degeneration of the eye’s drops may be prescribed, and the patient is advised retina. The disease affects 100,000 Americans, and to avoid heavy lifting and strenuous activity. approximately one in 80 persons carries the reces- Surgery to correct retinal detachment is highly sive gene for RP. There are approximately 1,560 successful. According to the National Institute of new cases of RP diagnosed each year, or an average Health, the success rate varies from 85 percent to incidence of 6/1,000,000. RP and related retinal 90 percent. degenerative diseases, including USHER’S SYNDROME and other rare syndromes, affect 400,000 Ameri- cans and 4 million people worldwide. retinal dystrophy See RETINA. Although the disease name includes “itis,” no infection or inflammation is associated with these retinal edema A condition in which the capillar- diseases. Retinitis pigmentosa is characterized by ies of the RETINA bleed, filling the spaces between a degeneration of the RODS AND CONES of the retinal cells with fluid. Retinal edema may be pre- retina. sent throughout the retina or it may be contained The retina of the eye receives the reflected light in a general area. from an object. The light-sensitive rods and cones If the MACULA, the central indentation of the translate the light into electrical impulses that the retina and section of sharpest sight, is spared, vision retina sends to the brain through the OPTIC NERVE. may be relatively unaffected at first. However, the The brain changes the impulses into an image. The macula tends to accumulate the fluid. In this case, rods of the retina function in dim light. They are MACULAR EDEMA occurs. The condition is character- responsible for detecting movement and shape. ized by inflammation of the macula and blurred or Scattered throughout the retina, they are account- impaired vision. If untreated, macular edema may able for peripheral vision. The cones, which discern develop into cystoid degeneration, and central detail and color, require brighter light to work vision may be permanently lost. effectively. They are packed into the central part of retinoblastoma 203 the retina, the MACULA, and are responsible for cen- plete blindness as a result of RP, although most will tral vision. retain some limited vision. Retinitis pigmentosa first affects the rods. As the In most types of RP, the onset is during child- rods are destroyed, vision in low light is decreased, hood or early adolescence. Congenital, recessive and peripheral vision constricts. As the disease pro- and disease-related types of the disease tend to be gresses, the cones are affected, and central vision is more severe than dominant RP. Sporadic RP varies lost. in severity with the individual. Retinitis pigmentosa is hereditary but rarely Retinitis pigmentosa is not easily diagnosed. may accompany other diseases. When accompa- Often during the ophthalmologic exam, a change nied by a serious hearing loss, the disorder is in the appearance of the retina may indicate RP. termed Usher’s syndrome. There are several types However, other tests, such as an electroretinogram, of RP. They include: may be necessary to confirm the diagnosis. An electroretinogram, or ERG, measures the • Congenital RP, or Leber’s congenital amaurosis, electrical activity of the retina when exposed to is apparent at birth or in infancy. This rare dis- light stimulus. Drops are first placed in the eyes to ease causes a steady, progressive loss of sight. dilate the PUPILS. Anesthetic drops are administered • Recessive RP is passed to the child of two individ- to the eye just before a contact lens attached to uals who carry the gene for RP but who may not electrodes is placed on the CORNEA of the eye. The have RP. There is a 25 percent chance that a child electrodes record the responses of the retina as (male or female) of two carriers will have RP. lights are flashed in both dark and light environmental conditions. • Dominant RP is passed to the child of one There is no cure or treatment for retinitis pig- affected parent and one unaffected parent. With mentosa. Vitamin-A therapy, topical treatment each pregnancy, there is a 50 percent chance that with DMSO, and light deprivation have been in- each child (both male and female) will inherit vestigated as cures with disappointing results. the disease. Unaffected children usually will not Research is continuing in the areas of retinal cell pass on the disease to their children. Three genes transplantation, gene therapy, pharmaceutical thought to cause dominant RP have been dis- therapy, and nutritional therapy. These areas of covered. research are thought to be very promising for vic- • Sex-linked RP is passed to a child by the mother, tims of RP. who is the carrier. Sons of a female carrier of sex- Low-vision aids such as the NIGHT VISION AID, linked RP and an unaffected male have a 50 per- prescriptive glasses, telescopes, large print, or cent chance of having RP. Daughters of such a closed circuit television may be helpful. Genetic pairing have a 50 percent chance of being carri- counseling may alert families to some types of ers but will not inherit the disease. hereditary RP. Finkelstein, Daniel. “Blindness and Disorders of the Eye.” The genetic cause and inheritance pattern for spo- The Braille Monitor (December 1988): 578–579. radic RP is unknown. Research is being conducted The Foundation for Fighting Blindness. “Frequently to investigate new mutations as they appear with Asked Questions Regarding Retinitis Pigmentosa.” each new generation. www.blindness.org, 2000. The most common symptom of RP is night Pagon, Roberta A. “Retinitis Pigmentosa.” Survey of Oph- blindness or difficulty seeing in dim light. There thalmology, 33, no. 3 (November–December 1988): may be a progressive loss of peripheral or side 137–168. vision, which results in tunnel vision. As the dis- Reynolds, James D. “Retinitis Pigmentosa,” HealthNet ease progresses, the individual may experience a Library. Columbus: CompuServe, 1989. loss of central vision. Many individuals may develop CATARACTS, or opaque sections on the LENS retinoblastoma A malignant eye tumor that orig- of the eye. Some individuals may experience com- inates in the retina. It is the most common child- 204 retinopathy of prematurity hood ocular tumor and may be the most common Although the precise cause of ROP is unknown, congenital tumor of any kind. it is a result of prematurity, with very low birth Retinoblastoma may be either hereditary or spo- weight (less than 1,000 grams) as the major factor. radic. According to the U.S. Department of Health These premature infants may develop an over- and Human Services, up to 40 percent of cases are abundance of blood vessels in the retina. This may hereditary. The hereditary type is usually present at resolve spontaneously or may result in hemor- birth and most frequently appears at approximately rhages and the development of fibrous tissue or one year of age. It often affects both eyes. Children scar tissue. High MYOPIA, UVEITIS, GLAUCOMA, AM- of families with a history of retinoblastoma should BLYOPIA, STRABISMUS, and RETINAL DETACHMENT may be examined regularly for tumors. Even without follow as secondary conditions. Total blindness prior family history of retinoblastoma, all bilateral may result. retinoblastoma tumors should be considered In approximately 80 percent of retinopathy of hereditary and capable of being passed to future prematurity, the retinal vessels heal themselves generations. within the first year of the child’s life. Approxi- The more common sporadic type of retinoblas- mately 15 percent of the remainder of cases toma is not hereditary. It usually affects one eye progress to mild or modest ROP. The remaining 5 only and appears at approximately two years of percent of cases develop severe ROP with retinal age. All forms of the disease are evident by age five detachment and other secondary conditions. in almost all cases. Treatment of ROP has recently included Symptoms of retinoblastoma may include red- CRYOSURGERY, or freezing therapy. In cryosurgery, ness, pain, and inflammation in the early stages. proliferative retinal vessels are sealed with a cry- Once the tumor has grown larger, the eyes may oprobe, an instrument with a tip cooled to cross or the PUPIL may change from black to white between 30 and 70 degrees below freezing. This or gray. This change in pupil color, called leukoko- therapy has shown good results and, if the ROP is ria, is the actual appearance of the tumor itself, vis- severe, has proven to be the most effective treat- ible through the hole of the pupil. ment. If retinal detachment occurs, it is difficult to Once the tumor has been diagnosed, treatment treat, resulting in only 30 percent to 50 percent must be given immediately. Both types of success rates. retinoblastoma are life threatening and can grow Historically, ROP was called RETROLENTAL FIBRO- and spread rapidly up the OPTIC NERVE to the brain. PLASIA and thought to be caused by an overabun- Sometimes, the affected eye is enucleated, or dance of oxygen used in the incubators of removed. In the case of bilateral retinoblastoma, premature infants. Modern, well-managed neona- the more seriously affected eye may be enucleated tal intensive care units for premature infants mon- and the less affected eye given radiation or itor oxygen, electrolytes, vitamins, and nutrition, chemotherapy treatments. carefully maintaining each at the best level for nor- Retinoblastoma is caused by the absence of mal growth and development. Despite these paired retinoblastoma genes on the 13th chromo- efforts, ROP may be unavoidable for very low birth some. This can occur from heredity and/or envi- weight premature infants. ronmental causes. Although retinoblastoma has one of the highest rates of spontaneous regression retinoscope An instrument used during the eye among all tumors, the cause of regression is examination for determining the refractive power unknown. of the eye. The examiner shines the light of the retinoscope onto the eye from an arm’s distance retinopathy of prematurity (ROP) A condition away. that appears soon after birth, generally in prema- As the light moves across the PUPIL, the speed ture infants, in which abnormal blood vessels and direction of the lights and shadows are evalu- develop in the retina. This condition may progress ated and recorded. This data indicates to the exam- to a retinal detachment that may cause blindness. iner the refractive power of the eye and is used to rods and cones 205 determine nearsightedness, farsightedness, or as- concentrations of oxygen and retrolental fibroplasia tigmatism. was accepted and medical practices were altered. The blood level of infants is now monitored care- retrobulbar neuritis A form of optic neuritis, or fully, and oxygen is used only in amounts sufficient to prevent brain damage or death. swelling of the OPTIC NERVE associated with MULTI- RLF is sometimes confused with RETINOPATHY OF PLE SCLEROSIS. Retrobulbar neuritis is commonly seen among younger patients with multiple sclero- PREMATURITY (ROP), an eye disorder that occurs in sis and is often a first symptom of the disease. premature infants of very low birth weight. Using Symptoms of retrobulbar neuritis include sud- the terms synonymously is not correct because it den loss of vision in one eye accompanied by pain implies that ROP is caused by an overabundance of associated with eye movement. Blind spots, or sco- oxygen. In the current epidemic of ROP, oxygen tomas, may appear within the field of vision as well use is not considered to be the cause. as color blindness and difficulty seeing in bright Most of those who developed RLF are now adult light. Vision may be affected in the entire field or and blind. Their condition affected the education may begin in the center of the field and progress to system, since the majority of these children entered peripheral fields. Retrobulbar neuritis also can be school during a short span of time. Demands for caused by a neurological lesion, and is not neces- MAINSTREAMING in education by the parents of RLF sarily a symptom of multiple sclerosis. children forced public school systems to develop The condition may be treated with the drug programs that exist today for all disabled children. ACTH and oral steroids. Although recurrence is possible, the prognosis for remission is good. river blindness See ONCHOCERCIASIS. Patients usually recover partial or full vision within three months. rods and cones The photoreceptor cells within the RETINA of the eye. They provide information to retrolental fibroplasia (RLF) The historical the eye about the object in view. term for a disorder responsible for an epidemic of When light falls on an object, the reflected light blindness during the 1940s and 1950s. During this is focused by the eye’s CORNEA and CRYSTALLINE period, it was the most common cause of visual LENS onto the retina, an inner layer in the back of impairment in children. the eye. Rods and cones within the retina provide The condition appeared in conjunction with the information about the shape, color, and detail of widespread use of infant incubators. Premature the object. The retina transforms this information infants or those in respiratory distress were placed into electric impulses that it sends to the brain via into incubators supplied with 100 percent oxygen. the OPTIC NERVE. The brain translates the impulses The high levels of oxygen caused the retinal arteries into an image. and veins of the eyes to constrict. Once the infants The retina contains over 125 million rods and were removed from the incubator and breathed cones. The rods outnumber the cones by a margin normal air, the arteries and veins expanded and of nearly five to one. They are scattered through- proliferated causing hemorrhages and the develop- out the retina and are responsible for peripheral, or ment of fibrous tissue or scar tissue. side, vision. The rods react to faint light, darkness, The scar tissue blocked light from reaching the shape and movement. Because the rods do not photosensitive RODS AND CONES of the RETINA and require high levels of light to function, they enable resulted in partial or total blindness. Secondary dis- the eye to see at night. orders, including RETINAL DETACHMENT, GLAUCOMA, The cones distinguish detail and color. Each UVEITIS, CATARACT, MYOPIA, and STRABISMUS some- cone contains visual pigments that are sensitive to times followed within months or years. one of the three primary color light wavelengths. The epidemic of retrolental fibroplasia reached One group of cones recognizes green, one red, and its peak in 1952, and by 1954 the link between high one blue. By blending the colors together in differ- 206 rubella ent combinations, the eye is able to see a spectrum Ocular disturbances may include congenital of hues. CATARACT, GLAUCOMA, IRIS, or retinal disorders or Unlike the rods, the cones require high levels of defects and undersized eyes. Cataracts may be light to operate. Because of the need for light, they bilateral or unilateral and may develop slowly or are concentrated into a central area of the retina appear severe at birth. Severe cataracts may be called the MACULA. removed, but the patient often requires removal of The cornea and lens of the eye focus the incom- the posterior capsule at a later date. Those with ing light onto the macula. In the center of the mac- congenital cataracts often develop AMBLYOPIA, dys- ula is an indentation called the FOVEA. The fovea is function of one eye due to disuse. packed with cones and is the point of clearest, most distinct vision. Because of their location, the cones Runyan, Marla The first legally blind person ever are responsible for central, or straight-ahead vision. to qualify for the U.S. Olympic team and a finalist Diseases or disorders of the retina and heredi- in the 1,500 meters event at the 2000 games in tary factors may affect or destroy the rods and Sydney. Runyan also broke the U.S. indoor record cones. RETINITIS PIGMENTOSA (RP) is a group of disin the 5,000 meters category in February 2001. eases that attack the retina and cause the degener- Legally blind since the age of nine due to STAR- ation of the rods and cones. GARDT’S DISEASE, Runyan played soccer as a child RP first affects the rods. As they are destroyed, but switched to track and field at age 14. She com- night vision deteriorates and peripheral vision is peted in the high jump by placing reflective tape on lost. As the disease progresses, increasing tunnel the bar, and learned to jump hurdles by counting vision occurs. Finally, the cones are destroyed, and the number of steps between jumps. central vision is affected. Born in Santa Maria, California, in 1969, Run- Color blindness affects the cones only. Anopic yan graduated with honors from San Diego State cones lack the visual pigment that reacts to a cer- University in 1991 with a degree in education of tain band of color. Anomalous cones contain faulty the deaf. She earned a master’s degree in education visual pigment that fails to react, or reacts incor- of deaf-blind children from the same school, and rectly, to its corresponding color. Both conditions works teaching handicapped children in Eugene, result in the inability to see some color. Oregon. She was quoted as saying, “I think what I rubella Rubella, or German measles, is known to represent is achieving what you want in life. It’s cause blindness when contracted in utero during a matter of attitude. Some people have a nega- the first three months of pregnancy. Although the tive attitude, and that’s their disability.” Runyan mother may feel little discomfort, the disease may has been featured on numerous television sports cause vision impairment, mental retardation, hear- and news shows, as well as in various publica- ing impairment, heart defects, and respiratory tions. problems. S sarcoidosis A systemic disease whose symptoms globe of the eye. The sclera joins the transparent resemble those of tuberculosis. The disease is char- CORNEA at the front of the eye and circles around to acterized by nodules in the skin and lymph nodes join the OPTIC NERVE at the back of the eye. The and fibrosis of the lungs. The disease most often sclera lies atop the CHOROID, the vascular layer that affects young adults and produces ocular disorders supplies blood to the eye. in roughly half the cases. The sclera may appear red as a result of an infec- Sarcoidosis causes posterior and anterior UVEITIS, tion or disorder of the CONJUNCTIVA, the mucous an inflammation of the uveal tract, the pigmented membrane lining the sclera and the inside of the portions of the eye including the CHOROID, the IRIS, lids. The sclera is also subject to SCLERITIS,or and the CILIARY BODY. Prolonged uveitis may lead to inflammation of the sclera. Scleritis is closely linked secondary GLAUCOMA, CATARACT, MACULAR EDEMA to rheumatoid arthritis, gout, and collagen disease. or SCARRING, and loss of vision. Uveitis is treated Symptoms include redness, pain, and erosion of with local and systemic STEROIDS. the sclera. The condition is treated with systemic Sarcoidosis, which often produces no symptoms, antiinflammatory agents but seldom with steroids, is diagnosed with a Mantoux test, biopsy of the which destroy collagen and exacerbate scleral thin- nodules, X rays, and blood tests. There is no cure ning. for sarcoidosis. scleral buckling A surgical procedure performed to correct a RETINAL DETACHMENT. A retinal detach- Schirmer’s test An ocular test used to determine ment occurs when the retina becomes separated the amount of moisture or tear production in the from the back of the eye. Some detachments are eye. The test is often conducted as a part of a rou- caused by retinal holes or tears that must be surgi- tine eye examination or in response to patient cally repaired and that often requires scleral buck- complaint of dry eye. ling. The Schirmer’s test is painless and involves the The surgery, performed under general anes- placement of one folded end of a thin strip of filter thetic, first involves producing a scar near the hole paper into the lower eyelid. The uninserted end of with heat, as in surgical diathermy, or with cold, as the strip projects forward, out of the eye. The strip in cryotherapy. In order to bring the RETINA into is left in place for one to five minutes during which position so that the scar will adhere to the retina, a time the tears of the eye wet the strip. scleral buckle is applied. A measurement is taken of the amount of mois- A silicon belt or buckle is placed around the eye. ture accumulated in the strip. Normal readings may This returns the detached retina into contact with be 12 millimeters or more, and dry readings may be the underlying retinal pigment epithelium where it from 1 to 5 millimeters. adheres due to the scar tissue. The scleral buckle is permanent and completely unnoticeable by the sclera The tough, outer protective layer of the patient and others. eye. It is seen as the white portion of the eye sur- The surgery takes place underneath the mem- rounding the colored iris but it lines the entire brane that covers the sclera so that the inner eye

207 208 scleritis need not be breached. The procedure requires a bright or colored lights. Migraine scotomas usually short hospital stay and post-operative eye drops. last from five minutes to an hour. They tend to retreat with the onset of the migraine headache. scleritis An inflammation of the SCLERA, the outer protective layer of the eye. Scleritis produces screening Screening examinations are eye exam- a red, painful eye and sensitivity to light. Scleritis inations that are used to detect the possibility of a may be linked to rheumatoid arthritis, collagen dis- visual disorder in individuals. General screenings ease, disorders of menstruation, and gout, but may are routinely performed on the population during develop for unknown reasons as well. It is particu- patient eye and medical exams, driver’s license larly found among young women. renewals, and entrance to the armed forces. Scleritis leads to thinning of the sclera and may Specific screening exams look for particular expose the underlying uveal pigment. If untreated, visual field losses or ocular diseases. Screening scleritis may lead to necrosis (death of tissue) or exams performed in retirement communities perforation of the globe. Scleritis is treated with would concentrate on those diseases and disorders systemic nonsteroidal antiinflammatory agents. associated with aging, such as AGE-RELATED MACU- Corticosteroids are usually contraindicated, be- LOPATHY, CATARACT, and GLAUCOMA. An exam per- cause they encourage scleral thinning. Treatment formed on a patient complaining of lost vision generally is directed at the underlying condition. would screen for scotomas (blind spots) or specific field losses. scotoma A blind spot or area of blocked vision in Often, a screening examination leads to a diag- the visual field. It may be caused by eye injury, dis- nosis. Evidence of DIABETIC RETINOPATHY found in a ease, or disorder or migraine headaches. routine screening examination detects both the Each eye contains one scotoma. This is the blind result of the disease and its underlying cause. Diag- spot in the normal field of vision caused by the nostic examinations follow the screening exams. The diagnostic exam is used on those who test pos- OPTIC DISC. The optic disc is the part of the RETINA itive or who show indications of disease or a disor- where the OPTIC NERVE meets the eye. It is here that the blood supply enters the eye. The optic disc con- der on a screening exam. This examination confirms the presence of a disorder and diagnoses tains no photosensitive RODS AND CONES and is therefore unable to “see.” the cause. (See EYE EXAMINATION.) Scotomas may be present in either the central or peripheral field of vision. Macular diseases attack Seeing Eye, Inc. A nonprofit organization that the MACULA, the point of clearest vision in the cen- breeds and trains dog guides for use by qualified tral field. A scotoma, or blind spot, develops that blind persons. Incorporated in 1929 by Dorothy permanently blocks central vision but that usually Eustis, it was the first dog-guide school in the leaves peripheral vision intact. United States. Scotomas caused by RETINITIS PIGMENTOSA and The Seeing Eye breeds and trains German shep- GLAUCOMA block vision in the peripheral or side herds and Labrador retrievers and trains golden visual fields. These diseases continue to destroy retrievers or other working breeds. The school pro- peripheral vision until tunnel vision results. vides a 20- to 27-day in-residence training program Scotomas caused by migraines are temporary. for its students. It has placed more than 12,500 They occur during the preheadache or prodrome trained dogs with nearly 6,000 blind people from stage of migraines and may forewarn of the subse- the United States and Canada. quent headache. Migraine scotomas may appear in Most dog-guide recipients are totally blind or any part of the visual field and may move during have light perception. Applicants must be physi- the course of the prodrome or headache stages. cally fit, able to maintain a reasonable amount of These scotomas may simply block out vision or walking exercise, able to absorb and apply instruc- may be scintillating and shimmer or blink with tions in the care and use of a dog guide, and show senses 209 a willingness to be independent. Age limits are usu- The teacher of the class provides general cur- ally between 16 and 65 years for new dog-guide riculum instruction and special education. The pro- candidates. gram is designed to fit the unique needs of each The Seeing Eye charges a fee of $150 for the first individual. visit and $50 for each subsequent visit. The fee Although one-fifth of all programs for visually includes the dog guide, in-residence instruction impaired students centered on self-contained class- with the dog, the dog’s equipment, and round trip rooms in the early 1960s, the model has since lost economy air fare from any place in the United popularity except in large metropolitan areas serv- States and Canada. Payment, which is only a frac- ing multihandicapped blind students. tion of the cost of the program and intended to In order to achieve maximum enrollment, self- impart a sense of ownership to the participant, may contained classrooms are centered in one or a few be made in installments over a period of years. The schools within a district. This often necessitates fee is not payable by any other individual or orga- bussing the visually impaired student to a school nization. outside his neighborhood. Contact: Barraga, Natalie C. Visual Handicaps and Learning. Bel- The Seeing Eye, Inc. mont, California: Wadsworth Publishing Company P.O. Box 375 Inc., 1976. Morristown, NJ 07963-0375 Scholl, Geraldine, ed. Foundations of Education for Blind 201-539-4425 (ph) and Visually Handicapped Children and Youth. New York: 973-539-0922 (fax) American Foundation for the Blind, 1986. www.seeingeye.org senses The body obtains information from all five Selective Placement Program The Selective senses plus the equilibrium and kinesthesis. The Placement Program was established as an amend- tendency is to rely on the sense of sight or to use ment to the Rehabilitation Act of 1973. The the other senses to validate sight information when amendment allowed the federal government to the same information can often be provided by the employ mentally or physically disabled individuals. other senses alone. Administrators of this program work with state, When vision is lost or impaired, the affected per- public and private rehabilitation agencies to refer son must learn to use the other senses in more and place disabled employees. In addition, the pro- effective ways. Contrary to the myth, the other gram works to reappoint to another suitable posi- senses do not become heightened, nor does ESP tion individuals who become unable to perform a develop as compensation for the lost sight. Rather, job due to a disability. the visually impaired person integrates the other U.S. Department of Education. Summary of Existing Legis- senses with any remaining vision and uses them lation Affecting Persons with Disabilities. Washington, more effectively. D.C.: USDE, 1988. Most visually impaired persons have some remaining vision. This vision may range from clear self-contained classroom One of five major edu- vision within a limited central or peripheral field to cational models or plans for the instruction of visu- being able to determine light. Individual vision ally impaired students. The other models are the may vary from one day to the next due to general RESIDENTIAL SCHOOL, ITINERANT TEACHER, TEACHER- health, diet, stress, fatigue, medication side effects, CONSULTANT, and RESOURCE ROOM. or environmental factors such as glare or artificial The self-contained classroom is a classroom in a light. public school that is specially equipped and staffed Use of the residual vision may require the visu- with special education teachers for the visually ally impaired person to adopt new head or body impaired. All the students in the class have visual movements, or to use a visual aid such as a magni- impairments or other disabilities. fier when viewing an object. The remaining vision 210 sensory aids may allow for information about the size, shape, Kinesthesis is the body’s ability to remember a color, or contrast of the object in view. movement. It is a muscle sense or awareness that The sense of hearing is used for subject identifi- allows the body to perform a movement or physi- cation, direction, distance, size, and structure. Visu- cal task with little mental concentration. This sense ally impaired people must learn to recognize and provides information about the tilt in surface or discriminate between sounds and to determine the grade, allows one to effectively estimate distances relative distance and direction between the source and positions and enables one to touch-type and of the sound and themselves, a concept termed sign a signature without looking. localization. Localization is dependent on adequate The equilibrium is the body’s sense of balance. It binaural hearing, or balanced, relatively equal provides information as to the position of the body hearing in both ears. and allows for balance in turning or changing posi- Hearing may also be used in echolocation, lis- tion. tening for the echo of a sound rising from an object. The person using echolocation makes a sensory aids Any aids, devices, or systems that sound such as clapping hands, whistling, or snap- enable an individual to overcome, compensate, or ping fingers and listens for the faint echo that alleviate the performance losses caused by an rebounds from the object. The echo’s sound impairment of any of the senses. Sensory aids may changes as the user gets closer to, or farther away either enhance remaining vision or replace the from, an object. With practice, echolocation can be visual information with information in a tactile or useful in determining the distance, size, or exis- auditory form. tence of an object in the area. Because sensory aids increase independence and Echolocation users must have adequate binaural are related to job performance, they are often asso- hearing and must be able to hear high-frequency ciated with VOCATIONAL AIDS, or aids that enable an sounds. The use of echolocation is more effective in individual to perform a job. Such sensory aids certain environmental conditions. Hard, large sur- include talking computers, electronic devices to faces such as walls and cars reflect echoes better enlarge print, reading machines, electronic braille than smaller, softer surfaces such as drapes or peo- devices, and telephone communication devices. ple. Echolocation is also related to facial vision. (See ADAPTIVE AIDS.) Facial vision is the ability to locate nearby obstacles, without touch, by a feeling of pressure on the face. The close objects reflect background noise in a shaken baby syndrome A medical term used to particular manner that can be interpreted to locate describe a form of child abuse in which a baby or objects. Facial vision depends on adequate binaural child is shaken violently enough to cause trauma hearing. from acceleration forces. Also called shaken infant The sense of touch involves every part of the syndrome, this form of abuse can cause brain dam- body from the top of the head to the soles of the age and bleeding in and on the surface of the brain. feet. Touch provides information about the size, It also can result in ocular injuries such as retinal weight, density, texture, and temperature of an hemorrhages. object or the environment. Touch may be used to The American Academy of Ophthalmology has compensate for lost vision in specific tasks such as encouraged parents and caregivers to learn the reading braille. symptoms of shaken baby syndrome and to make The sense of smell is used to determine location or sure a baby who may have been shaken receives an landmarks, such as the corner bakery, to detect dan- eye exam, which can reveal evidence of shaking. ger such as leaking gas or the presence of smoke, or More than 75 percent of all severely shaken babies to confirm information provided by another sense. have retinal hemorrhages, a symptom rarely seen Smell is closely linked to taste, which is used to iden- with an accidental head injury. tify foods and provide information about the fresh- Babies and toddlers have weak neck muscles, ness and texture of ingested foods or medications. which give them little control over their relatively sickle-cell disease 211 heavy heads. When shaken, their heads vibrate Kevlar helmet, tracheotomy kits, and kitchen gad- rapidly back and forth, which can cause devastat- gets sold to military commissaries. ing damage. It is estimated that 85 percent of chil- Many workshops for the blind are associated dren who are violently shaken sustain serious with the NATIONAL INDUSTRIES FOR THE BLIND (NIB), a injury, including blindness, hearing loss, learning private nonprofit organization that develops indus- disabilities, permanent brain damage, paralysis, or trial employment for blind and multihandicapped even death. Americans. The NIB offers technical and manage- Shaken baby syndrome was first discussed in ment services and allocates federal government medical literature in 1972, and public awareness of orders among its workshops. the syndrome has increased dramatically in recent years. There often are no obvious outward signs of injury to a baby who has been shaken, although sickle-cell disease A term used to describe any the child may appear to be stunned and glassy- condition that involves inherited sickle-cell hemo- eyed or sluggish. Vomiting, difficulty in breathing, globin of the blood. The disease is most common inability to lift or turn the head, lack of appetite, among those of African descent and those with and seizures are signs of possible abuse. ancestors from Puerto Rico, Cuba, Haiti, Jamaica, Italy, Sicily, Greece, Cyprus, Turkey, Syria, and The Survivor’s Foundation. “Eye M.D.s Urge Parents to South India. Sickle-cell disease affects about 72,000 Request Eye Exam in Shaken Baby Cases.” www.sur- people in the United States—about one in every vivors-foundation.org, 2000. 500 Americans of African descent—and the disease American Humane Association Children’s Division. trait is present in one of every 10 Americans of “Shaken Baby Syndrome Fact Sheet.” www.csfpa.org/ pages/shaken.html, 2001. African descent. The disease affects the hemoglobin of the blood, the matter in red cells that enables the blood to sheltered workshops Any protected work set- carry oxygen to the body. Normal hemoglobin, tings for disabled individuals. These work locations called hemoglobin A or C, is characterized by may be nonvocational work-activity centers, tran- round red blood cells which flow easily through sitional rehabilitation training and employment the body’s vessels. Sickle-cell hemoglobin, hemo- centers, or long-term competitive employment globin S, is contained in sickle-shaped, elongated centers that provide opportunities for self-support. cells that resist flow and cause obstructions in cir- The first sheltered workshop was established in culation (microinfarctions), a lack of oxygen to the the Perkins School in 1840 as a separate work tissues (hypoxia), and the proliferation of addi- department. The idea was duplicated in other tional sickle cells. schools for the blind and later became separate Sickle cells have a shorter life span than normal workshops administered by voluntary organiza- cells. Their rapid breakdown rate results in a low- tions for the adult blind and state agencies. ered hemoglobin level, or anemia. For this reason, The Wagner-O’Day Act of 1938 established a sickle-cell disease is often referred to as sickle-cell program in which federal agencies could purchase anemia. selected commodities from qualified workshops for Sickle-cell disease occurs when hemoglobin A the blind. The act was amended in 1971 as the JAV- is changed to hemoglobin S by a genetic substitu- ITS-WAGNER-O’DAY ACT to extend the authority to tion of one amino acid in the hemoglobin chain. workshops for all severely disabled persons and to If both parents are carriers of sickle-cell hemoglo- services as well as products. bin, there is a one in four chance that the child Early workshops produced handmade objects will inherit normal hemoglobin and not carry the for household use, including brooms, chair caning, trait. and hand weaving. Modern sheltered workshops There is a two in four chance that the child will are often more industrial in nature and produce inherit one trait for sickle-cell hemoglobin and one such products as military equipment, including the for normal hemoglobin. This child is a carrier of the 212 sighted-guide technique trait and may develop very mild symptoms of the malaria. There is no cure for sickle-cell disease, but disease or none at all. medical treatment and monitoring may lessen its The remaining one in four chance is that the effects. Doctors recently began using hydroxyurea, child will inherit both sickle-cell hemoglobin traits. a drug often used to treat leukemia, on patients In this case the child will develop sickle-cell dis- with sickle-cell disease. The drug has been found to ease. reduce the painful crisis periods. Early symptoms of sickle-cell disease are mani- Galloway, N. R. Common Eye Diseases and Their Manage- fested in infancy and include listlessness, aches in ment. Berlin: Springer-Verlag, 1895. the arms, legs, stomach and back, poor appetite, Mayfield, Eleanor. “New Hope for People with Sickle-Cell and pallor. Patients experience “crisis” periods that Anemia.” FDA Consumer, May 1996, p. 16. involve intense bouts of these symptoms. A crisis Rhode, Stephen J., and Stephen P. Ginsberg. Ophthalmic may last one day to two weeks and is often pre- Technology. New York: Raven Press, 1987. ceded by an infection, cold, or sore throat. Crises Schweitzer, N. M. J., ed. Ophthalmology. Amsterdam: may recur several times a year, but the patient Excerpta Medica, 1982. remains quite healthy between occurrences. Sickle Cell Anemia Research and Education Inc. Facts In patients with sickle-cell disease, the vision is About Sickle Cell Anemia. Oakland, California: SCARE, affected when blood vessels become blocked in the 1977. CONJUNCTIVA, CHOROID, or RETINA. In turn, this may cause anterior segment ischemia, PUPIL irregularity, sighted-guide technique A method of guiding a IRIS atrophy, retinal degeneration, and loss of visual visually impaired person. The sighted person field. holds the disabled person’s arm in a relaxed A serious condition called sickle-cell retinopathy position close to the body. The arm may be is a common result of sickle-cell disease. As vessels straight or bent at a right angle. The visually within the peripheral sections of retina become impaired person grasps the guide’s arm just above blocked, the retina becomes starved for oxygen. It the elbow. This position allows the sighted guide develops new vessels that tend to be weak and to walk a step ahead. The visually impaired per- hemorrhage. The neovascularization may cause son can then follow the guide’s movements and leakage into the VITREOUS or RETINAL DETACHMENT. directions. A loss of vision results. The guide may inform the visually impaired per- Photocoagulation therapy, laser treatments, are son about steps or cracks in the path or overhead performed once neovascularization has begun. This obstacles. The guide may pause when reaching the may stop the hemorrhaging but can cause compli- bottom or top landing of a flight of stairs. This alerts cations such as vitreal neovascularization. Cryo- the visually impaired person that one last stair therapy, freezing treatments, may be performed on remains. When traveling through a narrow pas- the smaller areas of neovascularization. sage, the guide moves the guide arm behind him- Scleral buckling may be used to reduce the self so that his wrist is behind the small of his back. traction that causes retinal detachment. This nor- This alerts the visually impaired person to drop mally simple procedure is difficult in cases of back. The guide then proceeds through the pas- sickle-cell disease because there may be overlying sage, and the visually impaired person follows sin- bleeding that interferes with localization of the gle-file. hemorrhage source, and since the procedure may Partially sighted persons may be asked whether trigger necrosis, localized tissue death, in anterior they prefer to take a sighted guide’s arm in a dark- areas. ened room. The sighted guide should never force It is thought that the sickle-cell trait may have assistance or lend assistance without first asking developed as a natural response to malaria, a more permission. Rehabilitation classes teach visually serious disease commonly found in descendant impaired persons how to break the grasp of well- countries of those affected by the disease. Those meaning but unwanted guides. (See ETIQUETTE; with sickle-cell disease carry a high resistance to ORIENTATION AND MOBILITY.) Smith-Kettlewell Eye Research Institute 213 signature guide An aid that enables the user to braille writers learn the number configuration of sign a signature within a specific space on a page. the dots. The guides may be made of plastic or metal and often have a rubber component that holds the slit lamp See BIOMICROSCOPE. guide in place. Designs vary, but most guides are a template Smith-Kettlewell Eye Research Institute A non- with a rectangular window or opening that profit, independent medical and scientific institute conforms to the standard signature area of a incorporated in 1963 and dedicated to research on check, credit card receipt, etc. The signature guide human vision. The 50-person research staff is a is placed on the paper with the lower straight blend of laboratory and clinical research scientists edge of the opening centered on the signature with degrees in medicine, ophthalmology, experi- line of the document. The individual uses the mental psychology, physiology, engineering, opto- edge as a guide and signs the signature within the metry, computer science, and physics. opening. The institute concentrates on three main areas of interest: clinical studies related to the diagnosis slate and stylus The braille slate and stylus are and treatment of eye diseases and disorders, basic tools used to print braille. The slate is made from research to understand how the eye and brain two rectangular metal plates hinged together at work as a basis for clinical and rehabilitation pro- one end. The upper plate has rows of small, open grams, and development of devices and vocational windows punched out of the metal. Directly programs to aid partially sighted and blind persons. underneath each window on the bottom plate is an The development of devices and programs is the indentation of a complete braille cell. main focus of the Rehabilitation Engineering Cen- The braille cell is made up of six dots, two across ter. Established in 1975, the nonprofit center is and three down. Each dot is numbered. Different funded by the National Institute on Disabilities and configurations or combinations of dots are used to Rehabilitation Research, a division of the federal stand for each letter of the alphabet. For instance, Department of Education. dot 1 stands for the letter A, and dots 1 and 2 stand The center conducts ongoing research and for the letter B. development programs in the area of sensory aids In order to make a braille letter with the slate that are suitable for solving problems in the reha- and stylus, a card or sheet of braille paper is placed bilitation of blind, low-vision, and deaf-blind indi- between the two metal plates of the slate. The sty- viduals. The emphasis is on the design of practical, lus, a short metal prong fastened to a handle, is low-cost aids and efforts to ensure the aids reach the user. held in the palm and used to make the letters. The The aids and devices may consist of vocational writer presses the stylus downward onto the paper aids, educational devices, communication aids, and within an open window. The stylus pushes the orientation and mobility aids. Major achievements paper against the corresponding indentation of the of past years include the Volatile Braille Display, a braille cell dot on the bottom plate. A raised dot is Universal Job Instrumentation System (Flexi- formed on the reverse side of the paper. The writer Meter), the Braille Notetaker, the Auditory Data- continues to press against the correct dots in the Flow Indicator, and the Auditory Arcade. Currently, cell until the correct letter is formed. The writing is staff is working to develop medication reminders for read when the paper is turned over and the dots blind and blind-deaf consumers, and to expand the are facing upward. usefulness of KnowWare, a system that provides Therefore, in order to write braille, which must virtual reality maps for blind people. be read from left to right, the slate and stylus user Contact: must write from right to left and reverse the normal configuration of dots on the braille cell. Rather Smith-Kettlewell Eye Research Institute than learning to picture each letter in reverse, San Francisco, CA 94115 214 Snellen chart

