Rubella, also known as German measles or three-day measles, is an infection caused by the rubella

virus. This disease is often mild with half of people not realizing that they are sick. A rash may start
around two weeks after exposure and last for three days.
Venereal disease: A disease that is contracted and transmitted by sexualcontact, caused by
microorganisms that survive on the skin or mucus membranes, or that are transmitted via semen, vaginal
secretions, or blood during intercourse. The genital areas provide a moist, warm environment that is
especially conducive to the proliferation of bacteria, viruses, and yeasts, so a great many diseases can be
transmitted this way, including AIDS, chlamydia, genital warts, gonorrhea, syphilis, yeast infections, and
some forms of hepatitis. Also known as a morbus venereus or sexually transmitted disease

Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn
baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or
gastroenteritis) in the setting of fever. Older textbooks may refer to neonatal sepsis as
"sepsis neonatorum".

What is visual impairment?

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By Dr Ananya Mandal, MD

The definition of vision impairment by the Centers for Disease Control and Prevention (CDC) says a
visually impaired persons eyesight cannot be corrected to a normal level.

It may be said that visual impairment is the functional limitation of the eye or eyes or the vision
system. This leads to (1-5)

Loss of visual acuity and inability of the person to see objects as clearly as a healthy person

Loss of visual field meaning inability of an individual to see as wide an area as the average
person without moving the eyes or turning the head.

Photophobia inability to look at light

Diplopia double vision

Visual distortion or distortion of images

Visual perceptual difficulties or difficulties of perception

Or any combination of the above features

Low visual acuity

The CDC and the World Health Organization suggest that low visual acuity means vision between
20/70 and 20/400 with the best possible correction, or a visual field of 20 degrees or less.

Blindness
 Blindness is defined as a visual acuity worse than 20/400 with the best possible correction, or a
visual field of 10 degrees or less.

Legal blindness in the US means visual acuity of 20/200 or worse with the best possible correction,
or a visual field of 20 degrees or less. (1)

Measuring visual acuity

Visual acuity is measured by use of a Snellens chart.

The chart consists of random letters and numbers of various sizes set at a distance of 6 feet.

The best possible vision if 6/6. Visual field is the width of the vision without moving or turning the
head. It is measured in degrees.

Causes of vision impairment

Vision may be impaired due to multiple reasons. These could be due to eye damage, failure of the
brain to receive and read the visual cues sent by the eyes etc.

Underlying diseases may also cause visual impairment. The commonest cause is diabetic
retinopathy, age-related macular degeneration, formation of cataracts and raised pressure within
the eyes leading to glaucoma.

Who does visual impairment affect?

Although impairment of vision can occur at any point in life, it is more common among the elderly.

Sometimes visual impairment may be inherited. It manifests at birth or in childhood in such cases.

Common conditions are retinitis pigmentosa, genetic or developmental abnormalities etc.

These children with partial or complete impairment are often developmentally delayed especially in
gross and fine motor skills. Visually impaired adults struggle with gainful employment and day to
day activities. (1-5)

How many people are visually impaired?

Some estimates suggest the approximately 10 million people in the United States are blind or
visually impaired.

Some sources suggest that one million adults over the age of 40 are blind, and 2.4 million are
visually impaired.

It is estimated that as the elderly population swells over the years, the number of adults with vision
impairments is expected to double.

Figures also show that only 46% of working-age adults have vision impairments and 32% of legally
blind adults of working age are gainfully employed. (1-5)

Edited by April Cashin-Garbutt, BA Hons (Cantab)

Types of visual impairment

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By Dr Ananya Mandal, MD
The World Health Organization (WHO) International Classification of Impairment, Disabilities, and
Handicaps (ICIDH) system is used to classify the types of visual impairment.

This system, as the name suggests, is used to classify disorders, impairments, disabilities, and
handicaps.

Definition of impairment

Impairment is defined as any loss or abnormality in an anatomical structure or a physiological or

psychological function.

Similarly a disability is any restriction or lack (resulting from an impairment) of ability to perform
an activity in the manner or within the range considered normal for a human being.

This places an individual in a handicap that is a persons disadvantaged position in society due to
an impairment or disability.

Definition of visual impairment

Visual impairment is defined as the limitation of actions and functions of the visual system.

The National Eye Institute defines low vision as a visual impairment not correctable by standard
glasses, contact lenses, medication or surgery that interferes with the ability to perform activities
of daily living.

Types of visual impairment

According to the CDC and the World Health Organization the classification of visual acuity and
impairment includes (1, 2)

Low visual acuity means vision between 20/70 and 20/400 with the best possible correction,
or a visual field of 20 degrees or less

Blindness is defined as a visual acuity worse than 20/400 with the best possible correction,
or a visual field of 10 degrees or less

Legal blindness in the US means visual acuity of 20/200 or worse with the best possible
correction, or a visual field of 20 degrees or less.

Visual acuity of 20/70 to 20/400 (inclusive) is considered moderate visual impairment or low
vision.

