Blindness and Visual Impairment

What is visual impairment?

Visual impairment is a term that experts use for any kind of sight loss or limitation. This includes not seeing at all or partial vision loss. Visual impairment does not include vision or eye conditions that can be corrected with eyeglasses or contact lenses.

Around 12 in every 1,000 children have a visual impairment. Less than one in every 1,000 children is totally blind. Of the people with visual impairments, 85% have some sight and 15% are fully blind.

Visual impairment can be mild to severe. American Foundation for the Blind, the World Health Organization (WHO) and other experts use different terms for visual impairments in children and adults, including:

• Low vision – A permanent and significant visual impairment. Low vision can’t be fully corrected with eyeglasses, contact lenses, medicine or eye surgery. People with low vision have many different types of vision abilities and eye conditions.
• Vision loss – Also includes a range of vision abilities. Some vision loss can be corrected with eyeglasses, contact lenses, medicine or eye surgery – and some cannot. There is no legal definition for vision loss. It is sometimes called “partial blindness.” Children with vision loss have some ability to see.
• Total or complete blindness – No ability to see light, forms or shapes at all.
• Legal blindness – Children or adults who might have some sight but would have to stand 20 feet from an object to see it as well as someone with perfect vision could see from 200 feet away. “Legal blindness” is a definition used by the United States government to decide who is able to get certain types of support, job training, disability benefits, low vision devices and tax savings. It doesn't tell us very much about what a person can and cannot see. Most people with legal blindness have some sight.

What causes blindness and visual impairment?

Visual impairment can be caused by damage to the eye itself, an issue with the shape of the eye or by a head injury. It can also be part of another diagnosis or condition a child has at birth or develops.

Some babies cannot see when they are born or have vision loss as a newborn. This is called “congenital visual impairment” or “congenital blindness.” It can happen because of certain infections during pregnancy or be related to a genetic disorder. Vision loss can also happen later in a child’s life.

Here are some other reasons behind vision loss or impairment:

• Amblyopia (“lazy eye”)
• Complications from diabetes
• Glaucoma (an eye condition where too much pressure builds up behind the eye)
• Macular degeneration (a sensitive part of the eye that breaks down over time)
• A serious infection
• Injury or trauma

This article from TeensHealth explains more about how the eye works and visual impairment.

What are the symptoms of visual impairment?

According to the Centers for Disease Control and Prevention (CDC), a child with vision loss might:

• Close or cover one eye.
• Squint the eyes.
• Frown.
• Complain that things are blurry or hard to see.
• Have trouble reading or doing other close-up work.
• Have trouble with hand-eye coordination.
• Hold objects close to their eyes to see them.
• Blink more than usual.
• Seem cranky when doing close-up work, such as looking at books.

In a child with vision loss:

• One eye could look to the side.
• Their eyes might look crossed.
• One or both eyes could be watery.
• One or both eyelids could look red-rimmed, crusted or swollen.

When should I call my child’s healthcare provider?

Healthcare providers should check a child’s vision many times while they are young. And you should reach out to a healthcare provider and ask questions any time you have a concern. Also, see our page on How to Talk to Your Doctor.

If your child is age 3 or under, you can also reach out to your local Early Childhood Intervention program using the ECI Program Search to find the one in your area. If your child is age 4 and older, you can also talk to your local public school. If your child is birth to 22 years old, you can also call or email the Texas Blind Children’s Vocational Discovery and Development Program for resources and support.

A child’s vision should be checked during their well child visits when they are:

• A newborn to 3 months old
• 6 months to 1 year old
• About 3 years old
• About 5 years old

It is very important to have your child’s vision checked early if someone in your family has had vision problems.

If your child has a disability or special health care need that includes visual impairment, stay in touch with your child’s health care provider about vision. Ask to see a specialist if you think your child needs more tests or help.

How is visual impairment diagnosed?

Your child’s regular doctor or nurse can check your child’s eyes and sight first. Usually, the doctor starts by shining a special light into your child’s eyes. If the doctor has concerns or you notice other eye symptoms, you might visit a specialist for more testing. Specialists called ophthalmologists or optometrists can diagnose visual impairment. This article, “What Kind of Eye Doctor Should My Child See?” explains the difference between specialists.

A specialist tests visual acuity and visual field. Visual acuity is how clearly someone sees an object and how sharply they can see details. Visual field is what someone can see to the sides, above and below, when they are looking straight ahead and not moving their head.

Every person with a visual impairment has different abilities. No two children are alike. A diagnosis is important for your child, and it is just as important to understand what exactly your child can see and how. This article from Family Connect explains more.

Vision Scores

When a doctor tests a child’s vision, they give it a measurement. 20/20 is perfect vision. If your child, for example, has 20/40 vision, it means that they would have to be 20 feet away from an object to see it as well as someone with perfect vision could see from 40 feet away.

This measurement does not give information about what the child can actually see. That is why other tests are important too.

Vision Tests in Schools

Schools might do other tests to better understand your child’s vision and how to support their learning. If a child is legally blind or has a visual impairment, a school looks at the causes and at how much the child can see.

A Teacher of the Visually Impaired (TVI) might do tests called a functional vision assessment or functional vision evaluation (FVA or FVE) and a learning media assessment.

A functional vision assessment shows what a child can actually see and how they use their vision. It is legally needed as part of the special education process. This article from Family Connect explains more about functional vision assessments.

A learning media assessment helps the school understand what reading and learning materials will work best for your child.

To see what tools and devices might help your child, you or the school can also ask for an assessment for assistive technology.

These two articles have more information about assistive technology:

• This Perkins School for the Blind blog article was written by a person with low vision and has an “A to Z list” of assistive technology options.
• Family Connect explains more about an assistive technology assessment.

How is visual impairment treated?

There is no one-size-fits-all treatment. Visual impairment is treated in different ways, depending on each child’s abilities and needs. Below are some examples:

• Assistive technology, such as a large print keyboard, a blindness cane, a screen reader, and different apps and programs to help someone see better or see more clearly.
• Classroom accommodations, including changes in how content is taught, supported or tested.
• Eyeglasses can help some children with visual impairment see better, though glasses will not fully treat the problem.
• Changes to the environment, such as dimmer lighting or a chance to rest their eyes, can help some children. And some children can benefit from service dogs.
• If your child has vision loss because of a neurological condition affecting how the brain and eye work together, Neuro-ophthalmology specialists or clinics can give them special tools.

Your child’s other senses, such as hearing and touch, can help them understand their world. These senses might even be stronger to make up for vision loss. But other senses give a child different information than sight does, so it can be helpful to for a child with visual impairments to learn new skills for using their other senses to support their development.

Family Connect has an article on how young children with visual impairments learn, and how to support them as a parent.