415-345-2000 (ph) from above and the eyes are afforded some protec- 915-345-8455 (fax) tion by the eyelids, eyelashes, and eyebrows. In www.ski.org cases of snow blindness, the rays are reflected from the snow and enter the eye from below, a relatively Snellen chart The eye chart routinely used in the unprotected position. (See RADIATION BURNS.) EYE EXAMINATION to determine central visual acuity. VISUAL ACUITY is the measurement of the amount of Social Security Benefits The Social Security detail an individual sees as compared with the Administration (SSA) operates two programs that amount of detail a person with normal vision sees. provide financial assistance to visually impaired The visual-acuity test involves reading the Snellen individuals. These programs are called Social Secu- chart when positioned 20 feet away. The chart con- rity Disability Insurance (SSDI) benefits and Sup- tains nine lines of letters, written in progressively plemental Security Income (SSI). smaller print. Title II of the Social Security Act provides federal Each line corresponds to a degree of vision. Line old age, survivors, and disability insurance, also one corresponds to 20/200 vision; line two, known as OASDI. Disability insurance benefits are 20/100; line three, 20/70; line four, 20/50; line paid to people who have paid Social Security taxes five, 20/40; line six, 20/30; line seven, 20/25; line but have become disabled before reaching retire- eight, 20/20; and line nine, 20/15. If an individual ment age. A disabled person is described in the act can read all nine lines, the vision is measured as as one who is unable to work due to a physical or 20/15, or able to read at 20 feet what a normally mental impairment that is permanent, long-lasting sighted person can read at 15 feet. If the person can (12 months or more), or may result in death. read only the top line, or big E, that vision is mea- Applicants must be unemployed or employed sured as 20/200, or able to read at 20 feet what a but earning less than a determined amount and normally-sighted person can read at 200 feet. This must have a qualifying medical disability according is classified as legally blind. to the ruling of the Disability Determination Ser- The Snellen chart has been criticized for inaccu- vice. An applicant must also have contributed to racy since each line on the chart must cover a wide the Social Security fund for approximately half of range of visual ability. Those with borderline vision the years since attaining age 21. may fall between two lines of ability and be incor- Dependents of an eligible disabled person may rectly classified. also qualify for benefits under Section 202 of the Act. Children must be unmarried and under 18 years old, or 19 if a student, or unmarried of any snow blindness An eye injury caused by intense age with a disability that occurred before age 22. light reflected off snow. The bright light in pro- Spouses may be eligible if aged 62 or over, or of any longed exposure produces an ultraviolet burn on age if a child in their care is disabled or under age the CORNEA of the eye. Symptoms of snow blind- 16 and receiving Social Security benefits. ness appear in both eyes, and include extreme A child’s benefit is one-half of that received by pain, a feeling of sand in the eyes, and severe sen- the eligible living parent collecting Social Security sitivity to light. The symptoms are usually delayed retirement or disability benefits. The payment is two to nine hours after exposure. The burn heals three-quarters of the amount when the parent is itself within two to three days. Antibiotic or steroid deceased. drops may be prescribed to ease discomfort and dis- There is a five-month waiting period before courage infection. Snow blindness can be pre- becoming eligible for disability insurance. The vented by wearing protective goggles or glasses. waiting period is waived if the recipient reapplies Although the rays that cause snow blindness are for the benefits within five years of discontinuing the same as those that cause sunburn at the beach, benefits. sunbathers rarely get snow blindness. This is The benefits are paid in cash monthly to eligible because most of the rays at the beach are coming people and their dependents. The age of the Social Services Block Grant 215 worker when he became disabled, his earned sumer Price Index figure. The Social Security income and the length of time he was employed Administration considers earned and unearned determine the amount of the benefit. The amount income, amount of savings and assets, and other may be decreased if the worker is a recipient of factors when determining how much in SSI bene- other state or federal benefits. After receiving dis- fits to allocate to a particular person. ability benefits for 24 months, the recipient is eligi- Individuals who live in another household that ble for Medicare health insurance benefits. supplies support or maintenance receive benefits Under Section 222 of the act, all recipients and that are reduced by one-third. Those who live in a applicants are referred to state vocational rehabili- public or private medical or health-care institution tation agencies to encourage individual productiv- that receives Medicaid or SSI benefits on behalf of ity and self-sufficiency. After a recipient has been the individuals, receive personal allowances each trained and employed for nine months, the voca- month. Individuals admitted to a medical or psy- tional rehabilitation agency is reimbursed for its chiatric facility for a projected three months or less services with Disability Insurance Trust funds. may receive full benefits. Those living in a public, A trial work period of nine consecutive or non- nonmedical facility do not qualify for benefits. consecutive months is allowed to enable recipients Recipients between the ages of 21 and 65 are to test their vocational suitability without losing referred to state vocational rehabilitation agencies benefits. Each month that the recipient earns more to encourage their return to the work force. If it is than a certain amount is counted as one of the determined that an individual is eligible and would nine. benefit from these services, the recipient may not An extended period of eligibility lasting up to 31 refuse them without good cause. months may be allowed if the recipient retains the To encourage recipients to work, the program disability or if the earned income is below a speci- allows individuals to continue to receive SSI bene- fied amount. If the individual’s earnings exceed the fits and Medicaid coverage if they are able to work set amount during a month, benefits are not paid but still retain their disabilities. The individual must during that month. If a recipient never exceeds the suffer from the original disability and must con- set amount, benefits continue indefinitely as long tinue to meet all the program requirements. Bene- as all other requirements are met. fits are discontinued when the individual’s Supplemental Security Income, or SSI, is a fed- earnings exceed the amount of benefit, but the eral program authorized under Title XVI of the individual may still qualify for Medicaid coverage. Social Security Act to provide a minimum income (See FINANCIAL AID.) to low-income elderly and disabled individuals. SSI requires that recipients meet requirements of U.S. Department of Education. Summary of Existing Legis- financial need, and unlike Social Security Disability lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. Insurance, does not base eligibility on the amount U.S. Social Security Administration. Part 416—Supple- of taxes paid into the Social Security Fund. mental Security Income for the Aged, Blind and Dis- Needy individuals or couples disabled or aged 65 abled. www.ssa.gov/op-Home, 2001. or older may qualify for SSI benefits if financial needs requirements are met. Disabled children under age 16 are referred to a state agency funded Social Services Block Grant The Social Security by the Maternal and Child Health Block Grant Pro- Act was amended in 1974 to establish, under Title gram or another appropriate agency. Disabled indi- XX, the Social Services Block Grant program. The viduals are described under the program as those program allows each state to provide social services who have a physical or mental disability that is per- to its residents in ways it deems most appropriate manent, long-term (12 months or longer), or one and effective. States may use Title XX funds to pro- that may result in death. vide services to disabled persons. Funds may be Monthly cash benefits are paid directly to recip- used to prevent or reduce dependency, attain and ients. The amount of payment is based on a Con- maintain self-sufficiency, prevent neglect or abuse 216 Sonicguide of either adults or children, improve or prevent clinical similarity to age-related macular degenera- inappropriate institutional care, and obtain institution. Symptoms include retinal edema, hemor- tional care. rhages, and exudates in the macular area. As the Funds may also be used to improve state pro- disease progresses, considerable scarring may occur. grams concerning day-care services of either chil- Symptoms usually occur first in one eye, with the dren or adults, protective services, foster-care other eye developing symptoms months or even services, home-care management and mainte- years later. As with age-related macular degenera- nance services, transportation and health services, tion, central vision is affected first. employment services, information and counseling The disorder was first addressed in 1949 in a services, and meal-delivery programs. Services study of five British families who were afflicted by must relate to the special needs of children and the the disease. It has been identified in patients in elderly, and those who are blind, mentally re- Europe, North America, South Africa, Australia, tarded, emotionally disturbed, physically disabled, and Japan. or drug or alcohol dependent. The eligibility of recipients is determined by special education See EDUCATION. each state. Allotments to the state are proportion- ally set according to population. In fiscal year 2001, Congress allocated $1.725 billion for this program. sports and recreation Sports and recreation activities benefit all persons, both disabled and U.S. Department of Education. Summary of Existing Legis- able-bodied, by developing self-assurance and con- lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. fidence, competitive spirit and athletic skills, and by providing stress reduction, comradeship, and fun. Local, state, regional, national, and interna- Sonicguide The Sonicguide is an ELECTRONIC tional competitions exist for participation in sports TRAVEL AID developed and designed by HUMANWARE by visually impaired persons as well as persons INC. for the visually impaired. The device has three with other disabilities. components: a pair of spectacles, earphones, and a Although some sports or games require some control box for the electronic components and adaptation to allow full participation by visually power supply. impaired individuals, many do not. Adaptation is The spectacle-mounted transmitting device dependent on the participant’s eye condition, gen- sends out ultrasonic waves that bounce off objects eral health and interests and requirements of the in the user’s path. The reflected waves are con- sport. verted into audible tones heard in stereophonic A visually impaired jogger or runner may run earpieces. The pitch of the tone provides informa- alone on a track with high contrast or distinctive tion as to the distance, position, and surface char- texture to differentiate the path or on a track spe- acteristics of the detected object. The device has a cially equipped with guide ropes or poles for visu- range of five meters. ally impaired athletes. A visually impaired person Other similar devices are known by the trade may run with a sighted partner while holding onto names Kay binaural sensor and Sensory 6. Versions the guide’s elbow, a stick held between the two, or of the device are available for children, wheelchair a rubberbandlike tether. users, and orientation and mobility instructors. Competitive games in track and field exist for Correct use of all such devices requires training visually impaired athletes. Competitive events from a qualified instructor. include the triple jump, shot put, long jump, javelin throw, discus, and meter races. Sorsby’s fundus dystrophy (SFD) A rare genetic Bicycling is possible when the rider rides a tan- disorder that causes macular degeneration to occur dem bike with a sighted partner in the front, or pilot, at an early age, usually between the ages of 30 and position. The visually impaired person sits behind in 40. Researchers are interested in SFD because of its the stoker position and provides the power base for Stargardt’s disease 217 the pair. Tandem cycling may take the form of Horseshoes may be played by adapting the leisurely recreation or competitive riding. horseshoes by color or texture. The post can be Bowling programs and tournaments are offered accented with a bright color or by an auditory cue. through blind bowling or athletic associations. Horseback riding is widely available and pur- Bowling lanes can be adapted with a portable sued in the company of a sighted rider who pro- bowling rail that is assembled and placed next to vides information concerning directions and the aisle as a banister guide. overhead obstacles. Riders may be required to wear Skiing clubs and programs are available to visu- a safety helmet. ally impaired skiers. Many ski areas have staff to Exercising and weight lifting programs are avail- teach or accompany blind individuals in either able in gyms and fitness centers that provide indi- nordic (cross country) or alpine (downhill) skiing. vidualized instruction. Weight lifting or power Nordic skiing is pursued in flat terrain at fairly lifting requires no adaptation for blind participants slow, controllable speeds. Since nordic skiing gen- but may necessitate a “spotter” or guide to monitor erally follows tracks made from previous skiers, the the lift. sport is only minimally dependent on a sighted Judo and wrestling are two sports that need no guide who calls directions to the visually impaired adaptation for participation by visually impaired skier. individuals. The referee makes verbal calls con- Alpine or downhill skiing is a faster sport that cerning scoring and penalties. relies on excellent communication between the Gymnastics programs are available through ath- visually impaired skier and the sighted guide. The letic organizations and local gymnasiums. The visu- guide calls out directions to indicate turns and ally impaired individual may participate in all guide the partner around obstacles. Often, visually activities including the uneven bars, balance beam, impaired skiers wear tunics or shirts printed with floor exercise, and vault. A “spotter” or guide may “Blind Skier” to advise sighted skiers of their pres- monitor the activity, and an additional layer of ence. floor matting and padding covering all metal parts Ice skating, speed skating, or roller skating may may be recommended. be pursued with a sighted guide. The guide may Competitive or recreational darts are played on call out directions or may skate in tandem, allow- the Audio Dart Game. The dart board talks to con- ing the partner to hold onto his elbow or a stick trol the game. It informs players when it is their held between the two. turn, the score earned, and the status of the game Swimming is a popular sport for recreation or as it progresses. competition. A pool with rope lane markers makes Balls of all types including basketballs and chil- swimming laps possible without a sighted guide. dren’s playground balls are adapted with inner Some visually impaired swimmers prefer to use an bells or beeps that alert the visually impaired user outside lane that borders the side of the pool and to to the location of the ball. Goal ball is a game count the number of strokes required to reach played exclusively by the visually impaired. The complete a lap. object is to roll a ball containing bells past the Competitive blind swimmers are tapped on the opposing team and into the goal net. Each team head or hand at the end of each lap to indicate the consists of three players who alternately roll and approach of the pool wall. The tapper taps just as defend. The floor is marked with tape to accent the the swimmer should start the turn. This enables the goals and boundaries. See Appendix for sports visually impaired swimmer to duplicate the turning organizations. (See TOYS AND GAMES.) techniques of nondisabled swimmers in safety. Boating or canoeing is usually pursued with a squint See STRABISMUS. sighted guide partner who takes the lead position in the craft. The guide supplies continuous information on obstacles, rapids, or changes in direction. All Stargardt’s disease An inherited disease that boaters should wear personal flotation devices. causes people to lose central vision, usually in the 218 stereotypes

first or second decade of life. It is sometimes The condition in which eyes tend to turn inward referred to as juvenile macular degeneration. Doc- toward each other is termed ESOPHORIA. When one tors estimate that between 17,000 and 25,000 peo- eye turns inward it is called ESOTROPIA. The condi- ple in the United States have Stargardt’s disease. tion in which the eyes tend to turn outward away The disease typically starts between the ages of six from each other is called EXOPHORIA, and when one and 15. Some children lost most of their central eye turns outward, it is called exotropia. An eye that vision quickly, while others experience a slow and turns upward is an example of HYPERTROPIA, and an gradual loss of sight. Researchers in May 1998 iden- eye which turns downward is an example of tified a gene that causes Stargardt’s disease. The gene HYPOTROPIA. causes cells to produce a protein that functions only The eyes may cross consistently, called constant in the retinas of the eyes. Discovery of this gene is tropia, or occasionally, called intermittent tropia. significant for several reasons. It will allow doctors to There is also a type of strabismus in which the devi- develop a specific test for Stargardt’s disease, which ation of the eyes is hidden much or all of the time. frequently is confused with other vision problems, This is called a phoria. The problem is not merely and, it may move researchers closer to finding the cosmetic, but can cause visual problems. In normal cause of age-related macular degeneration. vision, both eyes focus on one object. The brain receives two pictures of one object and translates that information into one three-dimensional image. stereotypes See ATTITUDES. In strabismus, one eye views one object while the other views something else. The brain receives steroids Drugs used in the treatment of eye dis- pictures of two different objects. Double vision may eases and disorders. They are most often used to result, or the brain, in its attempt to reconcile the combat inflammation in the eye. Steroids may be two pictures, may suppress one, causing a loss of prescribed in pill, ointment, or drop form. They are function. This suppression results in a condition most often topically applied, because systemic called AMBLYOPIA. (taken internally) steroids may have more serious Causes of all types of strabismus are not known. side effects. Since it is often associated with high amounts of Steroids increase the eye’s susceptibility to infec- MYOPIA (nearsightedness), HYPEROPIA (farsighted- tion and may encourage the multiplication of ness), or ASTIGMATISM, it is thought that these con- viruses such as HERPES SIMPLEX. Topical steroids may ditions may contribute to the cause. Strabismus can immediately cause a rise in intraocular pressure, develop after a major illness or injury, and some which may lead to GLAUCOMA. Over time, systemic forms of strabismus may also be hereditary. steroids may encourage CATARACT development. Because many infants under six months of age Thereafter, steroids should be prescribed for a spe- develop strabismus conditions that they outgrow, a cific disorder and only if other drugs have proven misconception persists that strabismus is self-cor- ineffective. They should be taken only as directed recting. Any strabismus that lingers after six and should not be used for extended periods of months of age, if only occasional, indicates a prob- time. lem and should be treated by a physician. Treatment for early stages of strabismus include the prescription of eyedrops and eyeglasses or bifo- Stoxil See IDOXURIDINE. cals. The lenses of the glasses often include a prism to bring the images closer together. strabismus Strabismus, or squint, is the name for Exercises may be prescribed if amblyopia is pre- misalignment of the eyes. The terms cross-eyed, wall- sent. The exercises train the eyes to stop suppress- eyed or cockeyed are often used to describe this con- ing one image and to experience stereoscopic dition. An eye may move inward, as in convergent vision. Further exercises then train the eyes to strabismus, outward, as in divergent strabismus, or bring both images together to form one three- up or down, as in vertical strabismus. dimensional image. Once the eyes are properly stroke 219 aligned, follow up treatment may include exercises riosclerosis causes fatty plaque to form inside the to keep the eyes in place. walls of the arteries, which slows or stops the flow If treatment fails, surgery may be necessary. of blood. This causes a stroke called a thrombotic During surgery, one or more of the six muscles stroke or cerebral thrombosis. attached to each eye are altered to bring the eyes Platelets, blood-clotting cells in the blood, may into position or to strengthen or weaken them cling to the arteriosclerotic plaque and form blood according to need. Since strabismus is a disorder clots that can block an artery. Often, such a clot is that affects both eyes, usually both eyes undergo jarred loose and floats through the blood stream surgery. Some patients may require additional until it becomes lodged in a smaller blood vessel. surgery to completely align the eyes. The blood flow is cut off and a stroke occurs. This type of stroke is called an embolic stroke. Blood vessels weakened by injury or hyperten- stroke An interruption of blood flow to the brain. sion (high blood pressure) may break and allow Stroke is the third most common cause of death in blood to flow into or around the brain and destroy the United States after heart attack and cancer. tissue. This causes a stroke known as a cerebral According to the American Heart Association, hemorrhage or a subarachnoid hemorrhage. A about 600,000 Americans experience stroke each cerebral hemorrhage is when blood flows into the year. brain, and a subarachnoid hemorrhage is when a More than 75 percent of those who suffer blood vessel on the surface of the brain ruptures strokes each year are over 65. The incidence of and bleeds into the space between the brain and stroke increases by more than 100 percent with the skull. each decade over 65. Men suffer 30 percent more Strokes can be categorized by severity into three strokes than women. Blacks suffer 60 percent more types: transient ischemic attack, stroke in progress, strokes than whites, and evidence suggests that and completed stroke. Transient ischemic attacks people from poor socioeconomic backgrounds are (TIA) precede more severe strokes in about 10 per- more susceptible than those from affluent circum- cent of cases. A transient ischemic attack is a block- stances. Strokes tend to run in families, occur more age of one small blood vessel to the brain. Stroke commonly in the southeastern part of the United symptoms such as loss of vision or tingling in the States, and occur most often during phases of limbs may last from a few minutes to 24 hours, extreme weather temperatures. then disappear. TIAs are usually a warning sign of A stroke is a type of cardiovascular disease. a more serious stroke to follow. Blood is brought to the brain via four large arteries. A stroke in progress is a stroke that begins sud- The brain cannot store nutrients, so it needs a con- denly and steadily worsens during the following stant supply of blood to furnish oxygen and nutri- few hours or days. The symptoms may include a ents and carry away carbon dioxide and other tingling or numbness of a limb or one side of the waste materials. When the flow of blood is inter- body that develops into total paralysis. rupted, a stroke occurs. Any cessation of blood to A completed stroke is one in which the blood the brain can cause damage, including paralysis, has been interrupted in its flow, and brain damage loss of consciousness, loss of speech, loss of mental has occurred. This may result in paralysis to one functioning, loss of vision, and death. side of the body, vision loss of one half of the field Strokes are caused by a blockage or bursting of of vision or one eye, slurred speech, mental confu- one of the arteries to the brain. These types of sion, coma, and death. strokes, called cerebral thrombosis and cerebral All three types of stroke may impair vision. Total embolism are the most common types of stroke. vision may be lost in one eye, or one-half of the They account for up to 80 percent of all strokes suf- visual field of both eyes may be lost. This condition fered in the United States. is called HEMIANOPSIA and is also present, temporar- ARTERIOSCLEROSIS, hardening of the arteries, is ily, in migraine headaches. Loss of vision may be a the cause of more than half of all strokes. Arte- result of stroke, a symptom of a stroke in progress, 220 subluxation of the lens or a TIA, a warning sign of a more serious stroke to damage done to the brain, the type of stroke and follow. the condition and age of the patient. Double vision may result from a stroke if the In the last 30 years, death due to stroke has muscles of one eye become paralyzed or damaged. been reduced 30 to 40 percent. In 1950, the death The weakened muscles may not be able to focus rate due to stroke was 88.8 per 100,000 people. In the eye properly on an object that the unimpaired 1985 the rate was 32.8 per 100,000. The rate con- eye views. The brain receives images of two differ- tinues to fall, and since 1973, the average rate of ent objects, and double vision occurs. decline has been 5.5 percent per year. From 1988 If the stroke damages the brain stem, NYSTAGMUS to 1998, the stroke death rate dropped 15.5 per- may occur. Nystagmus is a constant, involuntary cent. movement of the eyes. The condition may impair This may be because of increased awareness of vision, but the patient can often learn through stroke risk factors. Several conditions are recog- rehabilitation to work with the condition to see nized as risk factors for stroke. They are hyperten- adequately. sion, heart disease, diabetes, high red-blood-cell Patients suffering from any stroke symptoms count, TIAs, cigarette smoking, and obesity. Treat- require immediate medical attention. The symp- ment or control of these conditions may reduce the toms may be temporary or sustained and include risk of stroke. weakness or tingling of face or limbs, difficulty with speaking or understanding speech, hemianopsia, blurring of vision, double vision, total loss of subluxation of the lens Subluxation of the CRYS- vision in one eye, headache, dizziness, inability to TALLINE LENS occurs when the lens becomes par- swallow, mental confusion, and loss of memory. tially displaced due to a break in the fibers of the Treatment of stroke may include the use of anti- ZONULES that hold it in place. The condition may be coagulants or blood thinning drugs to reduce the congenital or acquired. It may be caused by a blow risk of arteriosclerosis. In the case of TIAs, a surgi- to the eye or other injury, MARFAN’S SYNDROME, cal procedure called carotid endarterectomy may homocystinuria (a metabolic congenital disorder be called for if the stroke was caused by a stenosis associated with mental retardation), and aging. or narrowing of the carotid artery. The stenosis is Symptoms of subluxation of the lens include caused by arteriosclerotic plaque that is removed rapid changes in vision and increased myopia during the procedure. (nearsightedness) due to the increased mobility of After a stroke, patients may enter rehabilita- the lens. On examination, the IRIS may appear tive therapy to regain lost abilities. Physical ther- wobbly or tremulous, and the lens may be visible apy may help restore coordination and use of in the pupil. The lens may subluxate up and out, as impaired limbs. Occupational therapy may assist in in Marfan’s syndrome, down and in, as in homo- the recuperation of hand movements and provide cystinuria, backwards into the VITREOUS, a condi- alternative methods for performing daily tasks. tion called posterior subluxation, or forward into Speech therapy may improve the ability to com- the ANTERIOR CHAMBER, a condition called anterior municate. Often, psychiatrists, psychologists, subluxation. social workers, and vocational rehabilitation coun- Subluxated lenses may develop CATARACTS or selors may be called on to assist in the rehabilita- may become trapped in the pupil. Aqueous fluid tion process. production forces the trapped lens into the anterior Those who survive stroke usually maintain a chamber, where it may cause a rise in intraocular plateau or a period of no change in condition after pressure, or secondary GLAUCOMA. the stroke. The plateau may last for hours or days. When the lens has drifted to the anterior cham- The recovery period may be rapid or last months ber, the pupils are dilated and the patient is set in a and range from complete restoration of abilities to supine position to encourage the lens to fall back maintenance of long-lasting or permanent impair- into place behind the iris. If the lens falls into place, ments. The degree of recovery is dependent on the the pupils are immediately constricted with miotic surgical procedures 221 drops, although recurrences are common. If the classes with Keller and translated class lectures and lens fails to move into position, it is surgically texts. removed, or a peripheral iridectomy is performed When Keller began writing articles and her book to allow aqueous flow. The Story of My Life, John Macy, an editor and Har- When the lens moves into the POSTERIOR CHAM- vard instructor, was recommended to the two BER, it may be left untouched if it does not cause women as an editor and writing assistant. Macy UVEITIS or cataract. In such cases, the lens may be and Sullivan married in 1905, and Keller lived with removed. If the lens moves from the central pupil the couple. Sullivan continued to assist Keller in area, becomes completely dislocated or detached or her writing and lecturing career. The marriage is removed, the eye becomes aphakic, or without a grew troubled and Macy sailed alone to Europe in lens. Aphakic characteristics such as lack of accom- 1913. In 1914, Polly Thomson joined Sullivan and modation, enlarged image, and color distortion can Keller as a companion and assistant. be corrected with prescription contact lenses or In 1929, Sullivan’s right eye was removed to spectacles. relieve constant pain. Her vision in the remaining eye and her general health deteriorated rapidly. Sullivan died in 1936. Her ashes reside next to Sullivan, Anne Anne Mansfield Sullivan Macy those of Helen Keller and Polly Thomson. was the teacher and companion to Helen Keller. Born in 1866 in Feeding Hills, Massachusetts, she developed TRACHOMA at age five. The eye disease Supplemental Security Income See SOCIAL SECU- arose from the poverty and unsanitary conditions RITY BENEFITS. of her environment and slowly destroyed her sight. In 1874, she was sent to a state poorhouse in surgical procedures Surgery may be required in Tewksbury where she remained off and on for six the treatment of an eye disorder or disease. Accord- years. Five unsuccessful operations were per- ing to the type of disorder, surgery may be indi- formed on her eyes that alleviated the pain but did cated immediately or reserved as a later alternative not improve her sight. in cases that do not respond to medication. In 1880, Sullivan entered the Perkins Institution CATARACT removal is the most common surgery for the Blind in Boston. During her time at the performed in the United States. There are two main Institution, she received two eye operations that types of cataract surgery: phacoemulsification and improved her vision. Sullivan graduated from extracapsular. Perkins in 1886, as valedictorian of her class. During phacoemulsification, which is the most In 1887, Sullivan was recommended by the common method of cataract removal, a small inci- Perkins Institution as a teacher for a deaf-blind sion is made on the side of the cornea, and a tiny child named Helen Keller. Sullivan went to live probe is inserted into the eye. The probe produces with the Keller family and battled with the unruly ultrasound waves that break up the cloudy center child, attempting to teach her the fingerspelling for of the lens. The lens can then be removed, using various objects in the environment. Keller was suction. unable to link the importance of the spelling to the In extracapsular surgery, a slightly longer inci- meaning of the object until one day at the well sion is made on the side of the cornea, and the sur- when Sullivan poured water on Keller’s hand geon removes the hard center of the lens. The while fingerspelling W-A-T-E-R into the other remainder of the lens is then removed using suc- hand. tion. Keller went on to master the manual and braille Once the cloudy lens has been removed, it is alphabet under the tutelage of Sullivan on whom usually replaced with a clear artificial lens called an Keller bestowed the lifelong title of “Teacher.” intraocular lens (IOL). The IOL becomes a perma- Keller attended and graduated from Radcliffe in nent part of the eye and does not require any addi- 1904, with the assistance of Sullivan, who attended tional care or attention. The person wearing the IOL 222 sympathetic ophthalmia does not feel or see it. In some cases, patients can- injury or trauma to the other eye. The condition is not have an IOL, due to problems that occur during most common among children and occurs follow- surgery or another eye problem. In these cases, a ing a perforation injury or surgery. It also can occur soft contact lens or glasses may be used instead. if a foreign body remains in the eye, causing great Certain types and conditions of GLAUCOMA irritation. necessitate surgery. Two major forms of surgery are Sympathetic ophthalmia occurs when the in- IRIDECTOMY and filtering surgery, called TRA- jured eye remains inflamed and infected due to BECULECTOMY. An iridectomy is a surgical procedure insufficient or delayed cleansing. Over a period of in which a portion of the iris is removed to elimi- two weeks to several months, an inflammatory nate the blockage of angle-closure glaucoma and response occurs in the UVEA. Examination of the prevent further attacks. A trabeculectomy bypasses choroid reveals the presence of eosinophils, giant damaged meshwork and creates a new drainage cells and lymphocytes, serious signals that threaten tract to allow the aqueous to flow from the eye. sight in the eye. CORNEAL TRANSPLANT, or keratoplasty, uses a After a period of two weeks to several years, the donor CORNEA to replace all or part of a diseased inflammation spreads to the unaffected eye. Symp- cornea and restore vision. A section of donor toms of blurred vision or PHOTOPHOBIA develop. An cornea is measured to the precise needs of the host eye examination with the slit lamp reveals the and removed from the donor cornea with scissors. presence of granulomatous keratic precipitates on A corresponding section of host cornea is measured the posterior surface of the cornea, a condition that and removed. The donor cornea is placed into the endangers vision. remaining cavity and sewn into position with small Sympathetic ophthalmia can be prevented by stitches or sutures. earnest attention to cleansing and care of the Tear duct surgery is often indicated in cases of affected eye or by enucleating (surgically remov- WET EYE. Obstructions are cleared surgically by sim- ing) the initially injured eye within a two-week ple probe and irrigation or silicone intubation pro- period following the injury. Any severely injured cedures, or the more serious surgical procedure, a eye that remains inflamed or infected up to a two- dacryocystorhinostomy. week period may need to be removed to prevent A TARSORRHAPHY is a surgical procedure in which sympathetic ophthalmia. a section of the eyelids is stitched together at the If sympathetic ophthalmia occurs after the two- corner of the eye. The surgery is performed in the week time period, the condition may be treated treatment of dendritic ulcers, Bell’s palsy, thyroid with local and systemic steroids. The treatment is disease, or any disorder in which the eye is in dan- often successful, but the condition is inclined to ger of overexposure or drying. recur. ENUCLEATION is the surgical removal of the eyeball. Enucleation is performed when the eye con- synechiae A condition in which the IRIS adheres tains a malignant tumor, when the eye is blind and to either the CORNEA or the LENS. The iris/cornea causes pain, and when the eye is nearly blind and adhesion is termed anterior synechiae and the sympathetic ophthalmia (an inflammation that iris/lens adhesion is termed posterior synechiae. occurs in both eyes as a result of injury to one eye) Synechiae of either type may be caused by anterior is a risk. UVEITIS, an inflammation of the iris and/or ciliary RADIAL KERATOTOMY (RK) surgery is elective body. Anterior synechiae may be caused by perfo- surgery designed to improve MYOPIA (nearsighted- ration of the cornea or injuries. ness). The surgery uses radial cuts or incisions to Posterior synechiae may cause a blockage of reshape the cornea. aqueous flow and an iris bombe, in which the iris bows forward unnaturally. This interferes sympathetic ophthalmia A rare condition in with the flow of AQUEOUS FLUID and causes sec- which one eye becomes inflamed as a result of an ondary GLAUCOMA, a disease in which the accu- syphilis 223 mulation of aqueous fluid causes a rise in intraoc- The voice is projected over an internal speaker, ular pressure. external speaker, earphones, or telephone, depend- Symptoms of synechiae include redness, pain, ing on the type of hardware. Often, a section of the oversensitivity to light, pus in the anterior chamber standard keyboard, a hand or foot switch or a key- on examination, constricted pupil, and inability of board on a control box is used to control that sec- the pupil to dilate. Synechiae is treated according tion of the screen that will be read and how it will to its cause. Since the condition generally includes be read. Most programs offer options of reading the inflammation of the iris, or IRITIS, the treatment text letter by letter or word by word and verbaliza- usually involves local steroids and mydriatic drops tion of the punctuation. to dilate the pupil. Some injury-induced synechiae Synthetic speech is a breakthrough in indepen- may be self-limiting. dence for those with visual impairments. The individual can privately transmit and receive personal documents and produce work-related material synthetic speech Artificial speech created by independently. It allows free access to information speech synthesizers. Speech synthesizers convert at times and in situations convenient to the indi- printed speech into spoken words to put informa- vidual, and not dependent on the assistance of oth- tion into, or remove information from, a com- ers. Many advances are being made in this area as puter. The first speech synthesizer was invented in technology continues to develop. 1936 by H. W. Dudley, a scientist at Bell Labs. The machine required an operator with a keyboard ABLEDATA. Speech Synthesizers. Newington, Connecticut: and foot pedals to provide the pitch, timing, and ABLEDATA, 1989. intensity of speech. Dudley’s machine was called a Chong, Curtis. “Speech Output for the IBM Personal voice coder, but soon became known as “The Computer.” The Braille Monitor (January 1986): 37–47. Hagen, Dolores. Microcomputer Resource Book for Special Voder.” Education. Reston, Virginia: Reston Publishing Com- Many commercially available personal-company Inc., 1984. puter software programs may be used with synthe- Lauer, Harvey, and Leonard Mowinski. Recommending sizers that read material that appears on the Computers for the Visually Impaired: A Moving Target or a computer screen or information sent to it from the Losing War? HealthNet Library. Columbus, Ohio: Com- computer. puServe, 1989. Speech synthesis may be used to access personal electronic mail and general print information as syphilis A venereal disease caused by the spiro- well. Electronic mail or E-mail is a system of receiv- chete Treponema pallidum. The disease may cause ing and sending personal communications through ocular disorders both congenitally and after birth. the personal computer. It is an instant, and with Approximately 800 cases of congenital syphilis the use of Braille printers or speech synthesis, pri- were reported in 1998. Syphilis is transmitted con- vate form of communication accessible to individu- genitally from the infected mother to the fetus als with visual impairments. through the womb after the fourth month of preg- General print information is accessible via nancy when the spirochete can pass through the speech synthesis through reading machines such as placenta. Congenital syphilis may result in vision the Kurzweil Reader. Printed material placed on loss and ocular impairment, deafness, dental defects, the scanning screen is scanned and read aloud. The mental retardation, organ damage, and death. voices of synthetic speech read English words and Ocular damage may involve severe KERATITIS,or numerals and are available in various forms of corneal inflammation, and chorioretinal scarring. male, female, or robotic voice, adult or child voice, Although the infection is present at birth, the ker- voice pitch, speed, and volume. Some synthesizers atitis may develop later in life between ages 5 and offer foreign languages, talking calculators, singing, 25. Severe keratitis may be treated with medication music with several octaves of pitch, musical key- but may result in corneal opacification and PHOTO- boards, and sound effects. PHOBIA. 224 syphilis

Syphilis contracted after birth can cause chori- the early stages, the damage resulting syphilis may oretinal scarring, IRITIS (an inflammation of the be mild. Congenital syphilis can be prevented if the iris), and OPTIC NERVE atrophy or degeneration. disease of the mother is treated and controlled Syphilis can be diagnosed with a Wasserman test, a before the fifth month of pregnancy. Toward this blood test to determine the presence of the spiro- purpose, most states have developed laws that chete in the blood. An eye examination may also require testing for syphilis at the beginning of each determine the presence of the disease and is often pregnancy. (See VENEREAL DISEASE.) used to confirm the diagnosis. Centers for Disease Control. “Congenital Syphilis— Syphilis is treated with ANTIBIOTICS, and ocular United States,” 1998. www.cdc.gov., 1999. disorders are treated with medication. If treated in T tactile aids Tactile aids provide information that A raised-line drawing kit is a board covered with visually impaired individuals access through the a soft underlay of rubber. The user places a sheet of sense of touch. These may include braille materials, acetate over the board and draws on it, creating braille-marked tools, or adaptive aids. raised lines and an embossed picture. Braille materials, printed materials that are read Tactile color is a standardized system of 12 dis- with the fingertips, are reproduced by transcribers, tinctive colors, each assigned a specific texture. publishers, and printing houses such as the AMERI- This allows visually impaired persons to better par- CAN PRINTING HOUSE FOR THE BLIND. Braille markings ticipate in creating or enjoying visual artwork. It is are found on adaptive aids such as rulers, measur- also useful in map-making, for labeling, and as an ing cups, and clocks in place of printed letters or educational resource. numbers. A Braillewriter is a six-key typewriter for A thermoform machine is a device that heats a typing braille. It produces raised dots onto specially sheet of plastic paper so that it may be molded to designed, heavy braille paper. whatever shape is placed beneath it. Thermoform The SLATE AND STYLUS are writing tools used to machines produce copies of braille and can be used write braille. The user places a sheet of braille paper to create raised line maps or graphs. between the two metal plates of the slate. The sty- TACTILE MAPS and globes are three-dimensional lus, a short metal prong fastened to a handle, is maps that are used as an orientation aid. They con- held in the palm and pressed downward onto the tain raised surfaces, textures, and braille markings paper within an open window. The stylus pushes and are designed to be read with the fingertips, in the paper against the corresponding indentation of a manner similar to braille. the braille cell dot on the bottom plate. A raised dot The Cranmer abacus is an abacus that has been is formed on the reverse side of the paper. The writ- adapted to prevent the beads from accidentally ing is read when the paper is turned over and the sliding. It is used to perform mathematical compu- dots are facing upward. tations. Templates and writing guides are frames used in The Optacon is a reading machine that converts writing on lines or in specified spaces. Window print into tactual letter configurations. The user openings in the templates serve as a guide for sign- scans a small camera over a line of print with the ing checks or writing letters. Raised line paper is right hand, while resting the left hand on an elec- writing paper with embossed lines to enable the tronic array. The machine electronically converts user to follow a straight writing path. each letter into a print letter configuration formed PAPERLESS BRAILLE or cassette braille is an infor- on the array by vibrating pins and read by the left mation system that is stored on audio cassette tapes index finger. and accessed in braille. The user runs his fingers See ADAPTIVE AIDS. over display cells to read the text and pushes a button to access the next segment of recorded material. The user can produce, edit, and record braille tactile maps Tactile maps or globes are three- with the system. It can be adapted for use with dimensional maps that may be used by visually computer terminals, calculators, and typewriters. impaired persons as an orientation aid. As opposed

225 226 talking books to large-print maps that label areas with large print talking books See NATIONAL LIBRARY SERVICE FOR and thick, dark lines on a contrasting light back- THE BLIND AND PHYSICALLY HANDICAPPED. ground, tactile maps contain raised surfaces, textures, and braille markings. They are designed to be targeted jobs tax credit See WORK OPPORTUNITY read with the fingertips, in a manner similar to TAX CREDIT. braille. Tactile maps may be used to represent countries, states, cities, or site locations. Tactile maps are com- tarsorrhaphy A surgical procedure in which a monly found in large publicly used facilities such as section of the eyelids is stitched together at the cor- hospitals, hotels, universities, airports, and train ner of the eye. The surgery may be performed in stations to enable visually impaired visitors to nav- the treatment of dendritic ulcers, Bell’s palsy, thy- igate independently. roid disease, or any disorder in which the eye is in Geographic embossed tactile maps are profes- danger of overexposure or drying. Tarsorrhaphy is sionally available, but instructors often produce reversible and may be used temporarily. their own maps for students when commercial maps are not available. tax benefits Additional income tax deductions Tactile maps may be produced in a variety of are available to legally blind individuals. The ways. An instructor may trace a map onto paper amount that may be deducted varies depending placed on top of a piece of screening material. The on marital status and age. A married blind indi- underlying screen forces holes to form in the paper vidual, for instance, may deduct an additional as it is traced. The student traces the line of holes to $850. Single blind individuals may deduct an follow the map lines. additional $1,100. To qualify for the deduction, an Aluminum foil is also used as a map material. individual must be legally blind, which means he Several layers of cloth or foam padding is placed on or she must have a visual acuity of 20/200 in the a table. A sheet of foil is placed on top and the better eye, after correction, or a visual field of 20 reverse side of the map is placed on top of the foil. degrees or less in the better eye after correction. The map is traced in reverse onto the foil, resulting The individual must attach to the tax return a in a raised line map in the foil. Water is differenti- statement from an ophthalmologist confirming ated from land by using cross-hatching marks or legal blindness. dots. Similar methods include using dried glue to Some medical expenses, such as eyeglasses, nec- make raised lines, felt areas pasted onto a card- essary home improvements, dog guides, tuition for board backing, and raised-line drawing kits. special education, prosthetic eyes, and, in some Professional quality maps can be produced with cases, attendant care, also may be deducted from thermoform, the method used to reproduce braille income if itemized. books. Thermoform is a device that heats a sheet of plastic paper so that it may be molded to whatever shape is placed beneath it. Using a thermo- Taylor slate One of the earliest manipulative/ form machine, an instructor places a tactile aids for visually impaired students studying topographical map, including braille lettering, into mathematics. The slate measures about 11 by 17 the device and reproduces it onto a plastic ther- inches, with holes running across and up and moform page. down in columns. Each hole looks like a plus sign Tactile maps are approached systematically. The (+) overlying an “X.” The one-inch pegs have the outlines or borders are first traced, and then the same shape as the holes and are stored in a tray on inner portions of the map are read. Tactile maps the slate when not in use. At one end of each peg may be larger than standard print maps or may there is a bar, and at the other end there are two cover a smaller portion of an area in a larger size conical projections. The angle at which each peg is map in order to accommodate reading by finger- inserted into the hole determines the numerical tips. (See ORIENTATION AIDS.) value represented. Very popular through the tear system 227

