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ACKNOWLEDGMENTS

To the many schools, agencies, private practitioners, and individuals with low vision and their
families who have contributed to the publication of this text, we offer our most sincere thank
you. Children and adults allowed many volunteer photographers to show how they live with
low vision. Colleagues were gracious in providing up-to-date information for specific
chapters and in providing comprehensive reviews and feedback on drafts. Expert reviewers
from the field provided careful feedback on each chapter. We appreciate the many hours spent
by Pamela de Steiguer of the University of Arizona on proofreading and editing. We especially
extend our appreciation to the staff of AFB Press, particularly to Ellen Bilof-sky and Natalie
Hilzen. They have been invaluable and infinitely patient in editing, reviewing, maintaining
contact with authors, and integrating diverse perspectives. Their knowledge and skill, good
nature, and passion for publishing in the field of visual impairments and blindness are truly
exceptional.
CONTRIBUTORS

Editors
Anne L. Corn, Ed.D., is recently retired from her position as Professor of Special Education,
Ophthalmology, and Visual Sciences at Vanderbilt University, Nashville, Tennessee, where she
was also coordinator of the teacher preparation program in visual disability at Peabody
College. A recognized expert on low vision, she is the coeditor of the first edition of
Foundations of Low Vision and of Blindness and Brain Plasticity in Navigation and Object
Perception, and coauthor of Looking Good: A Curriculum on Physical Appearance and
Personal Presentation for Adolescents and Young Adults with Visual Impairments and
Finding Wheels: A Curriculum for Nondrivers with Visual Impairments for Gaining Control
of Transportation Needs, as well as author of numerous other books, chapters, and articles. A
frequent speaker at national and international conferences, Dr. Corn also received a number of
awards, including the 2008 Josephine L. Taylor Leadership Award from the Division on
Personnel Preparation of the Association for Education and Rehabilitation of the Blind and
Visually Impaired (AER), the 2007 Alan J. Koenig Award for Research in Literacy from
Getting in Touch with Literacy, and the 2006 Mary Kay Bauman Award for Education of
Students with Visual Impairments from AER. Dr. Corn is past president of the Division on
Visual Handicaps (now the Division on Visual Impairment) of the Council for Exceptional
Children and past chair of AER's Division 17 (Personnel Preparation).

Jane N. Erin, Ph.D., is Professor in the Department of Disability and Psychoeducational

Studies in the College of Education at the University of Arizona, Tucson, where she has
coordinated the Program in Visual Impairment since 1994. She also served as Interim
Associate Dean of the College of Education and as head of the Department of Special
Education, Rehabilitation, and School Psychology. Previously she was on the faculty at the
University of Texas and was a teacher and supervisor at the Western Pennsylvania School for
Blind Children. Dr. Erin served as editor in chief of the Journal of Visual Impairment &
Blindness from 1998–2001 and was executive editor of RE:view. She coauthored Visual
Impairments and Learning with Dr. Natalie Barraga, was a coeditor of Diversity and Visual
Impairment, and was author of When You Have a Visually Impaired Student with Multiple
Disabilities in Your Classroom: A Guide for Teachers, as well as numerous articles, chapters,
and presentations. Dr. Erin received the 2000 Margaret Bluhm Award from the Arizona chapter
of the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER)
and the 1996 Mary K. Bauman Award as the Outstanding Educator in Visual Impairment from
AER.
Chapter Authors
Erika A. Andersen, M.Ed., a certified low vision therapist, is a Blind Rehabilitation
Specialist for the U.S. Department of Veterans Affairs in Denver, Colorado.

Jennifer K. Bell Coy, M.Ed., a certified teacher of students with visual impairments,
orientation and mobility specialist, and low vision therapist, is a private direct service
contractor for public school districts and schools for students with severe disabilities.

Katharina V. Echt, Ph.D., is Health Research Scientist at the Atlanta Veterans Affairs
Rehabilitation Research and Development Center of Excellence for Aging Veterans with
Vision Loss; Investigator and Site Director for Education at the Birmingham/Atlanta Veterans
Affairs Geriatric Research, Education and Clinical Center; and Assistant Professor in the
Division of Geriatric Medicine and Gerontology, Department of Medicine, Emory University
School of Medicine in Atlanta, Georgia.

Diane L. Fazzi, Ph.D., is Professor and Coordinator of the Orientation and Mobility Specialist
Training Program, California State University, Los Angeles.

Kay Alicyn Ferrell, Ph.D., is Professor in the School of Special Education and Executive
Director of the National Center on Sensory and Severe Disabilities, University of Northern
Colorado, Greeley.

Duane R. Geruschat, Ph.D., is a Research Associate in Ophthalmology at the Johns Hopkins

University Wilmer Eye Institute, Baltimore, and is editor in chief of the Journal of Visual
Impairment & Blindness.

Gregory L. Goodrich, Ph.D., is Supervisory Research Psychologist and Optometric Research

Fellowship Coordinator, Psychology Service and Western Blind Rehabilitation Center, U.S.
Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, California.

M. Cay Holbrook, Ph.D., is Associate Professor, Department of Educational and Counselling

Psychology and Special Education at the University of British Columbia, Vancouver, Canada.

