I. Blindness and Visual Impairment – Some Facts

I.1 Visual impairment throughout the world
Visual impairments are the most common cause of disability in the world, with approximately 35 million blind people worldwide. The World Health Organization estimates that each year 100 000 pre-school children in the so-called developing world are blinded by vitamin deficiency related diseases, in fact easily preventable malnutrition and diseases cause most cases of blindness and, in such countries, under-nourished (vitamin A deficient) children are as likely to become blind as older people are.
In the developed world, visual impairment arises from other causes, mostly age-related, such as macular degeneration, cataracts, diabetic retinopathy or glaucoma. For children, the causes are more often optic atrophy (30% of the total cases) retinal conditions and dystophies (20%) or congenital abnormalities.
Visual Impairment in the UK, The USA and France.
In the UK, according to the RNIB, sight loss is one of the commonest causes of disability. One million people are blind or partially sighted, representing 1/60th of the population. There are approximately 11 000 children aged 3-19 with a form of visual impairment. 200 000 people are registered legally blind people of which 4000 children under 18. In the USA, The American Foundation for the Blind estimates that there are 6.4 million visually impaired people, of which 1.7 million are classified as blind. In France, although there are no really reliable statistics on visual handicap, it is estimated that there are around 77 000 visually impaired people (12 000 of them children) of which 50 000 blind people (4500 children)
Paradoxically, the number of VIP seems to be on the increase, due to rise in life expectancy and therefore in the growing number of age-related cases of sight loss and, in the developed world, to medical progress enabling a greater number of heavily disabled infants to survive. Although there is a lack of epidemiological and statistical data, it is clear that the VI population is over-represented in the developing world. India and Africa account for over half of all global cases of blindness. It is widely accepted that 80% of all blindness cases could be prevented or reversed using existing knowledge and technology.
Major causes of avoidable blindness are Cataract, overwhelmingly represented in the over-50 population, Trachoma, an infectious, treatable disease, and Glaucoma.

(Statistics: Laflamme, M.)

I.2 Partial sight and blindness
It often comes as a surprise to sighted people that most visually impaired people possess a substantial amount of sight. Indeed, only 20 % of visually impaired people are classified as blind. Only 4% of these have no sight whatsoever, the others possessing a varying amount of useful vision, even if it is only light perception, that is, being able to tell where a window or a lamp is situated. However, even very slight residual vision (of less than 1/60) may be of considerable use, significantly for children, who can be taught how to interpret the imperfect images they see. 80% of legally classified blind children have some residual vision.
Visual impairment ranges from total lack of sight to more or less severe loss of vision. Different eye conditions imply different symptoms. Some people have no central or side vision, others see things as a vague blur, or see a patchwork of blank and defined areas. The following page shows RNIB photographs imitating the effect of these conditions.

I.3 Access to literacy: Different book formats available
In the UK, visually impaired children are educated in mainstream or specialized schooling. Integration is still very much an exception though in most countries, and in many parts of the developing world, access to literacy is often very difficult for visually impaired children and adults alike.
The choice of book format available to visually impaired people can depend on their disability and on their needs. A child or an adult with moderate or slight sight loss may be able to read ordinary print, though perhaps only very slowly and sometimes only with a magnifier and lamp. 70% of all visually impaired people will be able to read large print, though some may find this tiring and time consuming. Some prefer to listen to tapes or to other people reading to them. This may prove ideal for "leisure" reading but may perhaps be less useful for documents containing graphics or needing frequent consulting and reference. Electronic books downloaded from the Internet and transcribed into large print or Braille or read out by a synthetic speech output are an increasingly popular but still expensive option. Individuals with very little or no useful sight will often be part of the small number of VI people (about 20 000 people in the UK or 3% of the population) who use tactile systems like Braille or Moon.
To read Braille it is necessary to have a good sense of touch, and it is also, obviously, harder to learn later in life than as a child, so this may not always be an option for older people who have become visually impaired due to accidents, illness or age-related diseases. However for those who do learn Braille, it is often a favorite means of reading a book, and can be preferred to tapes, as it is perceived as an independent, individual effort. It may also prove useful for other VI people in their daily life, even if they are not fluent enough to read whole books, enabling them to read labels or short documents for example. It is worth remembering that Braille is the only means of access to books available to deaf-blind people. However, for most visually impaired people, all these aforementioned formats are complementary and an individual may use several of them each day, according to availability, preference and situation.

In 1998, the NLB (National library of the Blind) sent out a questionnaire to its readers in the 5 to 16 age group inquiring about their preferred book formats. Large print came first and audiobooks followed with 90 % of the children possessing tapes and reading facilities. Braille came third, before electronic books or Moon. The NLB, which has a stock of over 50 000 titles in Braille and 800 in Moon, ranked first as the favorite book source, while other sources mentioned were the RNIB, ClearVision, Calibre and the child’s own school. Over 60% of all visually impaired adults have another serious illness or disability such as arthritis or deafness and it is estimated that 50% of visually impaired children in the developed world have further handicaps, most commonly deafness, physical disability or learning difficulties that are liable to complicate their needs. These children may require greater assistance in order to learn how to read and enjoy Braille, large print and tactile books.

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