1930s and into the 1940s, the Taylor slate is no second layer is composed of watery tears from the longer used. lacrimal glands, and the third layer, which lies next to the cornea, is of mucouslike consistency and is teacher-consultant The teacher-consultant produced by accessory glands. The layers are main- model is one of five major education models or tained by constant blinking and are all necessary plans for the instruction of visually impaired stu- for proper health of the eye. Tears are constantly being produced and drained dents; the other models are RESIDENTIAL SCHOOL, from the eye. They drain through lacrimal puncta, SELF-CONTAINED CLASSROOM, RESOURCE ROOM, and holes in each inner corner of the upper and lower ITINERANT TEACHER. The teacher-consultant is a special educator lids. The tears are gathered in the lacrimal sac, an organ at the junction of the nose and lower lid. The who advises regular classroom teachers, teacher tears then pass under the tissue to drainage ducts in aides, administrators, and other school personnel the nasal cavity. in methods that will meet the visually impaired The nasolacrimal system is subject to functional student’s needs. The greatest proportion of the disorders, obstructions and infections that may work is consultative, rather than instructive. The result in WET EYE, DRY EYE, or DACRYOCYSTITIS. Inad- teacher-consultant travels from school to school equate drainage of tears leads to wet eye. Wet eye and often from county to county to work with per- may be a congenital or acquired condition. Con- sonnel. Since traveling time is significant, little genital wet eye occurs as a result of obstructions to time remains for direct instruction with the stu- the nasolacrimal ducts. Symptoms include tearing, dent. crusting of the lids or eyelashes, mucous discharge, The teacher-consultant model works best for and inflammation of the lacrimal sac. students who work independently and require Obstructions often clear spontaneously within minimal skills training. The program is least effec- the first 12 months of life. After this time, obstruc- tive for students who require intensive skills train- tions are cleared surgically by simple probe and ing or lack coping behaviors for study in a regular irrigation or silicone intubation procedures or the classroom. more serious surgical procedure, dacryocystorhi- Barraga, Natalie C. Visual Handicaps and Learning. Bel- nostomy, which connects the lacrimal sac to the mont, Calif.: Wadsworth Publishing Company Inc., nasal cavity. 1976. Acquired obstructions usually occur in middle Scholl, Geraldine, ed. Foundations of Education for Blind age, and most commonly among women. Tearing and Visually Handicapped Children and Youth. New York: becomes severe and annoying. The simple proce- American Foundation for the Blind, 1986. dures of probe and irrigation or silicone intubation are often ineffective, and a dacryocystorhinostomy tear system The tear or nasolacrimal system is is indicated. the system that the eye uses to produce, maintain The condition of dry eye may occur as a result of and eliminate tears from the eye. Tears protect, poor tear production (called keratoconjunctivitis nourish, and moisturize the eye. Without proper sicca), poor tear quality, or inadequate blinking, tear function, as in dry eye, the CORNEA and CON- which leaves the eye open to the drying elements JUNCTIVA may become dry and develop disorders. or which does not properly wet the entire surface In the normal eye, the tear film is made up of of the eye. three layers, which are produced by the lacrimal Symptoms of dry eye include burning, irritation, gland and accessory lacrimal glands and cells. The redness, and loss of corneal luster. Conditions that lacrimal glands are located in the ORBIT and inner can cause dry eye include SARCOIDOSIS, rheuma- eyelid. The accessory glands and cells are located in toid arthritis, vitamin-A deficiency, pemphigoid, the conjunctiva. TRACHOMA, Stevens-Johnson syndrome, chemical The top layer of tears is formed by the secretion burns, neuroparalytic and exposure KERATITIS, and of the meibomian glands and is oily in nature. The AGING. 228 technology

Dry eye may lead to corneal damage, permanent The telebraille can be used to communicate with corneal scarring, and opacification. Once the other standard TDDs over telephone lines or as an cornea has opacified, vision is lost. aid in communication for deaf-blind persons. In a Treatment of dry eye includes treating the conversation, the sighted person types words onto underlying cause or disease and the administration the standard TDD unit. The text is translated into of artificial tears. In some cases, ANTIBIOTICS may be braille and is read by the deaf-blind person on the prescribed, and the use of home vaporizers or refreshable display. To reply, the deaf-blind person humidifiers may be advised. Surgery may be per- types words on the braille keyboard, they are transformed to close the tear drainage ducts to ensure lated to text and read by the sighted person on the better utilization of reduced tear production. If the visual display. There have been several versions of cornea is severely scarred and vision is lost, a the telebraille. The latest is TeleBraille III. CORNEAL TRANSPLANT, or keratoplasty, may be indicated. However, those with dry eye conditions are Telephone Pioneers of America A service-ori- generally poor candidates for a successful corneal ented fraternal group made up of current and transplantation. retired employees with 15 or more years of service Dacryocystitis is an inflammation of the tear within the telephone industry. Established in 1911, drainage sac caused by an infection. It usually the membership has grown to 800,000 members affects one eye only and may become a chronic dis- and maintains a budget of $4 million. order. It is most commonly found in adult females, The organization sustains three goals: fellowship, and may be caused congenitally, from a blockage or loyalty, and service. Fellowship and loyalty goals are obstruction of the tear duct or from a trauma or met by providing opportunities for telephone injury. The resulting infection is caused most often employees to develop friendships, accurately pre- by bacteria such as Staphylococcus aureus and beta- serve the history of telephone technology, and hemolytic streptococcus, and by fungi such as Can- acknowledge the contributions of members. dida albicans. Symptoms may include constant Service programs provide services to the dis- tearing, swelling, discharge, and tenderness of the abled, including braille transcription, talking book eye. A culture of the discharge may identify the recording, support of eye banks, and development infecting agent. and repair of communication, mobility, and recre- Dacryocystitis is usually treated with warm ational aids. Additional programs encompass vol- compresses and topical or systemic antibiotics. unteer hospital services, work with the elderly, Blocked nasolacrimal ducts of infants may be mas- education, safety and health programs, and collec- saged to encourage dilation. If the duct fails to tion drives. open, it may require probe and irrigation therapy. Telephone Pioneers of America maintains 84 If the condition produces an abscess, it may be chapters in the United States, Canada, and Mexico. drained. They hold a yearly convention and print a quarterly publication, The Telephone Pioneer. technology See COMPUTERS. Contact: Telephone Pioneers of America telebraille A braille telephone device for 930 15th Street, Suite 1200 deaf-blind persons. Manufactured by TELESENSORY Denver, CO 80202 SYSTEMS, INC., the device is a modified TDD 303-571-1200 (ph) (telecommunications device for the deaf) system, 303-572-0520 (fax) which provides braille input and output. The sys- www.telephone-pioneers.org tem contains a standard TDD, including a standard alphabet keyboard and visual character display, Telesensory Systems, Inc. (TSI) A company plus a braille keyboard and refreshable braille dis- that designs, manufactures, and markets equip- play. ment for blind and visually impaired persons. The terminology 229 company was founded in 1970 when four mem- diagnosed and defined by a medical doctor. A visu- bers of the electrical engineering department at ally impaired person may range from an individual Stanford University developed the technology that with no sight to someone with low vision. was the basis for the Optacon, a portable electronic A disability is the effect the impairment has on print-reading device that was the company’s first the individual to function. It is the limitation, product. The Optacon was developed specifically to restriction, or disadvantage due to the malfunction. help the visually impaired daughter of one of the The word handicap stems from “cap in hand,” a inventors. reference to beggars. Because of this negative con- Today, the company provides personal comput- notation, the word disability is often the preferred ers, scanners, speech-output systems, video magni- term. A handicap may be defined as a disadvantage fiers, braille-based computer systems, braille in the performance of tasks as a result of expecta- printers, and closed-circuit television systems. TSI tions or attitudes about the impairment. Disabilities has more than 300 dealers, distributors, and are not necessarily handicaps. When the term visu- resellers across the United States, and its products ally handicapped is applied to a child it usually are available in 50 countries around the world. It refers to the requirement for special educational maintains sales offices in London, Paris, New York, provisions due to the sight loss. Detroit, Tampa, and Phoenix. Visually limited refers to an individual’s difficulty Contact: in using vision under average circumstances. A visually limited person may be able to see with cor- Telesensory Systems Inc. rective lenses or optical aids. 520 Almanor Ave. Blind is a term many reserve for those with no Sunnyvale, CA 94086 vision or light perception only. Legally blind is a 408-616-8700 (ph) term defined by the federal government to deter- 408-616-8720 (fax) mine eligibility for benefits. Legal blindness www.telesensory.com involves central visual acuity of 20/200 or less in the better eye with correction or a field of vision of terminology There is no complete consensus on 20 degrees or less in the better eye with correction. terms concerning the topic of blindness and vision Partially sighted or partially seeing is defined as a impairment. Rehabilitation experts, doctors, edu- central visual acuity between 20/70 and 20/200 in cators, legislators, and other leaders in the field the better eye with correction. Low vision is defined determine and define terminology according to as a central visual acuity of between 20/50 and their own preferences and viewpoints. 20/200 in the better eye with correction or a visual Over the past 150 years, visual impairments field of 20 to 40 degrees or less in the better eye have been described by numerous terms, including with correction. Low vision, partially sighted, and medically blind, economically blind, braille blind, visually impaired are often used interchangeably to educationally blind, functionally blind, partially describe individuals with some usable vision, seeing, partially blind, vocationally blind, legally regardless of how little. blind, low vision, visually defective, visually hand- Fully sighted individuals are those who have cor- icapped, visually impaired, visually disabled, and rectable vision to 20/20. The terminology does not visually limited. In recent years, those involved in include a term for those individuals with cor- the field of blindness and vision impairment have rectable vision between 20/20 and 20/50. These made strides to standardize terms to eliminate con- people fall between the definitions for the terms fusion or misinterpretation. The following defini- fully sighted or low vision. tions combine common aspects of terms drawn American Foundation for the Blind. Low Vision Questions from a variety of sources. and Answers. New York: AFB, 1987. An impairment refers to a recognizable defect or Barraga, Natalie C. Visual Handicaps and Learning. Bel- malfunctioning of an organ or any part of the body, mont, California: Wadsworth Publishing Company such as an eye. The defect or malfunction can be Inc., 1976. 230 thermoform

ERIC Clearinghouse on Handicapped and Gifted Chil- including diarrhea, constipation, cramps, nausea or dren. ERIC Digest: Visual Impairments. Reston, Virginia: vomiting. Reactions such as sore throat, fever, ERIC, 1982. blood system disorders, or upper respiratory diffi- Foundation for the Junior Blind. California Services for Per- culties indicate an allergy to the drug. sons with Visual Impairments. Los Angeles: FJB, 1987. Psychotropic or psychiatric drugs may interact Kelley, Jerry D., ed. Recreational Programming for Visually with Timolol to cause serious problems. Timolol Impaired Children and Youth. New York: American Foundation for the Blind, 1981. raises the effectiveness of antidiabetic medications. National Association for Visually Handicapped. Problems Physicians of diabetics taking Timolol may need to of the Partially Sighted. New York: NAVH, 1980. reduce present dosages of insulin or oral medica- National Information Center for Handicapped Children tion while the patient is taking Timolol. Timolol and Youth. General Information about Handicaps and Peo- also lowers the effectiveness of digitalis, so physi- ple with Handicaps. Washington, D.C.: NICHC, 1982. cians of heart-disease patients may need to increase Scholl, Geraldine T. Foundations of Education for Blind and the dosage of digitalis while the patient takes Tim- Visually Handicapped Children and Youth. New York: olol. Timolol may also interact with certain pre- American Foundation for the Blind, 1986. scription blood pressure medications and over-the-counter cold remedies. These should not thermoform A thermoform machine or duplica- be taken with Timolol without a physician’s advice. tor is a device that heats a sheet of plastic paper, Symptoms of Timolol overdose include heart called BRAILON, so that it may be molded to what- failure, decreased heart rate and blood pressure, ever shape is placed beneath it. Thermoform and upper respiratory problems. Overdose patients machines produce copies of braille and can be used require proper treatment at a hospital emergency to create raised-line maps or graphs. The user room. Timolol should be decreased slowly, over a places a sheet of thermoform plastic over a page of period of time. Abrupt discontinuance can cause braille or topographical material and inserts it into serious problems. the machine. The duplicator reproduces the material onto the Brailon sheet. tobacco amblyopia A condition in which the vision is lost due to the use of tobacco. The toxic Timolol A drug, in the form of timoptic eye drops effects of tobacco constrict the vessels of the body or Blocadren tablets, prescribed for open-angle and interfere with circulation. As a result, the OPTIC GLAUCOMA and high blood pressure. The drug is a NERVE swells, a condition known as optic neuritis. beta-adrenergic blocking agent that also decreases Early symptoms of tobacco amblyopia include the amount of fluid produced within the eye and painless blurring or loss of central vision that may increases the fluid elimination rate. The drug has be accompanied by numbness or tingling in the fin- been found to lower intraocular pressure by 26 to gers. If allowed to progress, the blurring may 38 percent. spread to the peripheral visual fields, and optic Timolol should not be used by pregnant or nurs- nerve damage may result. Reduction or elimina- ing women or those who cannot tolerate oral beta- tion of tobacco usage in conjunction with proper blocking drugs. Care should be exercised by those nutrition usually restores vision. Patients may be with upper respiratory disorders such as asthma, instructed to supplement the diet with additional hay fever, or allergies. Some patients may suffer vitamins, such as B12. side effects that include decreased heart rate, increased possibility of congestive heart failure, tomography Also known as computerized axial lowered blood pressure, insomnia, tingling in the tomography, tomography is a test that records the arms or legs, dizziness, depression, and fatigue. way tissues react when exposed to X rays. The Patients may also experience visual problems, computerized process measures the resistance of including hallucinations, disorientation, personal- the soft tissues to the passage of the rays and trans- ity change, memory loss, and abdominal disorders lates the measurements to pictures on film or video toxocariasis 231 screen. The process intensifies and contrasts sec- the deficiency of nutrients. The condition, also tions of the eye, eye orbit and brain, which are known as nutritional amblyopia, is usually bilat- indistinguishable with X rays alone. eral, and although in the case of wood alcohol and The process is a computer scan that can isolate arsenic poisoning the vision loss is irreparable, it segments of the eye as slight as three millimeters generally tends not to be permanent. thick. It can outline the CRYSTALLINE LENS apart Some poisons induce a central vision blurring or from the surrounding AQUEOUS FLUID and point out scotoma, a blind spot. These include tobacco, ethyl tumors to the back of the eye, such as in the alcohol, methyl alcohol, carbon disulphide, halo- CHOROID, which would be invisible to standard X genated hydrocarbons, aromatic amino and nitro- rays. Computerized axial tomography can often be compounds, sedatives such as barbiturates, opium, used as a safer alternative to more expensive and and morphine, anti-infective compounds and other risky procedures that require hospitalization, such drugs, and the metals lead and thallium. as injection of air or radiopaque dyes. Other compounds produce a reduction of the peripheral field, or tunnel vision. These include tonography A test to determine the fluid pres- organic arsenic, quinine, carbon tetrachloride, sure within the eye, called intraocular pressure. methyl iodide, and the drugs salicylic acid, hydro- The test is conducted as part of the routine annual cupreine derivatives, ergot, and aspidium. eye examination. Alcohol and tobacco amblyopia are common A tonometer is used to conduct the test. This is a conditions. Overuse of either compound affects the small instrument probe that is attached to a biomi- OPTIC NERVE and OPTIC DISK, causing optic atrophy. croscope or slit lamp. The biomicroscope is an A slow, progressive loss of central vision and, often, instrument that illuminates and magnifies the front color vision follows. Both conditions are associated part of the eye. The examiner looks through the with poor nutrition or diet, which also affects ocu- biomicroscope as the test is conducted. lar function. Treatment with VITAMINS and minerals The test is painless. The eyes are prepared by as well as reduction of alcohol and tobacco use first inserting anesthetic drops. Next, the examiner often restores vision. gently touches a strip of paper laced with fluores- Vitamin and mineral deficiencies are linked to cein dye to the inside of each lower lid. The nutritional amblyopia. Lack of vitamin A in the diet released orange dye mixes with the eye’s tears and causes blindness. A lack of zinc prevents the body from using adequate vitamin A stored in the body. covers the CORNEA. The examiner shines a blue light on each eye Thiamine and B12 deficiencies may cause optic and then gently touches the cornea with the neuropathy and vision loss. Generally, intensive tonometer. When the probe touches the cornea, a vitamin therapy and proper nutrition can restore pattern is created in the dye. The intraocular pres- lost vision. sure is measured by the amount of force needed to create the pattern. A normal reading varies from 14 toxocariasis An infection caused by dog tape- to 21. A higher reading may indicate the presence worm eggs called Toxocara canis. Human infection of GLAUCOMA. The procedure is regularly performed occurs with ingestion of infected fecal material. An as a glaucoma screening test and often is a step in estimated 10,000 cases of toxocariasis occur annu- presurgical evaluations to determine whether ally in humans in the United States. surgery is immediately prudent. The larvae causes acute CHORIORETINITIS,an inflammation of the CHOROID and RETINA. The infection spreads rapidly, involving the VITREOUS tonometer See TONOGRAPHY. and clouding it with inflammatory cells. As the center portion of the globe becomes involved, the toxic amblyopia A condition in which vision is condition is termed ENDOPHTHALMITIS. Complete lost as a result of the absorption of toxic agents or loss of sight in the affected eye may result. The 232 toxoplasmosis condition may be treated with steroids, and VITREC- priate for use by those with little or no vision, TOMY (removal and replacement of the vitreous) others, which have been specially adapted, are may be performed in advanced cases. available through adaptive-aids catalogs and organizations that serve the visually impaired. toxoplasmosis An infection caused by the para- Many games differ little from the original ver- site Toxoplasma gondii, a protozoan carried by wild sions and merely require tactile markings for num- or domesticated animals such as cats. Toxoplasmo- bers, letters, or space delineation to be adaptable. Others are original games specially designed for the sis causes CHOROIDITIS (or posterior uveitis), an needs and goals of the visually impaired. inflammation of the CHOROID. More than 60 mil- Board and card games are adapted with raised lion people in the United States are probably dots, braille, large print, a change in playing pieces infected with the toxoplasma parasite, according to or some other type of tactile marking. Playing cards the Division of Parasitic Diseases of the Centers for are printed in large print, braille, or a combination Disease Control and Prevention. Very few people of the two for use by both sighted and visually develop symptoms, however, because the immune impaired players. system keeps the parasite from causing illness. Checkers is played on an adapted board with Toxoplasmosis occurs when the parasite infects raised and recessed squares using square and round the body and enters the blood stream through playing pieces. Chess is played on a similar board ingestion of infected material. Adult infection is which may be drilled to hold pegs projecting from usually moderate, but the parasite may be trans- under the chess pieces. Since each piece is distin- mitted through the placenta and can cause serious guishable by shape, the only adaptation may be a infections in children. Congenital toxoplasmosis point on top to distinguish the white from the affects the brain and eyes and may cause epilepsy black. or mental developmental problems. Both eyes may Many popular games such as Monopoly, Scrab- develop choroiditis or CHORIORETINITIS of the macu- ble, bingo, backgammon, cribbage, dice, dominoes, lar region, a vision-threatening disorder. Chinese checkers and tic tac toe have been modi- The Toxoplasma parasite lives in fundus lesions of fied with large print, braille, or shape changes for the eye, which can be dye tested to confirm a diag- use by the blind and visually impaired. Board nosis. However, the diagnosis must be carefully games can be adapted at home by adding glue dots made since a large portion of the population has or lines that harden when dry or large-print or been infected with the parasite at some time even braille labels. though they may be unaware of any symptoms of Puzzles are available in a variety of forms rang- the infection. ing from children’s puzzles, which chime or play a Symptoms of toxoplasmosis chorioretinitis or tune when the pieces are in place, to large-print choroiditis include blurred vision and the appear- crossword puzzles, to the tactually marked Rubik’s ance of floaters, possibly preceded by a fever. Treat- Cube. ment of the condition is unsatisfactory but may Balls of all types, including basketballs and out- include systemic steroids or a combination of door game balls, are available with bells or elec- steroids and antibiotics if the infection threatens tronic beepers placed inside to alert the visually the macular region of the retina. impaired user as to the location of the ball. Other Most cases resolve themselves over time, leaving adaptations for sports exist, including a bowling chorioretinal scarring near the macula. Recur- rail, which is placed next to the aisle as a bannister rences are common and tend to originate on the guide for visually impaired bowlers. borders of scarred areas. Educational toys and games for children are See UVEITIS. available in a myriad of designs. They range from simple tactual clocks to more sophisticated toys, toys and games Although many familiar toys such as the Flexi-Formboard (developed at SMITH- and games played by sighted individuals are appro- KETTLEWELL EYE RESEARCH INSTITUTE, available from trachoma 233

Adaptive Communication Systems), which con- such as inflammation, scarring, and healing of the tains plastic shapes that fit into a corresponding drain. puzzle board. Placing a shape in its correct location Complications associated with trabeculectomy on the board activates a battery-operated toy. include flattened anterior chambers, scarring of the Other such games include modules to teach fine drainage site (which results in continued glau- motor skills, braille and large-print spelling coma), infection, inflammation, and hemorrhage. machines, math and reading games, bright or fluo- Approximately one-third of all trabeculectomy rescent materials to stimulate visual interest in chil- patients develop CATARACTS. (See SURGICAL PROCE- dren with low vision, sensory-stimulation games, DURES.) biology and science models, and TACTILE MAPS and globes. (See SPORTS AND RECREATION.) trachoma A contagious disease of the eyelids, CONJUNCTIVA and CORNEA. It is a leading cause of trabeculectomy A surgical procedure performed blindness in the world and may affect over 500 mil- to treat open-angle GLAUCOMA, a condition in lion people. It has caused blindness in about 6 mil- which the intraocular pressure builds within the lion people according to the World Health eye to cause damage and vision loss. Organization. While practically unknown in the Intraocular pressure is controlled by the flow of United States, the infection is widespread in under- AQUEOUS FLUID, a watery liquid that flows through developed countries with poor sanitation and med- the ANTERIOR CHAMBER, nourishing the avascular ical care. LENS and CORNEA and carrying away waste. The Trachoma is caused by the bacteria Chlamydia intraocular pressure rises when the aqueous fluid trachomatis and may be linked to bacterial infec- of the anterior chamber is unable to properly drain tions caused by agents Koch-Weeks bacillus, Morax from the eye through the trabecular meshwork. Axenfeld diplobacillus, and the gonococcus bacil- A trabeculectomy bypasses the damaged mesh- lus. It thrives in overcrowded conditions in which work drainage systems and creates a new drainage a lack of clean water and poor sewage disposal, duct from the eye. During the procedure, the sanitation, and hygiene exist. In such conditions, SCLERA, or white part of the eye, is dissected to the highly communicable disease may infect an make a “trapdoor” opening or flap. A block of tis- entire community. sue as thick as the sclera and corneal tissue and The infection attacks both eyes, scarring the containing trabeculum is removed. conjunctiva inside the eyelid and eventually Often, an IRIDECTOMY is then performed. A spreading to the cornea. Initial symptoms include peripheral iridectomy is the removal of a peripheral pain, oversensitivity to light, and impaired vision. section of IRIS blocking the anterior angle and The eye produces a surplus of tears and a dis- deterring aqueous fluid drainage. charge. Muscle spasms develop in the eyelids, and After the iridectomy, the opening is sutured shut the eyelashes turn inward, which further inflames in a loose stitch that will serve as a trapdoor the cornea. As the cornea becomes more scarred, drainage canal for the aqueous and relieve the it becomes more opaque, and blindness may intraocular buildup. The conjunctival covering of result. the sclera is then stitched closed. Trachoma can be successfully treated in the A trabeculectomy is performed with local or early stages with sulpha drugs, ANTIBIOTICS,or general anesthesia in a hospital operating room. surgery. Advanced stages of the disease resist treat- The procedure usually takes less than an hour. The ment and often result in blindness. A drug called patient remains hospitalized for up to three days, azithromycin is being used in some countries, with and eye drops are prescribed for up to one month. good results. Trachoma can be prevented by Heavy lifting, bending or strenuous activity is not improving sanitary conditions, such as the water permitted for one month. The results of trabeculec- supply, personal hygiene, and medical care. (See tomy surgery vary greatly, depending on factors WORLD BLINDNESS.) 234 Transceptor Technologies, Inc.

Transceptor Technologies, Inc. A company that national priority, including accessibility to mass produces the Personal Companion, a voice-driven transportation by elderly and disabled persons. communication system designed to aid the blind, 2. The Urban Mass Transportation Technical Stud- visually impaired, and physically disabled user. The ies Program funds grants for planning, engi- companion reads newspapers, personal correspon- neering, and designing mass-transportation dence and records, enters checkbook data, takes projects, including those specially designed with notes, files information, and dials and answers the accommodation for elderly and disabled passen- telephone. gers in mind. The Personal Companion is activated by the 3. The Urban Mass Transportation Demonstration user’s voice when spoken through the microphone. Grants Program funds demonstration projects Through voice commands, the user accesses the that improve accessibility using innovative Library for electronic national information net- methods. works, the Phone Management System (which automatically dials, receives calls, and takes The National Mass Transportation Assistance Act messages), a calculator for arithmetic functions, of 1974 amended the Urban Mass Transportation the Notepad to take notes and make lists, the Date formula-grant program by requiring project ap- Book to record appointments and set reminders, plicants to set fares for elderly and disabled passen- the Appliance Controller (which turns any ap- gers traveling at nonpeak hours at one-half the pliance on or off), and the Bank Book for record- normal, peak-hour fare price. The amendment ing information on both savings and checking allowed local transportation systems which trans- accounts. port elderly and disabled persons for free to remain Model 100 is designed for the blind and contains eligible for federal formula-grant aid. no monitor. Model 100/M is designed with a mon- The Surface Transportation and Uniform Reloca- itor that displays regular or large print for visually tion Assistance Act of 1987 required the Secretary impaired or physically impaired users. Model of Transportation to conduct a feasibility study for 100/MPC allows running of IBM-PC compatible standards development for UMTA-funded pro- software. grams concerning tactile aids to improve accessibil- Contact: ity to blind and visually impaired passengers. The Omnibus Budget Reconciliation Act of Transceptor Technologies, Inc. 1987 founded a three-year demonstration project 2001 Commonwealth, Suite 205 operated by the Easter Seal Society to improve Ann Arbor, MI 48105 accessibility to transportation for disabled persons. 313-996-1899 The program uses UMTA funds to develop methods for identifying disabled persons with- transportation laws Congress has enacted legis- in the community, outreach strategies, and train- lation that protects the rights of disabled persons, ing programs for transit operators and disabled including those with visual impairments, to use persons. public transportation. The Surface Transportation and Uniform Reloca- As amended in 1970, the Urban Mass Trans- tion Assistance Act of 1987 authorized a 95 percent portation Act of 1964 (UMTA) requires that mass federal share of the cost for specific capital transportation facilities and services be designed to improvement projects (excluding those required by accommodate use by elderly and disabled persons. federal law) that improve accessibility to elderly A program of grants and loans was authorized in and disabled persons using mass transportation. the act to fund such facilities and services. The act authorized grant assistance for programs The act established three programs: that concern human-resource needs relating to mass transportation. 1. The Mass Transportation Technology Research The Federal-Aid Highway Act of 1973 autho- and Demonstration Program funds projects of rized use of highway improvement funds to trauma 235 improve accessibility to disabled and elderly pas- normal vessels to clot. This stops the blood vessels sengers using transportation facilities. from leaking, and reduces the size of lesions in the The Rail Passenger Service Act as amended by area of the blood vessels. This is beneficial because the Amtrak Improvement Act of 1973 founded the the fluid and blood that leak from the vessels dam- National Railroad Passenger Corporation. The cor- age the light-sensitive photoreceptor cells in the poration is responsible for taking all necessary macula. steps to ensure accessibility to disabled and elderly Trials showed that about 20 percent of the 15 persons on all intercity transportation and on pas- patients who participated in a pilot study experi- senger trains operated by the corporation. enced a slight improvement in vision. All but a few The Federal Aviation Act of 1958 as amended in patients showed a notable decline in the thickness 1986 by the Air Carrier Access Act prohibits dis- of the retina, which doctors say indicates that the crimination against disabled persons in the use of growth and leakage of new blood vessels had been air transportation. The act directed the Department stopped—at least temporarily. Researchers are con- of Transportation to promulgate regulations ensur- tinuing to move forward with TTT and say that the ing nondiscrimination “consistent with the safe procedure appears to be promising in the area of carriage of all passengers on air carriers.” treatments for macular degeneration. The Americans with Disabilities Act of 1989, a bill passed by the senate and the House of Repre- sentatives in fall 1990, addresses the issue of public trauma Ocular trauma is any injury to the eye. services including public transportation. It man- Ocular trauma, even seemingly minor injuries, dates that all new transportation facilities and ser- should be examined promptly and thoroughly by a vices (not including air travel) must be accessible to physician. A trauma may be blunt (concussive) or disabled persons and that all new buses and trains perforating (invading the inner eye). An estimated solicited 30 days after enactment of the bill must be half million serious eye injuries occur each year, accessible. with 25,000 of them resulting in blindness. The eyelids are often the first line of defense in U.S. Department of Education. Summary of Existing Legis- an injury, and if closed in time can minimize the lation Affecting Persons with Disabilities. Washington, severity of the injury. However, in protecting the D.C.: USDE, 1988. eye, the eyelids are often damaged. A contusion, or blunt blow from a ball or fist, will result in hemor- transpupillary thermotherapy (TTT) A new rhaging and swelling under the skin. This will experimental laser treatment for patients who have appear as a “black eye” and will heal itself. the wet form of age-related macular degeneration, Minor cuts to the eyelids that are located away especially those who have a condition known as from the lid margin often do not require stitching. occult choroidal neovascularization. However, cuts that involve the eyelid margin are Occult choroidal neovascularization is a condi- considered serious and may require surgical repair tion in which the abnormal blood vessels that grow performed in an hospital operating room. beneath the macula in the wet form of age-related Care must be taken during examination and macular degeneration are hidden beneath layers of treatment to ensure that the eyelid properly closes. tissue. Because a doctor must be able to see the If left uncovered, the cornea could become dam- abnormal vessels in order to treat them with tradi- aged, and loss of vision may result. tional laser therapy or PHOTODYNAMIC THERAPY, Nasolacrimal (tear duct) injuries may result in patients with occult choroidal neovascularization constant tearing and must be surgically repaired. were considered unsuitable for those treatments. Often the area must be allowed to partially heal TTT involves using a low-intensity laser to apply before final surgery can be performed. In this case, heat to the area in which the abnormal blood and in minor injuries of the nasolacrimal area, a vessels are growing. The heat raises the tempe- tiny silicone tube is inserted into the tear duct to rature of the retina, causing the blood in the ab- ensure correct healing. 236 trauma

The CONJUNCTIVA and the CORNEA are subject to Severe contusion involving the LENS may cause injury by foreign bodies, lacerations and burns. The CATARACT, although the process of opacification set conjunctiva is the membrane that covers the white in motion by the injury may take years to mature part of the eye (SCLERA) and the inside of the eye- and be noticeable. A blow may also cause the lens lids. The cornea is the clear protective covering of to become completely dislocated or subluxated the eye. (partially displaced). A displaced lens is associated Foreign bodies may become lodged in the con- with secondary glaucoma. junctiva or cornea. Conjunctival foreign bodies The VITREOUS may hemorrhage or become usually wash out of the eye by the flushing action detached after a blunt injury. Vitreal hemorrhages of the tears. However, foreign bodies that imbed in generally are self-limiting, but a detached vitreous the cornea are painful and require removal by a can result in a retinal tear or detached retina. physician. The retina may hemorrhage and develop macu- Minor lacerations to the conjunctiva are usually lar edema as a result of a contusion. Blows to the not treated. Lacerations that produce significant eye may result in retinal tears which could lead to bleeding in the sclera should be examined for a a retinal detachment. more serious injury. Nonperforating lacerations Blunt injuries may cause tears in the choroid, such as scratches and abrasions, including those optic atrophy, and hemorrhaging into the optic caused by overwear of contact lenses, cause pain to nerve sheath, conditions that can result in perma- the cornea but are usually self-healing. In the case nent vision loss. of corneal abrasion, the cornea can be comfortably Severe contusion injuries such as automobile examined with anesthetic drops, but the continued accidents may involve the side of the cheek and use of the drops is discouraged since they delay one eye. This often results in a blow-out fracture of healing. Treatment may include antibiotic drops the orbit. The orbit is forced backwards, the orbital and temporary eye patching. floor is fractured, and the bone is displaced down- Chemical burns to the cornea are serious and ward. A plastic implant is placed in the floor of the vision threatening. The burns cause permanent, orbit to correct the situation. severe corneal scarring, which precludes vision. Perforating wounds pass the cornea and enter the Burns caused by acid or lye should be flushed inner eye. Perforating injuries are caused by pointed immediately and profusely with water. The eyes instruments such as scissors, darts, sharp tools, or must receive emergency care by an ophthalmolo- glass. Any perforating wound is considered an emer- gist. gency and may be subject to infection. The progno- Thermal burns such as those caused by sunlight sis for the health of the eye and the preservation of are generally not serious to the cornea and are self- the vision depends on the depth of the wound healing or treated with antibiotic drops. There may and the care taken to clean and repair the wound. If be substantial pain, however, and the lids may be the wound penetrates the cornea alone, it may be burned and require treatment. cleaned and sutured with excellent prognosis. Blunt injuries can also cause damage to portions If the lens has been breached, cataract or of the inner eye. Hyphema, hemorrhaging into the aphakia (an eye without a lens) may eventually anterior chamber of the eye can be caused by become the result. If the eye is further invaded, injury. The patient is usually instructed to rest retinal damage and detachment are possible. prone for up to three days to prevent secondary Perforating injuries are treated immediately bleeding, which may cause GLAUCOMA. Blood stain- with a preventative tetanus injection and systemic ing of the cornea may be permanent and cause an and local antibiotics. X rays are often ordered to opacity that interferes with vision. locate the presence of foreign bodies in the wound. Contusion may cause radial tears or splits in the Foreign bodies that breach the inner eye can cause IRIS and CILIARY BODY from the sclera. This may infection and blindness. reduce the angle of the ANTERIOR CHAMBER and Metal particles associated with some occupa- contribute to or cause glaucoma. tions can cause iron salt deposits to gather in the trifluridine 237 eye and result in blindness. The particles can be trephine A surgical instrument used in ophthal- removed with a surgical procedure that employs a mologic procedures. The metal instrument looks magnet. much like a small, round cookie cutter attached to Pellets from pellet guns cause massive damage to a handle. The round section comes in various the eye upon entry. The entire eye is usually enu- diameter sizes, ranging from three to five millime- cleated, or removed. Some glass or plastic particles ters. The size of the trephine is etched onto the that enter the eye may be of materials that are well handle for identification. tolerated by the eye and do not require removal. The trephine is generally used as a marker. Sympathetic ophthalmia must be considered When pressed gently onto the CORNEA, it makes after any perforation injury. This condition a distinct, temporary indentation for the surgeon involves the spread of inflammation from a steadily to follow. The trephine is used in corneal trans- inflamed eye to the uninjured eye over a period of plant surgery to mark duplicate sections of cornea two weeks. from host and donor, and in RADIAL KERATOTOMY The infected eye may be removed during the (RK) surgery, to mark the optical zone for radial two-week period, to prevent sympathetic oph- cuts. thalmia. If the condition develops after the two week period it may be treated with steroids but trichiasis A condition in which the eyelashes may continue to recur. (See INJURIES, PREVENTION grow inward into the eye. The lashes rub against OF BLINDNESS.) the CORNEA, causing pain and infection. This may Galloway, N. R. Common Eye Diseases and Their Manage- occur spontaneously or be caused by an injury, ment. Berlin: Springer-Verlag, 1985. infection, or disease such as trachoma. The lashes Reynolds, James D. Ocular Trauma. HealthNet Library. can be removed with epilating forceps to immedi- Columbus: CompuServe, 1989. ately remedy the disorder. If regrowth is a prob- Rhode, Stephen J., and Stephen P. Ginsberg. Ophthalmic lem, the lash roots can be destroyed by Technology. New York: Raven Press, 1987. electrolysis. travel aids See ELECTRONIC TRAVEL AIDS. trifluridine An antimetabolite drug used in the treatment of ocular herpes. It is also known TravelVision An organization that provides ori- by the names TFT, F3T, and Viroptic. Trifluri- entation and mobility training for visually impaired dine, along with idoxuridine, was one of the first people and their families. It was founded by Kathy drugs developed to treat herpes keratitis, an Zelaya, who is certified by the state of California in inflammation of the CORNEA caused by the herpes clinical rehabilitative services. TravelVision also virus. offers information about long canes, guide dogs, Trifluridine is a toxic drug since it is activated by and other mobility devices, plus a detailed history the enzymes contained in healthy human cells. of the orientation and mobility program. Its staff Since it cannot differentiate between healthy and trains health care workers how to best assist blind viral cells, it may attack and destroy normal cells and visually impaired patients. along with the unwanted viral cells. Because of its TravelVision staff are available to conduct orien- toxicity, trifluridine is not to be taken intra- tation and mobility training in the visually venously. It is available in ointment or drop form impaired person’s own environment. only. Contact: Trifluridine drops are used nine times per day TravelVision for a period of two to three weeks. P.O. Box 10763 Trifluridine is not a cure for herpes keratitis. It is Glendale, CA 91209-0763 effective only when the virus is active in the body. 818 551-0890 It is ineffective during periods when the virus is http://kathyz.home.mindspring.com latent or inactive. 238 trifocal lenses trifocal lenses Three lens prescriptions put into during a period of observation. The cause of one pair of contact lenses or eyeglasses. Trifocal melanoma is unknown. lenses are prescribed when bifocals are not suffi- Retinoblastoma is a malignant tumor of the cient for clear vision at all distances. Those who retina found in young children. The tumor spreads need trifocals are usually over 40 and suffering rapidly and may metastasize up the OPTIC NERVE to from PRESBYOPIA, aging of the eyes. As the eye the brain. ages, it loses the ability to bring close objects into The tumor is hereditary or may develop sporad- focus. ically. The more common sporadic type usually is The three sections of the trifocal include a read- limited to one eye and appears at approximately ing section for close work, a distance section for two years of age. The hereditary type often affects seeing objects five feet away or farther, and a sec- both eyes, appears near one year of age, and can be tion for the midrange between the two. passed to future generations. The placement and size of the segments within Symptoms of retinoblastoma include redness, the lens frame is determined by the wearer’s needs. pain, inflammation, crossed eyes, and change in The largest section is generally the one most often pupil color. Immediate treatment includes enucle- used. ation. In cases in which both eyes are involved, the Trifocal wearers must develop head and eye more affected eye may be removed and the less movements in conjunction with their new lenses. affected treated with radiation, chemotherapy, or It may be necessary to move the head up or down cryotherapy (freezing treatments). in order to match the section of lens to the object Retinoblastoma has one of the highest rates of viewed. spontaneous regression, but little is known about the causes for regression. The development of the tumor is caused by the absence of paired reti- tumors Tissue growths that can form in any part noblastoma genes on the 13th chromosome, a of the body and eye. Tumors may be malignant condition that may occur through heredity or envi- (cancerous) or benign (noncancerous). ronmental conditions. Malignant tumors carry specific characteristics. Metastatic tumors are malignant tumors that The cells of these tumors differ from the cells of the originate in another organ of the body and metas- encompassing tissue, tend to grow quickly and tasize to the eye. Metastatic tumors affect both eyes uncontrollably, do not stop growing once they approximately 25 percent of the time. have reached a particular size, and tend to spread Symptoms of the secondary ocular tumor may or metastasize to other parts of the body. Malignant be apparent before those of the primary tumor. tumors may be life threatening. Symptoms may involve pain, redness, glaucoma, Three common malignant tumors found in the and vision loss or interference. Once a diagnosis has eye are MALIGNANT MELANOMA, RETINOBLASTOMA, been made, the primary tumor is appropriately and metastatic tumors. All are serious disorders treated. Treatment of the ocular tumor may involve that benefit from early diagnosis and treatment. surgery, chemotherapy or radiation treatment. Malignant melanoma is a tumor that develops Basal-cell carcinoma and squamous-cell carci- from the melanin-laden cells in the CHOROID, IRIS or noma are two similar-looking malignant tumors CILIARY BODY. The tumor may develop sponta- found on the eyelids. They each first appear as a neously or from a mole. This type of tumor usually small bump and then develop into a saucer-shape grows and metastasizes at a slow rate and generally with a raised rim. affects one eye only. The tumor is removed and sent for biopsy to Symptoms of melanoma include redness, determine the identity of type. If left untreated, inflammation, vision loss, GLAUCOMA, and distor- the basal-cell carcinoma may spread to the under- tion of the PUPIL. Melanoma is usually treated by lying bone but rarely metastasizes further. enucleation, or removal of the eye, but may be Advanced basal-cell carcinoma is treated with radi- subjected to chemotherapy or radiation treatments ation therapy. tunnel vision 239

Squamous cell carcinoma is a more serious A peripheral field defect affecting all but 10 tumor. It may metastasize to the lymph nodes of degrees of central vision results in mobility difficul- the upper or lower lids. This type of carcinoma may ties but may not limit reading capabilities. A loss be treated with chemotherapy or radiation treat- affecting all but 5 degrees of central vision exposes ment. only the foveal (center portion of the MACULA or Rhabdomyosarcoma is a rare malignant tumor sharpest sight of vision) area. This affects mobility of the ORBIT. It affects children and is characterized and reading capabilities. Since the FOVEA contains by rapid growth. Early treatment with radiation no rods, this loss renders the individual night blind. gives the best hope for a cure. Peripheral-field loss involving tunnel vision may Benign tumors differ little from encompassing be caused by RETINITIS PIGMENTOSA, GLAUCOMA, tissue, grow more slowly than malignant tumors OPTIC ATROPHY, TRAUMA, TUMORS, Leber’s disease, and often stop growing at a certain point. Benign toxic conditions due to drugs, proliferative tumors do not spread to other parts of the body. In retinopathy, and vascular diseases. the case of benign ocular tumor, the growth may Optical aids to benefit those with tunnel vision be left intact if it does not interfere with sight. include prescriptive lenses, contact lenses, intraoc- Benign tumors may develop in any part of the ular lenses, field-expansion devices, or illumina- eye. The strawberry nevus and the cavernous tion aids. Prescriptive or contact lenses ensure that hemangioma are two commonly found in the eye- the remaining central vision is as clear as possible. lids. The nevus, or strawberry nevus, is a tumor Intraocular lenses provide the best possible central that appears as a pinkish or red raised mark on the vision correction for aphakic (without a natural skin. It is present at birth but is often undetectable lens) patients. until later in life when it starts to grow. It rarely Field expansion or widening devices employ becomes malignant and may spontaneously reverse telescopic systems, separate lens loupes, and regress. The nevus may be left untreated. prism systems. Reverse telescopic systems minify The cavernous hemangioma is a deeper tumor the image seen so that more visual information is that may appear as a blue raised area on the lid. included in the residual field. These devices produce The tumor tends to expand during periods of cry- a distortion that some users find distracting. ing. This tumor may spontaneously regress or may Separate loupes, or swing-down, small lenses, be treated by freezing methods. are attached to the prescription lenses frame of Benign tumors of the orbit include the pseudo- some individuals. By rotating the eye, the individ- tumor, or a mass of inflamed tissue found in the ual can use the lens to expand the visual field. PRISMS such as the Fresnel prism are incorpo- orbit. Symptoms of pseudotumor are EXOPHTHAL- rated into prescription lenses or pressed onto MOS, or bulging forward of the eyes, and double vision. If a biopsy reveals nonmalignant tissue, the uncorrective spectacles in sections above and tumor may be treated with steroids. below, or to the sides of the usable central visual field. By moving the eyes or the head slightly, the See CANCER. user can see through the prisms into the restricted field. tunnel vision The common term for the reduced Illumination aids are used to by those with night field of vision seen when a severe loss of peripheral blindness to improve or amplify the available light or side vision occurs. Commonly, a loss of night in the visual field. One such aid, the Night Vision vision accompanies tunnel vision since the rods, Aid (NVA), is an optical device that amplifies avail- which are responsible for night vision, are less able low light up to 800 times within the remain- numerous in the area of central vision. ing field, thus improving mobility.