Kathleen Mary Huebner, Ph.D., is Professor and Associate Dean, College of Education and
Rehabilitation, Salus University, Elkins Park, Pennsylvania; Director, National Center for
Leadership and Visual Impairment; and Director, National Leadership Consortium in Sensory
Disabilities.

Gaylen Kapperman, Ed.D., is Professor and Coordinator, Visual Disabilities Program,

Northern Illinois University, DeKalb.

Alan J. Koenig, Ed.D., now deceased, was Professor and Associate Dean of Graduate
Education in the College of Education at Texas Tech University, Lubbock.

Helen Lee, Ed.D., is Assistant Professor in the Department of Blindness and Low Vision
Studies at Western Michigan University, Kalamazoo.

Kelly E. Lusk, Ph.D., is a teacher of students with visual impairments for the Williamson
County Schools in Franklin, Tennessee.

Michele Capella McDonnall, Ph.D., is Associate Research Professor, Rehabilitation

Research and Training Center on Blindness and Low Vision, Mississippi State University,
Starkville.

Marla L. Moon, O.D., is a founding and principal partner in Nittany Eye Associates in State
College, Pennsylvania.

J. Elton Moore, Ed.D., is a Giles Distinguished Professor and Associate Dean for Research
and Assessment, College of Education at Mississippi State University, Mississippi State.

Brenda J. Naimy, M.A., is a full-time lecturer in the Orientation and Mobility Specialist
Training Program in the Division of Special Education and Counseling, California State
University, Los Angeles, and provides consultation services for the Los Angeles County
Americans with Disabilities Act paratransit agency.

Ike Presley, M.S., is National Project Manager at the American Foundation for the Blind,
Atlanta, Georgia.

Susan V. Ponchillia, Ed.D., now deceased, was Professor in the Department of Blindness and
Low Vision Studies at Western Michigan University, Kalamazoo.

Evelyn J. Rex, Ph.D., now deceased, was Professor Emerita of Special Education at Illinois
State University in Normal.

Sharon Zell Sacks, Ph.D., is Director of Curriculum, Assessment, and Staff Development at
the California School for the Blind, Fremont.

Terry L. Schwartz, M.D., is Professor in the Department of Pediatric Ophthalmology and

Adult Strabismus and Director, Children's Vision Rehabilitation Project, West Virginia
University School of Medicine, Morgantown.

Audrey J. Smith, Ph.D., is Dean and Associate Professor, College of Education and
Rehabilitation, Salus University, Elkins Park, Pennsylvania.

Jodi Sticken, M.S.Ed., is Director of Orientation and Mobility, Department of Teaching and
Learning, Northern Illinois University, DeKalb.

Irene Topor, Ph.D., is Adjunct Associate Professor in the Department of Disability and
Psycho-educational Studies, Specialization in Visual Impairment, College of Education at the
University of Arizona, Tucson.

Marjorie E. Ward, Ph.D., recently retired, is Associate Professor Emerita, College of

Education, Ohio State University, Columbus.

Gale R. Watson, M.A.Ed., is National Director of the Blind Rehabilitation Service in the U.S.
Department of Veterans Affairs, Washington, DC.

Mark E. Wilkinson, O.D., is Clinical Professor of Ophthalmology, Department of

Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine; and
Director, Vision Rehabilitation Service, Carver Family Center for Macular Degeneration,
Iowa City.

Karen E. Wolffe, Ph.D., is Director, Professional Development Department, American

Foundation for the Blind, Austin, Texas.

Kim T. Zebehazy, Ph.D., is Assistant Professor, Department of Educational and Counselling

Psychology and Special Education, Faculty of Education, at the University of British Columbia
in Vancouver, Canada.

George J. Zimmerman, Ph.D., is Associate Professor and Chair, Department of Instruction

and Learning, and Coordinator of the Vision Studies Specialization of the University of
Pittsburgh, Pittsburgh, Pennsylvania.

Sidebar Authors
August Colenbrander, M.D., is Affiliate Senior Scientist at the Smith-Kettlewell Eye
Research Institute, San Francisco, California.

Cheryl Kamei-Hannan, Ph.D., is Assistant Professor at California State University, Los

Angeles.

Judy C. Matsuoka, M.S.Ed., is an instructor at the Hadley School for the Blind in Winnetka,
Illinois.
INTRODUCTION

n the decade since the original Foundations of Low Vision: Clinical and Functional
I Perspectives was published, the field of has matured into a discipline that links medical,
educational, and rehabilitative services to provide new opportunities for people with low
vision. This second edition responds to this evolution with a wealth of new and updated
material. A new chapter on technology highlights the acceleration of technological solutions,
and a new chapter on orientation and mobility for children acknowledges the distinctions
between the functioning and experiences of adults and children. The importance of independent
living skills and the instructional needs of adults are addressed through two more new chapters
that underscore the importance of applied learning for adults. We welcome several new
authors along with many who have revised their chapters to reflect innovations that affect
people with low vision. We believe that the updated book will serve as a resource to inform
new and experienced professionals as specialists and members of teams who deliver low
vision services.
Foundations of Low Vision: Clinical and Functional Perspectives is a general text about
low vision, written for practicing professionals and soon-to-be professionals who will
provide education, rehabilitation, and clinical services to people with low vision. The editors
hope it will also be of value to individuals with congenital or acquired low vision and their
families and that those who have low vision will find that the challenges and successes they
experience are appropriately and respectfully portrayed.
The term perspectives was chosen as a unifying theme for this text. It exemplifies the
following concepts:

• This book is for professionals in various disciplines, each of which has its own and shared
perspectives with other disciplines.
• Low vision services are not based solely on a clear-cut science; rather, service providers
combine the tools of the discipline with their perspectives to develop high-quality, highly
individualized services.
• No two persons with low vision experience low vision the same way. Each brings to the
experience a medical and personal history that influences the development of his or her
personal perspectives about low vision.

