Eye Care Blog

Adults who become blind after several decades of normal or at least useful sight represent a different problem. Their psychological and practical difficulties are manifold. The sudden onset of blindness is a terrifying experience. Apart from the helplessness and inability to become mobile there is a horror of incapacity, accompanied by the realization that without help the sufferer is completely isolated, socially and physically. The adult who becomes blind is liable to become deeply embittered, much more so than if he or she had lost a limb. The loss of a limb is measurable and understandable. Sudden blindness is far more abstract, for a while incomprehensible. And because the loss of sight is rarely complete, the patient lives in hope of cure. Bouts of depression alternate with pitiable optimism. If the patient is rich, or if the public health authority permits, he or she will seek charlatan as well as professional advice. He or she will become subject to advice from the market place, faith healers and the like. Newly blind people will sometimes travel grêat distances to seek remission. If religious they will seek shrines and miracles (and some people become religious when they become blind). Equally they will alter their philosophy of life, to purge that which is supposed to have robbed them of their sight.

If blindness has come about traumatically, as the result of an injury at work or in a motor accident, the desire to obtain compensation from an insurance policy may become obsessional, for both the injured person and for his or her family.

The sudden onset of blindness naturally evokes the strongest emotive reactions from friends, colleagues and relations. Sympathy surrounds the unfortunate person. Apart from the measures organized by society to help the blind, there is nearly always someone to take full immediate care of the suddenly blind person. In most blind adults the period of hate and disbelief does not last long. They accept their change of circumstances and adapt to a society where the blind are accommodated and helped to a fuller life. The retraining of younger adults to white collar and manual jobs as well as sports activities is well and widely developed, while in non-industrial communities blind people still achieve the status of soothsayer, arbiter and wiseacre.

In Greek mythology, Tiresias, the blind prophet, is the natural corollary of Oedipus the blind sinner. Even today in some of the wilder places on the globe people are believed to have strange powers that are activated by the ‘feeling of hands’. Indeed, blindness everywhere does seem to give some people a serenity they never possessed previously. In addition, the blind often acquire new friends, both from among the blind and from the sighted, and a close friendship may also develop between the blind person and his or her guide-dog. The guide-dog is often referred to as the blind person’s ‘eyes’. Modern methods of dog training are such that they can indeed make the individual completely mobile even in a busy city. But these methods are very expensive (in Britain it may cost up to nine thousand pounds to train one dog), and so dogs are only given to those able and willing to look after them well.

Most modern states keep registers of the blind. Apart from being of statistical value, and giving health authorities information about how blindness occurs, they ensure that all benefits due to a blind person will be provided, and that any appropriate treatment indicated by the certifying ophthalmologist will be carried out. In most countries there are also voluntary organizations, usually of a charitable status, that bring further help and benefits to the nation’s blind population. And finally, the almost universal use of a white stick by the blind person means that, outside the home, he or she will never be far from help as and when necessary. If normal people generally exhibit a certain amount of caution or even nervous apprehension when approaching a blind person on the street, that is perhaps a reminder of an ancient but now moribund taboo, and also an indication that blindness itself carries complex social and psychological values for everyone.

The Causes of Blindness

Because the eye is an essentially sensitive and complicated organ, the root of blindness varies from one part of the eye to another in different patients. In general, blindness is most likely to occur at birth, in old age and in trauma (accidents) to the young and early- middle-aged adults. But if the pattern of incidence is more or less universal, the causes do vary regionally. Thus, in some parts of the world blindness is most often the effect of viruses and parasites. Trachoma, for example, is a viral condition which causes worldwide blindness, but more particularly in tropical areas and among the very poor. In the more advanced industrial nations hereditary diseases such as diabetes mellitus play a larger part. Again, short sight leading to retinal detachment (which if not treated certainly does lead to blindness) is mostly a problem of the more affluent, more literate countries. Depending upon race and age, many old people (20 per cent of those over seventy) develop cataract, which again, if no operation is available, leads to a greater or lesser degree of blindness. Blindness in some very restricted parts of the world is of almost epidemic proportions.

To some degree the tragedy of blindness is preventable. Presumably there are priorities at the World Health Organization that determine which cause of blindness will be eradicated next. When all the infective or virus causes have been removed, there still remain the inherited and senile conditions which perhaps a future century will be better able to attack.

People often ask whether a severely diseased eye can be transplanted. Their hopes have generally been raised in inaccurate references to ‘eye-transplants’ in the media. At present there is no technique capable of joining the very fine nerves of the optic nerve to an implanted eye, and in any case the tissues supplied with blood are likely to be rejected. What is meant by an ‘eye-transplant’ is in fact a corneal transplant, which is possible in a limited number of cases, since the cornea is made up of mainly non-nervous tissue. A blind person, therefore, has little hope of seeing again if either the retina or optic nerve is atrophied. In cases where the optic nerve has been severed there is no hope whatsoever. Thus an eye that may in every other respect be perfectly healthy will be blind if it cannot transmit messages to the brain. Blindness may also result where brain damage has been sustained in or near the visual cortex, although there is sometimes a very slow recovery of partial vision as the brain, if it is young enough, works out an alternative ‘neural pathway’.

The development of radar and video-type cameras in miniature-sized units has recently given some new hope to the blind. Where these instruments can be made to transmit impulses to the visual cortex through the brain it is possible to produce a crude visual image inside the head. But, while this may one day provide some solutions to people with irreparably damaged retinae and/or optic nerves, much research remains to be done before scientists can assess even the feasibility of the idea.

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