U ultrasonography The use of sonic waves in oph- The gift or donation can be specified in a written thalmologic tests. High-frequency sound waves are will or document. The document may be as simple used to probe and view the inner eye when other as a card carried by the donor or, as is offered in 43 instruments prove ineffective. The sonic waves are states, a signed section of the driver’s license. How- directed to the eye, and the echoing sounds are ever, family members must confirm the donation at translated into a picture of it. the time of death, so it is important that they be Ultrasonography is used to examine the tissues notified in advance of intent to donate. of the eye for the presence of tumors, retinal The document or card need not be filed with or detachments or fractures. Ultrasonography may be delivered to a government agency. The only re- performed after GLAUCOMA surgery to review quirement needed to validate the document is the results. It is used to take measurements of the eye written intention of the donor, his signature, and or to determine the health of the underlying RETINA the signatures of two witnesses. The document in presurgical tests for CATARACT surgery. becomes invalidated when it is destroyed or muti- The A-SCAN applies ultrasonography to measure lated. The act also allows the next of kin of the the length of the eye to determine the correct deceased to donate all or part of the cadaver, unless strength of intraocular lens needed for cataract the donor left documentation to the contrary. surgery. The B-SCAN uses the sound waves to view The UAGA also contains a section that permits a a retina obscured by a dense cataract. medical examiner or coroner to remove body parts from a cadaver for use in transplantation or therapy. The act lists specific actions to be taken by the See EMPLOYMENT, EMPLOYMENT unemployment official before removal. Within the limits of time DISINCENTIVES. needed to maintain the usefulness of the part, the official must make a reasonable effort to locate and Uniform Anatomical Gift Act (UAGA) Legis- examine the donor’s medical records and provide lation that allows for the donation of the body or the next of kin with the opportunity to approve or body parts, including eyes and CORNEAS, for trans- deny the donation. plantation or research. It was approved by the Twenty-two states have medical examiner sec- National Conference of Commissioners on Uniform tions included in their laws. Of these, 12 require State Laws in 1968. Since that time, all 50 states the medical examiner to take the specified steps and the District of Columbia have adopted some before removal. The remaining 10 do not require form of this act. the official to examine the medical records or The act permits any individual over 18 years of notify the next of kin. age and of sound mind to donate his entire body Two court cases, Georgia Lions Eye Bank Inc. v. or parts of his body to any organ bank, hospital, Lavant and Florida v. Powell, established the consti- medical school, surgeon, or physician. It further tutionality of the removal of body parts (in these allows a donor to specify an individual as the cases, corneas) without the notification and recipient of the organs for therapy or transplanta- approval of the next of kin. The court noted the tion. significant increase in available tissue to the donor

241 242 United States Association for Blind Athletes pool resulting from enactment of the law as judo, gymnastics, goal ball, and Nordic and alpine stated. skiing. Statistics were presented that showed that the USABA trains, coaches, and prepares blind ath- number of corneal donations increased. In Florida, letes for national and international competition. It 3,000 corneas were available for transplants in sponsors clinics and workshops for coaches, athletes, 1985 as compared with 500 that were available in and volunteers in leadership and skills develop- 1976. The statistics also showed that the percent- ment. The association works to promote indepen- age and numbers of usable corneas for transplanta- dence and ability through athletic contest and plays tion increased with the medical examiner law. a critical role in mainstreaming blind persons into Normal corneal tissue donations are often unsuit- regular education and physical education courses. able for transplantation due to the advanced age of USABA offers memberships to both sighted and the average donor. In comparison, up to 85 percent visually impaired persons interested in supporting of tissue obtained under medical examiner laws is sports competition and participation. It publishes acceptable for transplantation. In this decade, of the newsletter Insight. the 185,000 corneal transplants performed, In 2000, four USABA athletes achieved national 100,000 used tissue obtained under the medical ranking in three sports. One of them was runner examiner laws. Marla Runyan, who became the first legally blind The Uniform Anatomical Gift Act has been crit- person ever to qualify for a U.S. Olympic team. icized for unresolved issues such as the lack of pro- Contact: cedure for determining who may receive United States Association for Blind Athletes unspecified donations and the lack of criteria for 33 N. Institute Street determining the moment of death. As the law Brown Hall, Suite O15 stands, one doctor is required to determine the Colorado Springs, CO 80903 moment of death. This doctor is not allowed to par- 719-630-0422 (ph) ticipate in the process of removing or transplanting 719-630-0616 (fax) donor parts. www.usaba.org Other countries, such as France, Czechoslova- kia, and Portugal, require two doctors to determine the time of death as a protection for the donor. United States Housing Act of 1937 As amended, Some states, including California, Virginia, and the Housing Act of 1937 established programs Kansas, have included statutes that specify the that help disabled and elderly individuals acquire moment of death as the time of brain death. acceptable housing. Section 8, or the Lower Income Housing Assistance program, is a rent-subsidy program designed to assist low-income families and United States Association for Blind Athletes develop an economic mix within neighborhoods. (USABA) A national volunteer, nonprofit organi- Title IV of the act establishes congregate housing, a zation that provides opportunities for athletic par- mixture of residential care and personal services, ticipation and competition to blind and visually for disabled or elderly persons. impaired athletes regardless of age or degree of Single, disabled individuals are included in the impairment. It was established in 1976 following act’s definition of a low-income family. A disabled the 1976 Olympiad for the Physically Disabled, the person, as defined by the act, is one who has a per- first games to include the blind. manent or long-term impairment that hinders USABA is the only organization to sponsor local, independent living and who would benefit from state, regional, national, and international compe- improved housing. titions for the blind and visually impaired. Through Section 8 was designed to encourage the build- its state chapters, the 3,000 members compete in ing and renovation of low-income housing such as nine sports, which include wrestling, track and privately or publicly developed new or consider- field, tandem cycling, swimming, power lifting, ably renovated housing, or new state-supported universities 243 housing. Although this was its original intent, the universities There are no universities or colleges program is most often used to supplement rent on exclusively for blind or visually impaired students. existing housing. It is generally considered desirable for them to Rent subsidies, or housing-assistance payments, attend the same institutions of higher learning as are direct payments made to private home owners nondisabled students. Section 504 of the Rehabili- or public housing agencies that provide safe, clean, tation Act of 1973 mandates that no qualified dis- suitable housing for eligible needy families. Eligible abled individual can be excluded solely on the basis families must pay up to 30 percent of their net of disability from participation in any program, income for rent. The rent subsidy compensates the including educational programs, that receive fed- owner for the difference between the fair market eral financial support. rent amount and the resident’s payment. Although programs vary on campuses across the Housing vouchers are also offered under Section country, most offer a number of “core” services: 8. The voucher program authorizes housing pay- interpreters, readers, notetakers, counselors, and ments to owners who provide safe, clean, suitable tutors. These services are usually available from a housing for very-low-income families. Eligible university or college Office of Disabled Student families pay up to 30 percent of their net income Services. Many university programs rely on fed- toward rent. The voucher makes up the difference eral, state, and private grants to expand services for between this payment and the local payment stan- disabled students. There is a trend for higher edu- dard, or amount paid for rents in comparable hous- cation institutions to offer specialized technology to ing in that region. meet the educational and employment needs of the The main difference between the voucher sys- disabled students they serve. tem and rent subsidy is that the rent for the hous- The Center on Disabilities at California State ing is not kept to a fair market price, but rather, is University, Northridge (CSUN), near Los Angeles, negotiated between the landlord and the tenant. is widely regarded as a model for other university Also, the voucher program is restricted to 5 years, programs. CSUN serves a disabled student body of whereas the rent-subsidy program lasts 15 years. In approximately 3 percent of the entire student pop- 1998, about 1.4 million households participated in ulation, a figure twice that of the national average. the Section 8 program. In addition to offering core services, CSUN’s Congregate housing services were designed to Office of Disabled Student Services has taken a allow disabled individuals who cannot live inde- leadership role in delivering technological services pendently to live within their own residence and to the disabled student body and the professionals avoid institutionalization. The program contracts who serve them. This office has established a Tech- with public-housing agencies or disabled/elderly nology Group, a critical mass of programs and pro- housing sponsors that qualify under Section 202 of fessional personnel, that: the act. The three- to five-year contracts direct the con- • Conducts one of the largest conferences in the tractor to provide a minimum of two meals per day, world on the subject of Technology and Persons seven days per week. Other necessary social and with Disabilities. Some scholarships are available personal services that the contractor may provide for parents and persons with disabilities, making include grooming, transportation, or housekeeping. it one of the most accessible conferences in the Contractors who serve the disabled must confer country for these groups. with disability organizations such as rehabilitation • Established a Computer Access Lab offering the and vocational agencies, developmental-disabilities latest in peripherals (braille printers, speech syn- councils, and state mental-health or mental-reha- thesizers) and software such as the VISTA large- bilitation organizations. print program for blind and visually impaired users. U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, • Conducts training in technology for rehabilita- D.C.: USDE, 1988. tion counselors and employers throughout Ca- 244 Urban Mass Transportation Act

lifornia, Arizona, Nevada, Guam, Saipan, and 3. The Urban Mass Transportation Demonstration American Samoa. Grants Program funds demonstration projects • Conducts engineering research through projects that improve accessibility using innovative such as the Universal Access System, which pro- methods. vides access to any computer through a laptop computer. The National Mass Transportation Assistance Act of 1974 amended the Urban Mass Transportation • Hosts a monthly radio show on KIEV (Los Ange- formula-grant program by requiring project appli- les) on the subject of Technology and Persons cants to set fares for elderly and disabled passengers with Disabilities. traveling at nonpeak hours at one-half the normal peak-hour fare price. The amendment allowed Other CSUN-sponsored conferences include local transportation systems that transport elderly those concerning learning disabilities, art for dis- and disabled persons for free to remain eligible for abled persons, and employment-related topics. federal formula-grant aid. Students entering universities or colleges may The Surface Transportation and Uniform Reloca- receive funding for personal readers or educational tion Assistance Act of 1987 required the Secretary materials from the state agency for the blind. Fed- of Transportation to conduct a feasibility study for eral transition services offered through state com- standards development for UMTA-funded pro- missions for the blind or vocational-rehabilitation grams concerning tactile aids to improve accessibil- agencies are a federal priority but are not man- ity to blind and visually impaired passengers. dated. The Omnibus Budget Reconciliation Act of 1987 Contact: founded a three-year demonstration project oper- CSUN Center on Disabilities ated by the Easter Seal Society to improve accessi- 1811 Nordhoff Street bility to transportation for disabled persons. The Northridge, CA 91330-8340 program uses UMTA funds to develop methods for 818-677-2578 (voice and TTY) identifying disabled persons within the community 818-677-4929 (fax) and training programs for transit operators and dis- www.csun.edu/cod abled persons. The Intermodal Surface Transportation Effi- Urban Mass Transportation Act (UMTA) As ciency Act of 1991, signed into law by President amended in 1970, the Urban Mass Transportation George H. W. Bush, allocated funds for public Act of 1964 (UMTA) requires that mass transporta- ground transportation, provided it complied with tion facilities and services be designed to accom- the Americans with Disabilities Act. modate use by elderly and disabled persons. A U.S. Department of Education. Summary of Existing Legis- program of grants and loans was authorized in the lation Affecting Persons with Disabilities. Washington, act to fund such facilities and services. D.C.: USDE, 1988. The act established three programs:

1. The Mass Transportation Technology Research Usher’s syndrome An inherited condition com- and Demonstration Program funds projects of bining a serious hearing loss and a progressive loss national priority, including accessibility to mass of vision caused by RETINITIS PIGMENTOSA (RP). transportation by elderly and disabled persons. According to the RP FOUNDATION FIGHTING BLIND- 2. The Urban Mass Transportation Technical Stud- NESS, there are between 10,000 and 15,000 people ies Program funds grants for planning, engi- with Usher’s syndrome in the United States. It is neering, and designing mass-transportation the major cause of deaf-blindness. projects, including those specially designed with There are three known types of Usher’s syn- accommodation for elderly and disabled passen- drome. Type I individuals are born with a profound gers in mind. hearing loss and retinitis pigmentosa. Individuals Usher’s syndrome 245 with Type II are born with a mild to moderate hear- pairing of two carriers of the gene results in a one ing loss and generally have a less severe form of RP. in four chance of producing Usher’s syndrome. A Type III Usher’s syndrome is characterized by hear- pairing of a carrier and a noncarrier of the gene seling loss and vision loss due to RP that are both pro- dom results in Usher’s syndrome, but the gene is gressive. passed on to future generations. At present, there is Retinitis pigmentosa is characterized by a degen- no method for determining a gene carrier other eration of the RODS AND CONES (light-sensitive cells) than tracing family history of the disease. Genetic of the RETINA. The retina of the eye receives the counseling may be beneficial in prevention of the reflected light from an object, and the rods and disease. cones translate the light into electrical impulses Scientists have made significant progress in the that the retina sends to the brain through the OPTIC late 1990s to learn more about the defects that NERVE. The brain changes the impulses into an cause Usher’s syndrome. Researchers think there image. are nine different genes that contain mutations The rods function in low light or darkness and that cause various types of Usher’s syndrome. They are responsible for detecting movement and shape. are currently working to develop rodent models of They are scattered throughout the retina and are Usher’s syndrome that will help them understand accountable for peripheral or side vision. The cones how the genes function and how mutations in the discern detail and color and require light to work gene lead to the hearing and vision loss that is typ- effectively. They are concentrated into the central ical of the disease. section of the retina, the MACULA, and are respon- There is no cure for Usher’s syndrome or retini- sible for central vision. tis pigmentosa although a specified amount of vit- Retinitis pigmentosa attacks the rods first, then amin A has been found to slow the progression of the cones. As the disease progresses, night vision RP in some people. The hearing loss tends to diminishes and peripheral or side vision is lost. remain stable, but since it is an inner ear loss, Over long periods of time, central vision is affected. surgery is not possible to restore hearing. Some The vision loss may not be apparent for several individuals without any residual hearing have been years. Tunnel vision and night blindness may candidates for cochlear implants. Many of those become noticeable during adolescence, and pro- with residual hearing have benefited from hearing gressively worsen. aids. Roughly 30 percent of those with retinitis pig- The progressive sight loss is untreatable. Each mentosa report a hearing loss, some of whom may case is unique and unpredictable. The retina be considered to have Usher’s syndrome. Usher’s may degenerate rapidly or over a period of de- syndrome accounts for up to 3 percent of all cases cades. Usually, some central vision is maintained of profound deafness. The hearing loss is caused by through middle age. Most Usher’s syndrome pa- a malfunction in the sensory cells of the inner ear tients who become legally blind retain some cen- by an unknown cause. The loss is generally present tral vision. at birth or follows shortly after birth. Cataracts, a clouding of the eye’s lens, may Usher’s syndrome can be diagnosed. The hear- develop in patients with RP and Usher’s syndrome. ing loss is easily detected with audiometric testing. If the CATARACT is removable, the surgery does not RP can be diagnosed by the characteristic changes improve retinal degeneration but can restore the that take place in the retina. Tests such as an elec- visual acuity lost to the opacity of the cataract. troretinogram and a visual-field test may be per- In the research for a cure or treatment for formed to confirm the diagnosis. Usher’s syndrome and retinitis pigmentosa, experi- Usher’s syndrome affects individuals of all races, ments and studies involving DMSO applications ethnic and cultural backgrounds and is equally and light deprivation have had less than satisfac- prevalent among males and females. It is a reces- tory results. Usher’s syndrome patients may maxi- sively inherited disorder that requires the neces- mize their residual vision with low-vision aids. sary gene from both the mother and father. A Optical aids such as Corning or NOIR glasses, 246 uvea telescopes, microscopes, and night-vision aids may unknown cause. In addition, each section of the be useful. Nonoptical and electronic aids such as uvea is subject to inflammation, including IRITIS the Wide Angle Mobility Light, large print, talking CYCLITIS and CHOROIDITIS. computers, and closed-circuit television may further independence. However, these low-vision aids cannot restore vision that has been lost to RP or uveitis An inflammation of the uveal tract of the Usher’s syndrome. eye. The uveal tract includes the IRIS, the CILIARY BODY, and the CHOROID. The entire tract is highly Annala, L. “Facing the Future with Usher’s Syndrome.” vascularized and contains the pigment melanin, Workshop on Usher’s syndrome (December 2–3, which is also found in the skin. Uveitis may occur 1976). Helen Keller National Center, Sands Point, NY. because of an injury, in connection with another Boardman, L. “My Son has Usher’s Syndrome.” The Deaf- disease of the eye or body, or spontaneously. The Blind American. (June 1985): pp. 50–60. The Foundation Fighting Blindness. Usher Syndrome Gene disorder is usually categorized as either anterior or Identified. Hunt Valley, Md.: The Foundation for Fight- posterior uveitis. ing Blindness, 2001. Anterior uveitis (or IRIDOCYCLITIS) occurs when Pimentel, A. “Handling the Upper, Secondary and Col- the inflammation involves the iris and the ciliary lege Usher’s Syndrome Student.” Workshop on body. The iris is the colored part of the eye. It con- Usher’s syndrome (December 2–3, 1976). Helen trols the PUPIL, which opens and shuts to regulate Keller National Center, Sands Point, NY. the light that enters the eye. The ciliary body lies Roehrig, A. “Living with Usher’s Syndrome.” Workshop behind the iris and is connected to the LENS of the on Usher’s syndrome (December 2–3, 1976). Helen eye. The ciliary body produces AQUEOUS FLUID and Keller National Center, Sands Point, NY. moves the lens to focus the eye properly. Symp- RP Foundation Fighting Blindness. Answers to Your Ques- tions about Usher’s Syndrome. Baltimore, Maryland: toms of anterior uveitis include redness, light sen- RPFFB, 1988. sitivity, blurred vision, and extreme pain, especially Vernon, McCay, Joann A. Boughman and Linda Annala. when focusing on near objects. A thorough oph- “Considerations in Diagnosing Usher’s Syndrome: RP thalmologic examination may be needed to deter- and Hearing Loss.” Journal of Visual Impairment and mine the cause of uveitis. Additional tests such as Blindness, 76 (1982): 258–261. X rays of the chest, skull or sinuses, blood tests, and examinations for arthritis or other diseases may be uvea The uvea, or uveal tract, is a heavily vascu- necessary. larized layer that supplies blood to the eye. It Usually, a specific cause for anterior uveitis is includes the melanin-pigmented portions of the not found, and the condition is determined to have eye: the IRIS and CILIARY BODY in the front of the occurred spontaneously. Other diseases and dis- eye and the CHOROID to the back of the eye. orders may cause uveitis and include arthritis, The iris is the colored portion of the eye. It con- tuberculosis, SARCOIDOSIS, sinus disorders, venereal trols the size of the PUPIL, which regulates the disease, ulcerative colitis, and injuries. amount of light that enters the eye. The ciliary The prognosis for anterior uveitis is generally body lies just behind the iris and is attached to the good, unless the eye develops complications due to LENS of the eye. The ciliary body produces AQUEOUS recurrences. Recurrent uveitis may result in FLUID and moves the lens to focus properly. The CATARACTS or secondary GLAUCOMA due to choroid is a layer of blood vessels between the increased intraocular pressure. Mild anterior RETINA and the SCLERA, or white part of the eye. It uveitis is treated with the application of steroid eye nourishes and supports the eye. drops to reduce the inflammation. Acute uveitis Disorders of the uvea may include inflamma- may be treated with steroid pills or injections. In tions, injuries or infections. A common disorder, both cases, cycloplegics, drops that widen the pupil, UVEITIS, is an inflammation of the uveal tract. It can such as atropine sulfate, may be prescribed to be caused by an injury or other illness present in restrict the focusing power of the inflamed eye and the body or can appear spontaneously from an allow for a rest period. uveitis 247

Posterior uveitis involves the choroid and is also and entails the center of the globe, the condition is called CHOROIDITIS. The choroid is a layer of blood called endophthalmitis, which may be treated with vessels between the RETINA and the SCLERA,or ANTIBIOTICS and possibly reversed. Treatment for white part of the eye. The choroid nourishes and posterior uveitis includes steroid eye drops or pills. supports the eye. In more serious cases, immunosuppressive medica- Posterior uveitis is not usually as painful as ante- tions may be used. (See IRITIS.) rior uveitis. There may be redness of the eye, In 1990 researchers at the University of Iowa blurred or lost vision, light sensitivity, and the identified a gene defect that they believe is the appearance of floaters (small dark spots that seem cause of a new clinical syndrome they call heredi- to float through the field of vision). If the uveitis tary uveitis. The proper name of the syndrome is remains in the area of peripheral vision, the symp- autosomal dominant neovascular inflammatory toms may not be noticed. vitreoretinopathy (ADNIV). Many of the features Posterior uveitis, like anterior uveitis, may occur of the syndrome are common to those found in spontaneously. It has been associated with toxo- uveitis. plasmosis, tuberculosis, sarcoidosis, venereal dis- In 1992, researchers established that the gene ease, viruses, and injuries. If untreated, posterior that causes ADNIV is located on the long arm of uveitis can spread from the choroid to the retina chromosome 11. They are still working, however, and the VITREOUS. If the inflammation involves the to isolate the particular gene that they believe MACULA, permanent central vision loss may occur. causes ADNIV. When the inflammation spreads into the vitreous

V venereal disease Any disease of the genitals, tion than do infants, and may develop a severe usually contracted by sexual contact. Some vene- puslike discharge. The organism may invade the real diseases, or sexually transmitted diseases cornea and cause blindness. Gonorrhea in adults (STDs), such as gonorrhea, syphilis, herpes, and may be diagnosed from a Gram’s stain or a cervical nongonococcal urethritis can cause eye disease and culture. vision loss. Treatment for gonococcal ophthalmia involves In the United States, gonorrhea is the second use of local antibiotic drops or ointments such as most reported communicable disease to the Cen- penicillin or tetracycline. Systemic or injected ters for Disease Control and Prevention; chlamydial ANTIBIOTICS may also be prescribed. infections are first. In 1997, there were 324,901 At one time, congenital gonorrhea was the lead- cases reported. This is a drop from the mid- to late ing cause of blindness in children. The legislation 1980s, when nearly a million cases were reported all states requiring the administration of silver each year. Researchers say the disease may have nitrate drops, or comparable antibiotics, to the eyes been more prevalent during the latter part of the of all new born infants has drastically reduced its 1980s because doctors were treating it with antibi- incidence. otics to which the disease had become resistant. SYPHILIS is a venereal disease caused by the The Centers for Disease Control recommended in spirochete Treponema pallidum. The disease may its 1998 Sexually Transmitted Disease Treatment cause ocular disorders, both congenitally and after Guideline that only highly effective antimicrobial birth. Syphilis is contracted congenitally from the agents be used to treat gonorrhea. infected mother to the child through the womb Gonorrhea is caused by the gonococcus bacteria after the fourth month of pregnancy when the and may result in blindness when contracted con- spirochete can pass through the placenta. Congen- genitally. The disease is passed from mother to ital syphilis may result in vision loss and ocular child during birth. As the infant moves through the impairment, deafness, dental defects, mental retar- birth canal, the infant’s eyes come into contact dation, organ damage, and death. with the gonococcus bacteria growing in or near Ocular damage may involve severe KERATITIS,or the cervix and become infected. corneal inflammation and chorioretinal scarring. The infection, called gonococcal ophthalmia, or Although the infection is present at birth, the ker- OPHTHALMIA NEONATORUM in the case of the new- atitis may develop later in life between ages five borns, causes severe CONJUNCTIVITIS. First symp- and 25. Severe keratitis may be treated with med- toms include swelling and redness of the CORNEA, ication but may result in corneal opacification and CONJUNCTIVA and eyelids. Without treatment, the PHOTOPHOBIA. condition may progress to damage the cornea and Syphilis contracted after birth can cause chori- result in blindness. oretinal scarring, IRITIS (or inflammation of the iris) Adults may contract gonococcal ophthalmia by and OPTIC NERVE atrophy or degeneration. introducing the eyes to anything carrying the bac- Syphilis can be diagnosed with a Wasserman teria. Adults exhibit more serious signs of the infec- test, a blood test to determine the presence of the

249 250 venereal disease spirochete in the blood. An eye examination may Recurrent ocular herpes are eye infections, usu- also determine the presence of the disease and is ally involving only one eye, that happen as a result often used to confirm the diagnosis. of a reawakening of the dormant herpes virus. The Syphilis is treated with antibiotics, and ocular virus, which may have first infected the mouth, disorders are treated with medication. If treated in travels to the fifth nerve ganglion, the trigeminal, the early stages, the damage due to syphilis may be where it remains dormant. The fifth ganglion has mild. connecting fibers to the upper part of the face, Congenital syphilis can be prevented if the dis- including the eyes. On reactivation, the virus trav- ease of the mother is treated and controlled before els back up these fibers and infects the eye. the fifth month of pregnancy. Toward this purpose, A recurrent infection is typified by redness, pain, most states have developed laws that require test- and a watery discharge of the eye. Herpes keratitis, ing for syphilis at the beginning of each pregnancy. or corneal infection, iritis, GLAUCOMA, and CATA- HERPES SIMPLEX is a virus that is accountable for RACTS may result from this infection. As the eye most corneal blindness due to infection in the attempts to heal itself, corneal scarring may United States. Herpes simplex is one of four types of develop, followed by loss of vision. Each recur- herpes virus and may infect the genitals, skin, brain, rence increases the possibility of scarring and vision and eyes. The other types of herpes virus are herpes loss. zoster, cytomegalovirus, and Epstein-Barr virus. Herpes keratitis is treated with the drugs vidara- Herpes simplex virus cells usually enter the body bine, TRIFLURIDINE, IDOXURIDINE, and ACYCLOVIR, through the mouth, genitals, or eyes. In the past, antiviral eye drops or ointments. These drugs are those infections that occurred above the waist were not a cure for herpes. They stop the reproduction of commonly referred to as Type I, and those below viral cells but cannot rid the body of the virus. Dur- the waist were referred to as Type II. However, the ing periods of dormancy, the drugs are ineffective above- and below-the-waist categorizations are in fighting the virus. used less commonly, because Type I herpes is now Severe scarring is treated with CORTISONE eye frequently seen below the waist and Type II is drops. Cortisone is a steroid that may actually increasingly diagnosed above the waist. worsen the herpes infection and is therefore used Herpes simplex may infect the eyes in one of only for short periods of time. Severe vision loss three ways: congenitally, primarily, or recurrently. due to scarring may in some cases be corrected Congenital herpes is contracted by infants during with a corneal transplant, or keratoplasty. birth. If the mother has active genital herpes, the Nongonococcal urethritis, NGU, is a venereal infant may become exposed to the virus when the disease caused most often by two organisms, water breaks or when traveling through the birth Chlamydia trachomatis and plasma urealyticum. canal. NGU causes inflammation of the urethra in men Congenital herpes may result in permanent and cystitis and pelvic inflammatory disease (PID) damage to the eyes, brain, liver, or kidneys, or in in women. death. Ocular damage may involve the RETINA, con- NGU may infect the eyes of adults when the junctiva, optic nerve, LENS, and cornea. Congenital eyes are exposed to the live infection, or congeni- herpes may be prevented by a Caesarean section tally as the infant travels through the birth canal. birth if the mother is aware of an active herpes When the eyes become infected, conjunctivitis infection. results. If left untreated, the infection could lead to Primary herpes infection of the eyes is rare in corneal scarring and blindness. Symptoms of NGU adults and generally occurs only in children or ado- conjunctivitis are similar to those of gonococcal lescents. The symptoms include fever, fatigue, conjunctivitis and include redness, swelling, and a swollen eyelids, conjunctivitis, and a blistering rash pus discharge. Those with symptoms of NGU are around the eyes. The infection is usually mild and given a Gram’s stain test to rule out gonorrhea. If short-lived. It can be treated with antiviral eye the culture from the stain is negative for gonor- drops or ointments. rhea, treatment for NGU is prescribed. Treatment veterans 251 involves local administration of antibiotics such as each year due to common eye diseases such as AGE- chlortetracycline ointment and oral antibiotics. RELATED MACULOPATHY, GLAUCOMA, and RETINITIS PIGMENTOSA. The U.S. Department of Veterans Affairs (VA) venous occlusion A condition that results from a provides a wide range of benefits to American vet- blockage to a retinal vein. The disease usually erans, including those with vision impairments, involves the central retinal vein, or CRV. The dam- and their families. The vision loss does not need to age to the RETINA occurs when blood flows into the occur during military service in order for a veteran eye from the undamaged arteries but cannot flow to qualify for benefits. from the eye due to the blockage. Hemorrhaging Veterans who receive an honorable discharge and swelling occur, and vision is damaged. are eligible for all benefits, including educational The condition may occur suddenly or over a benefits. Those receiving general discharges qualify period of days. The vision may regress to 20/400 or for all benefits except educational. Those who worse, but there is rarely accompanying pain. The receive dishonorable and bad-conduct discharges cause of the disease is unknown, but it is suspected are not eligible for veterans benefits. Those who that it occurs as a result of an intraluminal throm- receive other than honorable discharges may or bosis, or a blood clot in the lamina cribrosa of the may not qualify for some benefits. These cases are OPTIC NERVE. reviewed individually by the VA. Veterans rated Because of the high occurrence of CRV obstruc- nonservice-connected are required to complete an tion and ARTERIOSCLEROSIS of the central retinal income questionnaire (means test) when applying artery, it is believed that arteriosclerosis may lead to for medical care and may be denied medical care the obstruction. Open-angle GLAUCOMA, orbital or depending on the results. global trauma, and optic-nerve or orbital tumors Those who originally enlisted after September may also lead to occlusion. 7, 1980, and those who entered military service Treatment for venous occlusion includes ther- after October 16, 1981, must complete the shorter apy for the underlying cause, if apparent, and may of two possible terms in order to qualify for bene- include anticoagulation medications and photoco- fits: either 24 months of continuous active duty or agulation therapy. Laser surgery may be advised to the full period for which the individual was called help reduce macular swelling, prevent abnormal to active duty. This does not apply to veterans with growth of new vessels, or prevent bleeding. It is a service-connected disability or who were dis- not, however, always successful. Once a venous charged near the end of an enlistment term occlusion has occurred, vision loss can be perma- because of a disability incurred or aggravated in the nent. Complications of venous occlusion include line of duty or due to hardship. neovascular glaucoma (20 percent chance), neo- The U.S. Department of Veterans Affairs pro- vascularization, and RETINAL DETACHMENT. vides the benefits through three major offices: Branch-vein occlusion occurs because the vein crosses over a hard arteriosclerotic arteriole (small 1. The Veterans Benefits Administration adminis- part of an artery that ends in capillaries). It can ters compensation, pensions, GI loans, insur- cause central vision loss, neovascularization and ance, education, and job-training programs, glaucoma. including vocational-rehabilitation and disability benefits. The Veterans Administration operates the Blind Rehabilitation Service, which VersaBraille See PAPERLESS BRAILLE. administers programs for blinded veterans at VA Blind Rehabilitation Centers and Clinics. veterans According to the Blinded Veterans 2. The National Cemetery System administers Association, there are approximately 120,000 visu- death benefits. These include burial expenses ally impaired veterans in the United States. Many and compensation to surviving spouses and more veterans become blind or visually impaired children. 252 vidarabine