Throughout this text, the reader will also note the focus on the functional aspects of low
vision, the overriding theme of this volume and the central concept contributed and advanced
in the original edition. The contributing authors, experts on low vision, were asked not to write
a review of the academic literature or research alone but rather to use their personal and
professional expertise to help the reader understand how children and adults with low vision
learn to function with their visual abilities. In doing this, authors kept in perspective the extent
to which low vision is an efficient sensory channel. The themes of perspectives and
functionality are emphasized in this book to provide the reader with a real-life sense of what
low vision is, what the needs of people with low vision are, and what the effective delivery of
low vision services entails.
The text is divided into three parts: Personal and Professional Perspectives, Children and
Youths with Low Vision, and Adults with Low Vision. The first section addresses the entire
population of people with low vision, while the second part of the text emphasizes children,
and the final section focuses on adults. Readers of the original text will find this to be a new
structure; it was developed based on a survey and interviews of university faculty and readers
of the 1996 edition. We trust this new structure will be better aligned with planned course
work and will also help professionals in the field and individuals with low vision to locate
and apply specific topics about low vision.
The chapters all follow the same pattern. Each begins with key points to be developed in
the body of the chapter, followed by a vignette of a person or persons with low vision that
introduces the reader to several essential concepts. Although the characters in the vignettes are
fictitious, their experiences are based on the real lives of many persons with low vision with
whom the authors and editors are acquainted. The reader is encouraged to consider how the
information in each chapter relates to the vignette of a person’s life. Authors were asked to
include in their chapters information that a new professional would need to begin to carry out
his or her responsibilities.
Each chapter concludes with suggested activities and From Your Perspective. The
activities are designed to present experiences related to the content of the chapter and promote
involvement in community services and interaction with children or adults who have low
vision. From Your Perspective asks the reader to reflect on the content of the chapter and to
think deeply about and respond to a philosophical query and its implications for persons with
low vision.
This book thus provides a compendium of perspectives about low vision that should be of
use to a wide range of readers, from professionals who work with children or adults with low
vision to persons with low vision or those who have relatives with low vision to those who
are conducting research or who are intellectually curious about the topic. Its goal is to help
readers develop a deep understanding of low vision, a flexible approach to meeting the needs
of individuals, and a belief that people with low vision can have a good quality of life.
Over the years, terminology concerning low vision has changed or been modified. In this
revision we have tried to update terms and references to low vision services. Optical aids
have become optical devices, and low vision devices now refers to optical, electronic, and
nonoptical devices. The orientation and mobility instructor has come to be known as an
orientation and mobility specialist. The former rehabilitation teacher, who specializes in
working with people who experience low vision or blindness, is now referred to as a vision
rehabilitation therapist. Another example of this change in terminology relates to specific
technology. The closed-circuit television or CCTV is currently called a video magnifier. While
these are not the only changes the reader will see in this revision, we trust that the updates will
be helpful as readers communicate with other professionals and pursue current literature in the
field.
Readers may also notice that there is overlapping information in various chapters. For
example, several chapters include material on instruction in the use of prescribed optical
devices. During the planning stages for the revised text, surveys and interviews were
conducted with university professors and others who have experience in using Foundations of
Low Vision with students and practitioners. A common practice was to use chapters in the
foundations text independently rather than in the sequence followed in the book. Therefore, the
authors were encouraged to consider other chapters in the text while writing their chapters, but
not to avoid presenting information that might be included elsewhere. In this way it is hoped
that the book supports instruction and informed practice as well as reinforces key content.
__________

As editors, we want to acknowledge the passing during the final editing of this volume of
two important contributors, Dr. Susan V. Ponchillia, a seminal figure in rehabilitation teaching
and the development of that discipline into vision rehabilitation therapy, and Dr. Evelyn J. Rex,
a longtime educator and advocate for the literacy of students who are visually impaired.
Finally, we are deeply saddened that this text had to be completed without Dr. Alan
Koenig, whose untimely death occurred during the revision. Dr. Koenig was one of the original
editors, and his expertise and creative contributions will forever be a part of Foundations of
Low Vision. Along with his good friend and coauthor, Dr. Cay Holbrook, we have preserved
most of his original writing and ideas in this revision. We dedicate this new edition to Dr.
Koenig, with hopes that it will advance his goal of improving the quality of life of individuals
who are visually impaired.
PART ONE
Personal and Professional Perspectives
CHAPTER 1
Perspectives on Low Vision
Anne L. Corn and Kelly E. Lusk

KEY POINTS
• The population of people with visual impairments is increasing, and services are needed to
meet their needs for education and rehabilitation.
• Terminology related to low vision has changed over time and does not always have precise
definitions; professionals need to understand and present clear descriptions of this population.
• Clinical measurements of vision (such as visual acuity and peripheral field) do not directly
correlate with how a person uses vision or is able to function visually.
• Theories of how people with low vision learn to use their vision include visual,
psychosocial, cognitive, and experiential factors.
• Effective low vision services require the coordinated use of a team approach.

