Three Lenses Blog (Blindness or Visual Impairment)

Hi everyone,

Here, I want to share my findings about blindness or visual impairment through medical model, social model, and autobiography view. Please enjoy your reading and make comments or questions. Thank you.

Medical Model Lens

In this model, I gleaned definitions related to blindness, its causes, and its treatments from several resources of medical model of blindness. In the end, I relate the way of medical model to the application of reducing the number of infants with lacking of vitamin A that might cause blindness in Indonesia.

According to Centers for Disease Control and Prevention (CDC). There are some terms, which are: blindness, legal blindness, and vision impairment. Blindness is defined as a severe vision impairment that is not correctable by standard glasses, contact lenses, medicine, or surgery. Legal blindness is defined as vision with best correction in the better eye worse than or equal to 20/200 as a result of visual acuity. Visual acuity is a number that indicates the sharpness or clarity of vision. For example, a person with a visual acuity measurement of 20/70 means that a person who stands 20 feet from an eye chart can see the letters or things in which a person with unimpaired (or 20/20) vision can see from 70 feet away. Then, vision impairment is prescribed as having 20/40 or worse vision in the better eye even with eyeglasses, however, they can experience challenges in their daily activities. For example, people with vision less than 20/40 cannot obtain an unrestricted driver’s license in most states. By referring to medical model, these terms connected to visual impairment are focus on the function of seeing with eyes as a problem, and this condition influences a person’s ability to perform everyday activities.

In addition to the meaning of blindness, Healthline accessed from www.healthline.com posts that blindness is the inability to see anything, even light. However, there is a term of partially blindness or limited vision for those may have blurry vision or the inability to distinguish the shapes of objects. Another term is complete blindness which means that you cannot see at all and are in total darkness. This blog also defines legal blindness as a term referring to vision that is highly compromised. What a person with healthy eyes can see from 200 feet away a legally blind person can see only from 20 feet away.

Given the view of what causes blindness provided by Centers for Disease Control and Prevention (CDC), there are major blinding eye diseases namely cataracts, age-related macular degeneration, diabetic retinopathy, and glaucoma. A cataract is a clouding of the eye’s lens, which causes vision to become blurred or dimmed because the light cannot be transmitted properly through the lens of retina. Age-related macular degeneration affects the part of the retina responsible for sharp central vision. Diabetic retinopathy is an eye disease that affects the tiny blood vessels in the retina of people with diabetes. Glaucoma is a group of disease usually associated with increased pressure within the eye. They are common causes of blindness. In addition to that, www.healthline.com also states that the following eye diseases and conditions can cause blindness, among others:

• Glaucoma refers to four different eye conditions that can damage your optic nerve, which carries visual information from your eyes to your brain.
• Macular degeneration destroys the part of your eye that enables you to see details. It usually affects older adults.
• Cataracts cause cloudy vision. They’re more common in older people.
• A lazy eye can make it difficult to see details. It may lead to vision loss.
• Optic neuritis is inflammation that can cause temporary or permanent vision loss.
• Retinitis pigmentosa refers to damage of the retina. It leads to blindness only in rare cases.
• Tumors that affect your retina or optic nerve can also cause blindness.

All in all, these eye diseases and conditions are mostly major causality that made people blind, vision impaired, legally blind, or partially blind.

According to Healthline accessed from www.healthline.com, blindness is diagnosed by following a series of tests by eye doctor that measures the clarity of the vision, the function of eye muscles, and how pupils react to light, and examines the general health of eyes. In the same way, Medicinenet retrieved from www.medicinenet.com says that the diagnosis of blindness is made by examination of all parts of the eye by an ophthalmologist, a medical doctor who specializes in eye and vision care, by testing each eye individually and by measuring the visual acuity and the visual field, or peripheral vision. Regarding to the treatments for those with blindness, www.healthline.com states that some of the following may help them to restore their vision: eyeglasses, contact lenses, surgery, medication. Moreover, they sometimes require approaching life in a new way and learning new skills. For example, they need to learn how to: read Braille, use a guide dog, memorize the keypad on your phone, organize your home so you can find things easily, fold money in distinct ways to distinguish bill amounts, use a magnifying glass to read, increase the text size on your computer, and use audio clocks and audiobooks. What is more, Democracy Disability and Society Group through http://ddsg.org.uk exposes the medical model seeing the problem is focused on body impairment. It should be rehabilitated or healed, so it would help them in minimizing its consequences in activities of daily living. For example, the blindness is a problem that needs to be fixed or corrected. When someone is diagnosed as having vision impairment, s/he would be recommended by an eye doctor to use eyeglasses or take an eye surgery in order to help her/himself in adaptation.

Picture 1. The Medical Model of Disability

Based on the the aforementioned explanations about the definitions of blindness, its causes, how to diagnose it, and treatments that they may need, I think that this medical model of disability focuses on the condition of blindness. This condition is considered as a problem and needed to be fixed or cured in order to reduce its impacts on their daily life, so they can be more capable or “normal”. Regardless of that, I also think that medical perspective on the state of vision impairment could influence the betterment of health services in my country, Indonesia, especially for the prevention for lacking of Vitamin A that frequently happens in rural areas. According to the www.depkes.go.id, the Indonesian government has a program in terms of reducing the lack of Vitamin A and preventing from eye diseases for infants. They will be having supplemental capsule of vitamin A in every February and August in health services, and it is free.