3. The Veterans Health Services and Research The BAVF funded the research and development Administration administers health-care bene- of the Americane, a sensory aid that has been cer- fits, such as hospitalization, nursing-home care, tified by the Department of Veterans Affairs and domiciliary care, outpatient medical and dental distributed to more than 2,500 blind veterans. treatment, beneficiary travel, alcohol- and drug- Contact: dependency treatment, Agent Orange or nu- The Blinded American Veterans Foundation clear radiation exposure treatment, prosthetic P.O. Box 65900 appliances, readjustment counseling centers, Washington, DC 20035-5900 medical care for dependents, overseas benefits, www.bavf.org appeals, and blind aids and services. The Blinded Veterans Association Aids and services are available to blind veterans 477 H Street who are eligible for medical services. Veterans Northwest Washington, DC 20001-2694 are considered blind if they meet the specifica- 202-371-8880 tions of legal blindness. Most blind veterans qual- www.bva.org ify for an annual review by the Visual Impairment Services Team (VIST), adjustment to blindness vidarabine See ARA-A. training, home improvements and structural alterations to homes, low-vision aids and training, approved electronic and mechanical aids for the Viroptic See TRIFLURIDINE. blind (as well as their repair and replacement), and dog guides and the cost of the dog’s medical visual acuity The measurement of the amount of care. detail an individual sees in relation to the amount In order to inform blind veterans of the benefits of detail someone with normal vision sees. Visual available to them, Congress chartered the Blinded acuity is stated as an equation with 20 as the first Veterans Association (BVA) to serve veterans with number, a slash mark and a second number of severe vision loss. The organization works through either 15, 20, 25, 30, 40, 50, 70, 100 or 200, such a field service program and an outreach employ- as 20/20. The first number of the equation, 20, ment program to help veterans obtain services, indicates the distance at which the measurement is benefits, rehabilitation training, and employment. taken. The second number indicates the distance at (See BLINDED VETERANS ASSOCIATION and REHABILI- which a normally sighted person can see specific TATION.) detail or print. Another group, the Blinded American Veterans Normal or “perfect” vision is written as 20/20. Foundation (BAVF), was formed in 1985 by three Someone with 20/20 vision sees detail at 20 feet American veterans who had lost their sight while that a normally sighted person sees at 20 feet. serving in Korea and Vietnam. The BAVF has three Someone with 20/100 vision sees detail at 20 feet primary goals: research, rehabilitation, and reem- that someone with normal vision could see at 100 ployment. It does not maintain a membership, but feet. serves as a clearinghouse for research and educa- The eye chart usually used for the visual acuity tional efforts and advancements. test is called the SNELLEN CHART. Using this chart as The BAVF supports medical research concerning a measurement, the individual can be given a blindness and other sensory disabilities, participates visual acuity range from 20/15 to 20/200. A mea- in outreach programs to learn the needs and con- surement of 20/200 means that the individual was cerns of veterans with sensory disabilities, and con- only able to see the largest letter on the chart, the ducts informational programs directed at big E. government, business, and the general public. It The term count fingers refers to an individual who also has developed a national volunteer corps to cannot see the big E, but who can count the num- help veterans with sensory disabilities. ber of fingers the examiner holds up. Hand motion vitamins 253 is the term used to describe someone who cannot one or both eyes but are not legally blind. Legally see the separate fingers, but who can discern some blind persons have a visual acuity of 20/200 or less movement when the hand is waved. in the better eye after correction or a visual field of Light perception, or LP, describes the person less than 20 in the better eye after correction. who can perceive only light or its absence. NLP, or According to National Eye Institute, there are no light perception, refers to one who is unable to approximately 14 million persons who are visually discern any light. impaired in the United States. That is about one in Visual-acuity measurements help describe legal every 20 people. Worldwide, it is estimated that definitions for blindness. These classifications 135 million people are visually impaired. determine eligibility for federal benefits. Someone The majority of visually impaired persons are with corrected vision of 20/50 in the better eye is male between the ages of 25 and 64. Most of those classified as having LOW VISION. An individual with with severe impairments are female and 65 or corrected vision of 20/200 in the better eye is clas- older. sified as LEGALLY BLIND. CATARACT is a leading cause of all degrees of visual impairment. Age-related macular degenera- visual aids See ADAPTIVE AIDS. tion is the leading cause of vision impairment among people who are 75 and older. It is the most common cause of new visual impairment in those visual field The area in which a person can see. 65 and older. Injury, GLAUCOMA, and congenital This area or field is measured in degrees. A person causes are commonly responsible for lesser impair- with normal vision can see objects within a field of ments, whereas diabetes and cardiovascular dis- about 150 degrees with one eye and 180 degrees eases are commonly responsible for severe with both eyes when looking straight ahead. The impairments. (See BLINDNESS.) central 60 degrees seen by both eyes is called CEN- TRAL VISION. It is also known as “seeing” vision, Prevent Blindness America. “Age-Related Macular Dege- because it is the vision you use to look directly at neration FAQ.” www.preventblindness.org: 2001. something. National Eye Institute of the National Institutes of Health. The vision on either side of these 60 degrees is “Low Vision.” www.nei.nih.gov/nehep/faqs.htm#2: 2000. called PERIPHERAL VISION. This is the vision surrounding what you are looking at. It describes side vision, or the things you see out of the “corner of vitamins Vitamins are essential to the health of your eye.” Peripheral vision is also called “travel- the eyes and maintenance of vision. Vitamin A, or ing” vision. retinol, is an element most closely tied to vision. A loss of visual field can occur in the central The retina contains light sensitive RODS AND CONES, vision, the peripheral vision or both. An individual which receive light and provide information about with a visual field of 40 to 20 degrees of a possible the seen object. This information is converted by LOW 180 in the better eye is classified as having the RETINA to electrical impulses sent to the brain. VISION. Someone with a field of 20 degrees or less The brain translates the impulses into an image. of the possible 180 in the better eye is classified The cones are responsible for central vision, LEGALLY BLIND. detail, and color, and require light to function. The rods are responsible for peripheral vision and func- visual impairment A term that describes a recog- tion in low light. nizable defect or malfunctioning of the eye. Impair- The rods contain the pigment rhodopsin, or ments are diagnosed and defined by a medical visual purple, which is chemically very similar to doctor. Visual impairments range from total blind- vitamin A. When light strikes a rod, the rhodopsin ness to low vision. is broken down and used up. In order to make new The term visually impaired is also used frequently rhodopsin and continue to function, the rod must to describe those persons who have sight loss in draw on vitamin A within the body. Without 254 vitamins replenishment of vitamin A, the rod will eventually research and studies in this area differ in their con- be destroyed. clusions, this theory remains controversial. The first sign of vitamin-A deficiency is night Vitamin-C deficiency, or scurvy, may lead to blindness. In dim light the eye depends on the rods ocular hemorrhage. For any hemorrhage of the eye to maintain vision. When the rods are not func- not related to DIABETES, hypertension or another tioning, night blindness occurs. cause may be investigated as a symptom of scurvy. Vitamin-A deficiency causes XEROPHTHALMIA,a Vitamin-C treatment may produce results in a leading cause of blindness in developing countries week. of the world. According to Helen Keller Interna- An excess of vitamin D may cause opacities in tional, xerophthalmia impairs the vision of 5 mil- the CORNEA or CONJUNCTIVA and scleral calcification. lion to 10 million children annually, and causes Overdosage in infancy may produce optic atrophy, irreparable blindness to 500,000 of these. optic neuritis, or convergent STRABISMUS. Vitamin A is found in yellow vegetables such as Researchers at the Department of Newborn carrots and is stored in the body for long periods of Medicine at the Royal Alexandra Hospital in time in the liver. A normal diet that includes veg- Edmonton, Alberta, have found that a dose of vit- etables and vitamin A-rich foods will prevent vita- amin E given within 12 hours of birth may reduce min-A deficiency. the incidence of severe forms of RETINOPATHY OF Vitamin-B deficiency may cause vision loss. A PREMATURITY. This has not been confirmed in other deficiency of thiamine, vitamin B1, affects the studies and remains an unproven controversial OPTIC NERVE, which carries the electrical impulses to form of treatment. the brain, thus interrupting or interfering with the Supplements of vitamins A, C, and E may be message. This condition, referred to as nutritional prescribed in combination to retard the progression AMBLYOPIA, produces scotomas, or blind spots, in of diabetic retinopathy, age-related maculopathy, the field of vision. Thiamine supplements can often and cataracts, help maintain the health of blood correct and restore vision lost to B1 deficiency. cells and vessels of the retina, and assist in the heal- Vitamin-B2 (riboflavin) deficiency may cause ing process after surgery. cornea disease or KERATITIS, and vitamin-B6 (pyri- Zinc is necessary to healthy vision and is con- doxine) deficiency may cause vascular congestion tained in the highest concentration in the body in and corneal neovascularization. Vitamin-B12 defi- the retina. Zinc allows vitamin A to be released ciency, or pernicious anemia, is associated with from the liver and is used in the process of metab- RETROBULBAR NEURITIS (swelling of the optic nerve). olism in the retina. Since a zinc deficiency prevents Treatment with adequate dosages of these vitamins the body from using the available vitamin A, it may usually reverses or improves the conditions caused cause the same effects as a vitamin-A deficiency. by their lack. Vitamin products that claim to help guard Vitamin C, in large doses, has been shown to be against age-related macular degeneration and effective in drawing fluid away from the eye and other diseases are available. Most doctors, how- reducing elevated intraocular pressure associated ever, warn that vitamins, while important in main- with GLAUCOMA. It is not used as a treatment for taining eye health, are not miracle cures for eye glaucoma but rather as a diet supplement. diseases. Vitamin C may be effective in the prevention of CATARACTS and retinal disorders such as DIABETIC Carden, Robert G. “Vitamins for Healthier Eyes.” Let’s Live, September 1984, pp. 10–11. RETINOPATHY and AGE-RELATED MACULOPATHY. Editors of Prevention Magazine. Prevention’s New Encyclo- Cataracts and retinal damage may be caused by an pedia of Common Diseases. Emmaus, Pennsylvania: excess of free radicals, chemicals that are generated Rodale Press, 1984. by a normal body process called oxidation. Since Havener, William H. Ocular Pharmacology. St. Louis: C.V. vitamin C is an antioxidant, a diet containing vita- Mosby Company, 1970. min C may decelerate the process of developing Helen Keller International. Facts About Helen Keller Inter- cataracts or retinal disorders. Because subsequent national. New York: HKI, 1987. vitreous 255

Vaughn, Lewis, ed. The Complete Book of Vitamins and Min- sends it via the OPTIC NERVE to the brain, where the erals for Health. Emmaus, Pennsylvania: Rodale Press, information is translated into an image. In order for 1988. light to be focused on the retina, the vitreous must Yukin, John. The Penguin Encyclopedia of Nutrition. New remain clear. When the vitreous becomes obscured York: Viking Press, 1985. or cloudy, vision may be lost. The vitreous can become clouded due to many vitrectomy A surgical procedure in which the conditions and diseases. This clouding is frequently VITREOUS of the eye is removed and replaced. The associated with hemorrhaging due to injuries, DIA- vitreous is the clear, gel-like substance that fills the BETES, SICKLE-CELL DISEASE, or RETINAL DETACHMENT. back section of the eye and supplies support to the DIABETIC RETINOPATHY is a complication of dia- entire eyeball. The vitreous must remain clear to betes in which the retinal blood vessels deteriorate function properly. It may become clouded due to and hemorrhage into the vitreous. As new blood infection, injury, or RETINAL DETACHMENT, or as a vessels form, the vitreous may become inflamed complication of other diseases, such as SICKLE CELL and develop vitreous membranes. As the mem- DISEASE and DIABETIC RETINOPATHY. These conditions branes contract, a process called traction, they may often result in hemorrhaging into the vitreous, for- cause the retina to detach from the underlying mation of new blood vessels and scar tissue and epithelial layer. clouding of the vitreous. In other types of retinal detachments, the vitre- Once the vitreous is obscured, a loss of vision ous may accumulate under the retina causing it to results. Vitreous hemorrhaging can spontaneously bulge forward and detach, or it may flow into a resolve itself, but if the underlying condition is not retinal hole or tear and float the retina away from arrested, it may continue to cloud the vitreous and the epithelial layer. destroy vision. In some cases, vitrectomy can Sickle-cell anemia is a disease in which the restore or improve vision. This microsurgery blood vessels of the retina develop small aneurysms involves the use of a VISC, a vitreous infusion suc- and hemorrhages. New vessels may develop that tion cutter. This specialized instrument is inserted also leak into the vitreous to further obscure it. RETINITIS PIGMENTOSA into the eye through the CILIARY BODY. The motor- produces changes in the driven VISC illuminates the inside of the eye, sep- vitreous. In the early stages, the vitreous may arates and removes the vitreous and replaces it appear clouded by evenly distributed dustlike par- with a sterile saline solution. ticles. Later, opaque sections may develop, or the According to the National Institute of Health, vitreous may collapse within the orbit. vitrectomy improves vision in over 60 percent of all Occasionally, an obscured vitreous may sponta- cases. The procedure is being studied for use in neously clear. However, if the underlying cause is treatment of corneal and macular edema, acute not arrested, it may continue to cloud the vitreous inflammation, and severe penetrating eye injuries. and destroy vision. Some instances of obscured vitreous can be treated with a vitrectomy. This is a surgical procedure in which the cloudy vitreous vitreous A clear gel-like substance within the and its scar tissue are drained from the eye and back of the eye between the LENS and the RETINA. replaced with a clear solution. Vitrectomy improves If fills approximately 80 percent of the volume of vision in over 60 percent of the cases. the eye and gives support to the other organs The vitreous is also subject to inflammation. within. When the inflammation involves the vitreous, pos- Light passes through the CORNEA and the ANTE- terior uveal tract, and much of the center of the RIOR CHAMBER filled with AQUEOUS FLUID and enters globe, the condition is called ENDOPHTHALMITIS. This the back of the eye through the PUPIL. It then passes may occur after an injury or ophthalmologic through the lens and the vitreous and is focused surgery. onto the retina. The retina is a light-sensitive layer ANTIBIOTICS are often injected into the vitreous that receives and encodes light information and to combat the infection. Unfortunately, the antibi- 256 vocational aids otics may diffuse from the vitreous into the retina determine characters on punched computer and poison this organ. As endophthalmitis spreads cards), voice-prompting automatic data-entry to the entire eye, it becomes a condition called terminals, braille printers and embossers (which PANOPHTHALMITIS. As panophthalmitis destroys the interface with computers), talking computer ter- eye, it shrinks and may require removal. minals or software with speech output or syn- As the eye ages, the vitreous gel liquefies and thesis, or talking telephone directories (which shrinks. This may lead to posterior vitreous detach- respond vocally to typed requests). ment in which the vitreous collapses from above • Magnifying aids, such as simple hand-held MAG- and separates from the retina. Although there are NIFIERS or mounted magnifiers, loupes, bioptics, often no symptoms of posterior vitreous detach- telescopic devices, and CLOSED-CIRCUIT TELEVISION ment, it can cause retinal tears or traction, reduced (CCTV) systems. vision or the appearance of light flashes or floaters. • Illumination aids, which may be as simple as Floaters are bits of debris that float in the vitre- replacing low-wattage bulbs with higher-wattage ous and appear in the field of vision. Floaters occur light bulbs, may also include devices to reduce in normal vision and are not considered a serious glare and flicker, special lamps, or hand-held symptom unless they appear suddenly in great flashlight magnifiers. numbers. • Measuring aids, such as circuit testers (which vocational aids Any devices that allow an indi- emit a tone when a circuit or test cable attach- vidual to perform any facet of a job. Vocational aids ment is complete), talking frequency measurers, are often called sensory aids, because frequently auditory meter readers, brailled calipers, audi- they are devices that compensate for a loss of one tory or tactile dial indicators, electronic levels, of the senses. tactually marked protractors, saw guides and Vocational aids for visually impaired individuals tape measure, and auditory thermometers or compensate for a lack of vision or a reduced field of pressure gages. vision. The aid may be an adapted form of an old • Reading aids, such as the Kurzweil Personal device that has been marked with raised dots, Reader, the Optacon, and speech output for the braille, or large print. It may have an auditory sig- Optacon. nal or voice output component, or may be designed • Recorders, such as cassette recorders and play- in a new form to compensate for the user’s lack of back machines with variable-speed playback or sight. time-compression systems. Vocational aids may be categorized by type, • Tactile aids, such as the Sensory Quill, raised-line including: drawing kits, tactile maps, phone adaptors for determining tactually which lines on a multiline • BRAILLE devices, such as a brailler or braille typewriter, a braille shorthand machine, braillex phone are activated, or Lamp Activated Signal (which records braille information in digitized Terminal for telephone system workers. form), digicasette (which records and stores • Organizational aids, such as large-print or braille braille on magnetic tape from a braille key- label makers, talking label makers, and file fold- board), or paperless braille (which records and ers differentiated by color. stores braille information to discs). • Time-keeping aids, such as raised-dot marked • Calculators, such as those that provide a braille watches, talking clocks, metronomes, and raised- paper tape or printout of the display, electronic dot or talking stop watches. tone calculators that sound out a series of beeps • Tools, including adaptive chiseling guides, dove- to indicate a number, and talking calculators. tailing guides, drill positioners, tactually marked • Computers and computer-related items, such as framing squares, light probes for determining punched-card readers (which enable users to indicator lights, and copy holders. vocational rehabilitation 257

Vocational Education Act The Vocational Educa- Under Title IV of the act, grants are awarded for tion Act of 1963 established the first permanent research into improving and expanding vocational system to fund state vocational education through education to targeted groups of students, including public schools. Amendments to the act in 1968 those with disabilities. The act also assists the required each state to apply 10 percent of the funds National Center for Research in Vocational Educa- received to programs specially designed for handi- tion and the National Institute of Education in pro- capped students. grams these institutions coordinate for disabled In 1976, the act was amended to require states to persons. match 50 percent of the funds received with state The act was further amended in 1998 to include funds that must be applied to disability services. technical education. The current act is known as These funds were further earmarked to be used to the Carl D. Perkins Vocational Education Act of assist disabled students to participate in nondisabled 1998, or Perkins III. vocational programs and reduce segregation of pro- EducationDaily.com. Carl D. Perkins Vocational and grams. Funded states were also directed to create Applied Technology Education Amendments of 1998. vocational education procedures and plans in com- www.educationdaily.com/FTP/Laws: 1998. pliance with the policies described in the act. U.S. Department of Education. Summary of Existing Legis- As rewritten in 1984, the act, known as the Carl lation Affecting Persons with Disabilities. Washington, D. Perkins Vocational Education Act of 1984 D.C.: USDE, 1988. includes two major parts, Titles II and III. Title II, parts A and B, award state grants, and Title III vocational rehabilitation Vocational rehabilita- funds special services and programs. tion services are programs that provide vocational Part A of Title II establishes the Vocational Edu- training or support to disabled individuals from cation Opportunities program, which receives the federal, state, or private agencies. Vocational reha- majority of state grantfunding allocated by Con- bilitation enables visually impaired individuals to gress. Part B establishes the Innovation and Expan- continue employment or train for new work. Voca- sion grant program, which receives the remainder tional rehabilitation may be offered through a pub- of the appropriated funds. lic or private residential school, within a program States receiving Part A monies must earmark 10 of special education in a public school, through an percent or more for vocational-education services organization for the blind, by a private rehabilita- for disabled students. Disabled students must be tion facility, by a sheltered workshop, through cor- afforded equal opportunities in recruitment, regis- respondence courses or by state rehabilitation tration and placement. They must be allowed equal agencies. opportunity in course choices and apprenticeship All 50 states administer programs of vocational programs. Courses must be held in the least restric- rehabilitation and DAILY LIVING SKILLS for the pur- tive facility in compliance with the Education of pose of enabling disabled individuals to become the Handicapped Act. independent, employed, integrated members of Vocational programs supported by federal funds society. These agencies are listed under various must provide each disabled student with a written names, such as Department of Rehabilitation; evaluation concerning his interests, skills, and Commission for the Visually Handicapped: State needs as they apply to a vocational-education pro- Services for the Blind and Visually Impaired; and gram. The state must supply any needed adaptive the Bureau of the Blind. equipment, curriculum materials or facilities. The Each state program varies according to the range programs must provide special guidance or career of services and training available and the amount of development counseling, as well as transitional financial assistance provided. Services may include employment counseling by professionally trained medical and vocational diagnostic services, rehabil- instructors. The state is required to pay one-half of itation training, physical restoration, braille instruc- the cost for supplemental disability services. tion, communication-skills training, books and 258 VTEK training supplies, transportation allowance, reader Educational tuition and expenses may be sup- services for the blind, vocational rehabilitation, plied if college is necessary to the vocational reha- job-placement services, postemployment services, bilitation. The plan may furnish financial assistance procurement of job-related equipment and occupa- during the rehabilitation process, as well as trans- tional licenses, ADAPTIVE AIDS evaluation, and selec- portation costs, job referral and placement services, tion, counseling, and family-member services. and job modification or reevaluation services. Legally blind individuals may qualify for state Vocational-rehabilitation training may result in rehabilitation services if they can provide certifica- disabled individuals being employed in the main- tion of disability, if the disability results in a sub- stream of industry. These individuals earn and stantial handicap to employment, and if the state work at the same level of productivity as their has a reasonable expectation that the recipient will sighted peers. Others may be employed in a Busi- get or hold a job as a result of vocational training. ness Enterprise Program (BEP). These are usually Rehabilitation services are available at little or vending, short order or cafeteria-style stands, or no cost to the individual. Some aspects of the reha- small businesses that are given priority for opera- bilitation program may require financial contribution within federal facilities such as post offices, tion by the individual. In some states, services such federal offices, or military institutions. The BEP is as psychological counseling, equipment purchase, administered through the state vocational-reha- transportation to school, or school tuition may be bilitation agency and is supported by federal financed by the state or a combination of the state, funds. the individual, and grants or loans. An individual may work in a sheltered work- In all state programs, each individual’s case is shop. A sheltered workshop is any place of employ- carefully evaluated by a vocational-rehabilitation ment that protects employment of the disabled. counselor for the blind with input from the dis- The individual may also be employed at home as a abled individual. College-trained vocational-reha- homemaker and family care provider. bilitation specialists evaluate existing skills and The success of vocational-rehabilitation training aptitudes, evaluate and recommend occupations, varies by individual. The extent of the visual loss, outline needed skills, provide vocational-skills the time in life when the loss occurred, and the training and education, and recommend and pro- abilities and aptitude of the individual all affect the vide training in the use of vocational aids or outcome. The length of time for rehabilitation ser- devices. vices also differs and may continue six months or Every eligible individual is given an Individual- longer. ized Written Plan that outlines the rehabilitation American Foundation for the Blind. An Introduction to goals, the individual’s skills and needs, and the Blindness Services in the United States. www.afb.org/ process that will be taken to meet those needs. into_document_view.asp?documentid=930, 2001. The plan may provide for a medical examination American Foundation for the Blind. Rehabilitation Services. to ascertain the extent and limitations of the dis- New York: AFB, 1988. ability, in order to assess suitable employment pos- California Department of Rehabilitation. Client Informa- sibilities. Medical treatment or equipment, tion Booklet. Sacramento: CDR, 1987. including surgery, psychiatric counseling, hospital California Department of Rehabilitation. Rehabilitation is services, prostheses, and eyeglasses, may be pro- Here to Help. Sacramento: CDR, 1986. vided to reduce or alleviate the disability and Lions Club International. Rehabilitation of the Blind. Oak improve productivity on the job. Brook, Illinois: LCIRB, 1984. National Association for Visually Handicapped. The Adult Guidance counseling may be suggested to assess Partially Seeing. New York: NAVH, 1984. the individual’s potential for rehabilitation, independent living, and appropriate employment. Job training may be provided at home, rehabilitation VTEK See TELESENSORY SYSTEMS INC. centers, trade schools, or on-the-job settings. W

Wagner-Peyser Act The Wagner-Peyser Act of Weihenmayer, Eric Eric Weihenmayer is a blind 1933, as currently amended, established a state and speaker, writer, and adventurer who in 2001 be- federal employment security program to find jobs came the first blind person to climb Mount Everest, for the unemployed and qualified workers for the highest peak on Earth. Weihenmayer, who was employers. Amendments to the act in 1954 re- born in 1969, began the climb in March and quired a designated staff person within each reached the summit shortly after midnight on May employment-services office to help disabled indi- 25. He relied on his sense of touch and followed viduals find employment or training. other climbers who wore bells during the ascent. Further amendments to the act were made in Born with retinoscheses, a degenerative eye dis- 1982, by the Job Training Partnership Act (JTPA), order, Weihenmayer knew as a child that he would and again in 1998 by the Workforce Investment become blind by the time he was 13. He credits his Act of 1998. The 1982 amendments established a family with helping him to develop and keep a pos- coordinated effort between local JTPA programs itive outlook and to overcome the disadvantages and state employment services and offered Wag- that resulted from his blindness. In addition to mountain climbing, Weihenmayer ner-Peyser funding incentives to states assisting enjoys acrobatic skydiving, scuba-diving, long-dis- targeted populations, including disabled persons. tance biking, running marathons, skiing, ice climb- The 1998 amendments specified that job training ing, and rock climbing. He is determined that his programs must be managed at the local level where blindness will not stop him from attaining his goals employers’ needs are best understood, and gives and has become an inspiration for blind people all more control to individuals to choose the services around the world. The National Federal of the they require. Blind sponsored Weihenmayer’s Everest climb. Disabled persons are described in the act as Weihenmayer has become well known to cor- those who have a physical, mental, or emotional porations and schools as an inspirational speaker. disability, including drug or alcohol dependence, He has been featured in Life, People, Sports Illus- which hinders employment. Employment services trated, Inside Edition, The Today Show, Good Morning to the disabled strive to provide equal opportunity America, the Learning Channel, and many other for employment and equal wages, the highest level newspapers, magazines, radio, and television of employment possible given the individual’s shows. He recently completed his first book, Touch skills, suitable accommodation to the job or work the Top of the World: A Blind Man’s Journey to Climb station, and an occupation that will not endanger Further than the Eye Can See. He lives in Englewood, the individual or others. Colorado, with his wife, Ellie, and daughter, Emma. U.S. Department of Education. Summary of Existing Legis- lation Affecting Persons with Disabilities. Washington, D.C.: USDE, 1988. Western Blind Rehabilitation Center (WBRC) A U.S. Department of Labor. Workforce Investment Act of blind rehabilitation center founded in 1967 by the 1998. www.workforce.org, 1999. United States Department of Veterans Affairs. The

259 260 wet eye

32-bed inpatient facility serves 14 western states, drainage. It may be an annoying condition but the largest geographic area designated by the VA. rarely affects visual acuity. The WBRC program is available to any legally Tears are constantly being produced and drained blind, honorably discharged veteran. The average from the eye. They drain through lacrimal puncta, age of veterans entering the program is near 60, holes in each inner corner of the upper and lower but individuals of any age may be eligible. lids. The tears are gathered in the lacrimal sac, an Current figures from WBRC indicate that over organ at the junction of the nose and lower lid. The 20,000 legally blind veterans in the 14 states are tears then pass under the tissue to drainage ducts in served by the WBRC. The number of those served is the nasal cavity. expected to triple in the future due to the aging of When the tears fail to drain adequately, wet eye veterans and age-related vision-limiting conditions. occurs. This may be a congenital or acquired condi- The program offered by the WBRC has four tion. Congenital wet eye occurs as a result of parts: living skills, manual skills, orientation and obstructions to the nasolacrimal ducts. Symptoms mobility, and visual skills. Living skills consists of include tearing, crusting of the lids or eyelashes, training to perform daily tasks independently. It mucous discharge, and inflammation of the lacri- covers personal care, home management, commu- mal sac. nications, kitchen skills, and a computer-reading- Obstructions often clear spontaneously within aids program. the first 12 months of life. After this time, obstruc- The manual skills section concerns sensory tions are cleared surgically by simple probe and development, organizational skills, and self-confi- irrigation, silicone intubation procedures, or the dence. Activities such as woodworking, leather more serious surgical procedure of dacryocystorhi- projects, copper tooling, and home mechanics im- nostomy. prove tactual perception, bimanual coordination, The probe and irrigation procedure is a five- finger dexterity, and hand-foot coordination. minute operation that involves syringing the Orientation and mobility teaches independent obstructed area under general anesthetic. The sili- traveling and safety skills. Long-cane travel skills, cone intubation consists of inserting and looping a techniques for using electronic travel aids, and tiny silicone tube through the tear-duct system to low-vision travel evaluations are included. link the upper and lower puncta. The tube is tied Visual skills consists of instruction for veterans and left in the tear-duct system for several with low vision. It introduces low-vision aids and months. A dacryocystorhinostomy is a surgical devices and nonoptical aids. Optometry services operation that connects the lacrimal sac to the develop and provide an individualized vision reha- nasal cavity. bilitation plan. Acquired obstructions usually occur in middle The facility also offers psychological counseling, age, and most commonly among women. Tearing social services, family training, nutrition and becomes severe and annoying. The simple proce- dietetics counseling, nursing and medical services, dures of probe and irrigation or silicone intubation and recreation therapy. are often ineffective, and a dacryocystorhinostomy Contact: is indicated. Western Blind Rehabilitation Center 124 Veterans Affairs Medical Center work opportunity tax credit (WOTC) A federal 3801 Miranda Avenue tax incentive aimed at getting employers to hire Palo Alto, CA 94304 individuals from seven groups that are seen as dis- 650-493-5000 advantaged for employment purposes according to www.palo-alto.med.va.gov government guidelines. The WOTC replaces the targeted jobs tax credit, which had expired at the wet eye a condition in which the eye contains an end of 1994. The new program went into effect overabundance of tears due to inadequate tear September 30, 1996. world blindness 261

The groups targeted as disadvantaged for Cataracts commonly worsen progressively over employment purposes are qualified veterans, qual- time. ified food-stamp recipients, qualified ex-felons, The most common form, senile cataract, is a nat- and qualified youth during the summer months. ural result of aging, although heredity, nutrition, Also, it includes vocational rehabilitation refer- general health and environment may influence the rals, which include workers with a physical or onset. There is no preventative treatment for senile mental handicap; high-risk youth; and some work- cataracts, but they can be removed surgically. In ers who recently received some types of federal developing countries, cataract extraction is often assistance. performed in mobile clinics or surgery units oper- Employers who choose to employ the WOTC ated by mission or governmental agencies. may claim a credit of 35 percent of qualified first- Trachoma, a contagious ocular disease caused by year wages paid to an employee from one of the a chlamydial eye infection, may have a prevalence designated targeted groups. Tax credits generally of as much as 500 million people worldwide and range from a maximum of $2,100 for a full-time has caused blindness in about 6 million people. The worker and $1,050 for a qualified summer infection causing the disease is due to the TRIC employee. agent Chlamydia trachomatis. The infection is linked to bacterial infections caused by agents Koch- Weeks bacillus, Morax Axenfeld diplobacillus, and world blindness Blindness is an international the gonococcus bacillus. Trachoma thrives in over- problem that exists in both developed and develop- crowded conditions in which poor sewage disposal, ing countries. Because of differences in methods sanitation, and personal hygiene, along with a lack used to gather statistics and differences in defini- of clean water supply, exist. In such conditions, this tions of blindness, statistics measuring the number highly communicable disease may infect an entire of blind persons in the world vary. According to community. 2001 statistics from the World Health Organization The disease first appears as a form of CONJUNC- (WHO), there are an estimated 40 million to 45 TIVITIS on the inside of the upper eyelids, later fol- million blind people in the world. WHO projects lowed by symptoms of irritation, light sensitivity, the number will double by the year 2025, unless and tearing. As the infection progresses to the decisive public health action is taken. CORNEA, it may cause ulceration leading to scarring, Blindness is more prevalent in developing coun- opacification, and vision loss. tries, where up to 85 percent of the population may Trachoma is treated with topical antibiotic eye have little or no access to hospitals in urban areas. ointment for several weeks. However, vision loss Throughout Africa, South America, and Asia, due to corneal scarring may be irreversible. Tra- blindness rates are increasing with the growth of choma is prevented by improving environmental the population. Four major causes of blindness in factors such as providing a clean water supply and developing countries are CATARACT, TRACHOMA, employing simple methods of good personal XEROPHTHALMIA, and ONCHOCERCIASIS. Cataract is hygiene. the leading cause of blindness in all parts of the XEROPHTHALMIA is the leading cause of blindness world. In developed countries, sight is restored in children of developing countries. According to with cataract surgery and extraction. In developing Helen Keller International, xerophthalmia annu- countries, an estimated 16 million adults have ally affects 5 million to 10 million children in the cataract-induced vision loss due to lack of trained world and completely destroys the vision in personnel and facilities to perform cataract surgery. 350,000 of these per year. The disease occurs In most countries of Africa and Asia, cataracts worldwide but is found most commonly in Asia account for half of all blindness. and Africa. Children under six years of age are at Cataract is any opacity in the eye’s normally greatest risk. CRYSTALLINE LENS. The vision may be completely Xerophthalmia results from a lack of vitamin A obstructed in specific areas of the visual field. in the diet. It occurs as a result of malnutrition and 262 World Blind Sailing Championship is closely associated with measles, diarrhea, and Since 1986, human trials have shown that a acute respiratory infection in vitamin-A-deficient drug, ivermectin, discovered by Merck, Sharp and children. Early symptoms include night blindness Dohme Inc., is highly effective in killing the micro- and Bitot’s spots, a result of the drying of the CON- filariae in humans and does so with few adverse JUNCTIVA leading to a sloughing of conjunctival reactions. The drug is available for worldwide dis- epithelial cells. tribution from Merck, Sharp and Dohme Inc., free The disease causes fundamental changes in the of charge to onchocerciasis-control programs under conjunctiva and cornea, which can lead to blind- the trade name Mectizan. ness. In severe cases, the cornea ulcerates and can World blindness can be addressed by strength- perforate, causing AQUEOUS FLUID loss and collapse ening infrastructures and training health workers of the ANTERIOR CHAMBER. The cornea becomes in the community being served. Indigenous people opaque, and the eyeball is destroyed. can be trained to become community health work- Xerophthalmia can be detected during an eye ers. The workers can maintain health-screening examination or by electroretinogram, a method projects to diagnose and treat eye diseases in the impractical in field work. Treatment of the disease earliest stages. Health education and awareness consists of three megadoses of 200,000 IU vitamin programs can improve personal hygiene, environ- A by mouth, coupled with a protein- and calorie- mental conditions, sanitation, and nutrition. rich diet, and treatment of any accompanying sys- Mobile teams and surgical units can provide spe- temic infection. cialized treatment, surgery, and follow-up care. One 200,000 IU vitamin-A dosage may be Bath, Patricia E. “Blindness Prevention Through Pro- administered twice a year as a preventative mea- grams of Community Ophthalmology in Developing sure. Other preventatives include enrichment with Countries.” In Ophthalmology. Vol. 2. Edited by K. vitamin A of a commonly ingested staple such as Shimizu and J. Oosterhuis. Amsterdam: Excerpta tea or sugar, nutrition education and improvement Medica, 1979. in diet. Cupak, K. “The Importance of Eye Camps in Underde- ONCHOCERCIASIS is a disease caused by the filar- veloped Countries.” In Ophthalmology. Vol. 2. Edited by ial worm, Onchocerca volvulus, transmitted by the K. Shimizu and J. Oosterhuis. Amsterdam: Excerpta Simulium blackfly. The disease occurs mainly in Medica, 1979. West Equatorial Africa, Central America, and Helen Keller International. Facts About Helen Keller Inter- South America. It is estimated to have infected national. New York: HKI, 1987. over 18 million people and blinded an estimated Helen Keller International. Diseases/causes.www.hki. org/diseases/index.html, 2000. 270,000 people. Visual impairment is projected for Phillips, Calbert I. Basic Clinical Ophthalmology. London: 20 percent of all those infected. Pitman Publishers Limited, 1984. Onchocerciasis occurs when the worm infests World Health Organization. Available Data On Blindness the human body. The human becomes host to the (Update 2000). New York: WHO, 1987. worm, which may live up to 15 years within the body’s skin, organs, and blood. The disease causes corneal inflammation, or World Blind Sailing Championship A competi- KERATITIS, corneal scarring, and vision loss. The tion started in 1992, when it was hosted by a blind inflammation can also cause chronic IRIDOCYCLITIS group in New Zealand. The championship was held and GLAUCOMA. again in 1994 in Australia and in 1997 in England. Prior to 1986, there was no effective medical Sailing is an activity in which blind people can par- treatment for onchocerciasis. Prevention of the dis- ticipate and excel. In 1999, 29 four-person teams ease consisted of vector control, using insecticides participated in the championships held that year in to rid the community of the worms, avoidance of Miami. breeding sites such as rivers and open waterways, A team includes two visually impaired crew and wearing protective clothing, and excising of skin two sighted guides. One of the visually impaired nodules that contain the worms. persons is the helmsman, responsible for steering World Health Organization 263 the boat around the course. The other controls the services, provides and trains health and medical foredeck. The sighted guides, who are experienced technicians and supports national health programs sailboat racers, give verbal instructions to the visu- of disease control. WHO priorities include maternal ally impaired crew. and child health care, elimination of malnutrition, promotion of mass immunization of preventable World Health Organization (WHO) A special- diseases, provision of safe water supplies, and con- ized agency, founded in 1948 by the United trol of malaria, tuberculosis, smallpox, and leprosy. Nations, for improving world health levels that will The World Health Assembly serves as the leg- permit all citizens of the world to lead a socially islative body and is formed of representatives from productive life. the member states. The assembly meets annually to Through cooperation with its member states, determine budget and policy decisions that are WHO maintains advisory and technical activities enacted by an executive board. A director-general around the world, including research, technical manages a secretariat in Geneva, Switzerland. assistance, establishment of international health- Contact: level standards, health-information dissemination World Health Organization and statistics collection, and aid to victims of nat- 1211 Geneva 27 ural disasters. Switzerland WHO provides aid and assistance at the coun- (+00-41-22) 791-21-11 try’s request. It establishes health programs and www.who.int

Xalatan See EYE DROPS. eye, which can lead to blindness. In severe cases, the cornea is perforated and AQUEOUS FLUID is lost. As a result, the ANTERIOR CHAMBER flattens, the IRIS xanthelasma Yellow plaques that form on the adheres to the cornea, and the eyeball is destroyed. eyelid. The plaques consist of fat deposits and sug- Xerophthalmia can be detected during a corneal gest that the body may be unable to process fats or examination or by electroretinogram, a method cholesterol. Xanthelasma occasionally accompanies impractical in field work. Treatment of the disease DIABETES, hypercholesterolemia, and histiocytosis. consists of megadoses of 200,000 IU of vitamin A The blood should be tested for cholesterol and by mouth, coupled with a protein- and calorie-rich treated by diet or medication as indicated. diet, and treatment of any accompanying systemic The condition is harmless and does not affect infection. vision. Xanthelasma may be removed but may The vitamin-A dosage may be administered recur. twice a year as a preventive measure. Other preventatives include enrichment of a commonly in- X-Chrom lens See CONTACT LENSES. gested staple such as tea or sugar with tasteless form of vitamin A, nutritional education, and im- xerophthalmia A disease caused by a vitamin-A provement in diet. deficiency in the diet. It may occur as a result of Bath, Patricia E. “Blindness Prevention Through Pro- malnutrition, protein malnutrition, or diarrhea. grams of Community Ophthalmology in Developing Early symptoms of the disorder include night Countries.” In Ophthalmology. Vol. 2. Edited by K. blindness, conjunctivitis, and tearing. Shimizu and J. Oosterhuis. Amsterdam: Excerpta Xerophthalmia is the second leading cause of Medica, 1979. blindness in the world and a leading cause of blind- Cupak, K. “The Importance of Eye Camps in Underde- ness in children in third world countries. Helen veloped Countries.” In Ophthalmology. Vol. 2. Edited by Keller International cites that xerophthalmia visu- K. Shimizu and J. Oosterhuis. Amsterdam: Excerpta Medica, 1979. ally impairs 5 million to 10 million children world- Helen Keller International. Facts About Helen Keller Inter- wide each year and blinds 350,000 of these. national. New York: HKI, 1988. Although the disease occurs worldwide, it is most Phillips, Calbert I. Basic Clinical Ophthalmology. London: concentrated in Southern Asia and Northern Saha- Pitman Publishers Limited, 1984. ran Africa. Children under six years of age are at World Health Organization. Available Data On Blindness greatest risk. (Update 2000). New York: WHO, 2000. The disease causes fundamental changes in the CORNEA, CONJUNCTIVA, and anterior segments of the

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YAG laser The YAG, or Neodymium: Yttrium- The YAG laser is unique in its ability to perform Aluminum-Garnet, laser is used in the postsurgical this procedure because, unlike other lasers, it is not treatment of CATARACT-removal patients. After dependent on pigmented tissue to be effective. The extracapsular cataract surgery, many patients expe- argon and other lasers depend on pigment such as rience opacification of the cataract capsule left that found in the IRIS of the eye or in blood flowing behind in the eye. The YAG laser is used to create through blood vessels in tissue. The pigmented tis- an opening in the capsule to restore vision. sue absorbs the energy from the argon laser and is The physician focuses the laser to a fine point on destroyed. However, cataracts or their remaining the capsule and releases a series of 500,000 watt capsules contain no pigmentation and are immune explosions of energy that destroy the capsular mat- to the power of the argon laser. ter. Because the laser can be so minutely focused, In the past, when the postoperative vision the physician can aim the beam accurately and declined due to this clouding of the capsule, a sec- avoid surrounding tissue or an intraocular lens ond surgery, a posterior capsulectomy, was neces- resting on the opaque capsule. sary to restore good vision. The YAG approach is The procedure is quick and painless and is most viewed as a safer, quicker procedure with fewer often performed without local anesthesia. The possible complications. patient is able to walk or drive home after treatment.

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Z zonule The zonules, or zonule of Zinn, is the focus on a near object, the lens must thicken and group of thin, tightly drawn fibers that hold the bulge forward. The ciliary muscle contracts, allow- lens in place in the EYE. The thousands of threading the zonule to slacken and the lens to thicken like fibers are attached to the ciliary muscle and and protrude forward. To focus on a distant object, work with the muscle to change the shape of the the lens must flatten. The ciliary muscle expands, LENS. the zonule is pulled taut, and the lens flattens. In order to focus on objects at different distances, the lens must adjust or accommodate. To Zovirax See ACYCLOVIR.