VIGNETTE
Carla, an experienced journalist, has written a variety of stories on topics associated with
human services, from childhood nutrition to new living options for elderly people to the
opening of new rehabilitation centers for persons with traumatic head injury. While on
assignment to cover an iceskating competition, Carla noticed that a woman seated nearby was
watching what looked like a television up close to see the skaters. The announcer mentioned
that the mother of a skater was legally blind and was using special equipment to see the action
in the rink. Carla was intrigued and decided to write a story about people who are legally
blind but can see.
Within weeks, Carla had spoken with people from the American Council of the Blind, the
American Foundation for the Blind, and the National Federation of the Blind, as well as
several schools for blind children. Although she asked similar questions about blindness and
described the video magnifier to everyone she interviewed, Carla found that some
professionals thought that legal blindness was not a useful term. Each person with whom she
spoke told her about people with vision who nevertheless met this definition of blindness.
Some professionals commented that the current term was low vision but could not really define
it; others said that people with vision who are visually impaired should not be considered
blind. They all said that their schools or organizations served people who were not “really”
blind as lay people would define the word.
 Carla wanted a story that would attract interest, but she could not see how she could write
about such an ill-defined group of people. She thought that describing how people “who could
see a little” could improve the quality of their lives would be interesting, but she wondered
whether she should get her information from organizations “for the blind.”
Finally, Carla decided to go to the library to find a text on the subject. She came upon
Foundations of Low Vision: Clinical and Functional Perspectives, an introductory text about
people with visual problems who are not totally blind. She also found several other texts and
journals. How could she digest it all? Furthermore, she realized that she would also need to
speak directly to a number of people with low vision to get some idea of the wide variety of
experiences associated with this condition.

INTRODUCTION
As a journalist who was attempting to learn about people with low vision, Carla discovered
that people are not just blind or sighted and that sometimes people who are called “blind” can
see. She also found that there is a rich literature about the problems of people who are “in the
middle” between typical vision and blindness. Most important, however, she decided that to
understand how people with low vision function and how they can get on with their lives, she
would have to ask individuals with low vision themselves.
This chapter is an introduction to the issues faced by persons with low vision and the
professionals who provide services for them, including, but not limited to education,
rehabilitation, clinical low vision, orientation and mobility, and psychological. This chapter
addresses the functional use of vision in relation to the definitions and the demographics of the
population, the roles of professionals on a low vision team, and the services available for
children and adults with low vision.

DEFINITIONS

Low Vision
In the opening vignette, a woman wanted to watch ice skaters up close. People with typical
vision watching the performance could see the skaters with or without their standard
eyeglasses (or by using binoculars). However, the woman with low vision needed to enhance
her vision, or “extend her visual reach,” to see the skaters well enough to derive pleasure and
gain information from the visual experience. Therefore, to gain access to the action in the rink,
she used an electronic device that in effect allowed her to move as close as necessary to view
the image.
People with low vision often need to make such adjustments in viewing objects. For them,
a discrepancy exists between what they want to do with vision and what those with typical
vision are able to do. However, persons with low vision can use low vision devices (optical,
electronic and nonoptical), techniques, and/or modify their environments to increase the visual
information they receive and to complete tasks more efficiently. They also may become expert
at reading environmental cues that become more significant for them than for those with typical
vision.
Although the use of the term low vision varies—and this use will be discussed throughout
this chapter—the following definition of a person with low vision is used in this book: a
person who has measurable vision but has difficulty accomplishing or cannot accomplish
visual tasks, even with prescribed corrective lenses, but who can enhance his or her ability
to accomplish these tasks with the use of compensatory visual strategies, low vision devices,
and environmental modifications. Low vision devices include optical (for example,
magnifying lenses, optical prisms, and low light transmission lenses), nonoptical (for example,
bold-lined paper and typoscopes, a rectangular hole cut in cardboard to show one line of print
at a time), and electronic (for example, a video magnifier, formerly called a closed-circuit
television or CCTV). This definition, which encompasses a complex set of variables, provides
a foundation for the remainder of this book.

Caption: People with low vision can use low vision devices and techniques and modify
their environment to carry out tasks and to achieve educational and employment
goals. As the director of physical education in a large school, this man uses a video
magnifier and enlarged images on a computer to perform his job. (Anne L. Corn)

