When there is no effective treatment for a vision-damaging ocular condition, or when treatment fails to prevent or restore vision loss, patients may experience blindness, which, defined on a functional basis, is the inability to function visually. Less severely affected patients may experience visual impairment, that is, the ability to function visually but at less than the optimal level. Depending on patient age at the onset of the vision problem, desired personal and occupational goals may be unachieved or may have to be abandoned. People under age 65 who are blind or visually impaired (VI) comprise a group of patients often lost to maximal vision rehabilitation. Only 41.5% of the blind population is employed. A second, smaller group is composed of patients over age 65 who are blind or VI. With improvements in the management of extremely premature newborns and with increasing longevity of the population, both of these groups can be expected to grow significantly in future years. Many individuals in both groups spend their days sequestered in their homes or group facilities. Others may cope with their situations by setting unnecessarily limited goals.

Alternative, nonvisual skills are available to blind and VI people of all ages seeking higher education or attaining/maintaining competitive careers. These include: 1) orientation and mobility, 2) braille skills, and 3) competency in technologies that improve communication and broaden access to information. No statistics are available regarding the impact of these skills on the ability of these individuals to enter or remain in the workforce. Years of experience have shown that many of those blind and VI individuals who are the most motivated and who are given access to these skills can achieve or maintain integration within their communities and retain an ability to compete on the same level as their sighted peers for higher education and employment (eg, co-authors V.J.D., J.A.K., and J.J.R.). For these blind and VI individuals, reading, writing, and communicating on a level equal to that of the sighted population is an absolute necessity and is an attainable goal.

Low-vision aids are not an option for blind people, who have little or no useful vision. While these modalities are of unquestioned benefit to VI persons when performing less demanding everyday tasks, reading 10 to 30 words a minute with high-plus magnifiers or closed-circuit television is restrictive and insufficient for those hoping to attain or maintain their desired lifestyles or careers in the same competitive environment as the sighted population.

Patients in both groups often are told by their physicians, “There is nothing more I can do for you” (eg, co-authors V.J.D., J.A.K., and J.J.R.). While this sentiment may be accurate on a purely medical basis, there is a very real psychological benefit associated with “doing something”—which can provide some desperately needed hope to these patients. The ability of ophthalmologists to provide information regarding the availability of vision rehabilitation services, specifically nonvisual skills, as well as the encouragement to make use of them can make a profound impact on the independence and productivity of these individuals.

For blind people, public and private agencies teach adaptive daily living skills for orientation and mobility such as personal grooming, dressing, grocery shopping, homemaking, and kitchen skills, thus enhancing independent living. It is an accepted fact that traveling independently can be expedited with a long, white cane or a dog guide.

These agencies also provide braille skills and training in assistive technologies to blind and VI individuals, thus enabling many of them to communicate at a level equal to that of the sighted population. Braille is currently read by only 10% of blind people, but of those, approximately 90% are employed. This compares to only 30% to 40% of braille nonreaders. Thirty percent of braille readers have advanced degrees. Common myths regarding braille include: only young children can learn braille; it is too slow; it is a poor substitute for “normal” reading; and braille materials are not readily available. None of these is true. Although scientific data are not available, there are many blind and VI individuals of all ages who have learned braille and can read as fast as sighted people and with the same level of comprehension.

Recent innovations in assistive technology have dramatically increased opportunities for blind and VI people to succeed in competitive situations. Screen readers utilize voice software to read out loud information on a computer screen. Other devices utilize embossed or refreshable braille. Note-takers provide access to e-mail and the internet through speech and braille output. Jobs that have previously been beyond the reach of blind or VI employees—such as executive positions and jobs in information technology, medical transcription, and teaching, for example—are now open to those blind and VI individuals who have acquired adaptive skills.

Most nonmedical people—even many ophthalmologists—are unfamiliar with a truly independent blind or VI individual and, thus, many harbor misconceptions about blindness. The sighted public’s fear of blindness is exaggerated by the act of closing one’s eyes and thinking, “How can I do anything?” Sighted people, unfamiliar with the independence afforded by nonvisual skills, have low expectations for blind and VI individuals. Even those blind and VI people who are unaware of the benefits and availability of nonvisual skills harbor these same misconceptions and low expectations of themselves.

Ophthalmologists naturally concentrate on stabilizing vision and maximizing remaining vision with emphasis on visual acuity rather than on visual function. Ophthalmologists tend to think of blindness (20/200 or worse in the better-seeing eye ) and visual impairment (less than 20/40 in the better-seeing eye ) on a visual basis. Blind and VI individuals of all ages frequently are advised to utilize their remaining vision, predominantly by means of low-vision aids. For blind individuals especially, putting emphasis on unreliable vision can foster an attitude of dependence rather than independence.

Two goals must be attained. First, physicians must shift their attitude from thinking of vision loss as a deficiency, to that of understanding what is possible. Thinking of capabilities instead of disabilities emphasizes strength and opportunity as opposed to weakness and limitation. Don’t think, “Without a dog guide or a cane, Mr. Jones cannot travel.” Think, “With a dog guide or a cane, Mr. Jones can travel.” Blindness skills thus become liberating rather than restrictive.

Second, physicians must understand what can be accomplished with nonvisual skills and know where blind and VI individuals can acquire them. The National Council of State Agencies for the Blind (NCSAB) maintains a continually updated website, www.ncsab.org , which details the state agencies for blind and VI individuals in all 50 states. A link for physicians facilitates acquisition of this information. Vision Serve Alliance, found on the web at www.visionservealliance.org , is a similar organization of private agencies that serve blind and VI clients. Ophthalmologists are encouraged to make this information available to their blind and VI patients and motivate them to investigate these services that can provide significant enhancement of their quality of life.

Motivated blind and VI individuals who are made aware of the availability of nonvisual skills and are encouraged to make use of them can achieve high levels of independence, self-esteem, and productivity. However, as valuable as these assistive technologies may be, braille, the computer, the dog guide, and the cane only enable the person. It is the individual’s attitude and talent that make him or her successful. The ophthalmologist has a responsibility and a unique opportunity to educate these individuals. By means of the ancillary role of counselor and advisor, the ophthalmologist, who has nurtured the physician-patient relationship, can influence whether someone takes the first step toward attaining or retaining personal success.