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APPENDIXES

I. Companies II. Disability Databases III. Dog-Guide Schools IV. Federal Agencies V. National Organizations VI. Schools for Blind and Visually Impaired Students (by state) VII. Periodicals VIII. Radio Reading Services IX. Rehabilitation Services (by state) X. Scholarships for the Blind XI. Sports and Recreation Organizations and Publications XII. Diagram of the Eye

APPENDIX I COMPANIES

American Thermoform 978-692-3000; fax 978-692-7912 1-800-468-4789; fax 847-498- Corporation http://www.duxburysystems.com 1482 1758 Brackett Street http://www.lsgroup.com Enabling Technologies Company La Verne, CA 91750 1601 Northeast Braille Place NanoPac, Inc. 800-331-3676; fax 909-593-8001 Jensen Beach, FL 34957 4823 South Sheridan Road http://www.atcbrleqp.com 561-225-3687; fax 561-225-3299 Suite 302 Arkenstone, Inc. http://www.brailer.com Tulsa, OK 74145-5717 555 Oakmead Parkway 918-665-0329; fax 918-665-0361 Henter-Joyce, Inc. Sunnyvale, CA 94086 http://www.nanopac.com 11800 31st Court North Street 800-444-4443; fax 408-328-8467 St. Petersburg, FL 33716 Noir Medical Technologies http://www.arkenstone.org 800-336-5658; P.O. Box 159 Artic Technologies fax 813-803-8001 South Lyon, MI 48178 55 Park Street http://www.hj.com 1-800-521-9746; fax 734-769- Troy, MI 48083-2753 1708 HumanWare, Inc. 248-588-7370; fax 248-588-2650 Talking Computers, Inc. 6245 King Road http://www.artictech.com 140 Little Falls Church Road Loomis, CA 95650 Suite 205 Bavisoft 800-722-3393 Falls Church, VA 22046 P.O. Box 8 http://www.humanware.com 703-241-8224 or 1-800-458-6338 Dewitt, NY 13214 IBM Accessibility Center http://www.bavisoft.com Telesensory Corporation 11400 Burnett Road 520 Almanor Avenue Berkeley Systems, Inc. Building 901, Room 5D-014 Sunnyvale, CA 94086 1700 Shattuck Avenue Austin, TX 78758 408-616-8700; fax 408-616-8720 Berkeley, CA 94709 www.ibm.com/able http://www.telesensory.com 415-540-5535; fax 415-540-5115 Independent Living Aids Tojek & Associates BIT Corporation 200 Robbins Lane 17355 Mierow Lane 52 Roland Street Jericho, NY 11753 Brookﬁeld, WI 53005 Boston, MA 02129 800-537-2118; fax 516-937-3906 414-784-4979 617-666-2488; fax 617-666-4646 http://www.independentliving. Transceptor Technologies, Inc. com Blazie Engineering 2001 Commonwealth Boulevard 105 East Jarrettsville Road Lernout & Hauspie Suite 205 Forest Hill, MD 21050 52 Third Avenue Ann Arbor, MI 48105 410-893-9333; fax 410-836-5040 Burlington, MA 01803 313-996-1899 http://www.blazie.com 781-203-5000; fax 781-238-0986 Vision Technology, Inc. http://www.lhsl.com Duxbury Systems, Inc. 8501 Delport Drive 270 Littleton Road LS&S Group, Inc. St. Louis, MO 63114-5905 Unit 6 P.O. Box 673 1-800-560-7226; fax 314-890-8383 Westford, MA 01886-3523 Northbrook, IL 60065 http://www.visiontechinc.com

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APPENDIX II DISABILITY DATABASES

ABLEDATA 301-468-6555 Job Accommodation Network 8401 Colesville Road http://chid.nih.gov (JAN) Suite 200 West Virginia University CompuServe Silver Spring, MD 20910 P.O. Box 6080 232 N. Main Street 800-227-0216 Morgantown, WV 26506 Marysville, Ohio http://www.abledata.com/index. 800-526-7234 937-642-0002 htm http://janweb.idci.wvu.edu http://www.compuserve.com Accent on Information MEDLINEplus CTG (Closing the Gap) Solutions P.O. Box 700 National Library of Medicine P.O. Box 68 Bloomington, IL 61701 8600 Rockville Pike Henderson, MN 56044 309-378-2961; fax 309-378-4420 Bethesda, MD 20894 507-248-3294; fax 507-248-3810 301-594-5983 or 1-888-346-3656 Ageline http://www.closingthegap.com http://www.medlineplus.gov American Association of Retired Dialog Information Services Persons The National Rehabilitation Infor- 3460 Hillview Avenue 601 E Street NW mation Center (NARIC) Palo Alto, CA 94304 Washington, DC 20049 1010 Wayne Avenue 1-800-324-2564 800-424-3410 Suite 800 http://www.aarp.org Easter Seals Project ACTION Silver Spring, MD 20910 700 Thirteenth Street, NW 301-562-2400; fax 301-562-2401 Assistive Device Database System Suite 200 http://www.naric/com Assistive Device Resource Center Washington, DC 20005 California State University SPECIALNET 202-347-3066; fax 202-347-4157 6000 J Street GTE Educational Network http://www.projectaction.org Sacramento, CA 95819 Services 916-278-6916 ERIC 5525 MacAuthur Boulevard Educational Resources Informa- Suite 320 BRS Information Technologies tion Center Irving, TX 75038 1200 Route 7 U.S. Department of Education 800-927-3000 or 214-751-0964 Latham, NY 12110 Ofﬁce of Educational Research www.gte.net 518-783-7251 and Improvement Combined Health Information National Library of Education Database (CHID) 555 New Jersey Avenue, NW National Institutes of Health Washington, DC 20208-5721 Box CHID 202-219-2289 9000 Rockville Pike http://www.ed.gov Bethesda, MD 20892

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APPENDIX III DOG-GUIDE SCHOOLS

Canine Companions for 516-265-2121; fax 516-361-5192 Seeing Eye, Inc. Independence http://www.guidedogs.com P.O. Box 375 P.O. Box 446 Morristown, NJ 07960 Guiding Eyes for the Blind, Inc. Santa Rosa, CA 95402-0446 1-800-539-4425 611 Granite Springs Road 866-224-3647 or 1-800-572-2275 http://www.seeingeye.org Yorktown Heights, NY 10598 http://www.caninecompanions.org 914-245-4024; fax 914-245-1609 Southeast Guide Dogs, Inc. Eye Dog Foundation for the http://www.guiding-eyes.org 4210 77th Street East Blind, Inc. Palmetto, FL 33561 Guide Dogs of America 512 N. Larchmont Boulevard 813-729-5665; fax 813-729-6646 13445 Glenoaks Boulevard Los Angeles, CA 90004 http://www.guidedogs.org Sylmar, CA 91342 602-276-0051 818-362-5834; fax 818-362-6870 Upstate Guide Dog Association Fidelco Guide Dog Foundation, P.O. Box 165 Leader Dogs for the Blind Inc. Hamlin, NY 14464 1039 Rochester Road P.O. Box 142 716-964-8815 Rochester, MI 48063 Bloomﬁeld, CT 06002 810-651-9011; fax 810-651-5812 203-243-5200; fax 203-243-7215 http://www.leaderdog.org Guide Dog Foundation for the Pilot Dogs, Inc. Blind, Inc. 625 West Town Street 371 East Jericho Turnpike Columbus, OH 43215 Smithtown, NY 11787 614-221-6367; fax 614-221-1577

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APPENDIX IV FEDERAL AGENCIES

U.S. DEPARTMENT Office of Special Education Bureau of Health Professions OF EDUCATION Programs 5600 Fishers Lane 330 C Street, SW Rockville, MD 20857 Center for Libraries and Room 3086 301-443-5794 Educational Improvement Washington, DC 20202 400 Maryland Avenue, SW 202-732-1007 Health Services Administration/ Division for Maternal and Room 613 Office of the Secretary Child Health Washington, DC 20202 400 Maryland Avenue, SW 202-254-6572 Washington, DC 20202 Bureau of Health Care Delivery and Assistance Clearinghouse on Handicapped 202-732-3000 5600 Fishers Lane and Gifted Children Rehabilitative Services Adminis- Room 605 1920 Association Drive tration Rockville, MD 20857 Reston, VA 22091 330 C Street, SW 301-443-2170 703-620-3660 Washington, DC 20202 Division of Blind and Visually 202-732-1282 National Center for Health Impaired Statistics 330 C Street, SW U.S. DEPARTMENT OF 3700 East-West Highway Washington, DC 20202 HEALTH AND HUMAN Hyattsville, MD 20782 202-732-1316 SERVICES 301-436-8500 National Council on the Administration for Children, National Institutes of Health/ Handicapped Youth, and Families National Eye Institute 330 C Street, SW Donahoe Building Building 31, Room Ao3 Room 3118 400 Sixth Street, SW Bethesda, MD 20892 Washington, DC 20202 Washington, DC 20024 301-496-2234 202-453-3846 202-755-7762 Office of Human Development National Institute on Disability Administration on Aging Services and Rehabilitation Research North Building, Room 4760 400 Maryland Avenue, SW 200 Independence Avenue, SW 200 Independence Avenue, SW Washington, DC 20202 Washington, DC 20201 Room 309F 202-205-5666; TDD 202-245-0724 Washington, DC 20201 202-245-7246 202-205-4756 Health Care Financing Office of Special Education and Administration Office of Policy Planning and Rehabilitative Services 200 Independence Avenue, SW Legislation 330 C Street, SW Washington, DC 20201 200 Independence Avenue, SW Room 3132 202-245-6726 Room 306E Washington, DC 20202 Health Resources and Services Washington, DC 20201 202-732-1241 Administration 202-245-7027

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Office of the Secretary Department of Medicine and 1291 Taylor Street, NW 200 Independence Avenue, SW Surgery Washington, DC 20542 Room 615F 810 Vermont Avenue, NW 202-287-5100 or 1-800-424- Washington, DC 20201 Washington, DC 20420 9100 202-245-7000 202-223-2596 President’s Committee on Social Security Administration Department of Veterans Benefits Employment of People with 6401 Security Boulevard 810 Vermont Avenue, NW Disabilities Baltimore, MD 21235 Washington, DC 20420 1111 20th Street, NW 301-965-1234 202-233-2044 Washington, DC 20036 202-653-5044 Office of the Administrator U.S. DEPARTMENT 810 Vermont Avenue, NW Small Business Administration OF LABOR Washington, DC 20420 1441 L Street, NW 202-223-3775 Washington, DC 20416 Employment Standards Adminis- 202-653-6605 tration Branch of Special Employment OTHER AGENCIES U.S. Department of Justice 200 Constitution Avenue, NW Civil Rights Division/Coordination Washington, DC 20210 Architectural and Transportation and Review Section 202-523-8727 Barriers Compliance Board 10th Street and Constitution 1111 18th Street, NW Avenue, NW Office of Federal Contract Suite 501 Washington, DC 20530 Compliance Programs Washington, DC 20036 202-633-2151 or 202-724-7678 200 Constitution Avenue, NW 202-653-7834 (TDD) Washington, DC 20210 202-523-9475 Committee for Purchase from the U.S. Office of Personnel Blind and Other Severely Management Office of the Secretary Handicapped Governmentwide Selective Place- 200 Constitution Avenue, NW Crystal Square 5 ment Programs Division Washington, DC 20210 Suite 1107 1900 E Street, NW 202-523-8165 1755 Jefferson Davis Highway Room 5A09 U.S. Employment Service Arlington, VA 22202-3509 Washington, DC 20415 Patrick Henry Building 703-557-1145 202-632-5491 601 D Street, NW Washington, DC 20213 Equal Employment Opportunity 202-376-6750 Commission Office of Legal Counsel 2401 E Street, NW VETERANS Room 222 ADMINISTRATION Washington, DC 20507 202-634-6460 Blind Rehabilitation Service 810 Vermont Avenue, NW Library of Congress National Washington, DC 20420 Library Service for the Blind 202-233-3232 and Physically Handicapped APPENDIX V NATIONAL ORGANIZATIONS

Afﬁliated Leadership League 2323 Anderson Avenue Associated Services for the Blind 1030 15th Street, NW Suite 226 911 Walnut Street Suite 468 Manhattan, KS 66502 Philadelphia, PA 19107 Washington, DC 20005 785-532-2737 215-627-0600 202-775-8261 http://www.ksu.edu/acres Association for Education and American Academy of Ophthal- American Diabetes Association Rehabilitation of the Blind and mology National Service Center Visually Impaired P.O. Box 7424 P.O. Box 25757 206 North Washington Street, San Francisco, CA 94120 1600 Duke Street Suite 320 415-561-8500 Alexandria, VA 22313 Alexandria, VA 22314 http://www.eyenet.org 703-549-1500 or 1-800-232-3472 703-548-1884 American Association for Pedi- American Foundation for the Association for Macular Diseases atric Ophthalmology and Blind 210 East 64th Street Strabismus 11 Penn Plaza New York, NY 10021 P.O. Box 193832 Suite 300 212-605-3719 San Francisco, CA 94119 New York, NY 10001 The Association for Persons with 415-561-8505 212-502-7660 or 800-232-5463; Severe Handicaps American Association of Certiﬁed TDD 212-502-7662 29 W. Susquehanna Avenue Orthoptists http://www.afb.org Suite 210 St. Louis Children’s Hospital Eye American Optometric Association Baltimore, MD 21204 Center 243 North Lindbergh Boulevard 410-828-8274 or 800-482-8274; One Children’s Plaza St. Louis, MO 63141 TDD 410-828-1306 Room 2, South 89 314-991-4100 or 1-800-365-2219 http://www.tash.org St. Louis, MO 63110 http://www.aoanet.org Association of Radio Reading 314-454-2122 Services http://www.orthoptics.org American Society of Cataract and Refractive Surgery University of South Florida, American Association of the 4000 Legato Road WRB 209 Deaf-Blind Suite 850 Tampa, FL 33620 814 Thayer Avenue Fairfax, VA 22030 813-974-4193 Silver Spring, MD 20910 703-591-2220; fax 703-591-0614 Association on Handicapped American Council of the Blind http://www.ascrs.org Student Service Programs in 1155 15th Street, NW Postsecondary Education American Society of Contempo- Washington, DC 20005 P.O. Box 21192 rary Medicine, Surgery and 202-467-5081 Columbus, OH 43221 Ophthalmology http://www.acb.org 614-488-4872 820 North Orleans Street American Council on Rural Suite 208 Blind Children’s Center Special Education Chicago, IL 60610 4120 Marathon Street Kansas State University 312-440-0699 P.O. Box 29159

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Los Angeles, CA 90029 Eye Bank for Sight Restoration International Eye Foundation 213-664-2153 210 East 64th Street 7801 Norfolk Avenue New York, NY 10021 Bethesda, MD 20814 Blind Children’s Fund 212-980-6700 301-986-1830 230 Central Street http://www.iefusa.org Auburndale, MA 02166 Eye Research Institute of the 617-332-4014 Retina Foundation International Institute for Visually 20 Stanford Road Impaired, 0-7 Blind Outdoor Leisure Develop- Boston, MA 02114 311 W. Broadway ment 617-742-3140 Suite 1 533 East Main Street Mount Pleasant, MI 48854 Aspen, CO 81611 Fight for Sight 989-779-9966; fax 989-779-0015 303-925-8922 381 Park Avenue South http://www.blindchildrenfund.org Suite 809 Blinded Veterans Association New York, NY 10016 International Society on 477 H Street, NW 212-679-6060 Metabolic Eye Disease Washington, DC 20001 1125 Park Avenue Foundation Fighting Blindness 202-371-8880 or 800-669-7079 New York, NY 10128 11435 Cronhill Drive 212-427-1246 Braille Institute of America Owings Mills, MD 21117-2220 741 North Vermont Avenue 410-568-0150 or 1-888-394- In Touch Networks Los Angeles, CA 90029 3937; TDD 1-800-683-5551 15 West 65th Street 323-663-1111 or 800-272-4533 http://www.blindness.org New York, NY 10023 http://www.brailleinstitute.org 212-769-6270 or 800-456-3166 Friends of Eye Research Corneal Dystrophy Foundation 99 West Cedar Street Joint Commission on Allied 1926 Hidden Creek Drive Boston, MA 02114 Health Personnel in Kingwood, TX 77339 617-523-0303 Ophthalmology 713-358-4227 2025 Woodlane Drive Glaucoma Research Foundation St. Paul, MN 55125 Council for Exceptional Children 200 Pine Street 651-731-2944 or 800-284-3937 1110 North Glebe Road Suite 200 http://www.jcahop.org Suite 300 San Francisco, CA 94104 Arlington, VA 22201 415-986-3162 or 800-826-6693 Joslin Diabetes Center 703-620-3660 or 888-221-6830; http://www.glaucoma.org One Joslin Place TDD 703-264-9446 Boston, MA 02215 Guide Dog Users http://www.cec.sped.org 617-732-2400 14311 Astrodome Drive http://www.joslin.org Council of Citizens with Silver Springs, MD 20906 Low Vision 310-598-5771 or 888-858-1008 Knights Templar Eye Foundation 1400 North Drake Road http://gdui.org 5097 North Elston Avenue Kalamazoo, MI 49007 Chicago, IL 60630 Helen Keller International 616-381-9566 773-205-3838 90 Washington Street Delta Gamma Foundation 15th Floor Lions Club International 3250 Riverside Drive New York, NY 10006 300 22nd Street Columbus, OH 43221 212-943-0890 Oak Brook, IL 60570 614-481-8169 http://www.hki.org 630-571-5466 http://www.deltagamma.org http://www.lionsclubs.org Helen Keller National Center for Eye Bank Association of America Deaf-Blind Youth and Adults March of Dimes Birth Defects Inc. 111 Middle Neck Road Foundation 1725 Eye Street, NW Sands Point, NY 11050 1275 Mamaroneck Avenue Suite 308 516-944-8900; White Plains, NY 10605 Washington, DC 20005 TDD 516-944-8637 914-428-7100 202-775-4999 http://www.helenkeller.org http://www.modimes.org Appendix V 283

Maynard Listener Library National Association of Vision 15825 Shady Grove Road 171 Washington Street Professionals Prevention of Suite 140 Taunton, MA 02780 Blindness Society Rockville, MD 20850 617-823-3783 1774 Church Street, NW 301-948-3244 Washington, DC 20036 http://www.ahaf.org Myasthenia Gravis Foundation 202-234-1010 123 West Madison Street National Industries for the Blind http://www.members.tripod.com/ Suite 800 1901 North Beauregard Street charlie216 Chicago, IL 60602 Suite 200 312-853-0522 or 800-541-5454 National Braille Association Alexandria, VA 22311 http://www.myasthenia.org 3 Town Line Circle 703-998-0770 Myopia International Research Rochester, NY 14623 http://www.nib.org 716-427-8260 Foundation National Multiple Sclerosis http://www.nationalbraille.org 1265 Broadway Society Room 608 National Council of Private 733 Third Avenue New York, NY 10001 Agencies for the Blind Sixth Floor 212-684-2777 8770 Manchester Road New York, NY 10017 National Accreditation Council for St. Louis, MO 63069 212-986-3240 Agencies Serving the Blind and 314-968-9000 http://www.nmss.org Legally Visually Handicapped National Council of State National Rehabilitation 260 Northland Boulevard Agencies for the Blind Information Center Cincinnati, OH 45246 1213 29th Street, NW 1010 Wayne Avenue 513-772-8449 Washington, DC 20007 Suite 800 National Association for Parents 202-333-5841 Silver Spring, MD 20910 1-800-346-2742 or 301-562- of Children with Visual National Easter Seals Society 2403 Impairments 230 West Monroe http://www.naric.com P.O. Box 317 Suite 1800 Watertown, MA 02272 Chicago, IL 60606 National Society to Prevent 617-972-7444 or 800-562-6265 312-726-6200 or 800-221-6827; Blindness National Association for Visually TDD 312-726-4258 4200 California Street Handicapped http://www.easter-seals.org #101 San Francisco, CA 94118-1314 22 W. 21st Street National Eye Institute 415-387-0934; fax 415-387-1689 New York, NY 10010 2020 Vision Place http://www.eyeinfo.org 212-889-3141 Bethesda, MD 20892 http://www.navh.org 301-496-5248 New Eyes for the Needy National Association of Blind http://www.nei.nih.gov P.O. Box 332 549 Millburn Avenue Teachers National Eye Research Foundation Short Hills, NJ 07078 c/o American Council of the 910 Skokie Boulevard 201-376-4903 Blind Northbrook, IL 60062 1155 15th Street, NW 847-564-6522 ODPHP (Ofﬁce of Disease Washington, DC 20005 http://www.nerf.org Prevention and Health 202-467-5081 Promotion) National Federation of the Blind Ofﬁce of Public Health and Sci- National Association of State 1800 Johnson Street ence Directors of Special Education Baltimore, MD 21230 200 Independence Avenue, SW, Suite 320 410-659-9314 Room 738G 1800 Diagonal Road http://www.nfb.org Alexandria, VA 22314 Washington, DC 20201 703-519-3800; TDD 703-519- National Glaucoma Research 202-401-6295; fax 202-205-9478 7008 Program of the American http://www.odphp.osophs.dhhs. http://www.nasdse.org Health Assistance Foundation gov 284 The Encyclopedia of Blindness and Vision Impairment

Opticians Association of America 212-752-4333 or 800-621-0026 United States Association for 7023 Little River Turnpike http://www.rpbusa.org Blind Athletes Suite 207 33 North Institute Street Smith-Kettlewell Eye Research Annadale, VA 22003 Colorado Springs, CO 80903 Institute 703-916-8856 719-630-0422 2318 Fillmore Street http://www.opticians.org http://www.usaba.org San Francisco, CA 94115 Randolph-Sheppard Vendors of 415-345-2000 United States Braille Chess America http://www.ski.org Association 1808 Faith Place 428 West Lima Street Taping for the Blind #B Findlay, OH 45840 3935 Essex Lane Terrytown, LA 70056 419-422-2833 Houston, TX 77027 504-368-7785 or 800-467-5299 http://www.crisscrosstech.com/ 713-622-2767 http://www.acb.org/rsva usbca Telephone Pioneers of America Recording for the Blind Vision Council of America: Better 930 15th Street 20 Roszel Road Vision Institute Suite 1200 Princeton, NJ 08540 1700 Diagonal Road Denver, CO 80202 609-452-0606 or 1-800-883-7201 Suite 500 303-571-1200; http://www.rfbd.org Alexandria, VA 22314 fax 303-572-0520 703-548-4560 or 877-642-3253 Research to Prevent Blindness http://www.telephone- http://www.visionsite.org 645 Madison Avenue pioneers.org New York, NY 10022 APPENDIX VI SCHOOLS FOR BLIND AND VISUALLY IMPAIRED STUDENTS (BY STATE)

ALABAMA Blind Children’s Center FLORIDA 4120 Marathon Street Alabama Institute for Deaf and Los Angeles, CA 90029 Florida School for the Deaf and Blind 323-664-2153 Blind 205 East South Street http://www.blindcntr.org 207 North San Marco Avenue Talladega, AL 35160 St. Augustine, FL 32084 256-761-3259 California School for the Blind 904-827-2200 or 1-800-344-3732 http://www.aidb.state.al.us 500 Walnut Avenue http://www.fsdb.k12.ﬂ.us Fremont, CA 94536 Southwest Alabama Regional 510-794-3800 GEORGIA School for the Deaf and Blind http://goldmine.cde.ca.gov/csmt/ 8901 Airport Boulevard apendd.html Georgia Academy for the Blind Mobile, AL 36608-9503 2895 Vineville Avenue 334-633-0241 Palomar College Adapted Com- Macon, GA 31204 puter Training Center 478-751-6083 ARIZONA 1140 Mission Road http://www.gabmacon.org Sand Marcos, CA 92069 Arizona State Schools for the 760-744-1150; TDD/TTY 760- IDAHO Deaf and the Blind 471-8506 1200 West Speedway Boulevard http://www.palomar.edu Idaho School for the Deaf and Tucson, AZ 85745 Blind 520-770-3700; TTD/TTY 520-770- COLORADO 1450 Main Street 3213 Gooding, ID 83330 http://www.asdb.org Colorado School for the Deaf and 208-934-4457 the Blind http://www.isdb.state.id.us ARKANSAS 33 North Institute Street Colorado Springs, CO 80903-3599 ILLINOIS 719-578-2100; TDD/TTY 719- Arkansas School for the Blind Hadley School for the Blind 577-2101 2600 West Markham 700 Elm Street http://www.csdb.org Little Rock, AR 72203 Winnetka, IL 60093 1-800-362-1810; TTD/TTY 501- 847-446-8111 or 1-800-323- 296-1833 CONNECTICUT 4238; TDD/TYY 847-441-8111 http://www.hadley-school.org CALIFORNIA Connecticut Institute for the Blind/Oak Hill School Hope School Blind Children’s Learning Center 120 Holcomb Street 50 Hazel Lane 18542-B Vanderlip Avenue Hartford, CT 06112 Springﬁeld, IL 62705-5810 Santa Ana, CA 92705 860-242-2274 217-585-5437; TTD/ 714-573-8888 http://www.ciboakhill.org/ TTY 217-529-5766 http://www.blindkids.org index.htm http://www.thehopeschool.org

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Illinois School for the Visually LOUISIANA 601-984-8200; TTD/TTY 601-984- Impaired 8097 658 East State Street Louisiana School for the Visually http://www2.mde.k12.ms.us/msb Jacksonville, IL 62650 Impaired 217-479-4400 1120 Government Street MISSOURI http://www.il.us/agency/dhs/isvi. Baton Rouge, LA 70802-4897 htm 225-342-8694 Blue Springs Special Services Center Philip J. Rock Center and School MARYLAND 2103 West Vesper 818 DuPage Boulevard Blue Springs, MO 64015 Glen Ellyn, IL 60137 Maryland School for the Blind 816-224-1360 630-790-2474 or 1-800-771- 3501 Taylor Avenue 1158; TDD/TTY 630-790-4723 Baltimore, MD 21236-4499 Children’s Center for the Visually http://www.project-reach-illi- 410-444-5000 or 800-400-4915; Impaired nois.org TDD/TTY 410-319-5703 3101 Main Street http://www.mdschblind.org Kansas City, MO 64111-1921 INDIANA 816-333-3166 Ruth Parker Eason School Gary Community School 648 Old Mill Road Missouri School for the Blind Corporation Millersville, MD 21108-1373 3815 Magnolia Avenue Lew Wallace Building 410-222-3815 St. Louis, MO 63110 Suite B122 314-776-4320 or 1-800-622-5672 415 West 45th Avenue MASSACHUSETTS http://www.msb.k12.mo.us Gary, IN 46408 MONTANA 219-980-6305 Perkins School for the Blind 175 North Beacon Street Montana School for the Deaf Indiana School for the Blind Watertown, MA 02472 and Blind 7725 North College Avenue 617-924-3434 3911 Central Avenue Indianapolis, IN 46240 http://www.perkins.pvt.k12. Great Falls, MT 59405 317-253-1481 ma.us 406-771-6000 IOWA MICHIGAN http://www.sdb.mt.us Iowa Braille and Sight-Saving Michigan School for the Blind NEBRASKA School 1667 Miller Road 1002 G Avenue Nebraska Center for the Educa- Flint, MI 48503-5096 Vinton, IA 52349 tion of Children who are Blind 810-257-1420 or 1-800-622-6730 319-472-5221 or 1-800-645-4579 or Visually Impaired ext. 420 http://www.iowa-braille.k12.ia.us 824 Tenth Avenue http://www.msdb.k12.mi.us Nebraska City, NE 68410 KANSAS MINNESOTA 402-873-5513 or 1-800-826- Kansas State School for the Blind 4355 1100 State Avenue Minnesota State Academy for http://www.ncecbvi.org the Blind Kansas City, KS 66102 NEW JERSEY 913-281-3308 or 1-800-572-5463 P.O. Box 68 http://www.kssb.net Fairbault, MN 55021 LIFT 507-333-4800 or 1-800-657-3634 P.O. Box 4264 KENTUCKY http://www.msab.state.mn.us Warren, NJ 07059 908-707-9840 or 1-800-552-5438 Kentucky School for the Blind MISSISSIPPI 1867 Frankfort Avenue http://www.lift-inc.org Louisville, KY 40206 Mississippi School for the Blind Matheny School and Hospital 502-897-1583 1252 Eastover Drive Main Street http://www.ksb.k12.ky.us Jackson, MS 39211 Peapack, NJ 07977 Appendix VI 287

908-234-0011 NORTH DAKOTA SOUTH CAROLINA http://www.matheny.org North Dakota Vision Services: South Carolina School for the St. Joseph’s School for the Blind School for the Blind Deaf and the Blind 253 Baldwin Avenue 500 Stanford Road 355 Cedar Springs Road Jersey City, NJ 07306 Grand Forks, ND 58203-2799 Spartanburg, SC 29302 201-653-0578 or 1-800-457-8563 701-795-2708 or 1-800-421- 864-585-7711 or (toll-free) http://school.nj.com/school/sjsb 1181 1-888-447-2732; TDD/ http://www.ndsb.k12.nd.us TTY 803-798-4936 NEW MEXICO http://www.scsdb.k12.sc.us OHIO New Mexico School for the SOUTH DAKOTA Visually Handicapped Ohio State School for the Blind 1900 North White Sands 5220 North High Street South Dakota School for the Boulevard Columbus, OH 43214 Blind and Visually Impaired Alamogordo, NM 88310 614-752-1152 423 17th Avenue SE 505-437-3505 or 1-800-437- Aberdeen, SD 57401 3505 OKLAHOMA 605-626-2580 or (toll-free) http://www.nmsvh.k12.nm.us 1-888-275-3814; TDD/ Oklahoma School for the Blind TTY 605-626-7829 NEW YORK 3300 Gibson Street http://www.sdsbvi.sdbor.edu/ Muskogee, OK 74403 Lavelle School for the Blind 918-781-8200 or (toll-free) TENNESSEE 3830 Paulding Avenue 1-877-229-7136 Bronx, NY 10469 http://www.osb.k12.ok.us/index/ Tennessee School for the Blind 718-882-1212 html 115 Stewarts Ferry Pike New York Institute for Special Nashville, TN 37214 Education OREGON 615-231-7340 999 Pelham Parkway http://volweb.utk.edu/Schools/ Oregon School for the Blind Bronx, NY 10469 tsb/ 700 Church Street, SE 718-519-7000; TDD/ Salem, OR 97301 TEXAS TTY 718-519-6196 503-378-3820 http://www.nyise.org Texas School for the Blind and Visually Impaired New York State School for PENNSYLVANIA the Blind 1100 West 45th Street 2A Richmond Avenue Overbrook School for the Blind Austin, TX 78756-3494 Batavia, NY 14020 6333 Malvern Avenue 512-454-8631 or 1-800-872-5273; 716-343-5384 or (toll-free) Philadelphia, PA 19151-2597 TDD/TTY 512-206-9188 1-877-697-7382 215-877-0313 http://www.tsbvi.edu http://web.nysed.gov/vesid/nyssb. Royer-Greaves School for UTAH htm the Blind 118 South Valley Road Utah School for the Blind NORTH CAROLINA Paoli, PA 19301-1444 742 Harrison Boulevard 610-644-1810 Ogden, UT 84404 Governor Morehead School http://royer-greavesschoolforblind. 801-629-4700 or 1-800-990-9328; 2303 Mail Service Center com TDD/TTY 801-629-4701 301 Ashe Avenue http://www.usdb.k12.ut.us Administration Building Western Pennsylvania School for Raleigh, NC 27699-2303 Blind Children VIRGINIA 919-733-6381 201 North Belleﬁeld Avenue http://www.governormorehead. Pittsburgh, PA 15213-1499 Virginia School for the Deaf and net 412-621-0100 Blind at Staunton 288 The Encyclopedia of Blindness and Vision Impairment

P.O. Box 2069 WASHINGTON 301 East Main Street Staunton, VA 24402 Romney, WV 26757 540-332-9000 or 1-800-522-8732 Washington State School for 304-822-4800 the Blind Virginia School for the Deaf, 2214 East 13th Street WISCONSIN Blind and Multi-Disabled Vancouver, WA 98661-4120 at Hampton 360-696-6321 Wisconsin Center for the Blind 700 Shell Road http://www.wssb.wa.gov and Visually Impaired Hampton, VA 23661-2299 1700 West State Street 757-247-2050 WEST VIRGINIA Janesville, WI 53546 http://www.vsdbh.org 608-758-6146 or 1-800-832- West Virginia Schools for the Deaf 9784; TDD/TTY 608-758-6127 and Blind APPENDIX VII PERIODICALS

ABLA Newsletter The American Lupus Society Braille Forum American Blind Lawyers Quarterly American Council of the Blind Association The American Lupus Society 1155 15th Street, NW P.O. Box 1590 23751 Madison Street Suite 1004 Indianola, MS 38751 Torrance, CA 90505 Washington, DC 20005 662-887-5398 213-373-1335 202-467-5081 or 800-424-8666; fax 202-467-5085 ACB Parents Newsletter American Rehabilitation http://www.acb.org Council of Citizens with Low U.S. Department of Education Vision Mary Switzer Building The Braille Mirror 5707 Brockton Drive Room 3212 Braille Institute of America Suite 302 330 C Street, SW 741 N. Vermont Avenue Indianapolis, IN 46220 Washington, DC 20202 Los Angeles, CA 90029 317-254-1332 or 800-733-2258 202-205-5482 323-663-1111 AER Report http://www/brailleinstitute.com Blindness, Visual Impairment, Association for Education and Deaf-Blindness, Semiannual Braille Memorandum Rehabilitation of the Blind and Listing of Current Literature Braille Revival League Visually Impaired Association for Education of the 1010 Vermont Avenue, NW 4600 Duke Street Visually Handicapped Washington, DC 20005 Suite 430 Room 700 Alexandria, VA 22304 Braille Monitor 919 Walnut Street 703-823-9690 or 877-492-2708 National Federation of the Blind Philadelphia, PA 19107 http://www.aerbvi.com 1800 Johnson Street Baltimore, MD 21230 AFB News The Blind Teacher American Council of the Blind 410-659-9314 American Foundation for http://www/afb.org the Blind 1155 15th Street NW 11 Penn Plaza Suite 1004 CCB Outlook Suite 300 Washington, DC 20005 Canadian Council of the Blind New York, NY 10001 202-467-5081 or 800-424-8666; 396 Cooper Street 212-502-7660 or 800-232-5463; fax 202-467-5085 Suite 401 TDD 212-502-7662 http://www.acb.org Ottawa, Ontario K2P 2H7 Canada http://www.afb.org 613-567-0311 or 877-304-0968 Braille Book Review American Council of the Blind National Library Service for the CCLV Newsletter Federal Employees News Council Blind and Physically Handi- Council of Citizens with Low of Citizens with Low Vision capped Vision 5707 Brockton Drive 1291 Taylor Street, NW 5707 Brockton Drive Suite 302 Washington, DC 20542 Suite 302 Indianapolis, IN 46220 202-707-5100 Indianapolis, IN 46220 317-254-1332 or 800-733-2258 http://www.loc.gov./uls 317-254-1332 or 800-733-2258

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Deaf Blind New Summary American Printing House for International Eye Foundation Xavier Society for the Blind the Blind 7801 Norfolk Avenue 154 East 23rd Street 1700 W. State Street Bethesda, MD 20814 New York, NY 10010 Jamesville, WI 53545 Jottings 212-473-7800 608-755-2977 or 1-800-832-9784 Gospel Association for the Blind Deafblind Weekly Guide Dog News 7850 South U.S. Highway 1 Xavier Society for the Blind Guide Dogs for the Blind Bunnell, FL 32110 154 East 23rd Street 350 Los Ranchitos Road 904-586-5885 New York, NY 10010 San Rafael, CA 94903 Journal of Visual Impairment and 212-473-7800 415-499-4000 or 800-295-4050 Blindness http://www.guidedogs.com Diabetes ’90 American Foundation for American Diabetes Association Heresay the Blind 1701 Beauregard Street Association of Radio Reading 11 Penn Plaza Alexandria, VA 22314 Services Suite 300 703-549-1500 or 800-342-2383 National Ofﬁce New York, NY 10001 http://www.diabetes.org 4200 Wisconsin Avenue, NW 212-502-7660 or 800-232-5463; Diabetes Self-Management Suite 106-346 TDD 212-502-7662 R.A. Rapaport Publishing Inc. Washington, DC 20016 http://www.afb.org 202-347-0955 150 West 22nd Street Journal of Visual Rehabilitation New York, NY 10011 HKI Report Media Productions and Dialogue Helen Keller International Marketing Inc. Dialogue Publications Inc. 90 Washington Street 2440 O Street 3100 South Oak Park Avenue 15th Floor Suite 202 Berwyn, IL 60402 New York, NY 10006 Lincoln, NE 68510 212-943-0890 402-474-2676 Education of the Visually http://www.hki.org Handicapped Log of the Bridgetender Heldref Publications Inside MS Friends in Art of ACB 4000 Albemarle Street, NW National Multiple Sclerosis Council of Citizens with Low Washington, DC 20016 Society Vision 205 East 42nd Street 5707 Brockton Drive Encore New York, NY 10017-5706 Suite 302 Division for the Blind and 212-986-3240 Indianapolis, IN 46220 Visually Handicapped 317-254-1332 or 800-733-2258 Library of Congress Insight 1291 Taylor, NW Prevent Blindness News Long Cane News Letter Washington, DC 20542 National Society for the Preven- Boston College 202-707-5100 tion of Blindness 140 Commonwealth Avenue http://www.loc.gov/nls 500 E. Remington Road Chestnut Hill, MA 02167 Schaumburg, IL 60173 Lutheran Braille Evangelism Bul- Exceptional Children 312-843-2020 Council for Exceptional Children letin 1110 North Glebe Road Insight Lutheran Braille Evangelism Suite 300 John Milton Society for the Blind Association Arlington, VA 22201 in Canada 1740 Eugene Street 703-620-3660 or 888-221-6830; 40 St. Clair Avenue, E. White Bear Lake, MN 55110 TDD 703-264-9446 #202 651-426-0469 http://www.cec.sped.org Toronto, ON M4T 1M9 Canada Mainstream 416-960-3953 Free Press Pennsylvania Association for Wisconsin School for the Visually International Eye Foundation the Blind Handicapped Newsletter 2843 North Front Street Appendix VII 291

