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New Research: Surgery May Not Completely Undo the Effects of Long-Term Blindness

Journal of Neurophysiology logo

Is it possible to fully restore sight? New surgeries and advances in stem cell and gene therapies seem to indicate that this is possible and may happen within the next decade. Recent research in neuroscience, however, demonstrates that it may not yet be possible to restore full vision in persons with long-standing blindness or low vision.

A group of international neuroscientists has discovered, via a single-subject research design, that the rewiring of the senses occurring in the brains of persons with long-term blindness could mean that visual restoration may never be complete or may only be partially reversed by visual restoration in adulthood.

From the Journal of Neurophysiology

This new brain research, entitled Tracking the evolution of crossmodal plasticity and visual functions before and after sight-restoration, has been published online ahead of print in the December 17, 2014 edition of the Journal of Neurophysiology. [Editor's note: "Crossmodal" refers to perception that involves interactions between two or more different sensory systems, such as vision and hearing or vision and touch. "Plasticity" refers to the brain's ability to reorganize itself by forming new nerve cell connections to compensate for injury and/or disease.]

The authors are Giulia Dormal, Franco Lepore, Mona Harissi-Dagher, Geneviève Albouy, Armando Bertone, Bruno Rossion, and Olivier Collignon, who represent the following institutions: the Catholic University of Louvain, Belgium and the University of Montreal, Canada.

About the Research

Excerpted from How does the brain adapt to the restoration of eyesight? Surgery cannot completely undo the brain rewiring caused by long term blindness, via EurekAlert:

Recent scientific advances have meant that eyesight can be partially restored to those who previously would have been blind for life. However, scientists … have discovered that the rewiring of the senses that occurs in the brains of long-term blind [persons] means that visual restoration may never be complete.

"We had the opportunity to study the rare case of a woman with very low vision since birth and whose vision was suddenly restored in adulthood following the implantation of a Boston Keratoprosthesis [i.e., KPro, or artificial cornea] in her right eye," explained Giulia Dormal, who led the study.

"On one hand, our findings reveal that the visual cortex maintains a certain degree of plasticity – the capacity to change as a function of experience – in an adult person with low vision since early life. On the other, we discovered that several months after the surgery, the visual cortex had not regained full normal functioning." The visual cortex is the part of the brain that processes information from our eyes.

Scientists know that in cases of untreatable blindness, the occipital cortex – the posterior part of the brain that is normally devoted to vision – becomes responsive to sound and touch in order to compensate for the loss of vision. "This important brain reorganization represents a challenge for people encountering eye surgery to recover vision, because the deprived and reorganized occipital cortex may not be capable of seeing anymore…," Dormal said.

The researchers worked with a 50-year-old Quebec woman. This involved taking MRI images as she completed various visual and auditory tasks and comparing her scans with scans that had been taken from people with normal eyesight and people with untreatable blindness who had performed the same tasks. The study suggests that eye surgery can lead to a positive outcome even when performed in adulthood after a life-time of profound blindness.

There is however an important caveat. "The recovery observed in the visual cortex … is not total," Dormal explained. "Indeed, auditory-driven responses were still evidenced in certain regions of the visual cortex even seven months after surgery, and these responses overlapped with visually-driven responses. This overlap may be the reason some aspects of vision, despite having improved with time, still remained below normal range seven months after surgery."

What Does It Mean to See? More about the Eye and How It Works

side-view diagram of the eye

Diagram of the eye, viewed from the side

To understand this diagram of the eye, try to picture it as being split in two, like an apple that's been cut in half. Imagine yourself looking into the eye from the cut side.

The Cornea

The cornea is a transparent dome-shaped tissue that forms the front part of the eye. It functions as a window and allows light to enter the eye through the pupil and iris. It also begins the process of focusing light rays that help you see words and images clearly. The cornea does not contain any blood vessels, but instead contains nerve endings that make it extremely sensitive.

Aqueous Humor

Aqueous humor is a clear, watery fluid contained in a chamber behind the cornea that helps bring nutrients to the eye. It flows between, and nourishes, the cornea and the lens. Problems with the flow of the aqueous fluid can lead to problems with pressure inside the eye, including glaucoma.

