Eye Care Blog

There is a well-known story about Noel Coward. The dramatist was out walking with two small children one day when the party came into view of two dogs engaged in the act of copulation. `Uncle Noel, what are they doing?’ cried one of the boys. ‘It’s perfectly obvious,’ replied Coward. ‘Can’t you see? The dog in front is blind, and the dog behind is pushing him to St Dunstan’s!’

The subtlety of this anecdote lies in the substitution of one taboo subject by another. Historically, blindness has carried different cultural connotations. Among the ancients it was often considered as a punishment meted out by the gods. In the best known of the Greek myths, Oedipus gouges out his own eyes in a hubristic act of self-inflicted retribution. In modern times blindness is more simply perceived as a misfortune.

Nevertheless, the term ‘blindness‘ is different when considered from sociological and medically objective standpoints. In common parlance, blindness suggests the complete loss of sight. In practice it would be better defined as the loss of useful sight, sight which enables the individual to function normally in his environment. Thus, in a primitive community, the illiterate shepherd with a moderate visual handicap would still manage to function adequately, whereas the modern craftsman depending upon fine detail for his work might be decisively inconvenienced by, say, the loss of as little as five per cent of his natural vision.

In most civilized communities, blindness is categorized according to the services available for the care of the blind. Where such services are plentiful, a relatively large group of people will be considered to be blind, while in less developed countries only those who have suffered a complete loss of vision may be eligible. Generally speaking, there is a form of certification that depends upon a lengthy and expert examination of the patient’s eyes carried out by an ophthalmologist who is himself registered by an authority that is in some way acknowledged or chartered by the state. The social services to help the blind then fall into several phases. For example, there is the education of blind children and infants, and there is rehabilitation and vocational training for the young and notso-young adult who has become blind. In developed countries Ole welfare services endeavour to keep blind people mobile and supplied with food and social contacts.

The state usually offers further assistance by placing the blind in a preferential financial position when income is low, and so forth. In recent times, in common with other categories of ailment, the blind have been encouraged to build up their own community through a range of special activities. Thus, for example, there are now ‘Blind Olympics’.

To begin with, let us consider the individual who has little or no sight from birth. A baby born blind can become aware of his environment only from the sensations of smell, hearing and touch. Touch can be developed to a fine degree of discrimination, but it can only embrace what is within arm’s reach. Again, the size of an object that can be efficiently explored by touch is necessarily small. Braille books give some indication of how well the tactile sense can function. Some blind people have learnt to read using this technique very rapidly, and accurately, indeed.

On the other hand, the estimate of the size of an object must be relative to the patient’s own stature, and to the shape and size of other objects within his tactile vicinity. The size and shape of a large tree, for instance, may for ever be incomprehensible to a person blind from birth since by merely touching the bark of a tree, or walking round it, nothing can be learnt of its height. One is reminded of an old Buddhist parable. Three blind men are led towards an elephant. One blind man grasps its tail and thinks it is a kind of rope. The second feels its side and thinks it a wall. The third takes a hold of its trunk and calls it a tree. Also, our notions of stereoscopy (depth) and colour are purely visual. The blind person can learn of these only at second hand, by reading or listening to descriptions of these phenomena given by the sighted. As in a complicated puzzle or detective story the unknown factors which the sighted person takes for granted are stored in the blind person’s memory and synthesized into `meaning’ over a long period of time. In cases where sight is restored or made possible later in life, the perceptions of depth and colour accumulated by a blind person usually turn out to be very inaccurate. On the other hand, it is difficult for a person born blind to ‘miss’ a sensitivity he or she has never had, and it may even be wrong to talk about the ’suffering’ of people born blind.

Needless to say, the senses of touch, smell and hearing develop to a higher degree in the blind than in the normal- sighted person. They become aware of the presence of objects and movements almost as though they were able to detect material ‘echoes’. Empty spaces receive and reflect noise very differently from closed spaces, and the blind person is very aware of this. This form of primitive radar is exceptionally well developed in young blind persons, and it may even be that their brains have developed untypical neural pathways to compensate for the deprivation of visual sense. The examination of an object by the hands often follows the detection of the object by the other non-visual senses. Conversely, the desire for mobility is generally much slower in the blind child, and the smile response to the parent or guardian is often lacking.

The relaxed or ‘vacant’ look on the blind person’s face is not an indication of mental disability, but an inevitable non-involvement in the normal system of signals and feed-back. Sighted people tend to respond to the facial expressions of others reflexively: a smile is met with a smile, a look of surprise likewise. Recognition, avoidance of eye-contact and so forth are all signals that precede speech. The blind person has no such signals to give or receive. Indeed, it is noticeable even among the poor-sighted who do not use optical correction that their faces are `understimulated’. This often leads to misunderstanding. Miss So-and-So may be said to be snooty and aloof, and never speaks to anyone in the office, whereas she is just short-sighted and fails to recognize people. The very pretty short-sighted girl waiting to be invited to dance but not wearing an optical correction is very likely to radiate a ‘yes’ signal to the first male who approaches her, even though he may be a person she would prefer to greet with a ‘no’ signal if she were wearing her spectacles. Apprehension and nervousness will also be seen in the partially sighted person’s face whenever a situation demanding fine visual acuity arises.

To visit a school for blind children is to be instantly astonished at the mobility and ease of play, and the inter-personal contact that is present. The use of play-objects is almost without hazard. Indeed, in most instances the young blind learn about their environment much more quickly than the sighted individual because their comfortable survival and unconscious training depend upon it. And the intelligent blind patient, aided by Braille and modern tape machines, can enter into almost any mental learning activity. Thus we find blind computer programmers, academics and so forth. But there is greater expense in human effort and services to achieve these results.

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