Harrisburg, PA 17110 Pilot Guide Dog Foundation Suite 223 http://www.pablind.org Newsletter Cincinnati, OH 45246 Pilot Guide Dog Alumni 513-772-8449 MS Quarterly Report Foundation Demos Publications Student Advocate 1123 Wolfram Street 156 Fifth Avenue National Alliance of Blind Chicago, IL 60657 Suite 1018 Students 312-671-1336 New York, NY 10010 1010 Vermont Avenue, NW 212-255-8768 Recording for the Blind News Suite 1100 20 Roszel Road NARIC Quarterly Washington, DC 20005 Princeton, NJ 08540 National Rehabilitation 202-393-3666 or 1-800-425-8666 609-452-0606 or 1-800-221-4792 Information Center Talking Book Topics 8455 Colesville Road Reﬂections National Library Service for the Suite 935 Council of Citizens with Blind and Physically Silver Spring, MD 20910-3319 Low Vision Handicapped 5707 Brockton Drive NBA Bulletin Library of Congress Suite 302 National Braille Association 1291 Taylor Street, NW Indianapolis, IN 46220 3 Townline Circle Washington, DC 20542 317-254-1332 or 800-733-2258 Rochester, NY 14623 202-707-5100 716-427-8260 Scene http://www.gov.nls http://www.members.aol.com/ Braille Institute of America Towers nbaofﬁce/index.htm 741 N. Vermont Avenue Overbrook School for the Blind Los Angeles, CA 90029 News About Library Services for the 6333 Malvern Avenue 323-663-1111 Blind and Physically Handicapped Philadelphia, PA 19151 http://brailleinstitute.org SC State Library—DBPH Update 301 Gervais Street Seeing Eye Guide, The National Library Service for the P.O. Box 821 Seeing Eye Inc. Blind and Physically Columbia, SC 29202 Washington Valley Road Handicapped 803-737-9970 or 1-800-922- Morristown, NJ 07960 Library of Congress 7818 973-539-4425 or 800-539-4425 1291 Taylor Street, NW http://www.seeingeye.org NEWSBITS Washington, DC 20542 Talking Computers Inc. Sightsaving 202-707-5100 140 Little Falls Road National Society for the http://www.loc.gov/nls Prevention of Blindness Suite 205 USABA Newsletter 79 Madison Avenue Falls Church, VA 22046 U.S. Association for Blind New York, NY 10016 1-800-458-6338 Athletes Opportunity Smith-Kettlewell Technical File: A 33 North Institute Street National Industries for the Blind Quarterly Journal for the Blind Colorado Springs, CO 80903 1901 North Beauregard Street and Visually Impaired 719-630-0422 Alexandria, VA 22311 Smith-Kettlewell Eye Research http://www.usaba.org 703-998-0770 Foundation Utah Eagle http://www.nib.org 2318 Fillmore Street Utah Schools for the Deaf San Francisco, CA 94115 Paw Tracks and Blind 415-345-2000 Council of Citizens with Utah State Board of Education http://www.ski.org Low Vision 742 Harrison Boulevard 5707 Brockton Drive Standard-Bearer Ogden, UT 84404 Suite 302 National Accreditation Council for 801-629-4700 or 800-990-9328; Indianapolis, IN 46220 Agencies Serving the Blind TDD 801-629-4701 317-254-1332 or 800-733-2258 260 Northland Boulevard http://www.usdb.k12.ut.us 292 The Encyclopedia of Blindness and Vision Impairment

VIDPI News 5707 Brockton Drive 212-502-7660 or 800-232-5463; Visually Impaired Data Processors Suite 302 TDD 212-502-7662 International Indianapolis, IN 46220 http://www.afb.org Council of Citizens with 317-254-1332 or 800-733-2258 Worksight Low Vision Visionary Mississippi State University 5707 Brockton Drive Illinois Society for Prevention of Rehabilitation Research and Suite 302 Blindness Training Center on Blindness Indianapolis, IN 46220 407 South Dearborn Street and Low Vision 317-254-1332 or 800-733-2258 Suite 1000 P.O. Box 6189 VISTA Newsletter Chicago, IL 60605 Mississippi State, MS 39762 Council of Citizens with 312-922-8710 or 800-433-4772 601-325-2001 or 1-800-675-7782 Low Vision http://eyehealthillinois.org www.blind.msstate.edu/irr 5707 Brockton Drive Washington Weekly Review Alabama Radio Reading Service Suite 302 (AFB Washington Review) Network Indianapolis, IN 46220 American Foundation for 650 11th Street South 317-254-1332 or 800-733-2258 the Blind Birmingham, AL 35294 Vendorscope 11 Penn Plaza, Suite 300 205-934-6576 or 800-444-9246 Council of Citizens with Low New York, NY 10001 http://www.wbhm.org Vision APPENDIX VIII RADIO READING SERVICES

Arkansas Radio Reading for the Detroit Radio Information INSIGHT/WYMS Blind, Inc. Service 5225 West Vliet Street 2600 West Markham 4600 Cass Avenue Milwaukee, WI 53208 Little Rock, AR 72208 Detroit, MI 48201 414-475-8488 510-663-4540 313-577-4146 http://www.wyms.org http://pages.prodigy.com/blindnet http://www.wdetfm.org In-Sight Central Indiana Radio Reading, Evergreen Radio Reading Service 43 Jefferson Boulevard Inc. of the Washington Library Warwick, RI 02888 1401 North Meridian Street for the Blind and Physically 401-941-3322 Indianapolis, IN 46202 Handicapped In Touch Networks 317-636-2020 821 Lenora Street 15 West 65th Street http://www.wfyi.org Seattle, WA 98129 New York, NY 206-615-0400 Central Ohio Radio Reading 212-769-6270 or 800-456-3166 Service Georgia Radio Reading Service KPBS-FM Radio Reading Service 2955 W. Broad Street 260 14th Street, NW San Diego State University Columbus, Ohio 43204 Atlanta, GA 30318 San Diego, CA 92182 614-274-7650 404-685-2820 or 877-937-3378 619-594-8170 http://www.corrs.org http://www.galinks.com/garrs http://www.kpbs.org Central Savannah River Area Houston Taping for the Blind KUT 90.5 FM Radio Reading Service Inc. Radio University of Texas at Austin c/o WACG-FM, Augusta College 3935 Essex Lane Communications Building B 2500 Walton Way Houston, TX 77027 Austin, TX 78712 Augusta, GA 39010 713-622-2767 512-471-4683 706-737-1661 Iowa Radio Reading Information http://www.kut.org Chicagoland Radio Information Service Montana Radio Reading Service, Inc. 100 E. Euclid Avenue Service 77 E. Randolph Pedestrian Des Moines, IA 50313 126 East Broadway, #8 Walkway 515-243-6833 or 877-404-4747 Missoula, MT 59802 Chicago, IL 60601 Idaho Radio Reading Service 406-721-1998 or 800-942-7323 312-541-8400 P.O. Box 83720 http://www.mcs.net/~cmeans/cris North Eastern Indiana Radio Boise, ID 83720 .html Reading Service Inc. 208-334-3220 920 Florence Avenue Connecticut Radio Information Illinois Radio Reader Fort Wayne, IN 46808 Services 59 East Armory 219-422-8230 589 Jordan Lane Champaign, IL 61820 Wethersﬁeld, CT 06109 Northern Illinois Radio 217-333-6503 860-956-3579 Information Service http://www.will.uiuc.edu http://www.cslib.org/cris Riverfront Museum Park

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711 N. Main Street Radio Talking Book Service, Inc. Trade Winds Radio Reading Rockford, IL 61103 7101 Newport Avenue Service 815-961-8000 Suite 205 5901 W. Seventh Street http://www.northernpublicradio. Omaha, NE 68152 Gary, IN 46406 org 402-572-3003 or 800-729-7826 219-949-4000 or 800-694-4242; TDD 219-944-3733 Radio Vision Radio Information Center for http://www.thetimesonline.com/ 619 Route 17M the Blind org/tradewinds Division of Associated Services Middletown, NY 10940 for the Blind 845-343-1131 or 800-327-7343 UPDATE Radio Reading Service 919 Walnut Street http://www.rcls.org Chautauqua Blind Association 510 W. Fifth Street Philadelphia, PA 19107 Reading Radio Service Jamestown, NY 14701 215-627-0700 815 North Walnut 716-664-6660 http://www.asb.org Hutchinson, KS 67501 Radio Information Service 316-662-6646 Valley Voice Radio Reading Ser- vice for the Print Handicapped Wabash Valley College READ-OUT Radio Reading Services WMRA-FM 2200 College Drive P.O. Box 2400 James Madison University Mt. Carmel, IL 62963 Syracuse, NY 13220 Harrisonburg, VA 22807 618-262-8641, ext. 253 315-453-2424 703-568-3811 http://www.wcny.org Radio Reading Service http://www.valleyvoice.org RISE 4235 Electric Road, SW Virginia Voice for the Print c/o WMHT-FM Suite 105 Handicapped P.O. Box 17 Roanoke, VA 24014 P.O. Box 15546 Schenectady, NY 12301 540-989-8900 401 Azalea Avenue 518-356-1700 Richmond, VA 23227 Radio Information Service for http://www.wmht.org Blind and Handicapped 804-266-2477 Sight Seer 9541 Church Circle Drive Washington Ear Inc. West Michigan Radio Reading Belleville, IL 62223 35 University Boulevard East Service 618-394-6221 Silver Spring, MD 20901 213 Sheldon Boulevard, SE 301-681-6636 Radio Information Service for Grand Rapids, MI 49503 http://www.washear.org Blind and Print Handicapped of 616-235-0020 West Central Illinois http://www.thesightseer.org WCBU Radio Information Ser- Western Illinois University vice South Carolina Educational Radio 504 Memorial Hall 1501 W. Bradley Avenue for the Blind Macomb, IL 61455 Peoria, IL 61625 1430 Confederate Avenue 309-298-2403 309-677-3585 Columbia, SC 29201 http://www/wiu.edu/usus/miris/ 803-898-8755 or 1-800-922-2222 WYPL-FM wiv 1850 Peabody Avenue Sun Sounds of KJZZ Memphis, TN 38104 Radio Reading Network of 3124 East Roosevelt Street 901-725-8833 Maryland Phoenix, AZ 85008 http://www.memphis.lib.tn.us/ 2901 Liberty Heights Avenue 602-231-0500 wypl/wyptop.htm Baltimore, MD 21215 http://www.sunsounds.org 410-333-5720 or 800-5605 Radio Reading Service GW Talking Information Center 285 Dorset Street Radio Reading Services of Great 130 Enterprise Drive Springﬁeld, MA 01108 Cincinnati, Inc. P.O. Box 519 413-788-6981 2045 Gilbert Avenue Marshﬁeld, MA 02050 Cincinnati, OH 45202 781-834-4400 or 1-800-696-9505 Wichita Radio Reading Service 513-221-8558 http://www.radioview.com 3317 East 17th Street Appendix VIII 295

Wichita, KS 67208 Nashville, TN 37210 4202 E. Fowler Avenue 316-987-6600 615-862-5874 Tampa, FL 33620 813-974-8695 or 800-444-4193 WKAR Radio Talking Book WRKC-Radio Home Visitor http://www.wusf.usf.edu 283 Communication Arts and Kings College Sciences Building Wilkes-Barre, PA 18711 York County Blind Center’s Radio East Lansing, MI 48824 520-208-5811 Reading Service 1380 Spahn Avenue 517-353-9124; TDD 517-355- WTSU Radio Reading Service York, PA 17403 7508 252 Montgomery Street 717-848-1690 http://www.wkar.org Suite 312 http://www.forsight.org WLRN-FM School Board of Montgomery, AL 36104 Dade County Florida 334-241-9574 172 N.E. 15th Street WRBH 88.3 FM Reading Radio Miami, FL 33132 3606 Magazine Street 305-995-2218 or 1-800-273- New Orleans, LA 70115 6677 504-899-1144 http://www.wlrn.org WUSF Radio Reading Service WPLN Talking Library University of South Florida WRB 700 Second Avenue 209

APPENDIX IX REHABILITATION SERVICES (BY STATE)

ALABAMA 522 Main Street DELAWARE Suite 100 Alabama Department of Little Rock, AR 72203-3237 Delaware Department of Health Rehabilitation Services 501-682-5463 or 1-800-960-9270; and Social Services: Division for 2129 East South Boulevard TDD/TTY 501-682-0093 the Visually Impaired Montgomery, AL 36116-2455 http://www.state.ar.us/dhs/dsb 1901 North Dupont Highway 334-281-8780 or 1-800-441-7607 Biggs Building http://www.rehab.state.al.us CALIFORNIA New Castle, DE 19720 302-577-4730; TDD/ Workshop and Rehabilitation Ser- TTY 302-577-4750 vices for the Blind and Disabled California Department of Rehabili- http://www.state.de.us/dhss/dvi/ 2129 East South Boulevard tation: Services for the Blind dvihome.htm Montgomery, AL 36116-2455 2000 Evergreen Street 334-281-8780 or 1-800441-7607 Sacramento, CA 95815-3832 http://www.rehab.state.al.us 916-263-8953; TDD/ DISTRICT OF COLUMBIA TTY 530-345-3897 http://www.rehab.cahwnet.gov/ Columbia Lighthouse for the ALASKA Blind Alaska Center for the Blind Society for the Blind 1120 20th Street, NW 3903 Taft Drive 2750 24th Street Washington, DC 20036 Anchorage, AK 99517-3069 Sacramento, CA 95818 202-454-6400 or (toll free) 907-248-7770 or 1-800-770-7517 916-452-8271 877-324-5252 http://www.alaskablind.com http://www.societyfortheblind.org http://www.clb.org

ARIZONA COLORADO FLORIDA Arizona Center for the Blind and Colorado Department of Human Center for the Visually Impaired Visually Impaired Services: Rehabilitation Services 1187 Dunn Avenue 3100 East Roosevelt Street 2211 West Evans Street Daytona Beach, FL 32114 Phoenix, AZ 85008 Building B 904-253-8879 or 1-800-227-1284 602-273-7411 Denver, CO 80230 http://www.cfiflorida.org http://www.acbvi.org 720-884-1234 Florida Department of http://www.state.co.us Tucson Association for the Blind Education: Division of and Visually Impaired Blind Services CONNECTICUT 3767 East Grant Road 2551 Executive Center Circle Tucson, AZ 85716 Connecticut State Board of Educa- Tallahassee, FL 32399 520-795-1331 tion and Services for the Blind 850-488-1330 or 1-800-342-1828 184 Windsor Avenue http://www.state.fl.us/dbs ARKANSAS Windsor, CT 06095 Independent Living for Adult Arkansas Department of Human 860-602-4000 or 1-800-842-4510; Blind Services: Division of Services for TDD/TTY 860-602-4002 c/o Florida Community College at the Blind http://www.besb.state.ct.us Jacksonville

297 298 The Encyclopedia of Blindness and Vision Impairment

101 West State Street Chicago Lighthouse for People Wichita, KS 67208-4237 Jacksonville, FL 32202 Who Are Blind or Visually 316-682-4646 904-633-8220 Impaired 1850 West Roosevelt Road KENTUCKY GEORGIA Chicago, IL 60608 312-666-1331; TDD/ Kentucky Department for the Georgia Department of Human TTY 312-666-8874 Blind Resources: Division of http://www.thechicagolighthouse. 209 St. Clair Street Rehabilitation Services org Frankfort, KY 40602 Two Peachtree Street, NW 502-575-7315 or 1-800-334-6920 Suite 35-412 INDIANA http://www.state.ky.us/agen- Atlanta, GA 30303-3142 cies/wforce//dfblind/index.htm 404-657-3000 Indiana Family and Social Kentucky Department for the http://www.vocrehabga.org Services Administration: Division of Disability, Aging Blind: Independent Living Ser- Living Independence for Everyone and Rehabilitative Services vices, Charles McDowell Center 17-21 East Travis Street Indiana Government Center 8412 Westport Road Savannah, GA 31406 402 West Washington Street Louisville, KY 40242 912-920-2414 or 1-800-948- Room W-453 502-327-6010 or 1-800-346- 4824; TDD/TTY 912-920-2419 Indianapolis, IN 46204 2115 317-232-7020 or 1-800-545-7763 http://www.state.ky.us/agencies/ HAWAII http://www.state.in.us/fssa wforce/dfblind/kdfbhome.htm Hawaii Department of Human Trade Winds Rehabilitation Center LOUISIANA Services: Ho’opono Services 5901 West Seventh Avenue for the Blind, Vocational Gary, IN 46406-0308 Louisiana Center for the Blind Rehabilitation and Services 219-949-4000 or 1-800-694- 101 South Trenton Street for the Blind Division 4242; TDD/TTY 219-944-3733 Ruston, LA 71270 1901 Bachelot Street http://www.thetimesonline.com/ 318-251-2891 or 800-234-4166 Honolulu, HI 96817 org/tradewinds http://www.lcb-ruston.com 808-692-7716 Louisiana Department of Social http://www.rrhi.com/ IOWA Services: Louisiana Rehabilita- hooponoblindservices Iowa Department for the Blind tion Services IDAHO 524 Fourth Street 8225 Florida Boulevard Des Moines, IA 50309-2364 Baton Rouge, LA 70806 Idaho Commission for the Blind 515-281-1333 or 1-800-362- 225-925-3594 or 800-737-2958 and Visually Impaired 2587; TDD/TTY 515-281-1355 http://www.dss.state.la.us/ofﬂrs/ 341 West Washington Street http://www.blind.state.ia.us/ Boise, ID 83720-0012 MAINE 208-334-3220 KANSAS Maine Department of Labor: http://www.icbvi.state.id.us Kansas Department of Social and Bureau of Rehabilitation ILLINOIS Rehabilitation Services: Services, Division for the Blind Division of Services for and Visually Impaired Illinois Department of Rehabilita- the Blind, Rehabilitation 3 Anthony Avenue tion Services: Bureau of Center for the Blind #150 State House Station Blind Services 2516 SW Sixth Avenue Augusta, ME 04333-0150 623 East Adams Street Topeka, KS 66606 207-624-5959; TDD/ Springﬁeld, IL 62794-9429 785-296-3311 TTY 207-624-5955 217-785-3887 or 1-800-275- http://www.state.ks.us/public/srs MARYLAND 3677; TDD/TTY 630-495-2294 Vision Rehabilitation Center http://www.state.il.us/agency/ 6100 East Central Avenue Johns Hopkins School of Medi- dhs/bsnp.html Suite 5 cine: Wilmer Ophthalmological Appendix IX 299

Institute, Lions Vision Research Visually Impaired Center 2801 Wyandotte Street and Rehabilitation Center 725 Mason Street Third Floor 550 North Broadway Flint, MI 48503 Kansas City, MO 64108 Sixth Floor 810-235-2544 816-753-6533 Baltimore, MD 21205 410-955-0580 MINNESOTA MONTANA http://www.wilmereyeinstitute. Montana Department of Public org Minnesota State Academy for the Blind Health and Human Services: Maryland State Department of P.O. Box 68 Developmental Disabilities Education: Division of Fairbault, MN 55021 Program/Vocational Rehabilitation Services 507-333-4800 or 1-800-657-3634 Rehabilitation/Blind and 2301 Argonne Drive http://www.msab.state.mn.us Low Vision Services Baltimore, MD 21218-1696 111 North Sanders 410-767-9100 or (toll-free) Minnesota State Services for the Room 307 1-888-200-7117; TDD/ Blind Helena, MT 59604 TTY 410-554-9411 2200 University Avenue West 406-444-2590 or (toll free) http://www.dors.state.md.us/ Suite 240 1-877-296-1197 St. Paul, MN 55114-1840 Services for the Visually Impaired 651-642-0500 or 1-800-652-9000 NEBRASKA 8720 Georgia Avenue TDD/TTY 651-642-0506 Suite 210 http://www.mnworkforcecenter. Nebraska Commission for the Silver Spring, MD 20910 org/ssb/ Blind and Visually Impaired 301-589-0894 4600 Valley Road, Suite 100 MISSISSIPPI Lincoln, NE 68510-4844 MASSACHUSETTS 402-471-8100 or (toll free) 877- Addie McBryde Rehabilitation Massachusetts Association for 809-2419; TDD/TTY 402-471- Center for the Blind the Blind 2891 2550 Peachtree Street 200 Ivy Street Jackson, MS 39296-5314 NEW HAMPSHIRE Brookline, MA 02446 601-364-2700 or 1-800-443- 617-738-5110 or 1-800-682-9200 1000; TDD/TTY 601-853-5100 New Hampshire Division of Voca- URL: http://www.mablind.org tional Rehabilitation: Services Mississippi Department of Reha- Massachusetts State Commission for the Blind and Visually bilitation Services: Ofﬁce of for the Blind Impaired Vocational Rehabilitation for 88 Kingston Street 78 Regional Drive Boston, MA 02111-2227 the Blind Building #2 617-727-5550 or 1-800-392-6450 1281 Highway 51 North Concord, NH 03301 http://www.magnet.state.ma.us/ Madison, MS 39110 603-271-3537 or 800-581-6881 mcb 601-853-5100 or 1-800-443- http://216.64.49.52/vrweb/blind. 1000 html MICHIGAN http://www.mdrs.state.ms.us NEW JERSEY Michigan Commission for the MISSOURI Blind Training Center New Jersey Commission for the 1541 Oakland Drive Missouri Rehabilitation Services Blind and Visually Impaired Kalamazoo, MI 49008 for the Blind 153 Halsey Street, 6th Floor 616-337-3848 3418 Knipp Drive Newark, NJ 07101 http://www.mﬁa.state.mi.us/mcb Jefferson City, MO 65109 973-648-3333 573-751-4249 or 1-800-592-6004 Visual Rehabilitation and New Jersey Foundation for the http://www.dss.state.mo.us/dfs/ Research Center of Michigan Blind rehab.htm 15401 East Jefferson Avenue 230 Diamond Spring Road Grosse Pointe Park, MI 48230 Rehabilitation Institute: Center Denville, NJ 07834 313-824-2401 for Blindness and Low Vision 201-627-0055 300 The Encyclopedia of Blindness and Vision Impairment

NEW MEXICO 919-733-9822; TDD/TTY 919- Oregon Commission for the Blind 733-9700 535 12th Avenue, SE New Mexico Commission for the http://www.dhhs.state.nc.us/dsb/ Portland, OR 97214 Blind 503-731-3221 or (toll-free) 1- 1120 Paseo de Peralta NORTH DAKOTA 888-202-5463; TDD/TTY 503- PERA Building, Room 553 731-3224 Santa Fe, NM 87504 North Dakota Department of http://www.cfb.state.or.us 505-827-4479 or (toll free) 1- Human Services: Vocational 888-513-7968 Rehabilitation PENNSYLVANIA http://www.state.nm.us/cftb 600 South Second Street, Suite 1B Associated Services for the Blind NEW YORK Bismarck, ND 58504 919 Walnut Street Philadelphia, PA 19107 Helen Keller Worldwide 701-328-8950 or 1-800-755- 215-627-0600 90 West Street 2745; TDD/TTY 701-328-8968 http://www.asb.org Second Floor OHIO New York, NY 10006 Association for the Blind and 212-766-5266 or 1-800-535-5374 Ohio Rehabilitation Services Visually Impaired http://www.hkworld.org Commission: Bureau of Ser- 614 North 13th Street Allentown, PA 18102-2199 New York State Education vices for the Visually Impaired 610-433-6018 Department: Ofﬁce of Voca- 400 East Campus View Boulevard http://www.abvi.org tional and Educational Services Columbus, OH 43235-4604 for Individuals with Disabilities 614-438-1255 or 1-800-282- Center for Vision Rehabilitation One Commerce Plaza 4536; TTD/TTY 614-995-1161 Allegheny General Hospital Room 1606 http://www.state.oh.us/rsc Suite 116 Albany, NY 12234 Ohio State University: College of Ophthalmology Department 518-474-2714 or 1-800-222-5627 Optometry, Vision Rehabilita- Pittsburgh, PA 15212 http://web.nysed.gov/vesid tion Service 412-359-6300 or 1-800-637-3762 Resource Center for Independent 338 West 10th Avenue RHODE ISLAND Living Columbus, OH 43210 401-409 Columbia Street 614-292-1104 Rhode Island Department of Utica, NY 13503-0210 http://www.optometry.ohio- Human Services: Services for 315-797-4642; TDD/TTY 315- state.edu the Blind and Visually Impaired 797-5837 40 Fountain Street http://www.rcil.com OKLAHOMA Providence, RI 02903-1898 401-277-2382 or 1-800-752- Westchester Independent Living Oklahoma Department of Reha- 8088 Center bilitation Services http://www.ors.state.ri.us 200 Hamilton Avenue 3535 N.W. 58th Street, Suite 500 Second Floor Oklahoma City, OK 73112 SOUTH CAROLINA White Plains, NY 10601 405-951-3400 or 1-800-845-8476 914-682-3926; TDD/TTY 914- http://www.onenet.net/~drspi- South Carolina Commission for 682-0926 owm the Blind http://www.wilc.org 1430 Confederate Avenue OREGON Columbia, SC 29201 NORTH CAROLINA 803-898-8800 or 1-800-922-2222 Independent Living Resources http://www.sccb.state.sc.us North Carolina Division of Ser- 4506 S.E. Belmont, Suite 100 vices for the Blind Portland, OR 97215-1658 SOUTH DAKOTA 2601 Mail Service Center 503-232-7411; TDD/TTY 503- 309 Ashe Avenue 232-8408 South Dakota Department of Raleigh, NC 27699-260 http://www.ilr.org Human Services: Division of Appendix IX 301

Service to the Blind and 250 North 1950 West, Suite B P.O. Box 50890 Visually Impaired Salt Lake City, UT 84116-7902 State Capitol Complex East Highway 34 801-323-4343 or 1-800-284- Charleston, WV 25305-0890 500 East Capitol 1823; TDD/TTY 801-323-4395 304-766-4891 or 1-800-642- Pierre, SD 57501-5070 3021; TDD/TTY 304-766-4970 605-773-5990 or 1-800-265-9684 VERMONT http://www.state.sd.us/dhs/ WISCONSIN Vermont Association for the Blind TENNESSEE and Visually Impaired Wisconsin Center for the Blind 37 Elmwood Avenue and Visually Impaired Tennessee Rehabilitation Center Burlington, VT 05401 1700 West State Street 460 Ninth Avenue 802-863-1358 or 1-800-639-5861 Janesville, WI 53546 Smyrna, TN 37167-2010 608-758-6146 or 1-800-832- 615-741-4921 VIRGINIA 9784; TDD/TTY 608-758-6127 Tennessee Services for the Blind Virginia Rehabilitation Center for Wisconsin Council of the Blind and Visually Impaired the Blind and Vision Impaired 354 West Main Street 400 Deaderick Street, 11th Floor 401 Azalea Avenue Madison, WI 53703-3115 Nashville, TN 37248-6200 Richmond, VA 23227 608-255-1166 or 1-800-783-5213 615-313-4914 804-371-3151 http://www.wcblind.org

TEXAS WASHINGTON Wisconsin Department of Health and Family Services: Division of Texas Commission for the Blind: Washington State Department of Supportive Living, Bureau for Criss Cole Rehabilitation Center Services for the Blind the Blind 4800 North Lamar 402 Legion Way, SE, Suite 100 1 West Wilson Street Austin, TX 78756 Olympia, WA 98504-0933 Madison, WI 53707 512-377-0300 or 1-800-252-5204 360-586-1224 or 1-800-552- 608-266-3139 http://www.tcb.state.tx.us/ 7103; TDD/TTY 206-764-4051 http://www.dhfs.state.wi.us/ criss_cole.asp http://www.wa.gov/dsb WYOMING UTAH WEST VIRGINIA Wyoming Division of Vocational Utah Industries for the Blind West Virginia Department of Edu- Rehabilitation P.O. Box 1258 cation and the Arts: Division of 1100 Hershler Building Salt Lake City, UT 84110-1258 Rehabilitation Services, Infor- Cheyenne, WY 82002 Local Telephone: (801) 485-3847 mation and Referral Services 307-777-7389 Utah State Division of Services for for the Blind and Visually http://onestop.state.wy.us/ the Blind and Visually Impaired Impaired appview/ujn-home.asp

APPENDIX X SCHOLARSHIPS FOR THE BLIND

American Council on Rural Spe- George Washington University Council of Citizens with Low cial Education Scholarships Disabled Support Services Vision, Carl E. Foley Kansas State University Marvin Center Scholarship 2323 Anderson Avenue Suite 436 Pennsylvania College of Suite 226 Washington, DC 20052 Optometry Manhattan, KS 66501-2912 202-994-8250 1200 West Godfrey Street 785-532-2737 Blinded Veterans Association Philadelphia, PA 19141 http://www.kus.edu Scholarships 215-276-6268 American Council of the Blind Blinded Veterans Association Equal Opportunity Publications Scholarships 477 H Street, NW 445 Broad Hollow Road 1155 15th Street, NW Washington, DC 20001 Suite 425 Suite 270 202-371-8880 Melville, NY 11747 Washington, DC 20005 Christian Record Braille 631-421-9421 202-467-5081 or 800-424-8666 Foundation Scholarships http://www.eop.com 444 South 52nd Street American Foundation for the The Foundation for Exceptional Lincoln, NE 68506 Blind Scholarships Children Scholarships 402-488-0981 11 Penn Plaza 1920 Association Drive Suite 300 Citizens Scholarship Foundation Reston, VA 20190 New York, NY 10001 of America 703-264-3507 212-502-7600 or 800-232-5463 Jenneth Cote http://www.afb.org Citizens Scholarship Foundations Foundation for Science and the Amy Reiss Blind Student of America Handicapped Scholarships Scholarship Box 112A Chairperson of the Science Grant Fordham University Financial Aid Londonderry Turnpike Committee Ofﬁce RFD #7 Division of Rehabilitation 140 W. 62nd Street Manchester, NH 13104 Education 154 Juliet Court Room 125 and New York, NY 10023 Clarenden Hills, IL 60514 Ingrid LeMarie http://www.acenet.edu New Hampshire Charitable Fund George Peabody College, Vander- Association for Education and One South Street bilt University Department of Rehabilitation of the Blind and Concord, NH 03301 Special Education Visually Impaired http://www.csfa.org Nashville, TN 37203 Ferrell Scholarship Fund 615-322-2249 Council of Citizens with Low 4600 Duke Street Vision International Itzhak Perlman Award Suite 430 1155 15th Street, NW Denise Warner Alexandria, VA 22397 Suite 1004 Very Special Arts Education Ofﬁce 703-823-9690 Washington, DC 20005 Kennedy Center Barbara Jackman Zuckert Schol- 800-733-2258 Washington, DC 20566 arship http://www.cclvi.org 202-662-8899

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Jewish Braille Institute of Amer- Recording for the Blind Scholastic Vinland National Center ica Inc. Scholarship Achievement Awards P.O. Box 308 110 East 30th Street Public Relations Department 3675 Ihduhapi Road New York, NY 10016 Recording for the Blind Loretto, MN 55357 212-889-2525 20 Roszel Road 612-479-3555 Princeton, NJ 08540 Lighthouse International Vermont Association for 609-452-0606, ext. 246 Career Incentive and Achieve- the Blind ment Awards Ronnie Milsap Foundation Charles E. Leonard Memorial 111 East 59th Street 600 Renaissance Center Scholarship Fund New York, NY 10022 Suite 1300 P.O. Box 2000 212-821-9428 Detroit, MI 48243 Champlain Mill Winooski, VT 05404 National Federation of the Blind Rotary Ambassadorial Scholar- Scholarship Committee ships VSA (Very Special Arts) 805 Fifth Avenue Rotary International 1300 Connecticut Avenue, NW Grinnell, LA 50112-1653 Scholarship Dept. Suite 700 641-236-3369 1560 Sherman Avenue Washington, DC 20036 http://www.nfb.org Evanston, IL 60601 800-933-8721 847-866-3000 The New Hampshire Charitable Western Michigan University http://www.rotary.org Foundation Department of Rehabilitation 37 Pleasant Street University of Kansas Western Michigan University Concord, NH 03301-4005 Research and Training Center on Kalamazoo, MI 49008 603-225-6641 Independent Living BCR/4089 Dole Opportunities for the Blind Ind., Lawrence, KS 66045 Scholarships 913-864-4095 P.O. Box 510 Leonardtown, MD 20650 800-884-1990 http://www.oppblind.com APPENDIX XI SPORTS AND RECREATION ORGANIZATIONS AND PUBLICATIONS

Access to Art: An Art Resource Direc- 720-865-3616 Sun Sound Reading Service tory for the Blind and Visually http://www.ahta.org 3124 East Roosevelt Street Impaired Phoenix, AZ 85008 American Red Cross American Foundation for the 1-800-255-2777 Program of Swimming for the Blind Handicapped 11 Penn Plaza Bemidji State University 431 18th Street, NW Suite 300 Outdoor Program Center Washington, DC 20006 New York, NY 10001 Hobson Memorial Union 800-797-8022 212-502-7660 or 800-232-5463; Bemidji, MN 56601 http://redcross.org TDD 212-502-7662 218-755-2999 http://www.afb.org American Music Therapy Associa- Bibles and Other Scriptures in American Alliance for Health, tion Special Media Physical Education, Recreation 8455 Colesville Road, Suite 1000 National Library Service for the and Dance Silver Spring, MD 20910 Blind and Physically 1900 Association Drive 301-589-3300 Handicapped Reston, VA 22091 http://www.namt.org Reference Circular Library of Congress 703-476-3481 American Printing House for Washington, DC 20542 http://www.aahperd.org the Blind 212-287-5100 American Blind Bowling 1839 Frankfort Avenue Association P.O. Box 6085 Bible Outdoor Leisure Develop- 411 Sheriff Street Louisville, KY 40206 ment (BOLD) Mercer, PA 16137 502-895-2405 or 800-223-1839 533 East Main Street 412-662-5748 http://www.aph.org Aspen, CO 81611 303-925-2086 American Blind Skiers, Inc. Association of Disabled American 2325 Wilshire Boulevard Golfers Bradford Woods Outdoor Center Santa Monica, CA 90403 P.O. Box 280649 5040 State Road 213-828-5514 Lakewood, CO 80228 67 North 303-922-5228 Martinsville, IN 46151 American Camping Association http://www.toski.com/golf/adag 765-342-8456 5000 State Road 67 North Martinsville, IN 46151 Association of Handicapped Braille Sports Foundation 765-342-8456 Artists 4601 Excelsior Avenue South http://www.ACAcamps.org 5150 Broadway St. Louis Park, MN 55416 Depew, NY 14043 612-920-9363 American Horticulture Therapy 716-683-9316 Association Breckenridge Outdoor Education 909 York Street Association of Radio Reading Center Denver, CO 80206 Services 917 Airport Road

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P.O. Box 697 American Alliance for Health, 785-234-2156 Breckenridge, CO 80424 Physical Education, Recreation http://www.nbaa.org 970-453-6422 and Dance National Braille Association 1900 Association Drive Challenge Alaska 3 Towline Circle Reston, VA 20191 P.O. Box 110065 Rochester, NY 14623 800-213-7193 Anchorage, AK 99511 716-427-8260 http://www.aahperd.org 907-344-7399 http://www.nationalbraille.org http://www.challenge.ak.org Information Center for National Camp Directory for the Individuals with Disabilities Choice Magazine Blind and Visually Impaired P.O. Box 750119 100 Riverview Center American Foundation for the Arlington Heights, MA 02475 Middletown, CT 06457 Blind 781-860-0673 860-347-6933 11 Penn Plaza, Suite 300 http://www.disability.net Council for Disabled Sailors New York, NY 10001 American Sailing Association International Bicycle Tours Inc. 212-502-7660 or 800-232-5463; 60 Padanaram Road 12 Mid Place TDD 212-502-7662 Unit 16 Chappaqua, NY 10514 http://www.afb.org 914-238-4576 Danbury, CT 06810 National Committee/Arts for the Courage Center Kirkwood Instruction for Blind Handicapped Department of Sports, Physical Skiers 1300 Connecticut Avenue Education and Recreation P.O. Box 138 Suite 700 3915 Golden Valley Road Kirkwood, CA 95646 Washington, DC 20036 202-628-2800 or 800-933-8721 Golden Valley, MN 55422 Louis Braille Foundation for http://vsarts.org 763-520-0520 Blind Musicians http://www.courage.org 112 East 19th Street National Exhibits by Blind Artists Disabled Sports USA New York, NY 10003 919 Walnut Street, First Floor Philadelphia, PA 19107 41 Hungerford Drive Matilda Ziegler Magazine for the 1-800-222-1764 Suite 100 Blind Rockville, MD 20850 80 Eighth Avenue, Room 1304 National Gardening Association 301-217-0960 New York, NY 10011 180 Flynn Avenue http://www.dsusa.org 212-242-0263 Burlington, VT 05401 Discovery Blind Sports Interna- http://zieglermag.org 802-863-1308 tional National Arts and the Handi- National Handicapped Sports and 6811 Aitkem Drive capped Information Service Recreation Association Oakland, CA 94611 Arts and Special Constituency 5932 Illinois Avenue 510-399-0777 Project Orangevale, CA 95662 Evergreen Travel Service National Endowment for the Arts 916-989-0402 2401 E Street, NW 4114 North Avenue, SW National Therapeutic Recreation Washington, DC 20506 #13 Society Lynnwood, WA 98036 National Association for Sports 22377 Belmont Ridge Road 800-435-2288 for Cerebral Palsy Ashburn, VA 20148 Independent Living Aids 66 East 34th Street 703-858-0784 200 Robbins Lane New York, NY 10016 http://www.health.gov/nhic 212-481-6359 Jericho, NY 11753 North American Riding for the http://www.uscpaa.org 800-537-2118 Handicapped Association http://www.independentliving. National Beep Baseball P.O. Box 33150 com Association Denver, CO 80233 Information and Research Utiliza- 2231 W. First Avenue 303-252-4610 tion Center Topeka, KS 66606 http://www.harha.org Appendix XI 307

Outward Bound SIRE, Inc. (Self Improvement Mountain View, CA 94043-5274 945 Pennsylvania Street Through Riding) 1-800-286-8484 Denver, CO 80203 Rt. 2, Box 56 Travel Industry and Disabled 800-243-8520 Hockley, TX 77447 Exchange (TIDE) http://www.outwardbound.org 281-356-7588 5435 Donna Avenue People-to-People Committee for Skating for the Blind and Handi- Tarzana, CA 91356 the Handicapped capped Travel Information Center 1111 20th Street, NW, Suite 660 1200 East and West Road Moss Rehabilitation Hospital Washington, DC 20036 West Seneca, NY 14224 12th Street and Tabor Road 202-653-5007 716-675-7222 Philadelphia, PA 19141 http://www.sabahinc.org Peter Burwash International Ltd. 215-329-5715 2203 Timberloch Place, #126 Ski for Light United States Blind Chess Associ- The Woodlands, TX 77380 1400 Carole Lane ation 218-363-4707 Green Bay, WI 54313 30 Snell Street http://www.pbi-tennis.com 414-494-5572 Brockton, MA 02410 President’s Committee on SOAR United States Blind Golfers Asso- Employment of People with 5404 NE Alameda Avenue ciation Disabilities Portland, OR 97214 3094 Shamrock Street North 1331 F Street, NW Society for the Advancement of Tallhassee, FL 32308 Washington, DC 20004 Travel for the Handicapped 850-893-4511 202-376-6200 374 Fifth Avenue, Suite 610 http://www.usbga.org http://www.health.gov/nhic New York, NY 10016 Vinland National Center Recording for the Blind Inc. 212-447-7284 3675 Ihduhapi Road 20 Roswell Road http://www.sath.org P.O. Box 308 Princeton, NJ 08540 Sports Illustrated Loreetto, MN 55357 609-452-0606 Available through the National 615-479-3555 http://www.rfbdnj.org Library Service for the Blind West Chester University Outdoor Santa Monica Blind Skiers Inc. and Physically Handicapped Resource Center 2325 Wilshire Boulevard 1291 Taylor Street, NW West Chester, PA 19380 Santa Monica, CA 90403 Washington, DC 20542 215-436-1000 Science Products Telesensory Systems Box A 455 North Bernardo Avenue Southeastern, PA 19399 P.O. Box 7455 1-800-888-7401

APPENDIX XII

DIAGRAM OF THE EYE

NOTE The diagram of the eye that appears below will be useful in clarifying matters of anatomy and structure, and will be essential in understanding many of the entries throughout the book.

Cross section of the eye. Reprinted by permission of the American Academy of Ophthalmology.

