Some facts about visual impairment in a Swedish and international perspective
prepared by Örjan Bäckman
Who is visually impaired in Sweden?
Clinical definition
Central visual acuity ranging from 0.3 (6/18) to localisation/perception (the lower limit is difficult to define, and each case has to be individually subjected to trial).
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Moderate low vision |
0.3 - 0.1 (6/18 - 6/60) |
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Severe low vision |
0.1 - 0.03 (6/60 - 2/60) |
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Profound low vision |
0.016 (1/60) - Hm, L+P |
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Total blindness |
amaurosis |
Visual fields constricted to less than 10 - 15 °, regardless of the central visual acuity.
Other impairments of the visual acuity (e.g. defective eye movements, perceptional problems, cerebral damage etc).
WHO-agreed working definition on low vision
(Bangkok 1992)A person with low vision is one who has impairment of visual function even after treatment and/or standard refractive correction and has an acuity of less than 0.3 (6/18) to light perception or a visual field of less than 10° from the point of fixation, but who uses or is potentially able to use vision for the planning and execution of a task.
Conclusion:
More open definitions might be:
"those who need low vision training" or
"persons who have sufficient vision to see light or to take directions from it and to use it for functional purposes" (N. Barraga)
Who is visually impaired in Sweden?
Functional definition
"reduced ability to such a degree that it is difficult or impossible:
- to read normal print (books, newspapers) or
- to orientate oneself/move around independently at unfamiliar places or
- to manage daily living skills"
(adopted definition by the Swedish Association of the Visually Impaired)
Main causes for visual impairment/blindness in the world
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A-vitamin deficiency (xerophthalmia) |
South East Asia, Africa |
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River blindness (onchocerciasis) |
West Africa, South America |
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Trachoma |
Africa, Asia |
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Cataract |
all parts of the world |
WHO estimate:
45 million blind
135 million low vision
Total: 180 million visually impaired
9/10 in low-income/developing countries
1/10 in industrialized countries
80% of world's blindness is avoidable
People in developing countries are 10 times more likely to go blind than those living in industrialized countries
Global burden of blindness has a direct economic cost of $25 billion
Common eye diseases in Sweden
Children/youth:
Cerebral visual impairment, CVI
Congenital malformation:
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Congenital cataract |
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Optical nerve defect |
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Aniridia |
Optic atrophy
Retinopathy of prematurity
Retinal degeneration,
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eg. Retinitis Pigmentosa |
Nystagmus
Adults in working ages:
Diabetic retinopahty
Elderly persons:
Age-related macular degeneration
Cataract
Glaucoma
Present situation of visually impaired in Sweden (some data)
Slightly more than 1 % of 8.9 million = ~100.000 visually impaired
75 % elderly people (above 65 years)
90 % low vision cases
Around a third of all visually impaired have at least one other functional disability (50-70 % among children)
Almost all pre-school children and primary/secondary school children/students with a visual impairment get their education within the regular school system (~3.000 visually impaired in the age range 0-19 years)
No special schools (except for one school for children with visual impaiment and severe additional disabilities)
Approximately 50 % of visually impaired of employable age are without a job
Swedish comprehensive low vision rehabilitation model - components
Access to an effective identification and referral system in order to detect visual problems of all ages as early as possible.
Access to ophthalmologic service for proper diagnosis, prognosis, genetic counselling and treatment: surgery, medicine etc. if possible.
Access to functional, clinical, psychological, educational, vocational and social assessment.
Access to individually tailored optical and/or electronic-optical and/or computerised and/or non-optical devices.
Access to qualified, systematic, pedagogical training.
Access to adaptations of home, school, work or leisure hour environments.
Access to specialised services designed for children, adults, elderly and persons with multiple disabilities.
Access to follow-up and reassessment procedures.
Access to necessary information, documentation and feedback.
LOW VISION TEAM
Services for visually impaired in Sweden
34 low vision clinics - established (minimum one per county council, basis of
services =300.000-500.000 Swedes per low vision clinic)
The main responsibility of the low vision clinic: (re)habilitation of all ages regardless of visual ability
Each low vision clinic staffed by ophthalmologist(s), optometrist(s), low vision therapist(s), mobility instructor(s), social counsellor(s) etc. "team work"
Some other resources:
Resource centre vision Stockholm (former Tomteboda Resource Centre)
Resource centre vision Örebro (former Ekeskolan Resource Centre)
Advisors on special education/visual impairment: pre-school/school, employed by the Swedish Institute for Special Needs Education (servicing visually impaired in the regular school system)
Labour market institutes, in all 9 (job orientated rehabilitation)
Shorter courses for mainly elderly people with visual impairments at "folk high schools" for adult education, in all 6 (ADL-orientated rehabilitation)
Home instructors in each municipality (ADL-training at home)
Existing training facilities for:
Advisor on special education/visual impairment for pre-school and primary/secondary school
Low Vision Therapist (for Sweden) (trained to handle methods both for low vision training and total blindness: mobility, braille etc.)
International Low Vision Therapist (trained to handle methods just for low vision. This is a degree program in English, mainly for students from low income countries or countries where low vision services have not yet been established)
Duration:
Three semesters (one and a half year, 60 academic credits)
(part-time/distance learning possible)
Main objectives:
Understand the occurence and consequences of total blindness/low vision at birth/at an early age or later in life
Have a command of techniques for compensatory training and know how to teach them
Have a command of techniques for low vision rehabilitation and training and know how to teach them
Entry criteria:
* pre-school teacher
* primary or secondary teacher
* occupational therapist
* ophthalmic nurse/orthoptist
Structure and main contents:
* basic special education elements
* pedagogic/psychology
* paediatrics and geriatrics
* ophthalmology
* optometry
* communication
(Braille, mobility, computers, daily living skills, low vision rehabilitation and training, ergonomics, adaptations, didactics etc.)
* research and evaluation methods
* practice
* examination
(diploma and/or degree in special education depending on background qualifications)