Common Causes of Blindness

Susan Kosior University of Arizona IRLS 554, Spring 2014

What Is Vision? How Do We See?

Eyesight is a process of both the eye and the brain. An image (light) enters the eye and is picked up by the photoreceptors in the eye. The eye relays that information back to the brains visual cortex, which decodes the information and determines what it is that the eye is seeing. The eye is the camera, the brain is the computer, the optic nerve is the wire that connects the two. Consequently, damage to any of the three major parts affecting eyesight (eye, optic nerve, brain) can cause a loss of eyesight. It is possible to have a healthy, functioning eye, but a visual cortex that cant make sense of what is being seen. It is possible to have a healthy eye and visual cortex, but damage to the optic nerve which makes relaying information between the two impossible.

How Do We See?

Step 1: Eye sees image Step 2: Optic nerve relays image from eye to brain Step 3: Brain says We are looking at a coffee cup

Anatomy Terms
Cornea: The clear covering over the eye Sclera: the white part of the eye Anterior Chamber: fluid-filled area between cornea and pupil Iris: Colored part of the visible part of the eye (Do you have brown, blue, green, or hazel irises?) Pupil: black spot in the center of the iris, actually an opening that allows images into the eye for processing Lens: clear disk behind pupil that draws images into focus Retina: layer of photoreceptors and blood vessels lining the inside of the eye, feeding the eye oxygen and picking up images for transmission to the brain Vitreous: large chamber inside the eye, filled with fluid to give eye shape Fovea/Macula: miniscule portion of the retina which is responsible for central vision Optic nerve: Bundle of millions of nerves which transmit an image from the eye to the brain instantaneously

How Do We See, Part II

An image enters the eye through the cornea and pupil and is focused on the macula/fovea and retina by the lens. The lens focuses by getting either thicker or thinner depending on if the image is close or far away. That information is then relayed to the brain via the optic nerve.

Anatomy of the Eye

The majority of individuals with eye disease causing blindness have conditions which affect the lens, macula, retina, and optic nerve. Take a moment to locate these before proceeding.

What is Blindness?
The legal definition of blindness is that an individual has a central acuity of 20/200 or a field of vision restricted to 20 degrees or less in the better eye with correction. Lets break this down so it makes sense!

Legal Definition of Blindness: 20/200 Central Acuity

A person with perfect vision has 20/20 eyesight. That means if they stand 20 feet away from an eye chart, they can read the 20 foot line on the chart. A person with 20/200 acuity must stand only 20 feet away from the chart to read the 200 line (generally the giant E on top of the chart). Acuity can be diminished by blurring or spots (called schetoma)

Legal Definition of Blindness: 20 Degree or Less Field of View

Someone with typical eyesight can see about 180 degrees when looking straight ahead. To test this, look at the wall straight in front of you, hold your fingers up next to your ears, and slowly move them around to the front of your head. Stop when you can see your fingers. Someone with a 20 degree or less field of view can only see 20 degrees around when looking straight ahead. This is considered tunnel vision. A person may have absolutely perfect eyesight within that 20 degrees, but the degree of restriction renders them legally blind.

Legal Definition of Blindness: Better Eye With Correction

The individuals acuity or field reading must be 20/200 or less or 20 degrees or less in the better eye with correction. If one eye is severely restricted but the other is fine, the individual is not legally blind. If the individuals eyesight can be corrected to better than 20/200 or 20 degrees with glasses or contacts, that person is not legally blind.

Common Diseases of the Eye

The leading causes of blindness in the United States are:
Diabetic Retinopathy Macular Degeneration Glaucoma Cataract

Diabetic Retinopathy
A disease of the eye in which blood vessels inside the retina burst, leaving blood clots floating in the vitreous fluid. This means islands of vision are lost.

Macular Degeneration
The macula is responsible for our central vision, which is our clearest, crispest vision. In macular degeneration, the cells in the macula break down, leaving the individual with no useful central vision. MD is the leading cause of blindness in people 60 and older

Glaucoma
Glaucoma is caused when there is increased pressure in the eyes anterior chamber. The pressure affects the optic nerve, and causes tunnel vision. There are two main types: Open angle glaucoma slowly steals the eyesight of the sufferer. Because glaucoma works from peripheral vision where we do not see as well, it is referred to as the sneak thief of sight. Accounts for 90 percent of glaucoma cases Closed angle glaucoma has a quick onset, often accompanied by terrible headaches, nausea, and pain in the eyes. It must be treated as a medical emergency, or it can cause total blindness in 24 hours or less. Other types include: congenital, normal pressure, traumatic, and secondary glaucoma

Cataracts
Cataracts are a condition wherein the lens in the eye, which is responsible for focusing, becomes cloudy, obscuring the image being viewed. Think of driving with your windshield a little dirty and you have a sense of what cataracts are like

Other Causes
These are the leading causes of blindness. Other causes include:
Congenital conditions (hereditary) Accidents (for example: gunshot wounds, head trauma, car accidents) Premature birth Disease Malnutrition

Risk Factors
The number one risk factor for blindness and loss of eyesight is aging. Of the four main diseases covered, the risk factor increases for all as we age. Other risk factors include:
Smoking Hypertension/Cardiovascular disease Prolonged exposure to sun Early menopause Diets high in certain fats Race

Treatment and Cures

Cataract surgery today is common, and patients generally regain most of their lost eyesight. For most other forms of blindness there is no cure. Occasionally sufferers of diabetic retinopathy have laser surgery to seal off the leaking blood vessels and break up large blood clots. Some macular degeneration sufferers report slowing the disease through the use of vitamins, but said use does not help regain sight already lost. Glaucoma can be controlled with the use of drops to help the pressure remain stable, but the lost eyesight cannot be regained. Laser surgery is also an option to open block drains and relieve pressure