Social Model Lens

In this social model of blindness, i would like to combine some definitions from several resources and try to connect them into the application of Universal Design for Learning (UDL) that leads to inclusive environments for all people.

David Bolt (2005: 1) notes that the social model of disability holds that persons are impaired for a number of reasons, and they are disabled because of society. This means that it is socially constructed when the disabled is segregated from a community. Another resource, Aaron Carter Bates, states that organizations primarily engaging in advocacy for the social model of disability seek to create a more inclusive society instead of putting the onus to change on individuals with disabilities. For example, the National Federation of the Blind formulates this model of disability by framing the problem as the misconceptions surrounding blindness, not blindness itself. These are organizations who presume the competence of people with disabilities and then set out to change the world to get the accommodations necessary to achieve equal treatment.

Regarding to the statements described by David Bolt and Aaron Carter Bates, http://guides.library.illinois.edu adds that the social model of disability posits that disability is constructed by society and is caused by the way society is organized. Our society made by and for non-disabled people and anyone who cannot fit into that model is disabled. This site also provides a picture showing that the social model considers the barriers are outside of the disabled such as environments and attitudes. In accordance with people with blindness or vision impairment, they will face challenges in environment, attitudes, an/or organisations. Take for example of environment, they may face inaccessible building services such as there are no guiding blocks and dot blocks in sidewalks, and they grapple with the obtainable materials in schools. The example of attitudes is that society believes that the blind could not do their best compared to their peers. Then, organizations would be social barriers when there are several inflexible procedures or practices limiting the blind to get involved.

Picture 2. The Social Model of Disability

Here, attitudes are really important to come together with people with blindness in positive and meaningful ways. As stated by Susan Baglieri (2017: 111), there are some common-sense responses to interact with them, among others;

• we need to communicate verbally,
• using common words to refer to experiences will not be received offensively,
• we need to consider to use least movements or gesture cues,
• we need to support in guiding them properly by verbalizing specific directions, to help them in orienting surroundings, and to guide other’s hands to objects that could be useful.

For environments, social model brings the society to create an inclusive settings by implementing Universal Design for Learning (UDL) that allows general education students access to multiple ways of learning and making it be accessible for all users. Given that Anne Meyer, David Rose, and David Gordon (on page 18), there are Rubik’s cubes developed for the blind and all users. Initially, Konstantin Datz, a German university student, developed a white cube for the blind with words for each color in Braille. Although this is so interesting, but there are some flaws such as the blind users do not know about the Braille and this cube is significantly designed for a single user. Consequently, given the the extensive cuber’s community, the white cube is re-designed with more options, which are with colors and tactile information. The symbols that align with colors are easy to identify through touch, and it is more usable for all Cuber’s users. This design provides additional benefits enabling users to inspect the sides of each cube without turning the cube to look. This example of the application of UDL shows that supporting user variability is critically important. As stated by Convention on the Rights of Persons with Disabilities and Optional Protocol (page 4), universal design means the design of products, environments, programmes and services to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. So that, the universal design is designed environments more accessible for all users including particular groups of persons with disabilities.

       

Picture 3. A white Rubik’s cube with Braille

  

Picture 4. A tactile Rubik’s cube

In educational settings, Anne Meyer, David Rose, and David Gordon, (page 3), UDL uses the flexibility of digital technology to design learning environments for diverse learner needs, not just students with disabilities. The purpose of UDL is to reduce the barriers and impediments that interfere their ability to make optimal progress. Take for instance, CAST showed that how technology could alter the curriculum itself by developing digital book that was accessible and flexible to all students. This e-book was created with different features depending on what students needed. This book had an option page such as the audio, its speed, and its scan. These options enabled all students to use such as text read aloud for those with reading challenges and blindness, linked definitions for those with limited vocabulary,  large buttons that voiced their functions for students with low vision, and single-switch interface for those with physical challenges.

Picture 5. Digital books created by CAST

Autobiography View

Here, I would like to present the autobiography view from Mimi Mariani Lusli who wants to share the way she experienced as a blind person in Indonesia. Given the information provided by https://id.wikipedia.org, Mimi realized that when she was a fourth-grade student in elementary school, she could not keep her achievements up due to her vision. Her eyesight began to blur gradually. This situation made Mimi have to stop going to school because her condition was increasingly difficult to understand the lesson. At that time, her parents began to seek healing for her, ranging from ophthalmologists and neurologists to alternative medicine. During the process, Mimi finally went to school for students with intellectual disabilities. Later, the more day Mimi dreamed of healing even more felt far away, the condition of her eyes became worse and could not be cured, and the doctor diagnosed that Mimi had total blindness because of genetic retinitis pigmentosa. About a month after that, she chose to isolate herself from the outside world, and she was self-confident. However, this condition actually encouraged her family and relatives to give support, so that Mimi tried to get up.

