From Big Medical Encyclopedia

BLINDNESS (caecitas) — considerable decrease in sight up to its absence. Distinguish S. of one and both eyes. At S.'s interpretation as medico-social concept mean a state, at Krom sight of both eyes is sharply reduced or lost.

There are numerous criteria for evaluation and classifications of Page.

On the level of sight distinguish partial, or incomplete, S. and absolute, or full, Page. At partial S. residual sight ranging from photoperception to 0,05 is kept.

At absolute Page. visual acuity (see) it is equal to zero and even perception of light is lost. The absolute S. which is combined with a hearing loss and dumbness is called deafmutism with blindness (see).

In 1972 WHO offered the classification of vision disorders which entered the International classification of diseases of the IX review (1975). According to this classification distinguish three degrees of S. corresponding to the 3, 4 and 5 categories of a vision disorder. Refer states to the 3rd category of a vision disorder, at to-rykh visual acuity with the greatest possible correction it is equal or higher than 0,02, but less than 0,05, or borders fields of vision (see) less than 10 °, but more than 5 ° around a point of fixing. Refer the states which are characterized by visual acuity less than 0,02 or safety only of photoperception to the 4th category of a vision disorder (cm). Vision disorders enter the same category, at to-rykh border of a field of vision are in limits 5 ° around a point of fixing even if visual acuity normal. Refer lack of photoperception to the 5th category of a vision disorder. Disturbances sight (see) when the minimum indicator of visual acuity (with the maximum correction) is equal or more than 0,05, and maximum — less than 0,3, refer to the 1st and 2nd categories designated as «slabovideniye».

Almost blind consider people, at to-rykh visual acuity does not exceed the seeing eye 0,03 better and there cannot be a korrigirovan or the field of vision of both eyes is concentrically narrowed to 5 — 10 °. These people owing to difficulty of orientation need permanent foreign care or the help. At medical labor examination practically blind people are equated to completely blind.

Professional (production) S. means a state, at Krom an opportunity to perform the usual work demanding good sight is lost.

Color S. means high extent of disorder of color sensation with loss one (dichromasia) or two (monochromasia) components of perception of color (see. Color sight ).

Classifications Pages — Magnus (H. F. Magnus, 1883) and S. S. Golovina (1910) — formed the basis of S.'s division according to the etiological and anatomic principles. Carry S. which arose owing to disturbance of a pre-natal organogeny of sight to inborn. The acquired S. can result from various diseases of eyes, both local, and caused by the general diseases of an organism and intoxications, and also at damages of an organ of sight, diseases and damages of c. N of page. At damage of a cerebral cortex in the field of the visual center S. develops cortical, or cortical (see. Visual centers, ways ; pathology). The absolute S. which arose without visible anatomic changes in an eyeglobe is designated the term «amaurosis» (Greek amauros dark, blind). In most cases are the reason of an amaurosis inborn (an inborn amaurosis) or acquired diseases of c. N of page. The amaurosis owing to functional frustration, napr is possible, at hysteria (a hysterical amaurosis). At the same time loss of sight occurs, as a rule, suddenly, after mental affect.

Depending on S.'s reason can be curable (perhaps partial or complete recovery of sight) and incurable. WHO for the epidemiological purposes recommends to allocate four groups of the reasons calling S.: 1) damages of a cornea owing to an infection, insufficiency of food or an injury, at the same time in most cases S. it is possible to prevent or cure; 2) phacoscotasmus; Page, resulted from this reason, it is curable; 3) other diseases of an organ of sight and its damage; 4) unspecified reasons.

Features of an etiology Pages in the certain countries are various that is substantially caused by the different level of their development, and also social and economic, geographical and demographic features. In developing countries are the main reasons for S. trachoma (see), onchocercosis (see), xerophthalmia (see), keratomalacia (see) and cataract (see). In the developed countries — glaucoma (see), diabetic retinopathy (see), an atrophy of an optic nerve (see), a makulodistrofiya, a cataract, short-sightedness (see) and tapetoretinalny dystrophies (see). In the USSR the atrophy of an optic nerve, glaucoma, high degree the complicated short-sightedness, a cataract belong to the main reasons for S.

The number of blind people in the world is big and steadily increases what censuses of blind people and others epidemiol testify to. researches. The first censuses of blind people were conducted to the USA in 1790, in Belgium — in 1835, in Russia — in 1886.

On materials of the League of Nations, in 1929 on the globe was apprx. 6 million blind people. In 1978, according to WHO data, the number of blind people (visual acuity less than 0,05) in the world increased to 28,1 million. At the same time S.'s prevalence among the population varies from 0,2% in the developed countries to 1,0% in developing.