Confusion over Terminology

Although many professionals and people with visual impairments use the term low vision,
various definitions of the term exist. To date, there is no commonly accepted or legal definition
of low vision. Services for those who have low vision emerged from services for those who
are blind, and it is the term blind from which definitions of low vision have evolved.
Until the 20th century, people without sight were generally called “blind”; information or
references pertaining to persons with poor vision were rare. In the 20th century, several
countries, as well as the World Health Organization, began to use the term legal blindness,
rather than blindness, and their various definitions tended to encompass different levels of
visual impairment— even though most people think of a blind person as one who is completely
without sight. Herein lies a dilemma and the cause of widespread misunderstanding and
confusion: Can a person be “blind” and see? How a society defines the physical
characteristics of a group of people has the power to influence the sense of self and societal,
legal, and personal identities of members of the group. In this regard, one may say that people
are “blinded by definition rather than a lack of sight.” That is, persons with low vision who
have been told over and over again that they are blind, even “legally blind,” without an
explanation of the term, may come to believe that their vision is so impaired that it is “as if”
they are blind or more severely visually impaired than they may be. However, these persons
may include those who can read standard print (with or without optical devices), play ball, and
drive motor vehicles, as well as those who can use vision only for such tasks as becoming
oriented to an open door, finding a child who is wearing a red shirt, or using visual perception
of large objects to avoid bumps or falls. Professionals in the field of visual impairment know
that the terms blind and legally blind leave much room for interpreting the amount of vision a
person has and how the person functions with that vision. Nevertheless, people who receive
services “for the blind” and are told that they are legally blind may incorporate that term into
their self-image and beliefs about the extent to which their vision is available or unavailable,
usable or unusable.
The following two examples illustrate this point. One describes a person for whom the term
blindness defines an emotional identity; the other describes someone whose sense of identity is
relatively unaffected by the application of the term. These examples present two perspectives
on how individuals may perceive their visual impairments, even when the clinical measures of
their vision are similar. Neither identity implies a higher or different social value.

Over the years, Mr. Kennedy told people that his wife was blind and always made
references to his wife's “blindness.” He commented to his co-workers that he couldn't
travel out of town without his wife since she was blind and he didn't wish to leave her at
home alone. When an optometrist who knew Mr. Kennedy finally met Mrs. Kennedy at a
social event, she observed that Mrs. Kennedy had a significant amount of functional vision
for locating a chair, establishing eye contact, and signing her name in a guest book. Mrs.
Kennedy referred to herself as blind and believed that her vision was so impaired that she
could do little with it. Mrs. Kennedy's eye condition was significant in her life and she
often spoke of it and many of its implications. When she met new people, she believed that
getting this topic out of the way let people get to know her without wondering what was
“wrong.”
__________

Todd believed that he had vision problems but was certainly not blind, if blindness is
assumed to mean an absence of sight. He felt no shame about the term legal blindness, and
being able to do many tasks visually had convinced him that it was just a term that allowed
him to obtain financial assistance for hiring readers while he attended college. He also
thought that the term was confusing because his acquaintances knew he obviously could
see. When a representative of his state's commission for the blind visited Todd's college
campus, he told several professors that Todd was blind. When Todd's professors contacted
 him with great concern and asked whether he was losing his vision, Todd decided that he
should meet with the commission's representative. At that meeting, the representative told
Todd, “You're a blind student, and the sooner you stop denying your blindness, the better
off you will be.” Twenty-five years later, Todd still believes he has vision problems but is
not blind and he uses both visual and nonvisual approaches for various tasks.

Legal Blindness
Many persons with low vision do not know the origin of the term legal blindness. When they
are told they are legally blind, they are given no explanation of why they are classified that
way or what relationship the term has to their functional vision—that is, to their visual skills
and abilities and the way in which they use them. The term legal blindness has a long and
specific history. In 1934, following the Great Depression, the U.S. government asked the
American Medical Association to formulate a definition of blindness that could be used to
determine which people were in need of special care because of their visual impairments
(Koestler, 1976). The American Medical Association arrived at the following definition,
which was later incorporated into the Social Security Act of 1935:

central visual acuity of 20/200 or less in the better eye with corrective glasses or central
visual acuity of more than 20/200 if there is a visual field defect in which the peripheral
field is contracted to such an extent that the widest diameter of the visual field subtends
an angular distance no greater than 20 degrees in the better eye. (Koestler, 1976, p. 45)