309

BIBLIOGRAPHY

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Staff of Ready Reference Press. Directory of Information Trevor-Roper, P. D. and P. V. Curran. The Eye and Its Disor- Resources for the Handicapped. Santa Monica, Calif.: ders. Oxford, U.K.: Blackwell Scientiﬁc Publications, Ready Reference Press, 1980. 1984. Staff of Peninsula Center for the Blind. The First Steps. Turriff, Tod W. National Society to Prevent Blindness. Palo Alto, Calif.: Peninsula Center for the Blind, 1980. Telephone interview. 16 November 1989. Stark, Walter J. Cataracts: A Guide for Patients. Wall Town- “UCLA Finds Gene Tied to Blindness in Mice.” San Jose ship, N.J.: H I N, Inc., 1997. Mercury News, 15 December 1989, pp. 17A. State of California Department of Rehabilitation. Business United Cerebral Palsy Association. Cerebral Palsy—Facts Enterprise Training Program. Sacramento, Calif.: CDR, and Figures. New York: UCPA, 1986. 1983. ———. What Is Cerebral Palsy. New York: UCPA, 1978. ———. Regulations: Business Enterprise Program for the United States Association for Blind Athletes. SportsScoop: Blind. Sacramento, Calif.: CDR, 1983. July and August 1989. Colorado Springs, Colo.: USABA, Stephens, John W. Understanding Diabetes. Beaverton, 1989. Oreg.: The Touchstone Press, 1987. ———. Sports Summaries: Alpine Skiing. Colorado Springs, Summers, Laureen. “Reimbursing Adaptive Technology.” Colo.: USABA, 1989. NARIC Quarterly 2, no. 4 (Winter 1989): 1, 7–11, 17. ———. Sports Summaries: Goal Ball. Colorado Springs, Swail, J., and E. L. Bryenton. “Sensory 6: An Electronic Colo.: USABA, 1989. Travel Aid for Blind Persons.” Journal of Visual Impair- ———. Sports Summaries: Gymnastics. Colorado Springs, ment and Blindness (May 1987): 217–219. Colo.: USABA, 1989. Tait, Perla. “Play and the Intellectual Development of Blind ———. Sports Summaries: Judo. Colorado Springs, Colo.: Children.” The New Outlook (December 1972): 361–369. USABA, 1989. Talal, Norman, and Dan Lechay. Are You Aware of Lupus? ———. Sports Summaries: Nordic Skiing. Colorado Springs, San Jose, Calif.: Bay Area Lupus Foundation, 1989. Colo.: USABA, 1989. Talking Computers Inc. NEWSBITS. Falls Church, Va.: ———. Sports Summaries: Powerlifting. Colorado Springs, TCI, 1989. Colo.: USABA, 1989. ———. NEWSBITS Auditory Magazine: February 1989. Falls ———. Sports Summaries: Speed Skating. Colorado Springs, Church, Va.: TCI, 1989. Colo.: USABA, 1989. ———. NEWSBITS Auditory Magazine: June 1989. Falls ———. Sports Summaries: Swimming. Colorado Springs, Church, Va.: TCI, 1989. Colo.: USABA, 1989. ———. News From Talking Computers, Inc. Falls Church, ———. Sports Summaries: Tandem Cycling. Colorado Va.: TCI, 1989. Springs, Colo.: USABA, 1989. ———. Talk-To-Me Tutorials. Falls Church, Va.: TCI, 1989. ———. Sports Summaries: Track and Field. Colorado Taylor, Robert B. Feeling Alive After 65. New York: Arling- Springs, Colo.: USABA, 1989. ton House Publishers, 1973. ———. Sports Summaries: Wrestling. Colorado Springs, Telephone Pioneers of America. Pioneering: The Service Colo.: USABA, 1989. Connection. New York: TPA, 1986. ———. United States Association for Blind Athletes. Colorado Telesensory Systems, Inc. Focus on Technology. Mountain Springs, Colo.: USABA, 1989. View, Calif.: TSI, 1989. University of Maryland Medicine. “Refractive Errors.” ———. LapVert. Mountain View, Calif.: TSI, 1989. Available online. URL: http://www.umm.edu/eye- ———. Navigator. Mountain View, Calif.: TSI, 1989. care/visprobs.htm. ———. Optacon II. Mountain View, Calif.: TSI, 1989. ———. “Age-Related Macular Degeneration (AMD).” ———. See What You’ve Been Missing. Mountain View, Available online. URL: http://www.umm.edu/eye- Calif.: TSI, 1989. care/macular.htm. ———. Voyager. Mountain View, Calif.: TSI, 1989. U.S. Bureau of the Census. Disability, Functional Limitation, Thackray, John. “The High Cost of Workplace Eye and Health Insurance Coverage: 1984/85. Washington, Trauma.” Sightsaving 51, no. 1 (1982): 19–22. D.C.: USBC, 1986. Thijssen, J. M., and A. M. Verbeek, eds. Ultrasonography in U.S. Department of Health and Human Services. Diabetic Ophthalmology. Boston: Dr. W. Junk Publishers, 1981. Retinopathy. NIH Publication No. 85–2171. Washing- Transceptor Technologies, Inc. Introducing the Personal ton, D.C.: Government Printing Ofﬁce, 1987. Companion. Ann Arbor, Mich.: TTI, 1989. ———. Vision Research: A National Plan, 1983–1987 Vol- Transcript of Phil Donahue Show. “What They Did for ume Two/Part One. NIH Publication No. 83–2471. Love.” 13 February 1989, Mutimedia Entertainment, Washington, D.C.: Government Printing Office, New York. 1987. 324 The Encyclopedia of Blindness and Vision Impairment

———. Vision Research: A National Plan, 1983–1987 Volume ———. “Blindness and Early Development: Issues in Two/Part Two. NIH Publication No. 83–2472. Washing- Research Methodology.” The New Outlook (February ton, D.C.: Government Printing Office, 1987. 1976): 53–60. ———. Vision Research: A National Plan, 1983–1987 Volume Weale, R. A. Focus on Vision. Cambridge, Mass.: Harvard Two/Part Four. NIH Publication No. 83–2472. Washing- University Press, 1982. ton, D.C.: Government Printing Office, 1987. Weinberg, Nancy, and Rosina Santana. “Comic Books: ———. Vision Research: A National Plan, 1983–1987 Volume Champions of the Disabled Stereotype.” Rehabilitation Two/Part Five. NIH Publication No. 83–2475. Washing- Literature 39, nos. 11–12 (November–December ton, D.C.: Government Printing Office, 1987. 1978): 327–331. U.S. Department of Labor. Interviewing Guides for Specific Weiner, Florence. No Apologies. New York: St. Martin’s Disabilities. Washington, D.C.: DOL, 1977. Press, 1986. U.S. Postal Service. Mailing Free Matter for Blind and Visu- Weisgerber, Robert A., et al., eds. Training the Handicapped ally Handicapped Persons. Washington, D.C.: USPS, for Productive Employment. Rockville, Md.: Aspen Publi- 1985. cations, 1980. Vander, James F., and Janice A. Gault. Ophthalmology Western Blind Rehabilitation Center. WBRC Clinical Sum- Secrets. Philadelphia: Hanley & Belfus, Inc., 1998. mary. Palo Alto, Calif.: WBRC, 1987. Vaughn, Daniel, and Taylor Asbury. General Ophthalmol- ———. Western Blind Rehabilitation Center. Palo Alto, ogy. Los Altos, Calif.: Lange Medical Publications, Calif.: WBRC, 1987. 1977. Wilensky, Jacob T., and John E. Read, eds. Primary Oph- Vaughn, Lewis, ed. The Complete Book of Vitamins and Min- thalmology. New York: Grune and Stratton Inc., 1984. erals for Health. Emmaus, Pa.: Rodale Press, 1988. World Health Organization. Available Data On Blindness Vernon, McCay, Joann A. Boughman and Linda Annala. (Update 1987). New York: WHO, 1987. Considerations in Diagnosing Usher’s Syndrome: RP and ———. Control of Vitamin A Deficiency and Xerophthalmia. Hearing Loss. Baltimore: RP Foundation Fighting Geneva: WHO, 1982. Blindness, 1982. ———. Guidelines for Programmes for the Prevention of Blind- Veterans Administration. Federal Benefits for Veterans and ness. Geneva: WHO, 1979. Dependents. Washington, D.C.: VA, 1988. ———. The Use of Residual Vision by Visually Disabled Per- Vision Place (The). “Treating Glaucoma with Eye Drops.” sons. Copenhagen: WHO, 1981. Available online. URL: http://www.thevisionplace. Woods, Virgil L. Update in Lupus Research. San Jose, Calif.: com/VisionPlaceIII/discover/treatglcdrops.htm. Bay Area Lupus Foundation, 1984. ———. “Laser Treatment for Glaucoma.” Available Woodworth, Robert S., and Harold Schlosberg. Experi- online. URL: http://www.thevisionplace.com/Vision- mental Psychology. New York: Henry Holt and Com- PlaceIII/discover/treatglclaser.htm. pany, 1958. Wall, M., and D. R. May. “Threshold Amsler Grid Testing Worden, Helen W. “Aging and Blindness.” The New Out- in Maulopathies.” Ophthalmology (September 1987): look (December 1976): 433–437. 1126–33. Yanoff, Myron. “Magnetic Views of the Eye and Brain.” Walsh, Sara R., and Robert Holzberg, eds. Understanding Sightsaving 53, no. 4 (1984–85): 16–17. and Educating the Deaf-Blind/Severely and Profoundly Yudkin, John. The Penguin Encyclopedia of Nutrition. New Handicapped. Springfield, Ill.: Charles C. Thomas Pub- York: Viking Press, 1985. lisher, 1981. Ziegler, Martha. “Strength in Numbers: The National Net- Ware, Mary A., and Lois O. Schwab. “Child Rearing by work of Parent Coalitions.” Exceptional Parent (June Blind Parents.” The New Outlook (June 1971): 1983): 57–58. 169–174. Zimmerman, Phillip. “HealthWatch: Nutritional Waring, A. O. “Results of the Prospective Evaluation of Approaches to Degenerative Eye Diseases.” Townsend Radial Keratotomy (PERK) Study on Year After Letter for Doctors (February/March 1988): 2. Surgery.” Ophthalmology 92, no. 2 (February 1985): Zinn, Walter J., and Herbert Solomon. The Complete Guide 177–198. to Eye Care, Eyeglasses, and Contact Lens. Hollywood, Fla.: Warren, David H. Blindness and Early Childhood Develop- Frederick Fell Publishers Inc., 1986. ment. New York: American Foundation for the Blind, 1977. INDEX

Boldface page numbers indi- Aid to Families with Dependent Americans With Disabilities Act cate major treatment of a sub- Children (AFDC) 7–8, 95, 97 (ADA) 13–14, 165, 235 ject. air bags 8 American Thermoform Corpora- Air Carrier Access Act 235 tion (ATC) 13 A albinism 8, 46 ametropia 14 abacus 1 alcohol amblyopia 8–9 Amsler, Marc 14 ABLEDATA 1 Alice in Wonderland syndrome Amsler grid 14, 146 Abraham, David 116 153 Amtrak Improvement Act of accelerated speech 3 Alliance for Eye and Vision 1973 193, 235 Access-Able Travel Source 1 Research 9, 159 anesthetic drugs 69–70 accessibility 1–2 Alva Access Group 9 aneurysm 14–15 Access World 12 amaurosis 9 angioid streaks 200 accommodation 2 amblyopia 8, 9–10, 46, 183, 218 aniridia 15, 46 Act to Promote the Education of anisometropia and 15 anisocoria 15 the Blind 2 central vision and 39 anisometropia 15 acyclovir 2, 52 American Academy of Ophthal- ANSI. See American National ADA. See Americans With Disabil- mology 10–11, 86, 210 Standards Institute (ANSI) ities Act (ADA) American Association of Instruc- anterior chamber 15, 26, 85 adaptation, aging and 6 tors of the Blind (AAIB) 74 antibiotics 16 adaptive aids 2–5 American Association of the antifungal drugs 69 aging and 7 Deaf-Blind (AADB) 11 anti-inflammatory drugs 69 Administration for Children, American Association of Workers antiprotozoal drugs 69 Youth and Families 93 for the Blind (AAWB) 21 antiviral drops 87 Administration on Developmen- American Braille Press 129 antiviral drugs 2, 16, 51, 69 tal Disabilities 93 American Cancer Society 35 aphakia 16 adrenergic agents 70 American Council of Blind Lions appetite suppressants 16–17 adventitiously blind, defined 29 139 aqueous fluid 15, 17, 54, 81, advocacy 5 American Council of the Blind 85 AFB. See American Foundation (ACB) 11–12 ARA-A 17 for the Blind (AFB) American Foundation for Over- Architectural and Transportation AFDC. See Aid to Families with seas Blind 129 Barriers compliance Board 1 Dependent Children (AFDC) American Foundation for the Architectural Barriers Act of 1968 Age-Related Maculopathy (ARM) Blind (AFB) 12, 175, 194 17, 93, 165 6–7, 19–20 education and 74 arcus senilis 6, 17–18 central vision and 39 employment and 78, 79 argon laser 18, 135 laser treatment 135 American National Standards Arianne Beheer B.V. 116 progression of 145–146 Institute (ANSI) 1–2, 13 ARM. See Age-Related Maculopa- aging 5–7 American Printing House for the thy (ARM) AIDS 7 Blind (APH) 2, 12–13, 225 arterial occlusion 18–19, 200

325 326 The Encyclopedia of Blindness and Vision Impairment arteriosclerosis 14, 19–20, 117 Blinded Veterans Association cavernous hemangioma 239 central vision and 39 (BVA) 27, 251, 252 CCTV. See closed-circuit television stroke and 219 blindisms 27–28 Center for Libraries and Educa- Artic Technologies 20 blindness 28–30 tional Improvement 92 artificial tears 20, 70 Blind Rehabilitation Service 93 Center for the Partially Sighted artificial vision system 20–21 blind spot 30–31 (CPS) 38–39 A-scan 21, 37, 241 bold-line paper 4 Center on Disabilities at Califor- Association for Education and Borrelia burgdorferi 142 nia State University, Northridge Rehabilitation of the Blind braille 12–13, 31, 256 (CSUN) 243–244 and Visually Impaired (AER) ADA and 14 Centers for Disease Control and 21 books 4 Prevention 142, 249 Association for Education of the computers 45–46 central vision 39 Visually Handicapped (AEVH) paperless 179, 225 cerebral palsy (CP) 39–41 21 slate and stylus 213 chalazion 41, 89 Association for Research in Vision telebraille 228 Child Abuse Prevention and and Ophthalmology 9 Braille, Louis 31–32, 73 Treatment Act 41, 165 Association of Parents Having a “braille blind” 29 Child-Care Food Program 163 Kid in Contacts (APHAKIC) 21 Braille Book Bank (BBB) 160 Child Nutrition Act 41 astigmatism 14, 21, 117 The Braille Forum 11 Children of a Lesser God (film) 23 attitudes 21–23 braille music 32 Children’s Rehabilitative Service auditory aids 3–4, 23–24 braille writer 4, 32–33 (CRS) 95 autosomal dominant neovascular Brailon 13, 33, 230 chlamydia 42 inflammatory vitreoretinopathy Bridges, William 18 Chlamydia trachomatis 233, 250, (ADNIV) 247 B-scan 33, 37, 241 261 AZT 7 Burleson, Janet 107 chorioretinitis 42, 200 Business Enterprise Program choroid 42, 85 choroiditis 42–43, 232 B (BEP) 33, 78 ciliary body 15, 43, 54, 87 Barbier de la Serre, Charles 31 Civil Rights Commission Act 43 C basal-cell carcinoma 238 Civil Rights Commission Act BAVF. See Blinded American Vet- cancer 35–36 Amendments of 1978 165 erans Foundation (BAVF) Candida albicans 57, 228 Civil Rights of Institutionalized Bell, Sir Charles 25 carbonic anhydrase inhibitors 70 Persons Act of 1980 165 Bell’s palsy 20, 25 Carl D. Perkins Vocational Educa- Civil Service Reform Act 43 BEP. See Business Enterprise Pro- tion Acts 257 Clearinghouse on the Handi- gram (BEP) Carroll, Lewis 153 capped 92 beta-blockers 103 Carroll Center for the Blind Clinton, President Bill 121 bifocal contact lenses 48 36–37 closed-circuit television (CCTV) bifocals 25–26 cataract 6, 7, 37–38, 46, 253 3, 43–44, 140, 141 binocular indirect ophthalmo- aniridia and 15 magnifiers 147 scope 172 aphakia 16 coloboma 44, 46 binocular telescopes 147 blindness and 28 color blindness 44, 102, 206 biomicroscope 26, 88 defined 261 color vision, aging and 6 bioptics 26, 147 diabetics experiencing 61 Committee for Purchase from Bledsoe, John 74 genetic 101 People Who Are Blind or blepharitis 26–27, 89 rhegmatogenous detachments Severely Disabled 45, 93 Blinded American Veterans and surgery 201 Commodity Distribution Program Foundation (BAVF) 252 surgery 21, 221 163 Index 327

Community Development Block Department of Health and echolalia 60 Grant Program (CDBG) 115 Human Services 93 echolocation 210 Comprehensive Employment and Department of Veterans Affairs ectropion 73, 89 Training Act (CETA) 127 (VA), U.S. 251, 259 education 73–77 computers 45–46 dermoid cyst 174 Education of All Handicapped congenital disorders 46–47 Descriptive Video Service (DVS) Children Act 74 congenital herpes 112, 250 192 Education of the Handicapped congenitally blind, defined 29 Developmental Disabilities Assis- Act (EHA) 73, 74, 121 conjunctiva 6, 47, 207, 233, 262 tance and Bill of Rights Act 165 nondiscrimination 165 conjunctivitis 47 development of blind children EHA. See Education of the Handi- contact lenses 47–49 59–61 capped Act (EHA) APHAKIC 21 diabetes 61–62 electronic magnifying systems contrast 49 diabetic retinopathy 61, 62–63, 140, 147 aging and 6 200 electronic travel aids (ETA) 77, convergence 49 aging and 7 176, 179 Copyright Act 49–50 aneurysm 14 electroretinography (ERG) 77–78 cornea 15, 25, 26, 50, 205 laser treatment 135 employment 78–79 corneal degeneration 50–51 photocoagulation 182 Employment Assistance Referral corneal edema 51, 104 proliferative retinopathy 187 Network (EARN) 80 corneal transplant 51–52, 222 diopter 63 employment disincentives 79–80 corneal ulcer 52–53 diplopia 63–64 Enabling Technologies Company cortical blindness 29–30, 53 Disabilities Education Act 165 80 cortisone 53, 250 disability 64 endophthalmitis 80–81, 256 cortisporin ophthalmic antibiotic defined 229 endothelial cell count 81 53 Disability Insurance Trust funds endothelium 81 Council for Exceptional Children 215 Energy Conservation and Produc- (CEC) 53–54 Disability Rights Education and tion Act of 1976 81 count fingers 252 Defense Fund (DREDF) 64–65 enophthalmos 81–82, 174 cover-uncover test 64 divergence 65 entropion 6, 82, 89 Cranmer abacus 1, 225 Division of Blind and Visually enucleation 82, 222 cryosurgery 54, 204 Impaired 92 environmental aids 3 crystalline lens 54, 85, 205, 261 dog guide laws 65–66 esophoria 82, 218 Curtis, John 74 dog guides 66, 84 estropia 82 cyclitis 54–55 training 176 ETA. See electronic travel aids cycloplegic drops 55 dominant eye 66–67 (ETA) cytomegalovirus retinitis (CMV) double vision 220. See diplopia etiquette 82–83 7 Down’s syndrome 67 Eustis, Dorothy (Harrison) 83–84 dreams 67–69 Everest Expedition 84, 259 D drugs 69–70 excimer laser 133 dacryocystitis 57, 90, 228 dry eye 70–71, 227–228 exophoria 84, 218 daily living skills 57, 196 Dudley, H. W. 223 exophthalmos 84, 174 Dancing Dots Braille Music Tech- Duxbury Systems, Inc. 71 exotropia 218 nology 32, 57–58 extracapsular surgery 221 deaf-blind 58–59 E exudative retinopathy 187 Department of Education, U.S. early intervention 73 eye 85–86 92 Early Periodic Screening, Diagno- eye bank 86 Department of Education Organi- sis, and Treatment Program Eye Bank Association of America zation Act of 1979 59 (EPSDT) 95 (EBAA) 86–87 328 The Encyclopedia of Blindness and Vision Impairment eye drops 52, 87–88 generic sympathomimetics 69 Hauspie, Pol 138 eye examination 88 genetics 101–102 Hauy, Valentin 73 eyeglasses 88–89 glaucoma 46, 102–104 headband telescopes 148 eyelash dandruff. See blepharitis aging and 7 Head Start 93 eyelids 89–90 angle-closure 103 health aids 3 aniridia and 15 Health Care Financing Adminis- F anterior chamber 15 tration 93 blindness and 28 Helen Keller in Her Story (film) Fair Housing Act 91 diabetics experiencing 61 129 Fair Labor Standards Act of 1938 drugs 70 Helen Keller International (HKI) 91–92 110, 254 Fansanella-Servat 188 eye drops 87 Helen Keller National Center for Federal Advisory Committee Act laser trabeculoplasty 18 Deaf-blind Youths and Adults 92 laser treatment 135 (HKNC) 110–111 Federal-Aid Highway Act of 1973 Ocusert 169 Helen Keller Seminar 12 92, 234–235 open-angle 102–103 hemangioma 174 Federal Aviation Act of 1958 92, peripheral vision 180 hemianopsia 111 235 photocoagulation herpes keratitis 112, 250 Federal Employees Personal photophobia 182 herpes simplex 16, 52, 111–112, Assistance 92 surgery 222 250 federal resources 92–93 synechiae and 222–223 drug treatment 2 financial aid 93–96 treatment 230, 233 eye drops 87 floaters 256 goggles 185–186 herpes zoster 112–113 Floyd Quails Memorial scholar- gonioscopy 103, 104 Higher Education Act 113 ships 11 gonorrhea 104–105, 249 Hilton/Perkins Program 181 fluorescein angiography 96, 146 GOODFEEL software 57 HIV 7 fluorescein staining 96 grants 105 home eye injuries 186 Food Stamp Act of 1977 96–97 Grave’s disease 105–106 homeless assistance (HA) 8 Foscarnet 7 Gridley, Samuel 180 Hoover, Richard E. 113–114, Foundation Fighting Blindness Guide Dog Foundation for the 175 97 Blind Inc. 106 hordeolum 89, 114 fovea 39, 85, 97 Guide Dogs for the Blind, Inc. household aids 3 Franklin, Benjamin 26 106–107 Housing Act of 1937 242–243 Freedom Scientific Inc. 98 Guide Horse Foundation 107, Housing Act of 1949 114 Free Matter for the Blind or 108 Housing Act of 1959 114–115 Handicapped 148 guide horses 107–108 Housing and Community Devel- freezing therapy 204 Guiding Eyes for the Blind (GEB) opment Amendments of 1977 Fresnel prism 239 107 114, 115 Friedlander, Julius R. 73, 176 Howe, Samuel Gridley 73, 74, Fuch’s endothelial dystrophy H 115, 116 50–51, 98 Hadley, William A. 109 Howe Press 115–116, 180 fully sighted, defined 229 Hadley School for the Blind 109 HumanWare, Inc. 116–117, 154 functionally blind 29 Hall, Frank H. 74 hyperopia 14, 117 fundus 98–99 handicap 109 hypertensive retinopathy 19, defined 229 117 G handicapped, defined 29 hypertropia 117, 218 galactosemia 101, 101 hand motion 252–253 hyphema 117–118 gamma rays 192 haptic sense 109–110 hysterical blindness 30, 118 Index 329

I K Lions Club International 138–139 IBM 119 Keller, Arthur 129 Local Education Agency (LEA) idoxuridine 52, 119–120 Keller, Helen 12, 68, 110, 75 illumination 3, 120–121 129–130, 221 long canes 139 impairment 121, 229 LSTA and 138 Louis 13 Independent Living Aids Inc. Kelman, Charles 181 Lower Income Housing Assis- 121 Kennedy, President John F. 96 tance program 242 independent-living center 121 keratitis 16, 51, 52, 130, 223, Low Income Energy Assistance Individuals with Disabilities 249 Act 139 Education Act (IDEA) 73, keratoconus 50–51 low vision 139–140 121–122 keratometry 21, 37, 130–131 evaluation 197 injuries 122–123 keratonocus 130 low-vision aids 140–141 Institute for Blind Youth (Paris) keratoplasty 51, 222 low-vision clinics 141 73, 74 keratotomy 131 LS&S Group Inc. 141–142 International Braille and Technol- kinesthesis 210 lupus 142, 173 ogy Center 161–162 Kirschstein, Ruth L. 161 Lupus Foundation of America International Guiding Eyes Inc. Koch-Weeks bacillus 233 142 (IGE) 123 Kurzweil Educational Systems lutein 142 intraocular lens (IOL) 37–38, Group 131 Lyme disease 142–143 221 Kurzweil Reading Machine 3–4, Intrastromal Corneal Ring (ICR) 24, 131, 193, 223, 256 M Segments 123 IOL surgery 123–124 L MacDonald, Anne T. 194 iridectomy 124, 222, 233 macula 63, 97, 145, 202, 245 label markers 4 iridocyclitis 124 Macular Degeneration Founda- large print 133, 141 iridodonesis 124 tion 145 laser cane 133 iris 26, 125 macular disease 39, 101, laser in situ keratomileusis iritis 125, 224 145–146 (LASIK) 133–134 Isopto Carpine 125 macular dystrophies 46 lasers (Light Amplification by itinerant teacher 75–76, macular edema 146, 202 Simulated Emission of Radia- 125–126, 149 Macy, Anne (Sullivan). See Sulli- tion) 104, 134–136, 192 ivermectin 262 van, Anne Mansfield laser trabeculoplasty 18 Macy, John 129, 221 lazy eye. See amblyopia magnification aids 3 J legally blind 29, 93, 95–96, 137, magnifiers 140, 146–148 Javits-Wagner-O’Day Act 253 mailing privileges 148 (JWOD) 127, 162, 211 rehabilitation services 196 Mainman, Theodore 135 jerking nystagmus 167 Legal Services Corporation 137 mainstreaming 75, 148–149 Job Accommodation Network lens 15, 26 malignant melanoma 35, 149, (JAN) 127 leprosy 137–138 238 Job Opportunities for the Blind Lernout, Jo 138 Marfan’s syndrome 150, 220 (JOB) 161 Lernout & Hauspie 138 Maryland School for the Blind Job Training Partnership Act Library of Congress 93, 138, 74 (JTPA) 127–128, 259 162–163 Mass Transportation Technology Jones, Melvin 138 Library Service and Technology Research and Demonstration Josephine L. Taylor Leadership Act (LSTA) 138 Program 234 Institute 12 Lighthouse for the Blind 79 Maternal and Child Health Block juvenile retinoschisis 128 Lighthouse International 5 Grant Program 215 330 The Encyclopedia of Blindness and Vision Impairment

Maternal and Child Health Ser- National Federation of the Blind nonverbal communication vices Program 150–151 (NFB) 5, 84, 161–162, 259 166–167 mathematics, calculation 1 National Industries for the Blind Nutrition Education and Training Maxi Aids Inc. 151 (NIB) 79, 162, 211 Program 41 M.C. Migel Memorial Library and National Institute on Disability nystagmus 8, 46, 155, 167, 220 Information Center 12 and Rehabilitation Research 1, Medicaid 94–95, 215 92 O Medicaid legislation 151–152 National Institutes of Health/ object of regard 169 medical expenses, deduction 95 National Eye Institute 93 Occupational Safety and Health Medicare 94, 95, 137 National Keratoconus Foundation Administration (OSHA) 185 Medicare legislation 152 (NKFC) 162 ocular albinism 8 metastatic tumors 36, 238 National Library Service for the Ocusert 169 migraine 152–154, 208 Blind and Physically Handi- Office of Disability Employment Migraine Awareness Group: A capped 162–163, 194 Policy (ODEP) 169–170 National Understanding for National Mass Transportation Office of Federal Contract Com- Migraineurs (M.A.G.N.U.M.) Assistance Act of 1974 234, pliance 93 154 244 Office of Human Development miotics 69 National Multiple Sclerosis Soci- Services 93 The Miracle Worker (film) 129 ety 154 Office of Special Education and mountain climbing 84, 259 National Organization of Parents Rehabilitative Services (OSERS) Mowat Sensor 154 of Blind Children 5 59, 92 Multiple Sclerosis (MS) 154–155, National Rehabilitation Informa- Omnibus Budget Reconciliation 173 tion Center (NARIC) 195 Acts 97, 139, 234, 244 Museum of Ophthalmology 11 National School Lunch Act of Onchocerca volvulus 262 myasthenia gravis 67, 155–156 1946 41, 163 onchocerciasis 170, 262 myopia 14, 84, 117, 156 National Society for the Preven- opacification 6, 170 myths 156–157 tion of Blindness 62, 74 National Voter Registration Act of ophthalmia neonatorum 46, 1993 165 170–171 N ND-YAG laser 136 ophthalmic technician 171 National Alliance for Eye and NEI. See National Eye Institute ophthalmologist 3, 171 Vision Research (NAEVR) 159 (NEI) ophthalmoscope 88, 171–172 National Association for Parents New England Asylum for the Optacon 5, 172, 193, 225, 229, of the Visually Impaired Blind 73, 116, 180 256 (NAPVI) 159 New York Institute for the Blind optic atrophy 172, 173 National Association for Visually 73 optic disc 30, 86, 172 Handicapped (NAVH) 159–160 NFB. See National Federation of optician 172 National Braille Association the Blind (NFB) optic nerve 30, 39, 85, 172–173, (NBA) 160 NIB. See National Industries for 207 National Cemetery System 251 the Blind (NIB) optic neuropathy 173 National Center for the Blind 161 night blindness 164 optometrist 173 National Conference of Commis- Night Vision Aid (NVA) 203, 239 orbit 173–174 sioners on Uniform State Laws NoIR Medical Technologies 164 orbital cellulitis 174 241 no light perception (NLP) 28 orientation aids 4, 174 National Council on the Handi- nondiscrimination laws 164–166 orientation and mobility capped 92 nongonococcal urethritis (NGU) 174–176 National Eye Institute (NEI) 142, 250 orthokeratology 176 159, 161 nonoptical aids 3, 166 orthoptist 176 Index 331

Overbrook School for the Blind President’s Council on Employ- residential schools 199 73, 176–177 ment of People with Disabilities resource room 199 93, 169–170 retina 14, 18, 19, 199–201 P Prevent Blindness America 37, A-scan 21, 37 184–185 B-scan 33, 37 panophthalmitis 81, 179, 256 prevention of blindness 185–186 chorioretinitis 42, 200 paperless braille 179, 225 prisms 186, 239 cryosurgery 54, 204 papilledema 172, 179 progressive addition lenses 186 diabetic retinopathy. See dia- partial seeing 29 proliferative retinopathy 187 betic retinopathy Center for the Partially prosthesis 187–188 retinal degeneration 200 Sighted (CPS) 38–39 Protection and Advocacy for retinal detachment 6, 180, 183, defined 229 Mentally Ill Individuals Act of 201–202 pathsounder 179–180 1986 165 retinal dystrophy 200 pendular nystagmus 167 pseudotumor 174 retinal edema 202 Pennsylvania Institution for the ptosis 6, 46, 89, 188 retinitis 200 Instruction of the Blind 73 pupil 54, 183, 188–189 retinitis pigmentosa (RP) 46, perimetry 103 77–78, 101, 173, 200, 202–203, peripheral vision 30, 180, 253 244–245 Perkins, Thomas Handasyd 180 R night blindness and 164 Perkins School for the Blind 73, radial keratotomy (RK) 191, 222 peripheral vision 180 74, 115, 180–181, 221 radiation burns 191–192 retinoblastoma 35–36, 46–47, sheltered workshops 211 radio information services 192 203–204, 238 Permanent Blind War Relief Fund Rail Passenger Service Act 193, retinopathy 200. See also diabetic 129 235 retinopathy Personal Companion 234 Rain Man (film) 23 retinopathy of prematurity (ROP) phacoemulsification 181, 221 raised-line drawing kit 4, 193, 200, 204, 205 phoroptor 181 225 retinoscope 204–205 photocoagulation 181–182 Randolph-Sheppard Act of 1938 retrobulbar neuritis 205 photodynamic therapy 135 33, 78, 92, 193 retrolental fibroplasia 204, 205 photophobia 182 reading machines 193 rhabdomyosarcoma 36, 174, 239 photorefractive keratectomy Recording for the Blind and rhegmatogenous detachments (PRK) 136, 182–183 Dyslexic (RFB&D) 193–194 201 phototherapeutic keratectomy red krypton laser 18 rods and cones 30, 42, 85, 145, (PTK) 136 reduced rates 194 199, 205–206, 245 Plaquinil 142 reflection 3 color blindness 44 plasma urealyticum 250 refraction 194–195 vitamins and 253–254 pleoptics 183 refractive error 14, 195 rose bengal 70 pneumatic retinopexy 183 refractive keratology 195 rubella 58, 74, 206 Polaron 179 REHABDATA 195 Runyan, Marla 206 posterior chamber 85, 180, rehabilitation 195–197 Russ, John Dennison 73 183–184 Rehabilitation Act of 1973 5, 17, Russell Pathsounder 179 posterior uveitis 247 93, 113, 197–198 potential acuity meter (PAM) nondiscrimination 165 184 rehabilitation center 198 S Pratt-Smoot Act of 1931 162 rehabilitation engineering center Samuel P. Hayes Library 181 presbyopia 6, 184 198–199 Saper, Joel R. 154 President’s Committee on Mental Rehabilitation Services Adminis- sarcoidosis 207 Retardation 93 tration 92–93, 193 Schirmer’s test 71, 207 332 The Encyclopedia of Blindness and Vision Impairment

Schlemm’s canal 17, 183 sports-related injuries 186 telescopes 147–148 School Breakfast Program 41 squamous-cell carcinoma 36, Telesensory Systems, Inc. (TSI) School Milk Program 41 238–239 172, 228–229 sclera 207, 233 Staphylococcus auerus 57, 228 templates 4 scleral buckling 207–208, 212 Stargardt’s disease 206, 217–218 terminology 229–230 scleritis 207, 208 State Vocational Rehabilitation thermoform 4, 230 scotoma 9, 208 Agency 78 Thomson, Polly 129, 221 screening 208 stereotypes 22–23 TIAs. See transient ischemic script-writing guide 4 steroids 52–53, 218 attacks (TIAs) Seeing Eye, Inc. 208–209 The Story of My Life (Keller) 129, Ticket to Work and Work Incen- Selective Placement Program 221 tives Improvement Act of 1999 209 strabismus 47, 64, 67, 84, 80, 94 self-contained classroom 209 218–219 Timolol 230 self-protection 175 streptococcus 57 Title XX 215 senses 209–210 stroke 14, 67, 219–220 tobacco amblyopia 39, 230 sensory aids 210 TIAs 18–19, 219 tomography 230–231 Sensory Quill 256 Stromectol 170 tonography 231 sensory training 175 sty 89 tonometer 88, 103, 231 shaken baby syndrome 210–211 subluxation of the lens 220–221 tools and instruments 4 sheltered workshops 211 Sullivan, Anne Mansfield 12, toric contact lenses 49 sickle-cell disease 102, 211–212, 129, 221 total light transmission (TLT) rate 255 Summer Food Service Program 164 sickle cell retinopathy 200 163 toxic amblyopia 173, 231 Sieving, Paul A. 161 Supplemental Security Income Toxocara canis 231 sight-guided technique 212 (SSI) 94, 96 toxocariasis 80, 231–232 signature guide 213 Surface Transportation and Uni- Toxoplasma gondii 232 slate and stylus 213, 225 form Relocation Assistance Act toxoplasmosis 80, 232 Smith-Kettlewell Eye Research of 1987 234, 244 toys and games 232–233 Institute 213–214 surgical procedures 221–222 trabeculectomy 103–104, 222, Smith-Kettlewell Institute of sympathetic ophthalmia 222 233 Visual Sciences 198–199 synechiae 222–223 trachoma 16, 20, 90, 221, 233, Snellen chart 184, 214, 252 synthetic speech 3, 223 261 snow blindness 30, 192, 214 syphilis 223–224, 249–250 blindness and 28 Social Security Act 94, 215 Transceptor Technologies Inc. Social Security Administration T 234 93, 94, 214–215 tactile aids 225 transient ischemic attacks (TIAs) Social Security Benefits 214–215 tactile maps 225–226 18–19, 219 Social Security Disability Insur- talking aids. See auditory aids transportation laws 234–235 ance (SSDI) program 79–80 talking books 3 transpupillary thermotherapy Social Services Block Grant tape recorders 3 (TTT) 235 215–216 tarsorrhaphy 222, 226 trauma 235–237 software 45–46 tax benefits 79, 226 travel aids 4 Sonicguide 216 Taylor slate 226–227 TravelVision 237 sonography 31 teacher-consultant 149, 227 trephine 237 Sorsby’s fundus dystrophy (SFD) tear system 227–228 Treponema pallidum 223, 249 216 telebraille 228 trichiasis 90, 237 speech compressors 3 Telephone Pioneers of America trifluridine 52, 237 sports and recreation 216–217 228 trifocal lenses 238 Index 333

Truman, President Harry 169 veterans 27, 251–252 Weihenmayer, Eric 84, 259 tumors 201, 238–239 Veterans Administration 93 Western Blind Rehabilitation tunnel vision 239 Veterans Benefits Administration Center (WBRC) 259–260 typewriters 5 251 wet eye 222, 260 tyrosinase-negative oculocuta- Veterans Health Services and Wide Angle Mobility Light 246 neous albinism 8 Research Administration 252 Workforce Investment Act of visual acuity 6, 252–253 1998 259 U visual field 253 work opportunity tax credit ulcer. See corneal ulcer visual impairment 253 (WOTC) 79, 260–261 ultrasonography 241 visually defective 29 work-related injuries 185–186 ultraviolet waves 192 visually disabled, defined 29 world blindness 261–262 Uniform Anatomical Gift Act visually impaired, defined 29 World Blind Sailing Champi- (UAGA) 241–242 visually limited, defined 229 onship 262–263 United Cerebral Palsy Association visual prosthesis. See artificial World Health Organization 40 vision system (WHO) 261, 263 United States Association for Visudyne 146 The World I Live In (Keller) 68 Blind Athletes (USABA) 242 vitamins 253–255, 262, 265 World Wide Web Consortium 2 universities 243–244 vitrectomy 63, 187, 255 writing and communication aids Urban Mass Transportation Act of vitreous 6, 201, 255–256 4 1964 234, 244 vocational aids 256 Urban Mass Transportation Vocational Education Act 257 X vocationally blind 29 Demonstration Grants Program xanthelasma 265 vocational rehabilitation 197, 234 X-Chrom lens 49 257–258 Urban Mass Transportation Tech- xerophthalmia 164, 254, Vocational Rehabilitation Act of nical Studies Program 234 261–262, 265 1920 197 Usher’s syndrome 58, 101, X rays 192 244–246 Von Recklinghausen’s disease 174 uvea 85, 222, 246 Y uveal tract 42 uveitis 43, 246–247 W YAG laser 136, 267 Wagner-O’Day Act of 1938 45, Z V 127, 162 Valley Forge General Hospital sheltered workshops 211 Zelaya, Kathy 237 175 Wagner-Peyser Act of 1933 259 zinc 254 vasculitis 142 Washington Ear 192 zonule 54, 269 venereal disease 249–251 Wasserman test 224, 249–250 Zovirax 2, 16 venous occlusion 251 watches, clocks, and timers 4