The Sclera

The sclera is a tough white outer coating of fibrous tissue that covers the entire eyeball (all the way around) except for the cornea. The muscles that move the eye are attached to the sclera. The name sclera comes from the Greek word "skleros," which means "hard."

The Iris and the Pupil

The iris is a tissue containing muscles that surround and encircle the opening in the center of the iris. This opening is called the pupil. The iris regulates the amount of light that enters the eye by adjusting the size of the pupil opening.

In bright light, the iris closes (or constricts) and makes the pupil opening smaller to restrict the amount of light entering the eye. In dim light, the iris opens (or dilates) and makes the pupil opening larger to increase the amount of light entering the eye.

The Lens

The lens is composed of transparent, flexible tissue and is located directly behind the iris and the pupil. It is the second part of the eye, after the cornea, that helps to focus light and images on the retina. Because the lens is flexible and elastic, it can change its curved shape to focus on objects and people that are either nearby or at a distance.

The Choroid

The choroid is a dark brown membrane that is rich with blood vessels, located between the sclera and the retina. It supplies blood and nutrients to the retina and nourishes all of the other structures within the eye.

The Vitreous

The vitreous is a jelly-like substance that fills the inside of the back part of the eye and gives it nourishment and shape. Over time, the vitreous becomes more liquid and can detach from the back part of the eye, which can create "floaters."

The Retina and Optic Nerve

The retina is the light-sensitive tissue that lines the inside surface of the eye, much like wallpaper. Cells in the retina convert incoming light into electrical impulses. These electrical impulses are carried by the optic nerve (which resembles a television cable) to the brain, which finally interprets them as visual images. Thus, the process of "seeing" involves the eye and the brain and, in a healthy eye, occurs automatically.

The Prevent Blindness website provides a detailed view of the inside of the eye and its component parts at The Eye and How We See. You can read more about the eye and vision at Eye Health on the VisionAware website.

More about the Study from the Journal of Neurophysiology

From the article abstract:

Visual deprivation leads to massive reorganization in both the structure and function of the occipital cortex, raising crucial challenges for sight restoration. We tracked the behavioral, structural and [functional] changes occurring in an early and severely visually impaired patient (a) before, (b) 1.5 months, and (c) 7 months after sight restoration, using magnetic resonance imaging.

Robust pre-surgical auditory responses were found in occipital cortex despite residual preoperative vision. In the primary visual cortex, crossmodal auditory responses overlapped with visual responses and remained elevated even 7 months post-surgery.

However, these crossmodal responses decreased in extrastriate occipital regions [i.e., the brain regions located next to the visual cortex] after surgery, together with improved behavioral vision and with increases in both grey matter density [i.e., a major component of the central nervous system] and neural activation [i.e., brain activity] in low-level visual regions.

Selective responses in high-level visual regions involved in motion and face processing were observable even pre-surgery and did not evolve after surgery.

Taken together, these findings demonstrate that structural and functional reorganization of occipital regions are present in an individual with a longstanding history of severe visual impairment, and that such reorganizations can be partially reversed by visual restoration in adulthood.

Additional Eye and Brain Information


Topics:
Low Vision
In the News
Medical Updates

New Research: "Blindness Simulation" Activities May Do More Harm than Good

SSPS logo

New research findings from the University of Colorado indicate that blindness simulations – intended to be bridge-builders resulting in greater compassion and understanding – can sometimes harm rather than help. According to the authors, simulation activities, and blindness simulations in particular, "highlight the initial challenges of becoming disabled" and thus "decrease the perceived adaptability of being disabled and reduce the judged capabilities of disabled people."

The lead author is Arielle Silverman, now a postdoctoral fellow at the University of Washington in Seattle, who is blind and has experienced a variety of reactions from the public, related to people's familiarity (or not) with blindness and the capabilities of blind persons.

From Social Psychological and Personality Science

This thought-provoking research, entitled Stumbling in Their Shoes: Disability Simulations Reduce Judged Capabilities of Disabled People, has been published online ahead of print in the November 21, 2014 edition of Social Psychological and Personality Science (SSPS). SPPS publishes short reports of research studies that contribute to an understanding of critical issues in social and personality psychology, written to be accessible to a wide range of audiences. The authors are Arielle M. Silverman, Jason D. Gwinn, and Leaf Van Boven, from the University of Washington, Seattle and the University of Colorado, Boulder.