Fight against S. — an important medikosotsialny task, edges differently is solved in various countries. At the international level the social movement on fight against S. and assistance to blind persons is carried out by the International agency on prevention of a blindness and the World council of welfare of blind people.

In the Soviet Union fight against S. is actively carried out by bodies of health care and social security (see) with the assistance of republican societies of blind people among which the leader is All-Russian awards of the Labour Red Banner society of blind people (see). Fight against S. consists in holding versatile actions of the state and public character, among to-rykh the extreme importance prevention and treatment of diseases and damages of an organ of sight, medical and social rehabilitation of blind people have. The system to lay down. - the prof. of actions in the USSR provides timely, public and qualified Ophthalmolum. help to the population. Special attention is paid to protection of sight of children (see. Ophthalmology ). Thanks to lay down. - the prof. to actions S.'s prevalence in our country for years of the Soviet power decreased more than twice.

In the USSR the evidence-based system of medico-social rehabilitation of blind people including a complex of medical, psychological, sociological, pedagogical, professional and labor programs, the step-by-step and interconnected use to-rykh in every possible way is created promotes recovery of health, working capacity and social integration of blind persons. In a complex of rehabilitation measures (in addition to recovery treatment) elementary rehabilitation of blind people — development of mobility, touch perception, mastering skills of orientation in space, self-services, housekeeping, training in the letter and reading in the dot alphabet of Braille (giving the chance from a combination of six convex points to create 63 signs sufficient for designation of letters of the alphabet, figures, punctuation marks, and also mathematical and musical characters), overcoming a psychological inferiority complex is of great importance. For implementation of elementary rehabilitation in the USSR special schools are created, and also the relevant service at boards and at the enterprises of societies of blind people is organized.

In system of medico-social rehabilitation an important role is played by social and labor rehabilitation of blind people. Its initial stage is medical labor examination, edges is carried out specialized eye medical labor commissions of experts (see), created in all republics and in certain large administrative territories of the USSR. On the basis of inspection of the patient, complex assessment of set of kliniko-functional data and social and professional ‘factors In energy industry specifies the diagnosis, weight of functional frustration, including S.'s degree, establishes group of disability, finds out the need for recovery treatment, defines the kliniko-labor forecast, estimates working capacity and takes out the conclusion about the shown conditions and the nature of work.

The labor device — the main link in social and labor rehabilitation of blind people. In the USSR the evidence-based system of the labor device of blind people is developed, edges everywhere is implemented at the enterprises into blind people. The philosophy of the labor device is rationality: providing the work which is corresponding to functionality of the blind person and not exerting negative impact on state of his health. At manufacturing enterprises about-in blind people special conditions taking into account functionality of blind persons are created. Scientific organization of work, mechanization and industrial automation, existence of special technology, wide use tiflotekhnik (see) allow blind people to carry out the most difficult productions. A part of blind people works at the state enterprises.

Vocational education, necessary for social and labor rehabilitation, or retraining of blind persons is carried out in special technical schools, technical training colleges where they get professions available to them, and also directly at the enterprises about-in blind people.

Blind children take a course of elementary rehabilitation in special boarding schools (see) where they get the general secondary education. Training and education at these schools is based taking into account an originality of development of children at different forms of a vision disorder. There are separate schools for blind and visually impaired children. Training at schools is conducted according to the standard and special programs based on the principles of the Soviet tiflopedagogics. At boarding schools also the labor preparation having a polytechnical focus is carried out. Graduates of boarding schools work at the enterprises about-in blind people or at the state enterprises. Part of them continues training in the highest or average special educational institutions and upon termination of them works in various industries of the national economy in the specialty.

In the USSR social problems of life of blind people are successfully solved. It is paid to cultural and educational and sports work among blind persons much attention. Blind citizens take active part in all spheres of public life of the country. The system of rehabilitation of blind people accepted in our country in every possible way promotes their social integration and provides them completeness of social recovery.

Bibliography: Averbakh M. I. Ophthalmologic sketches, page 5, M., 1949; Avetisov E. S. Protection of sight of children, M., 1975; Golovin S. S. About a blindness in Russia, Odessa, 1910, bibliogr.; Zemtsova M. I. Training of blind and visually impaired children, M., 1978; B. V Zymin. Social and labor rehabilitation and integration of blind people, M., 1979; To ap l of An of A. I. Children's blindness, Color residual sight, M., 1979, bibliogr.; JI and-man E. S., Melkumyants T. A. and Reyfman M. B. Rational high-quality labor device of blind people, M., 1979; Gill J. M of a. ClarkL. L. International register of research on blindness and visual impairment, N. Y., 1978; Goldstein H. The demography of blindness throughout the world, N. Y., 1980, bibliogr.

E. S. Liebman.