Blindness and Partial Sight

Each local authority keeps a register of blind and partially sighted people living in its area. The register is held by the social services department, or by the local voluntary society for people with sight problems acting as agents for the local authority. The register is confidential. Registration is voluntary but it is helpful in getting extra support.¹ However, anyone having difficulties because of poor sight, is entitled to ask their local social services department to assess their needs, even if not yet registered.

• Blind:
  • Acuity below 3/60 or 1/18
  • Acuity better than 3/60 but below 6/60 with a very restricted visual field
• Partial sight
  • From 3/60 to 6/60 with a full field
  • Up to 6/24 with moderate restriction of visual field, opacities in the media or aphakia
  • 6/18 or better with a gross field defect (e.g. hemianopia) or a marked constriction of the field (e.g. glaucoma or retinitis pigmentosa)

• On 31 March 2003, 157,000 people were on the register of blind people in England. Between March 2000 and March 2003 the number on the register of blind people decreased slightly by 1,100 (almost 1%), however since 1982 there has been an overall increase of 45,000 or 40%.²
• On 31 March 2003, 155,000 people were on the register of partially sighted people. This is an increase of around 6,500 (4%) since March 2000 and more than double the figure at March 1982. The large rise from 1982 may be partly due to old registrations not being removed from the register, either through the death of the client or transfer to the register of blind people.²

The most common cause of gradual onset bilateral blindness in the developed world is macular degeneration. Diabetic retinopathy is the second most common cause. Other causes include:

• Diabetic maculopathy
• Hypertensive retinopathy
• Cataracts
• Chronic glaucoma
• Chiasmal or bilateral optic nerve compression
• Bilateral optic nerve damage, e.g. tobacco amblyopia
• Worldwide, chlamydial infection causing trachoma is a common cause

Sudden loss of vision is an ophthalmological emergency and requires immediate referral to the eye emergency department. Possible causes of rapid onset blindness includes:

• Bilateral occipital lobe ischaemia or infarction
• Bilateral occipital lobe trauma
• Severe bilateral papilloedema
• Rapidly progressive chiasmal compression
• Bilateral optic nerve damage, e.g. methyl alcohol poisoning
• Hysteria

The main forms are:³

• Form LVI: self-referral letter which a person with problems of sight loss can send to social services if they wish to be contacted for help. The form is available to be given by optometrists/opticians to appropriate patients.
• Form RVI: may be issued by staff in the hospital eye service to refer the patient (with consent) for a social care assessment. It should be used as soon as social needs become apparent, but where certification is not appropriate at this time, or cannot be carried out. (If, for instance, they are not being seen by a consultant.). Hospital eye services are able to download it from the NHSweb at or from Department of Health website.
• Form CVI performs has replaced the previously used form BD8. It formally certifies someone as sight impaired (partially sighted) or as severely sight impaired (blind) so that the local council can register him or her. The signature of a consultant ophthalmologist certifying eligibility to be registered is required on a CVI before registration can be offered. Registration is voluntary but entitles people to various benefits and concessions.

• The purpose of the register is to help local authorities provide the best service they can for people who have sight problems. To do this, they need a record of all the blind and partially sighted people in their area and what kind of services they need.
• The statutory requirements are that:
  • An assessment of needs is carried out.
  • Information about services for visually impaired people is provided in a format accessible to the individual.
• Registration is essential for claiming some financial benefits and concessions and for getting help from some local voluntary groups.
• On receipt of the appropriate form, Social services contact the person who is sight impaired about being added to the register. Social services assess the person's needs and any support that would help. The Royal National institute for the Blind have a helpline (0845 766 9999) which can advise the person before they are contacted by social services. This can be useful so that the person is fully aware of the process and the possible types of help that can be arranged.
• The social services department should arrange a community care assessment, with input from a worker for blind and partially sighted people.
• Specially trained staff can then provide support for a range of activities, including safe mobility indoors and out, skills for daily living such as cooking and leisure activities. They can also refer to other local services that would be able to provide further help and support.

• The requirement to drive a car or ride a motorcycle is that the person must be able to read in good light (with the aid of glasses or contact lenses if worn) a registration mark fixed to a motor vehicle and containing letters and figures 79 millimetres high and 50 millimetres wide at a distance of 20 metres, or at a distance of 20.5 metres where the characters are 79 millimetres high and 57 millimetres wide (i.e. pre 1.9.2001 font).⁴
• The minimum field of vision for safe driving is defined as field of at least 120° on the horizontal, and there should be no significant defect in the binocular field which encroaches within 20° of fixation above or below the horizontal meridian.⁴
• Group 2 licenses (includes large lorries and buses): new applicants are barred in law if the visual acuity, using corrective lenses if necessary, is worse than 6/9 in the better eye or 6/12 in the other eye. The uncorrected acuity in each eye must be at least 3/60.⁴

The difficulties experienced by anyone with significant sight loss can have a devastating effect if they are not properly advised and supported. In the provision of support, the needs, views and independence of the person with sight loss are of paramount importance. The list of possible complications is very long but includes:

• Social isolation
• Falls
• Accidents
• Restriction of activities and the requirement for supervision
• Education difficulties⁵
• Reduced employment possibilities⁵