Visual Disabilities and Impairment: Mostly Refractive, Mostly Preventable

In an earlier post, I had outlined fundamental principles of hyperopia (farsightedness) as a physical disability. Likewise, astigmatism is a frequently un-diagnosed and untreated visual impediment that contributes to child health, behaviour, development, and learning concerns. The impact of nearsightedness (myopia) are documented in countless studies on its functional impact and health risks.

Vision impairment and dysfunction impact children’s behaviour and development far more frequently than eye health concerns.

By far, the overall financial emphasis in eye care is in treating the elderly – largely for treatment of latter life conditions such as glaucoma, retinal disorders, and cataracts. The fact remains that in spite of spending billions annually on treatment of blinding eye disease, outcomes from interventions in eye disease remain modest at best.

Meanwhile, something just over 10% is committed to refractive concerns – that is, that broad category of visual impairment that is often debilitating, and virtually 100% preventable. A recent study in JAMA Ophthalmology underlines the simple (and to doctors and therapists painful) truth that by far, the greater portion of visual impairment is refractive.

Vision impairment and dysfunction impact children’s behaviour and development far more frequently than eye health concerns. Basic refractive problems, especially astigmatism and hyperopia which impede and frustrate work with near targets (i.e. reading, books, tablets, writing), are most often unchecked and untreated even in the most affluent of communities. It has been shown conclusively that vision impairment and dysfunction are inextricably linked to reduced academic achievement, for example.

The recent JAMA Ophthalmology study is a frank acknowledgment from Medicine that unchecked visual impairment is a significant and growing, in particular in minority and underprivileged communities. I personally have expressed grave concerns with respect to the impact of untreated refractive concerns among Indigenous communities – something that carries a great and unnecessary cost to healthcare, to social services, education, and certainly to families. Given the very profound effects of refractive concerns, and the great burden these impose on society and young families, it is a wonder we pay so little attention to them and prefer rather to put so much emphasis on medical interventions for later-life care.

The notion of ‘Vision Blindness‘ describes systemic and systematic disregard in Health and Education for visual impediments generally, and to refractive concerns more generally. There are a few reasons for this that we all need to address as a broader clinical community and these concerns are outlined in related posts. Until we do address these simple problems that prevent professionals from understanding vision function and development, we clinicians remain guilty of vision blindness, and complicit in denying so many thousands their basic rights to even try to succeed in life on an open playing field.


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