About the Research

Excerpted from How to worsen attitudes toward blindness - let people give it a try, via Science Codex:

A common claim about getting people to understand one another … is to "walk a mile in their shoes." But using simulation to walk in the shoes of a person who is blind – such as wearing a blindfold while performing everyday tasks – has negative effects on people's perceptions of the visually impaired, according to a new paper.

"When people think about what it would be like to be blind, they take from their own brief and relatively superficial experience and imagine it would be really, really terrible and that they wouldn't be able to function well," said Arielle Silverman, a postdoctoral researcher at the University of Washington in Seattle, who is lead author of the paper and blind.

In one part of the study, after simulating blindness by having their eyes covered, participants believed people who are blind are less capable of work and independent living than did participants who simulated other impairments like amputation, or had no impairment.

In another part of the study, participants who were blindfolded said they would be less capable if they personally became blind and slower to adjust to their new world compared with study participants who weren't blindfolded.

There also are variations on blindness simulations – activities that are implemented with good intentions but that can exploit blindness, said Silverman. These include trust walks, typically used as a group bonding exercise, and blind cafés, where diners are blindfolded and dine in the dark.

Another important consideration when it comes to evaluating the effectiveness of simulations is the fact that the built world and social environments are not designed for people with disabilities.

"A lot of the disability that I experience has nothing to do with not being able to see," said Silverman. "Instead, it's because I can't access something like a poorly designed website, for example. So if there's a way for simulations to capture how much difficulty is caused by the social environment and the built world, this could improve attitudes and help people understand that those with disabilities are just as competent as they are."

What are Blindness Simulation Activities?

As a longtime professional in the field of adult low vision and vision rehabilitation, I have participated in countless "blindness simulation" activities.

University-Based Training Programs

Some have been education-based and served as highly effective learning tools for students in my Master's and Certificate Programs in Vision Rehabilitation Therapy at Salus University. Our students learned to perform – and teach – a variety of daily living skills, including complex meal preparation, under the blindfold in structured laboratory settings.

Dining in the Dark

Daniel Aronoff the Blind Food Critic

Others have been less well-defined "awareness activities," such as the ubiquitous Dining in the Dark franchise, which I and my friend Daniel Aronoff, New York's well-known Blind Food Critic, discussed at length in Dining in the Dark: Does Its Mission Succeed? Part 1 and Part 2 after reading an aggressively negative review on the New York Eater blog.

In this case, did the Dining in the Dark blindness immersion experience succeed in its stated goal of providing "a unique sensorial, social, and human experience where guests dine in total darkness and are guided and served by the blind and visually impaired"? I think not; instead, it created confusion, frustration, and even revulsion, in some cases.

Dialogue in the Dark

I had an excellent experience, on the other hand, at the well-designed and executed Dialogue in the Dark, described as

... an awareness-raising social franchising company, offering exhibitions and business training in total darkness and creating jobs for blind, disabled, and disadvantaged people worldwide. The Dialogue exhibition uses blind and visually impaired guides to lead small groups of visitors through a series of darkened galleries that replicate everyday experiences. Without familiar sight clues, visitors learn to "see" in a completely new and different way by using their non-visual senses. It also offers the public an experience that can change mindsets about disability and diversity.

However, before Daniel and I visited the New York installation, we discussed our expectations over lunch, with Daniel expressing doubt about the accuracy of the Dialogue "message" transmitted to the general public:

"I don't understand Dialogue in the Dark. Instead of learning about blindness, people seem to treat me with either more pity or more admiration afterwards, neither of which I welcome. A woman from my building approached me and said, 'I saw the exhibit and it was so scary. You must be so brave to live like that!' I wasn't interested in attending Dialogue in the Dark before, but now I believe it might be the best way to assess its level of reality and accuracy."

To this day, I laugh about my bumbling performance in the Dialogue in the Dark exhibition, especially in the simulated subway gallery – but that was the point of the Dialogue experience and the educational discussion that followed. As a result, I acknowledged my own limitations and didn't generalize my own discomfort (and ineptness) as being representative of the experience of living with blindness. Instead, my takeaway was that I relied almost exclusively on my visual sense and needed to improve my ability to use input from my other senses to function more efficiently and independently.

What made the difference here? Thoughtful, knowledgeable guides and an individualized education component.

