There are over 50 definitions of blindness worldwide. The World Health Organisation definition of blindness is less than 3/60 in the better seeing eye. This means that the better seeing eye cannot read the top letter on the Snellen visual acuity chart at three metres. The Snellen visual acuity scale is the most widely used scale in the world.
The purpose of this article is to help blind individuals and those caring for them. The definition is only of academic importance but helps explain the fact blindness is more prevalent than we think it to be.
Blindness is a sad fact of life. It can happen to anyone. I remember the night when I reported for night duty in the intensive care unit and was told that my patient had not arrived but to prepare for the worst. I was told that the patient was a victim of the bomb explosion in Bali and he had chest injuries. So, I set up a ventilator, underwater seal drain, suction catheter and got the emergency trolley ready just in case the worst did happen.
The patient arrived at 02.00hrs accompanied by a doctor from Singapore. I was given the usual hand over – “multiple injuries, fractured leg, chest injuries etc”. The patient soon went into respiratory failure and had to be placed on the ventilator because the blood gases were deteriorating.
I was also informed that the patient was deaf, due to damage from the blast to the tympanic membranes of his ears. Worst of all the patient had eye patches on both eyes and could not see. I was his eyes, ears and “everything”. I am not sure what he meant by this because I did not get the chance to see him again. That night was too dramatic to be able to attend to intellectual meanings of words. My focus was trying to safe his eyesight. Apart from his breathing, everything else was secondary. Form a cardiac perspective he was stable.
The patient I was looking after was on vacation in Bali. He had become blind suddenly. In some situations blindness can be gradual. No matter how it happens the end result is devastating. In the case of my patient it was really sad and difficult because this innocent person was vacation and ended up being the victim of terrorists. It had devastating impacts on his wife, children, home environment and local economics. It costs about $60,000 each year to care for a blind person.
To this date, I the nurse caring for this patient, often have nightmares about him. It was one of the saddest situations in my lifetime. I have worked in the ICU and Emergency Departments in London, Toronto and Albuquerque. The other sad situation which I still remember is when I had to look after a patient, on Christmas Night who had lost both his leg and had not been told that his legs had to be amputated because they were severely crushed in a motor vehicle accident. My patient was on a motor cycle. His helmet saved his life.
Interventions for looking after blind persons are aimed at supporting the individuals in the home and hospital environments. It is often said that it takes a village to raise a child: I must say that it takes a country to look after a blind person.
The person(s) looking after the blind individual must keep track of appointments with specialists. Transport and other agencies will need to be involved. A personal care worker will need to accompany the patient to the appointment. Do not forget to take the patient’s medications with him to the appointment.
Extensive rehabilitation will be necessary. The blind person will need to be orientated to his environment. He will need help with many activities of daily living, including toileting, showering, eating, and moving around his living space.
Persons who are not completely blind can benefit from basic magnifiers which can be purchased relatively cheaply. If the patient also has arthritis, he/she may need the handle to be modified so that he/she can use it independently. Even though, the patient is blind, independence should always be encouraged as it has a motivating effect and positively affects his mood and wellbeing.
Special spectacles are available for people whose eyesight is really bad. These are paid for by the Federal Government if you live in Canada, Australia, US or the UK. These are no substitute for normal vision but do help the patient to gain some degree of respectability.
Some patients will benefit from bifocal lens. In this high tech society bifocals are of many types and help patients adjust both the near vision and distance vision problems.
Some patients will be able to read Braille writing. This is a useful skill because there are many books in Braille. When I was in a University in the UK I was privileged to know and help a student who was blind and was working on his PhD thesis. All books were available, to him, in Braille. In fact, I recall that he did not feel handicapped because he was well supported.
In some communities, blind persons can use “seeing dogs” to help them to get around. Seeing dogs are specially trained dogs which help individuals with impaired vision to get around.
Some legally blind people can see a little. For this group of people it is often helpful to have the right amount of light at the right angle and place. Do not change the positions of lights as these may have become reference points for the blind individual. If you need to change the position of a light, please let the patient/client know.
Use of color cues is helpful to the person who is not totally blind. I personally know of an individual who was legally blind but was able to recognize some colors and used these cues to go to the toiled, earned a living, and led a productive life.
Canes, modified walking sticks are useful aids for the person who has difficulty seeing. Modified walking sticks with rollers at the end allow a blind person the feel if the terrain is flat etc.
Nowadays, libraries are often equipped to get large print books for people who are visually impaired. These are often useful for patients who can read and enjoy reading.
Last, but not least, I must say that none of these aids will make the blind person as independent as ordinary people. We, the people who have normal eyesight need to be aware that we may end up being blind, one day. What goes around comes around. So let us help blind people lead a productive and happy life, let us not put obstacles in their way.
