A discussion on BBC Radio 4’s Today programme on Saturday 18th October reminded me that a number of issues to do with visual impairment may not be widely understood. These partly lead from how blindness is defined.
When a person is described as being blind many people assume that means the person has no vision at all, when in fact most people who are defined as blind have some vision. The route by which light falls on the eye to our perceiving something is complex and there can be problems at just about any point from the eye to the brain; where the damage lies will affect the nature of the visual problems the sufferer experiences. This means that problems with vision can be very varied from one person to another. Two important aspects which contribute to a person being defined as blind are how good central vision is and how good more peripheral vision is. We use the central field of vision to read and recognise things and people in our environment, while we use more peripheral vision to navigate and detect movement in our environment.
When a person has his or her eyes checked at the opticians there will be a number of tests, among which will be those which test the central field of vision and at least one to test the more peripheral field. A typical test of the central field will be designed to evaluate whether the person can see what the majority of people can see at a given distance. You are likely to have come across the terms 6/6 vision or 20/20 vision. These mean that a person can read letters at 6 metres which most people can read at 6 metres (or read at 20 feet what most people can read at 20 feet). A person can be defined as blind in England, Wales, Scotland and Northern Ireland if they fulfil one of the following criteria (wearing glasses that might have been prescribed for them, where appropriate):
Poorer central vision at 3 metres than would be expected at 60 metres, or
Poorer central vision at 6 metres than would be expect at 60 metres but with poor peripheral vision as well, for example what is sometimes described as tunnel vision or
Very reduced peripheral vision, particularly if the loss is in the lower part of the field
This range of definitions means that one person could be described as blind who cannot read but can navigate by use of vision, while another person can read but cannot navigate by vision alone.
The debate on the Today programme was over whether it is a good idea to use what is often called a white stick*. There were a number of issues raised. The first was over what it symbolised and signalled to other people, such as ‘I have an impairment’, and therefore what behaviour it might elicit from others, such as sympathy and offers of help.
There is a particular dilemma for those who, despite being defined as blind, have some useful sight. How do others perceive you if you carry a white stick and appear to have difficulty navigating but can read normal sized print? Will you be perceived as shamming? Will you be challenged, in such circumstances, if you sit in a seat on the bus or underground which is reserved for people with a disability?
This is another example of how other people’s behaviour or anticipation of what their behaviour might be can turn a person with an impairment into a person with a handicap. Fear of how others might react may stop a person using a tool which signals an impairment even though it is useful for getting around.
Therefore, how should you react when you see someone carrying a white stick? Risk embarrassment or rejection by offering to help rather than try to sneak past hoping not to be detected. Don’t take over but ask what would be useful and don’t be offended if they say they don’t need help. If you are guiding them then allow them to take your arm, usually just above the elbow, and let them set the pace. You can give a brief commentary to explain why you are having to stop, say at a kerb.
Please don’t say that you think they are so brave and don’t ask personal questions that you wouldn’t dream of asking someone who doesn’t have an impairment. The following is said to be a true story but even if it isn’t it illustrates misunderstandings about how to give assistance to someone with an impairment: a blind person who has a guide dog asks a passer-by for directions. The blind person becomes aware that the person has bent down and is whispering the directions to the guide dog.
*There are a number of sticks which are used by visually impaired people which are white or are mainly white:
The symbol cane. These are designed, as their name suggests, just to symbolise that the person carrying them has a visual impairment. They fold and can extend to be as long as 70 to 100 cm. They are too flimsy to be used to navigate well.
The guide cane. These are sturdier and generally longer than symbol canes. They are a compromise between the symbol can and the next cane as they fold but could be used to navigate.
The long cane. These are designed for navigation. The Royal National Institute of Blind People (RNIB) states that they should only be used by someone who has been trained to use them. One issue is that they can be much longer than the other two canes; for example, the RNIB sell one which is 135 cm long. Therefore they could trip another pedestrian up if not used carefully. They can be rigid, folding or even telescopic.
If the cane has red stripes on this usually signifies that the carrier also has a hearing impairment.
I asked Graham Kiff to look at this post and send me any comments he had. His response was:
I would just like to say before i start, what an excellent blog i am posting this reply to. It explains visual impairment far better than any EYE doctor explained it to me.
I was diagnosed with Retinitus Pigmentosa (tunnel vision) back in 2001 at the age of 33. I was registered blind at that same time, although it wasn’t until 5 years later that i realized that. The doctor who initially told me about my eye condition, hadn’t taken any time to explain to me the meaning of being registered blind. I just presumed that because i had a bit of sight left, the box they had ticked on my BD8 form was the wrong box, i thought that they should have just ticked the visually impaired box.
It was quite a long time before i would use a white stick, for me it was mainly about accepting that i needed to use one. For a long time in was in denial and just thought that the doctors had it wrong.
I would receive letters from the Oxford Association for the Blind and i would put them straight in the bin, in my mind why should a Blind Association send me letters and information and offer me help, when as far as i was concerned i wasn’t Blind.
Also i suppose i felt embarrassed about people seeing me use a white stick, and they might feel sorry for me. I think people’s attitudes to people using a white stick, can stop them from leaving the safety of their own homes, i think this is especially the case in elderly people with a visual impairment.
I have had many an occasion when i have had trouble with a bus driver , or things shouted at me in the street because i have a white stick.
I know of a Blind ex-Army lady, that used her bus pass to catch a bus, but the bus driver didn’t think she looked blind, so he took her bus pass off her and told her to get off the bus. I have had many a bus driver, start to drive off, and send me flying because they hadn’t waited until i had sat down before pulling away from the bus stop.
I have had time to come to terms with my sight loss, and also to using my white stick. But for many people especially i think the elderly they just stay in the safety of their own homes rather than go out into the scary world with a white stick that tells people that they can do or say what they want to you, because you can’t see them.
It’s not all bad though, i have also had many occasions when people have helped me. I remember one time at Stoke train station, i was just getting onto a train, the platform was really busy. A friendly had held my right elbow, and another my left elbow, i said thank you , and that made my day, just a small gesture by a couple of people i didn’t know, but those small things can make up for the negative experiences.
I would say to people that try and help someone, please don’t be offended if they say they don’t need your help, because the next person may appreciate it so much it may make their day.