More about the Study from Social Psychological and Personality Science

From the article abstract:

Simulating other people's difficulties often improves attitudes toward those people. In the case of physical disabilities, however, such experience simulations can backfire. By highlighting the initial challenges of becoming disabled, experience simulations decrease the perceived adaptability of being disabled and reduce the judged capabilities of disabled people.

In two experiments, participants engaged in a challenging blindness simulation and afterward judged blind people as less capable of work and independent living than did participants after simulating a different impairment, no impairment, or after merely watching someone else simulate blindness.

Blindness simulators forecast that they would be less capable themselves if blind and that they would adapt to blindness more slowly, highlighting the self-centered nature of judged capabilities of disabled people. The findings demonstrate that experience simulation can sometimes harm rather than help attitudes toward other people's difficulties.

What's Your Opinion?

Readers: Have you participated in, or planned, a blindness simulation exercise? If so, what was your opinion? Did the experience change your impressions of, or attitudes about, blindness? Please let us know in the comment section.

Additional Information


Topics:
Cultural Diversity
Personal Reflections
Getting Around
Education
Environmental assessment and modification

Meet Donald C. Fletcher, M.D., Internationally Recognized Authority on Low Vision Rehabilitation

Donald Fletcher, MD

Donald C. Fletcher, M.D., is one of the world's leading authorities on low vision rehabilitation.

Dr. Fletcher is a clinician and researcher in the field of retinal diseases and low vision rehabilitation. He is a medical doctor and an ophthalmologist who has completed fellowship training in both retinal diseases and low vision rehabilitation. After completing surgical training, he gave up surgery to devote his practice to patients who could not have their vision restored by any medical means.

He is affiliated with, and routinely sees patients at, California Pacific Medical Center, Department of Ophthalmology in San Francisco; Envision in Wichita, Kansas, where he is Medical Director; the University of Kansas Medical Center, Department of Ophthalmology in Kansas City; and Retina Consultants of Southwest Florida in Fort Myers, where he is Director of the Low Vision Rehabilitation Center.

Dr. Fletcher is also affiliated with the Smith-Kettlewell Eye Research Institute in San Francisco, where his research interests include macular function in low vision patients; outcomes of occupational therapy training of low vision patients; and psychology in low vision rehabilitation.

He has provided low vision rehabilitation care for over 25,000 patients in the last 28 years. He also is actively involved in research and education in low vision rehabilitation. He has extensive publications in the field and has brought several low vision products to the market.

Dr. Fletcher earned his M.D. degree in 1982 from the University of Alberta, Canada, and completed Fellowship training at Presbyterian Medical Center in Denver, Colorado and Pacific Medical Center in San Francisco, California.

He is the Past Chairman of the American Academy of Ophthalmology Low Vision Committee. He is the recipient of its 2013 Secretariat Award for volunteer service in helping others learn techniques to live with low vision and has also received its Honor and Senior Achievement Awards for outstanding contributions to ophthalmology. He is the recipient of the Meritorious Achievement Award from the Association for Education and Rehabilitation of the Blind and Visually Impaired for Outstanding Lifetime Contributions to Low Vision.

Dr. Fletcher has a special interest in the provision of low vision care in underserved areas and has helped establish low vision clinics in various US locations, Canada, China, the Philippines, Chile, Brazil, and Zimbabwe.

Maureen Duffy: Hello Dr. Fletcher. It's an honor to speak with you about your life and work in low vision rehabilitation. To begin, can you tell us what first drew you to the field of ophthalmology? And when did you become interested in the study and practice of low vision?

Dr. Donald Fletcher: While training in management of retinal diseases, I became frustrated by how many patients I could not help. I got tired of hearing myself say, "I'm sorry that is all we can do for you." So out of that frustration, I signed up for another fellowship in low vision rehabilitation. I fell in love with the discipline of low vision rehabilitation; that was in 1986 and I have done it full time since then. I am still having a lot of fun – I look forward to every day's work.

MD: Many of our readers tell us they had never heard of low vision rehabilitation services before visiting our website – and in fact, a student research group from the New England College of Optometry just completed a study in which they identified a number of barriers to low vision treatment. Can you explain to our readers what low vision rehabilitation services are (or should be) and what they can expect during an initial appointment with a low vision practitioner?