According to this definition, individuals can be considered legally blind for two reasons:
limitations in their visual acuity or limitations in their visual field. In this definition, visual
acuity refers to an individual's ability to see detail (for example, distinguish one letter from
another by seeing separations between lines) at specific distances. Visual field refers to the
area of the environment that individuals can see when their eyes are open. The majority of
those classified as legally blind are those whose visual acuity is 20/200 or less; that is, they
must be 20 feet (the first number) or closer to an object, using their best standard correction
(eyeglasses or contact lenses), to be able to recognize details that people with standard visual
acuity (20/20) can recognize at 200 feet (the second number). (The acuity measure is therefore
not a fraction; nor does it constitute a percentage of typical vision; for a more detailed
discussion of visual acuity notation, see Chapter 8.) Others are considered legally blind
because the extent of their visual field is 20 degrees or less, regardless of their visual acuity;
that is, they can detect objects only within a field of 20 degrees or less. (The typical field of
vision for both eyes extends 90 degrees to either side of the center, making a total visual field
of approximately 180 degrees.) Chapters 5 through 8 give additional information on these
topics.
The definition does not take into account other aspects of vision, such as tolerance of light,
contrast sensitivity, or whether the person's visual acuity fluctuates from day to day, which may
have a significant impact on an individual's ability to use vision. It also does not relate to
visual functioning, although it implies that there is a general degree of limitation—a person
with 20/200 acuity would not be able to read the line on an eye chart representing 20/70 or
20/30 acuity under specific levels of illumination. That is, the definition does not imply that a
person can or cannot catch a ball, visually recognize a friend in a store, or use vision when
clearing dishes off a table. In short, a wide range of visual abilities is exhibited by persons
classified as legally blind, and the clinical measures used to define that term make no
allowance for that reality. It is important to note that a person can have low vision and be or
not be legally blind; however, a person who is legally blind may have low vision or be totally
blind.
Another problem associated with the definition of legal blindness is related to the way in
which the frequently used Snellen eye chart measures visual acuity. On this chart, for example,
there are no measures between 20/100 and 20/200. One line with two letters on it represents
the 20/100 measure. If a person is unable to read that line, the next option is to read the 20/200
line. Although special charts have been designed to measure the visual acuity of people with
low vision (see Chapter 8), most general eye care specialists (optometrists and
ophthalmologists) do not include such charts in their examination procedures or ask an
individual to walk toward the chart to vary the size of the image on the person's retina. As a
result, people with visual acuities of 20/120, 20/140, or other measures between 20/100 and
20/200 who have a standard eye examination are said to have 20/200 visual acuity and as a
result are placed in the category of persons who are legally blind. Indeed, a 2008 publication
explaining the disability programs administered by the Social Security Administration
(Disability Evaluation Under Social Security, 2008, known as the Blue Book) states
explicitly that if the person “cannot read any of the letters on the 20/100 line, we will
determine that you have statutory blindness based on a visual acuity of 20/200 or less.”
The 2008 guidelines supply an additional criterion for legal blindness: “Visual efficiency
of the better eye of 20 percent or less after best correction.” The percentage of “visual
efficiency” is calculated based on multiplying together two separate measures of “visual acuity
efficiency” and “visual field efficiency” (see Disability Evaluation Under Social Security,
2008, Part I, Sec. 2.00A7 for details). It should be noted that the use of the term visual
efficiency to refer to how close a person's visual abilities are to someone with typical vision
is a different definition than that used in this book. As described later in this chapter in the
section on Visual Function and Efficiency, educators and rehabilitation personnel use visual
efficiency to describe how well a person with low vision uses his or her available vision. That
is, a person with 20/800 acuity may be visually efficient given his or her visual capacity while
a person with 20/200 may not be visually efficient if he or she is not able to employ vision for
visual tasks.
The label of legal blindness may not present difficulties for a person who is functionally
unable to perform the tasks of a person with better visual acuity and who can benefit from
services and equipment available to those who are categorized as legally blind. However, it
can pose a problem for persons who live in states where 20/160 visual acuity is required to
take a driver's test designed for those using a bioptic telescopic system (see Chapters 14, 16,
and 18). Another concern about this term is the psychological effects on some children or
adults who are considered “blind” by teachers, neighbors, and relatives. Because the Social
Security Administration criteria are generally accepted, these people are indeed legally
“blinded” by definition. And, since definitions of blindness vary from country to country, a
person may be considered legally blind in one nation but categorized as “legally sighted” after
crossing the border into another country.
A primary objection to the definition of blindness used in the United States is that it is an
arbitrary clinical standard that was developed more than 75 years ago, when there was little
information about how people use vision for performing various tasks. Thus, the authors
contend that functional definitions of visual impairment— the extent to which one can use
vision to complete activities—rather than clinical definitions should be used to determine who
is eligible for services.

Partial Sight
The term partially sighted came into vogue in the mid-20th century. In academic circles, it was
applied to persons with a best-corrected visual acuity in the better eye of 20/70 to 20/200.
However, it was commonly used to refer to any visually impaired person who could use
vision, and often the cutoff for legal blindness was not considered a criterion for judging who
was considered partially sighted. In addition, partially sighted people were sometimes
commonly delineated as “high partials” and “low partials” to indicate whether they were
functioning with a substantial or a minimal amount of vision, without relying wholly on their
tactile and auditory senses. The term partially sighted is still in use today; for example, in
some states children with “partial sight” are eligible for special education services. However,
the term low vision has, for the most part, become the more predominant term.

Functional Blindness
Another term that has emerged with regard to blindness is functional blindness, which has
come to mean a child or adult for whom the use of vision for various purposes, such as
reading, is not efficient. Although they may use vision for some tasks, such as locating a cup on
a tabletop, they are more efficient in the use of nonvisual approaches to literacy and other tasks
requiring more detailed vision.
The term functionally blind is sometimes used, mostly by educational agencies, to indicate
children with or without vision who could benefit from instruction in braille reading and
writing. One could infer that children who are not included in this category are functionally
sighted and would use print as a primary reading and writing medium. Therefore, such a
definition provides a direct link between the characteristics of students and appropriate
educational interventions, whereas legal or clinical definitions do not. In recent years,
increasing numbers of children have been receiving instruction in dual media, that is, both print
and braille (see Chapters 12 and 13). One should not assume that these children are
functionally blind or unable to comfortably and efficiently use print (e.g., they have not or will
not be expected to acquire a functional reading rate) as a primary or literacy mode at the time
the decision to instruct them in dual media is made.

