Kara Sears
In the United States, legal blindness is based on measurements of central visual acuity (what’s directly in front of you) and field of vision (what’s above, below, and to the sides). Visual acuity refers to the sharpness of one's eyesight. If an individual's better eye, while wearing glasses or contacts, has a visual acuity of 20/200 or less or a field of vision of less than 20 degrees, they are considered legally blind. This means that their vision cannot be improved beyond 20/200, and they can only read the single large letter at the top of an eye chart. Legal blindness is different from total blindness, as most people who are legally blind can still see light, but objects in their vision are very blurry.
| Characteristics | Values |
|---|---|
| Legal Definition of Blindness | Based on measurements of central visual acuity and field of vision. |
| Visual Acuity | Sharpness of eyesight. |
| Field of Vision | What's above, below, and to the sides of what's directly in front of you. |
| Legal Blindness vs Total Blindness | Legal blindness is different from total blindness, which is a complete loss of all visual light perception. |
| Peripheral Vision | A wide field of vision is critical for activities like driving a car or crossing a busy street. |
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What You'll Learn
What constitutes legal blindness?
Legal blindness is a definition used by the United States government to determine eligibility for various benefits and services. It is a guideline, not a medical term, and is defined by law establishments as a level of visual impairment that limits a person's activities without assistance.
The Social Security Administration (SSA) is the main US government agency responsible for setting the requirements for legal blindness certification. The SSA updated the definition of legal blindness in 2006, and the rules were put into effect in 2007. The SSA definition addresses the best corrected visual acuity (VA) of 20/200 or less in the better-seeing eye and the visual field (VF) limitation such that the widest diameter of the visual field is no greater than 20 degrees. This means that even with glasses or contacts, a person with legal blindness can only read the first letter at the top of the Snellen Chart, if that.
To be considered legally blind, one of the two criteria has to be met. Firstly, a person must have a reduced central visual acuity of 20/200 or worse in the eye they can see out of the best. Visual acuity refers to how close a person needs to be to an object that's 20 feet away to see it in detail. Secondly, a person must have a limitation of their field of view, meaning their visual field is no more than 20 degrees.
Legal blindness is uncommon, but experts expect the number of people with this condition to climb sharply over the next few decades due to the increase in diabetes and other chronic diseases, as well as the rapidly ageing US population.
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How is visual acuity measured?
Visual acuity is measured through a visual acuity test, which is used to determine the smallest letters a person can read on a standardised chart (known as a Snellen chart) or a card held 20 feet (6 meters) away. The test is used to detect vision problems and is often performed in schools, workplaces, or as part of a driving test.
During the test, the patient is asked to remove their glasses or contact lenses and stand or sit 20 feet (6 meters) from the eye chart. They keep both eyes open and cover one eye with their hand, a piece of paper, or a small paddle. They then read out loud the smallest line of letters they can see on the chart. Numbers, lines, or pictures are used for those who cannot read, especially children. The test is then repeated for the other eye. If needed, the test is repeated with the patient wearing their glasses or contact lenses.
The patient's visual acuity is expressed as a fraction. The top number refers to the distance the patient stands from the chart (usually 20 feet or 6 meters), and the bottom number indicates the distance at which a person with normal eyesight could read the same line. For example, 20/20 (6/6) is considered normal vision, while 20/40 (6/12) indicates that the line read by the patient at 20 feet (6 meters) away can be read by a person with normal vision from 40 feet (12 meters) away.
In addition to the standardised chart, there are special charts for testing at distances shorter than 20 feet (6 meters). Some Snellen charts are video monitors displaying letters or images. The patient may also be asked to read letters or numbers from a card held 14 inches (36 centimeters) from their face to test their near vision.
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What are the causes of legal blindness?
Legal blindness is a status set by government agencies, defining vision loss thresholds to qualify for disability benefits and support. The Social Security Administration (SSA) updated the definition of legal blindness in 2006, and the rules were put into effect in 2007. The SSA definition addresses the best corrected visual acuity (VA) of 20/200 or less in the better-seeing eye and the visual field (VF) limitation such that the widest diameter of the visual field subtends an angle no greater than 20 degrees. The criteria for visual acuity testing have changed, as most Snellen test charts did not have lines that could measure visual acuity between 20/100 and 20/200. Newer charts have this capability, and if a person cannot read any of the letters on the 20/100 line, they will qualify as legally blind.