DF: It really is no different from other forms of medical rehabilitation. When a patient is left with some type of impairment, it interferes with life's activities, decreases safety, and lowers the quality of life. Whether you have a broken back or low vision, rehabilitation aims to find ways to enhance residual capacity, make adaptations, and keep us doing the things we want to.

The specifics of low vision rehabilitation include an initial evaluation by an eye doctor where the type of impairment and rehabilitation potential are assessed. The doctor's assessment is followed by a period of training by rehabilitation professionals who teach the patient how to use remaining vision and utilize vision enhancement equipment such as magnifiers.

It is not a simple process and when comprehensive rehabilitation is undertaken it is infinitely more effective than ordering a magnifier from a catalogue. To undertake low vision rehabilitation on one's own is as silly as an amputee ordering an artificial limb from Amazon.com and strapping it on themselves!

For those with moderate or severe low vision, it usually requires several hours of training and weeks of practice to master adaptive skills. As well, vision can change and it is often necessary to revisit the process and repeat again. I recommend a yearly follow-up with your low vision doctor to ensure that optimal equipment and performance is being accomplished.

MD: Another important – but frequently overlooked – component of low vision rehabilitation services is emotional support for the person with low vision and his or her family members. Recent research by Dr. Barry Rovner and colleagues supports the concept that integrated low vision and mental health treatment – bridging ophthalmology, optometry, psychiatry, psychology, and rehabilitation – can reduce or prevent depression. I am aware you also believe that "the emotional status of the low vision patient is the major factor affecting rehabilitation outcomes." Can you tell us more about ways we can better combine emotional support and low vision rehabilitation?

DF: It is widely appreciated that vision loss leaves us human beings discouraged and often in a very profound way. Dr. Barry Rovner in Philadelphia has recently reported some fascinating research in addressing this problem. His research has shown that low vision patients experience less depression when they are involved in a structured program of behavioral activation therapy. The more active and involved the patient is, the less likely they are to become depressed. It makes a lot of sense to me and this is the whole point behind low vision rehabilitation. We want to keep people participating in life – as George Burns said approaching 100, "As long as you are alive, you might as well keep living."

MD: You are also one of the original founders of the Low Vision Rehabilitation Study Group, which meets annually in San Francisco. Can you tell us more about it? What topics will you be discussing this year?

DF: This is simply a gathering of us low vision rehabilitation professionals who get together to discuss tough problem cases and share any new ideas that we have come up with in the last year. Every year we meet the beginning of February in California to escape winter in other locations. There is no registration fee and I have yet to have any participants tell me that they did not get their money's worth!

MD: Can you tell us about your current research interests?

DF: Some of my current interests include how to train patients to make compensatory eye movements to overcome central visual field defects. We are looking at how macular degeneration can make hand/eye coordination difficult. We are also looking at new inexpensive reading charts that help to quickly isolate central visual field defects on reading performance. We are always interested in how the latest off-the-shelf technologies can be applied to low vision patients, too.

MD: What do you regard as the next great frontier in low vision rehabilitation practice?

DF: Looking into my crystal ball here … it is a little foggy … but I think when we start to implant stem cells into the retina it is going to be quite a rehabilitation challenge to teach patients how to use these newly connected cells. Vision is so much more than eyeballs – teaching the brain how to interpret these visual precepts should be no easy task. Personally, I don't see any of us in this field going out of business soon!

We thank Dr. Donald Fletcher for his support of VisionAware and for his longstanding research and practice on behalf of blind and visually persons worldwide. It has been a privilege to speak with you.


Topics:
Low Vision
Personal Reflections
Medical Updates

Braille Literacy Awareness Month: The Story of Louis Braille

Cover of Louis Braille: Touch of Genius

During Braille Literacy Awareness Month, VisionAware is pleased to celebrate the life and work of Louis Braille (January 4, 1809 – January 6, 1852), the creator of the braille code, which revolutionized reading and writing for blind people throughout the world.

This month, our examination of Louis Braille's life and work features Louis Braille: A Touch of Genius, authored by C. Michael Mellor and published by National Braille Press. The mission of National Braille Press is to promote the literacy of blind children through braille and to provide access to information that empowers blind people to actively engage in work, family, and community affairs.