Mimi continued her study in public middle school and high school. Many friends gave support to her. These schools motivated her to pursue her higher education in universities. However, the materials were not really accessible for her, she used a tape recorder to record courses, and she was assisted by friends and relatives when she had to complete assignments and move to other new places. Now, she can prove to herself that she is a lecture at Atma Jaya University in Jakarta. Moreover, she has concern about the blind or children with special needs that brings Mimi had the initiative to establish a disabled counseling place called the Mimi Institute in 2009. This institution is aimed to familiarize the issues of disability, so that she hope that it would make environments more inclusive or friendly for all people.

Based on Mimi’s life, she experienced that she could not accept herself labelled as having total blindness. This medical model led her to be more frustrated when it could not be cured, and she withdrew herself from society. What is more, the social model was not supportive for her when the elementary school could not give what she needed at that time causing her to move to a segregated school for students with intellectual disabilities. Not only that, she also dealt with the challenges during study in public schools and universities such as inaccessible environments and unobtainable materials. Consequently, she needed a tape recorder to help herself in supporting her way of learning. Moreover, the social model was getting better when friends and relatives assisted her in understanding the materials or assignments and in guiding to new places. She was motivated by them because they were concerned with her, and it was inspiring Mimi to initiate the institution in order to make environments more inclusive.

All in all, based on the three blog lenses explained above, I believe that the medical model and social model are similar to a double-edged sword in which the taken action has several effects both in positive way and negative way. That is why these models are important to understand people with vision impairment or blindness. Take for example, by measuring the eye condition, an eye doctor can give some inputs to a teacher such as the visual acuity, so the teacher could develop legible letters and materials for students with visual impairment. Therefore, I think that all the aforementioned lenses should be used to design a individual centered approach for people with blindness or visual impairment by considering the strengths and weaknesses of the lenses.

References:

Bolt, David. (2005). From Blindness to Visual Impairment: Terminological Typology and the Social Model of Disability. Retrieved from https://disability-studies.leeds.ac.uk/wp-content/uploads/sites/40/library/bolt-Bolt-From-Visual-Impairment.pdf (accessed on Monday, October 15, 2018 at 09:16 PM)

http://ddsg.org.uk/taxi/medical-model.html accessed on Tuesday, October 30, 2018 at 11:40 PM

http://guides.library.illinois.edu/c.php?g=549817&p=3774566 accessed on Tuesday, October 30, 2018 at 10:40 PM

https://id.wikipedia.org/wiki/Mimi_Mariani_Lusli accessed on Friday, October 26, 2018 at 11:43 PM

https://justdigitlaw.wordpress.com/2014/11/18/medical-model-v-social-model-of-disability/ accessed on Monday, October 15, 2018 at 09:41 PM

http://www.mimiinstitute.com/content/mimi-mariani-lusli-penyandang-tuna-netra-yang-jadi-dosen-di-atmajaya accessed on Friday, October 26, 2018 at 11:50 PM

http://udltheorypractice.cast.org/reading?3&loc=intro.xml_l1969951 accessed on Monday, October 15, 2018 at 07:37 PM

https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Blindness.html accessed on Monday, October 15, 2018 at 09:52 PM

http://www.depkes.go.id/article/print/16080600002/menkes-canangkan-crash-program-campak-diintegrasikan-bulan-pemberian-kapsul-vitamin-a-dan-obat-cacin.html accessed on Monday, October 29, 2018 at 21:52 PM

https://www.healthline.com/symptom/blindness accessed on Friday, October 26, 2018 at 11:20 PM

https://www.medicinenet.com/blindness/article.htm accessed on Monday, October 29, 2018 at 09:31 PM

Baglieri, Susan. (2017). Disability Studies and The Inclusive Classroom: Critical Practices for Embracing Diversity in Education (Second Edition). New York: Routledge.

United Nation. Convention on the Rights of Persons with Disabilities and Optional Protocol. Retrieved from http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf accessed on Tuesday, October 30, 2018 at 10:13 PM

Sources for the pictures:

Picture 1. The Medical Model of Disability

http://ddsg.org.uk/taxi/medical-model.html

Picture 2. The Social Model of Disability

http://guides.library.illinois.edu/c.php?g=549817&p=3774564

Picture 3. A White Rubik’s Cube with Braille:

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjDo5SmnaDeAhWm3YMKHdHHBvQQjRx6BAgBEAU&url=https%3A%2F%2Fwww.trendhunter.com%2Ftrends%2Fbraille-rubik-s-cube&psig=AOvVaw2HDquTP_5ybslK4MaiYohf&ust=1540509792401340

Picture 4. A Tactile Rubik’s Cube:

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiZjPHgnKDeAhXCoIMKHaDsAD8QjRx6BAgBEAU&url=https%3A%2F%2Fwww.maxiaids.com%2Frubiks-cube-with-tactile-markings&psig=AOvVaw2HDquTP_5ybslK4MaiYohf&ust=1540509792401340

Picture 5. Digital books created by CAST

http://udltheorypractice.cast.org/reading?3&loc=intro.xml_l1969951