Low Vision: Alternative Definitions

A variety of definitions and descriptions of low vision or persons with low vision has been
included in the literature. There is not one universally accepted definition of low vision, and
no legal definition has been established in the United States or, to the authors’ knowledge, in
any other country. Moreover, many of these attempts to define low vision are based on clinical
measures, which, similar to the definition of legal blindness, do not give a full picture of how
much vision an individual has or how he or she functions visually. Keeping this in mind, the
following examples of definitions are offered:

• A vision loss that is severe enough to interfere with the ability to perform everyday tasks or
activities and that cannot be corrected to normal by conventional eyeglasses or contact lenses.
(Jose, 1992, p. 209)
• Having a significant visual impairment but also having some usable vision; moderate low
vision is acuity of 20/70 to 20/160 in the better eye with the best possible correction; severe
vision loss is 20/200 to 20/400 or a visual field of 20 degrees or less. (Levack, 1991, p. 237)
• Bilateral subnormal visual acuity or abnormal visual field resulting from a disorder in the
visual system. The defect may be in the globe (cornea, iris, lens, vitreous, or retina), the optic
pathways, or the visual cortex. It may be hereditary, congenital, or acquired. Inborn or
acquired disease may affect visual acuity or visual field and a variety of other ocular
functions: color perception, contrast sensitivity, dark adaptation, ocular motility and fusion,
and visual perception or awareness…. By definition, the visual acuity cannot be corrected to
typical performance levels with conventional spectacle, intraocular, or contact lens refraction.
In patients with typical acuity, visual fields must be sufficiently impaired to prevent typical
performance. (Faye, 1984, p. 6)
• One who has an impairment of visual function, even after treatment and/or standard refractive
correction, and has a visual acuity of less than 6/18 [the metric equivalent of 10/60] to light
perception or a visual field of less than 10 degrees from the point of fixation, but who uses, or
is potentially able to use, vision for the planning and/or execution of a task. (World Health
Organization, 1992)

The common thread among all these definitions is the implied discrepancy between what a
person with typical vision is able to perform or accomplish and what a person with low vision
wishes to perform or accomplish. Although some definitions include clinical measures of
visual acuity or visual field, they seem arbitrary, given that there is no assurance that a person
with a specific clinical measure will or will not be able to complete specific tasks that do not
require the recognition of letters or symbols at specified distances. Clinical measures are also
limited as they generally include only measures of central visual acuity and the extent to which
one has a visual field (for example, the number of degrees of field). Rarely do individuals, or
the educators or rehabilitation personnel who work with them, receive from a clinician such
clinical measures as contrast sensitivity, a measure of photophobia, or whether an individual's
peripheral visual field is compromised or restricted. Recently researchers have begun to
identify differences in the ways in which children with low vision use their peripheral vision
in psychodynamic testing (Lappin, Tadin, Nyquist, and Corn, 2009). The definition of low
vision that the authors proposed at the beginning of this chapter is based only on the use of
functional vision. This definition is a reflection of the belief that persons with low vision
function in ways that cannot be fully correlated or predicted by clinical measures and that a
change in one's ability to use available functional vision can occur without a change in clinical
findings that are measured under specific environmental cues that are created for gathering
clinical measures (e.g., the amount of light falling on a contrast sensitivity chart). For example,
a person may be able to easily detect a set of stairs on a sunny day by seeing shadows but may
not detect the same stairway on a cloudy day.
Vision loss is a term that is being used to a greater extent in recent years to describe the
experience of people with visual impairments. This term, however, seems more applicable to
those for whom sight has been “lost” due to an acquired, or adventitious, visual impairment. In
other words, people who have experienced a loss are those who have had unimpaired vision at
some point or those who “lost vision” following a stable low vision condition. The term vision
loss is sometimes used to mean any departure from unimpaired sight, not specifically a loss of
vision to the point of having low vision, and a person with “vision loss” may also be someone
who is totally blind who has never experienced vision.
Children and adults who have low vision that was caused by an impairment that occurred
at or shortly after birth, up to as old as 2 years of age, are often considered to have a
congenital visual impairment. While a 2-year-old who loses vision will have experienced a
visual loss, the child born totally blind will not have had this experience. This may seem like a
semantic quibble similar to arguing about whether a vessel is half full or half empty.
Nonetheless, the person with a congenital visual impairment may argue that he or she has not
lost vision. Similar comments may be made about the use of the term residual vision or
remaining vision. These terms may be more applicable to those who have had the experience
of visual loss, thus resulting in residual vision or remaining vision, terms that imply what is
left following a loss (the glass has emptied to a certain extent), whereas functional vision
seems to imply that vision is available for planning or executing visual tasks (the glass has
been filled to some extent).
When one speaks of visual efficiency another set of terms is important to describe. At times
the term normal is used to describe an unimpaired visual or other body system. At other times,
the phrase typically developing is used to describe what may be the same population of
persons who are peers without visual impairments or disabilities. This term is used to
describe an expected status of visual or body functioning.