About Louis Braille: A Touch of Genius

Excerpted from the jacket copy:

In the early weeks of 1809, Abraham Lincoln, Charles Darwin, and Louis Braille were born. These three remarkable men would lend their brilliance to a century of great change and innovation, but only one escaped fame in his lifetime.

miniature portrait of Louis Braille

Louis Braille was born sighted, and accidentally blinded himself at the age of three. He was fortunate to be sent to Paris to board at one of the world's first schools for blind children.

There, at the age of 12, he began to work tirelessly on a revolutionary system of reading and writing by touch. Braille's passion to improve life for "my fellows in misfortune" was the driving force behind his creation of a code of raised dots that gave blind people the gift of literacy for the first time, whether they speak French, Chinese, or Urdu.

Drawing on primary sources that sort fact from fiction, Louis Braille: A Touch of Genius is the first full-color biography to include 31 never-before-translated letters, some written by Braille's own hand. An extraordinary collection of documents, photographs, and artistic works enhances the bibliographic narrative of the phases of Braille's life – as a child and student, talented musician, beloved teacher, astute businessman, and genius inventor.

Louis Braille: The Beginning

The following passage, entitled Home, describes Louis Braille's childhood in Coupvray, France and is excerpted, with permission, from Louis Braille: A Touch of Genius, pages 13-16:

Home

In the first few weeks of 1809, three baby boys were born who changed the course of history: Abraham Lincoln, sixteenth President of the United States; Charles Darwin, British father of the theory of evolution; and Louis Braille, the French inventor of a means of literacy for blind people worldwide. Unlike Lincoln and Darwin, Braille's genius is little known outside his native land, except among those who have been touched by his gift of literacy.

A Favorite Son

Louis Braille was born in the little town of Coupvray, 25 miles east of Paris, on January 4, 1809. He was the last child of Simon-René Braille and his wife of 17 years, Monique (née Baron). They already had three children: Monique-Catherine-Joséphine, born 1793; Louis-Simon, born 1795; and Marie-Céline, born 1797. Louis was the youngest by twelve years.

Louis was a small, listless baby, too sickly even to suck milk from his mother's breast. He was registered with the town authorities the next day and baptized three days later for fear he might die. Disease struck hard in early 19th-century France, and infant mortality was high, even for the wealthy.

Still, under the devoted care of his mother and family, Louis grew more robust. Mother and father were thrilled with their new baby, who came along, perhaps unexpectedly, when Simon-René was 44 and Monique 39. Simon-René proudly announced that Louis would be his "companion in old age." The doting parents called him their little "Benjamin"—a reference to the beloved son of the biblical Jacob—and he became their favorite.

Family Life

Simon-René supported his family as a harness maker (bourrelier), a trade first practiced by his own father some sixty years earlier. In an agrarian society, a bourrelier was a man of some stature, well known to the farming community and frequently visited by neighboring farmers over the course of a year. He made the leather tack – collars, straps, bridles – that allowed a farmer to tap and control the strength of a horse, the chief source of power on a farm and one of the few means of transport until well into the 19th century.

Simon-René was adept at his trade, earning the title of master harness maker before he was 27. "It was a point of honor with the master to deliver only work well done, to strive for perfection in the whole and in every detail." Young Louis was to draw on these traits—attention to detail and a desire for perfection—to invent a means of literacy for people around the world.

Life for Monique Braille, a wife and mother in rural France at the turn of the 19th century, was arduous. Lacking today's labor-saving amenities, Monique spent most of her waking hours taking care of the children, preparing food, cleaning, sewing, spinning, washing and mending clothes, and helping on the farm. There were chickens and a cow to attend to, and in the fall, she and the children helped to make hay as winter fodder.

Monique and Simon-René always encouraged young Louis to join in the work. Over the years, the industrious and frugal Braille family acquired an additional seven and a half acres of land, and managed their own two and a half acre vineyard, which yielded a year's supply of wine, stored in huge casks in the cellar.

the Wash House in Coupvray

"Lavoir des Médisances" (the Gossips' Wash House) in Coupvray, dating
from the Middle Ages, was also an important communications center.