Causes of visual impairment

Types of impairment are different for different causes of visual impairment. In total vision loss for
example there may be total darkness of the visual fields. Other types include visual impairment in
glaucoma, age-related macular degeneration and so forth. (1-5)

Visual impairment in glaucoma

This condition is due to the rise of normal fluid pressure inside the eyes. The type of vision is
usually like a tunnel.

The intact vision remains in the center while progressively the peripheries start decreasing. The
center of the tunnel reduces in size progressively till total vision is lost if left uncorrected.

Age-Related Macular Degeneration

A central area of woolly or cottony opacity obscures the central part of the vision.

The peripheries may be normally seen. AMD usually blurs the sharp, central vision that is needed
for closely viewed activities like reading, sewing, and driving. This is a painless condition.

Cataract
 There is general clouding of the vision. As the whole eye lens is affected the blurring of vision may
be diffuse until it is totally lost.

There may be other symptoms like photophobia inability to see the light; diplopia double vision
etc. Cataracts are very common in older people.

Diabetic Retinopathy

Diabetes leads to damage of the smaller arteries and blood vessels at the back of the eyes over the
retina.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in
adults.

Usually vision impairment in diabetics begins as black spots or floating shapes that appear in the
field of vision. Slowly complete vision may be lost if left unchecked.

Near sightedness

Myopia or near sightedness or short sightedness means a person can see nearby objects clearly but
distant objects appear blurred. High myopia may lead to vision impairment.

Retinitis Pigmentosa

This is a genetic or inherited condition. Initially it manifests as night blindness.

As the disease progresses there may be a tunnelling of vision with loss of peripheral vision followed
by complete blindness.

Causes of visual impairment

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By Dr Ananya Mandal, MD

There are many causes that may lead to loss of vision or lead to impairment of vision.

Common causes that lead to vision loss or visual impairment include injury to the eye, inherited
conditions, infections and so forth. (1-4)

Injury to the eyes

Injury to the eyes while playing or at work or due to accidents may result in vision loss and
impairment.

Particularly injuries to the cornea are the commonest cause of vision loss.

Inherited conditions of blindness and vision impairment

Retinitis pigmentosa is the most common cause of inherited blindness.

Infections of the eyes

Sometimes if the mother has had a viral infection like German measles that is transmitted from the
mother to the developing fetus during pregnancy the baby may be born with blindness or visual
impairment.
Trachoma of the eyes caused by contagious microorganism called Chlamydia trachomatis may also
damge eye sight. This is seen in the developing and underdeveloped countries with poor water and
sanitation facilities.

Amblyopia

This is basically impaired vision in one eye due to lack of its use in early childhood.

This is seen in squint or lazy eye since both the eyes project differently and send in different
messages to the brain the brain may then turn off or suppress images from the weaker eye.

This stops development of the weaker eye leading to amblyopia in that eye.

Cataract

Clouding of part or the entire lens of the eye.

Normally, the lens is clear to let in the light that focuses on the retina. Cataracts prevent light from
easily passing through the lens, and this causes loss of vision.

This condition usually affects the elderly. Symptoms include cloudy or blurry vision, difficulty in
seeing in dimly lit areas and bright lights, colors appear faded, double vision etc.

Cataract affects 20.5 million (1 in 6) Americans age 40 and older. By 80 years of age, more than
one half of Americans have cataract.

Cataract is the leading cause of blindness in the world (47.8%) compared to other eye disorders.

Diabetic retinopathy

Diabetes affects the small blood vessels in the retina. When damaged this leads to impairment of
vision.

This is the commonest cause of blindness and visual impairment in the United States.

An estimated 23.6 million people in the U.S. have diabetes.

Of those, 5.7 million are undiagnosed. Currently, 1 in 10 individuals has diabetes. Between 40% to
45% of all people with diabetes have diabetic retinopathy.

Glaucoma

This condition results due to raised pressure within the eyes. The increased pressure impairs vision
by damaging the optic nerve.

This may be seen in older adults and in some babies as well who are born with the condition.

Approximately 2.3 million Americans (1.9%) age 40 and older, have glaucoma.

African-Americans (age 40 and over) are 4 to 5 times more likely than any other ethnic group to
have glaucoma

Age related Macular degeneration

Age related Macular degeneration or AMD that is a progressive loss of the visual acuity due to
damage to the macula that is the most sensitive part of the retina.

AMD affects more than 1.75 million individuals in the U.S. This number is expected to increase to
almost 3 million by 2020 due to the rapid rise in the aging of the U.S. population.

The center of the visual field appears blurry or opaque. The patient is unable to focus clearly. This
mainly occurs in the elderly.

The risk of AMD rises in those exposed to excess sunlight and those who smoke excessively.
AIDS related visual impairment

This is usually caused by viral infections of the eyes called Cytomegalovirus or CMV retinitis.

The estimated proportion of persons with AIDS who will develop CMV retinitis ranges from 20 to
40%.

Cancer of the eyes

Retinoblastoma is the most common eye cancer of children. There are between 300 and 400 new
cases diagnosed annually.