Visual Function and Efficiency

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Stevens, Capt. W. B., i. 87, 88, 105; ii. 14, 220
Stewart, 2nd Lieut. J. M., i. 52, 75; ii. 218
Stirling Camp, i. 260
Stirling Castle, i. 222
Stokes, 2nd Lieut. A. S., i. 257, 265; ii. 222
Stoney, 2nd Lieut. T. S. V., i. 228, 234; ii. 218
Stove-explosion, Father Knapp’s, ii. 124
Straker, Lieut. L. S., i. 43, 50, 54, 81, 85, 88, 90; ii. 221
Stuff Redoubt, the, i. 195
Sussex Regt., i. 44
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Tait, Pte., i. 287

Tallents, Capt. S. G., O.B.E., i. 58, 81, 84, 85; ii. 220, 224, 231
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Thiepval, i. 156, 161, 195, 262
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Trench feet, i. 55, 56; ii. 31-32
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Vadencourt, i. 4, 6, 8
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Villeneuve, i. 14-15
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Wagnies-le-Petit, i. 324
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Wanquetin, ii. 180
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Wassigny, i. 3
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West Face Trench, ii. 22, 23, 24
West Indies battalion, boxing competition with, ii. 157
West Lane Trench, ii. 79
West Riding Regt., 2/5th, ii. 173-174
West Yorkshire Regt., 15th, ii. 186
Westhoek, i. 222
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Whittaker, Lieut. (Brigade Bombing Officer), ii. 117
Wieltje, i. 142, 145-146; ii. 75
Wieltje Trench, ii. 75
Wijden Drift road, i. 226
“Wild West Show,” Irish Guards’, ii. 164
Willerval-Bailleul sector, ii. 185
Williams, 2nd Lieut. D. R., i. 274; ii. 222
Williams, Lieut. G. V., M.C., i. 153, 168, 183; ii. 221, 225
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Winchester Farm, ii. 40
Winchester House, ii. 43, 60
Winchester Road, ii. 31, 41, 55
Windy Corner, i. 75
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Wisques, ii. 6
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Wordley, Lieut. S. S., ii. 176, 222
Wormhoudt, i. 136-137, ii. 63, 80
Wreford, Lieut. J. M. R., ii. 222
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Wylie, Sgt., i. 190
Wynter, Lieut. C. D., i. 69, 81, 86, 88, 105; ii. 10, 14, 219
Wytschaete, i. 50, 210, 211

Yerburgh, Capt. R. G. C., O.B.E., i. 58, 81, 86, 88, 111, 117, 129, 185, 189; ii.
224, 226
Yorkshire Regt., i. 187; ii. 187-188
Young, Major (R.A.), ii. 42
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Younge, Pte. A., D.C.M., i. 146, 147; ii. 280
Ypres and the Salient, i. 26
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(1915) Second Battle, i. 79-80, 82
(1916) i. 132-134, 137-146, 147-150, 152-154; ii. 67, 68, 69, 70 sqq., 82-83,
85-91
(1917) i. 210, 211;
Third Battle, i. 211-223, 224, 225, 226, 228-235; ii. 135, 138, 139, 140 sqq.
(1918) i. 269, 282, 309
Ypres-Staden railway, fighting round, i. 217, 219, 220, 221, 226, 229, 231, 232
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sqq.
Ytres, i. 206

Zandvoorde, i. 28, 32, 36

Zeebrugge, i. 25
Zero hour arrangements, German officer’s questions on, ii. 149
Zigomala, Lieut. J. C., M.B.E., i. 250, 266; ii. 83, 95, 219, 221
Zillebeke, i. 32, 38, 41
Zonnebeke, i. 28, 29, 30, 31
Zouave Wood, ii. 82
THE END
 FOOTNOTES:
[1] This was pure prophecy. Captain, as he was then, Alexander
was credited with a taste for strange and Muscovitish headgear,
which he possibly gratified later as a general commanding weird
armies in Poland during the spasms of reconstruction that
followed the Armistice.
[2] In those peaceful days when the Division was “fattening” for
the fight, Greer had kept a sympathetic eye on Sassoon, who had
gone down very sick some time before Greer came to command
the 2nd Battalion, and was convalescing in the Entrenching
Battalion where his heart was not. Greer, who had a keen eye for
good officers, said of him: “He writes me pitiful letters protesting
that he is now completely fit, and asking that he should be
allowed to come up to this Battalion.... He is a stout-hearted
savage, and a life-sentence with the Entrenching Battalion would
certainly be an awful prospect.” So Sassoon was rescued, and
Greer’s faith in his “stout-hearted savage” abundantly justified.
[3] On this basis, as is noted in the history of the 1st Battalion, a
Fourth Brigade of the Guards Division was created by the lopped
off battalions: viz., the 4th Grenadiers, 3rd Coldstream, and 2nd
Irish Guards, which as a brigade was attached to the thirty-first
Division, Thirteenth Corps (Major-General Sir Charles
Fergusson).
TRANSCRIBER’S NOTE
Obvious typographical errors and punctuation errors have been corrected after
careful comparison with other occurrences within the text and consultation of
external sources.
Some hyphens in words have been silently removed, some added, when a
predominant preference was found in the original book.
Except for those changes noted below, all misspellings in the text, and
inconsistent or archaic usage, have been retained.
Pg 14: ‘Sailly-Lebourse’ replaced by ‘Sailly-Labourse’.
Pg 107: ‘the Divison returned’ replaced by ‘the Division returned’.
Pg 224: ‘10.6.29’ replaced by ‘10.6.19’.
Pg 239: ‘5110, Pte., d. in w.’ replaced by ‘5110, Pte., d. of w.’.
Pg 247: ‘Kapanagh, Patrick, 3509’ replaced by ‘Kavanagh, Patrick, 3509’.
Pg 274: ‘9253’ occurs twice; one perhaps should be 9258.
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