The American Medical Association (AMA) set a definition for legal blindness in 1934, which is still used today. According to the AMA, "legally blind" means at least one of the following applies: You have 20/200 (or worse) eyesight, even with correction. This means that even with glasses or contacts, you have 20/200 eyesight or worse in the centre of your field of view. If you have better sight in one eye, the measurement is taken from that eye. You have a field of view that’s no more than 20 degrees wide. If one eye has a wider field of view, the measurement is taken from that eye.
The number of blind individuals is predicted to increase to 8.96 million by 2050 due to the increase in diabetes and other chronic diseases, as well as the aging U.S. population. Nearly 3% of children under 18 years are blind or visually impaired, according to the Centers for Disease Control and Prevention (CDC). Vision disability is one of the top 10 disabilities among adults and one of the most prevalent disabling conditions among children.
A Certificate of Legal Blindness is used to determine eligibility for benefits and services, such as vocational training, rehabilitation, schooling, Social Security disability benefits, IRS tax exemption, and state agency services.
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How does peripheral vision impact legal blindness?
Peripheral vision is the ability to see objects and movement outside of your direct line of vision. It is an important function that helps us navigate the world safely and effectively. When we drive, for example, we rely on our peripheral vision to be aware of other vehicles, pedestrians, and obstacles without having to take our eyes off the road ahead.
Legal blindness is a term used to describe a person whose vision is severely impaired to the extent that it impacts their daily life, including mobility and employment. While it does not mean total blindness, legal blindness indicates that a person's vision is 20/200 or worse in their best-seeing eye, even with corrective lenses. This means that they would need to be 20 feet from an object to see it as well as someone with perfect vision could from 200 feet away.
Peripheral vision plays a crucial role in determining legal blindness. One of the criteria for legal blindness is having a visual field of less than 20 degrees in diameter. This means that a person's peripheral vision is severely reduced, and they can only see things that are directly in front of them without moving their eyes. This limited visual field is sometimes called tunnel vision and can make everyday tasks, such as driving, extremely challenging or even impossible.
There are various conditions that can lead to peripheral vision loss and legal blindness. Glaucoma, for instance, often starts with vision loss in the periphery and can eventually lead to blindness if left untreated. Retinitis pigmentosa is another condition that affects peripheral vision, causing problems seeing at night and a gradual loss of peripheral vision over time. Age-related macular degeneration primarily affects central vision, but it can also impact peripheral vision in some cases.
In summary, peripheral vision is essential for our ability to function in the world, and its loss can significantly impact a person's life. When peripheral vision is severely reduced, it can contribute to a diagnosis of legal blindness, which brings with it certain rights and benefits to help individuals cope with the challenges of vision loss.
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Can legally blind people drive?
In the United States, each state determines its own threshold for "normal" vision acuity for driving. While these requirements vary, a person's vision must be at least 20/40 in both eyes to pass a vision test for a basic driver's license. However, some states allow individuals with low vision, often defined as having a visual acuity of 20/70 or worse, to drive under certain conditions. These conditions may include restrictions on driving only during the day, having a relatively good field of vision, and special modifications to the car.
For legally blind individuals, defined as having 20/200 vision or worse in the best eye and/or a visual field of 20 degrees or less, driving is not possible from a practical standpoint. However, with the help of appropriate vision aids, knowledge of state laws, and common sense, some legally blind individuals may be able to drive under specific circumstances. Most visually impaired people prefer to drive during the day and in good weather when there is better light.
It is important to note that state laws governing the use of telescopic lenses and other vision-enhancing devices vary greatly, so it is crucial to understand the specific restrictions in your state. Organizations like Prevent Blindness provide resources and information on state vision screening standards and licenses to drive. While the debate around restricting driving due to vision impairment is complex, the ultimate goal is to ensure the safety of all individuals on the road.
In summary, while legally blind individuals cannot drive in a practical sense, some may be able to drive under specific conditions and with the appropriate vision aids. It is essential to refer to the specific laws and requirements of your state regarding vision standards for driving and the use of vision-enhancing devices.
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Frequently asked questions
In the United States, legal blindness is based on measurements of central visual acuity (what’s directly in front of you) and field of vision (what’s above, below, and to the sides). Someone is legally blind if their better eye, while wearing any glasses or contacts, has a visual acuity of 20/200 or less or a field of vision of less than 20 degrees. Legal blindness is different from total blindness, which describes the complete loss of all visual light perception. Most people who are legally blind can still see light, but the objects in their vision are very blurry.
Visual acuity is the medical term for the sharpness of your eyesight. It’s one of several factors that determine the vision prescription you get from an eye doctor.
Several eye-related conditions can cause legal blindness and other levels of impaired vision. These include age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma.