Calamity in the Workshop

How young Louis Braille injured his eye in his father's workshop one summer day in 1812 is not clear. The most reliable account comes from Hippolyte Coltat, a former schoolmate and close friend of Louis's:

One day, at the age of three, sitting beside his father, who was working and lovingly thinking about his little "Benjamin" [i.e., Louis], the boy wanted to work too, and imitate the movements he saw his father make. In one of his little hands he seized a leather strap, and in the other a serpette (a slender, curved knife, rather like a small pruning hook) and there he was at work. Weakness often invites trouble; and it did: The sharp tool veered out of control at an angle and stabbed the poor worker in the eye.

Medical knowledge at that time could not save the eyesight of their "Benjamin." Lily water, thought to possess healing powers, was applied by an old woman from the village, probably doing more harm than good to the injured right eye. Louis's other (left) eye became inflamed, and the sight in that eye was eventually lost, too.

The right cornea became totally opaque, and the left eye partially so, with blue "striations." His eyes would have been very painful during this period; he would have cried a lot and needed much mothering. It is not known how long the process continued, but by age five, two years after the accident, Louis was completely blind.

an artist's interpretation of Louis Braille's blinding accident

"The Accident," a drawing by André Harfort, depicts
an inquisitive and energetic three-year-old boy climbing
to reach one of his father's sharp leather-working tools.

Sympathetic Ophthalmia

Even with today's medical advances, it is unlikely that Louis's wounded eye could have been saved, but the healthy (left) eye might have been treated with corticosteroids and immunosuppressive drugs. The development of pathology in a healthy eye after the other eye has been injured was noticed as long ago as AD 1000, though no term existed for this phenomenon until 1830, when William Mackenzie, a foremost Scottish ophthalmologist of his time, devised the term "sympathetic ophthalmia."

This is now thought to be an auto-immune disease in which the mechanism the body uses to repair damage goes awry and attacks healthy tissues. The seemingly drastic measure of surgically removing Louis Braille's injured eye within two weeks of injury might have prevented the development of blinding inflammation in his healthy eye.

About the Author

C. Michael Mellor

C. Michael Mellor embarked on a biography of Louis Braille when he first saw the letters of Louis Braille on display at l'Institut National de Jeunes Aveugles, the school in Paris where Louis was a student, teacher, and creator of an embossed code that carries his name.

As editor of the Matilda Ziegler Magazine for the Blind for eighteen years, Mike has long held a fascination for braille. His published paper, "Making a Point: The Crusade for a Universal Embossed Code in the United States," was delivered at the International Conference on "The Blind in History and the History of the Blind," in Paris, France, where he came upon Louis's extant letters and decided to translate them for publication. He holds an M.A. in the History of Science from the University of Leeds in England, where he was born.

You can listen to a National Public radio interview with C. Michael Mellor at the National Braille Press website.

How to Buy the Book

Louis Braille: A Touch of Genius is available for purchase at the National Braille Press website, in the following formats: (a) braille, (b) ebraille (CD-ROM), (c) ebraille (download), and (d) print. For a limited time, the price of the braille or print edition is $20.00 (regularly $35.00).

Resources for Braille

Photo Credits

All Louis Braille images courtesy of La Maison Natale de Louis Braille, Coupvray, France. All images and text are reprinted with permission from National Braille Press. Thank you to Diane L. Croft, Publisher, National Braille Press, for providing the source material for this story.


Topics:
Reading
In the News
Personal Reflections

Progress Update: United States Accessible Currency Project for Blind and Visually Impaired Persons

US Treasury logo

Last week, I received the following update on the United States Treasury Department's long-term and ongoing project to create paper currency (i.e., banknotes) that is independently accessible by people who are blind and/or have low vision.

Excerpted from Nationwide Release of the BEP's U.S. Currency Reader Program to Help the Blind and Visually Impaired:

The Department of the Treasury's Bureau of Engraving and Printing (BEP) is accepting and processing applications nationwide from blind or visually impaired individuals who wish to receive a currency reader to identify U.S. currency. Under the U.S. Currency Reader Program, U.S. citizens or persons legally residing in the U.S. and its territories who are blind or visually impaired can obtain a currency reader device at no cost. The currency reader, known as the iBill Talking Banknote Identifier, is compact, easy to use, and provides a response within seconds.

A user inserts a Federal Reserve note into the device, presses a button, and the currency reader identifies the denomination. The device operates on a standard AAA battery and can read U.S. currency in circulation today. The reader can be set to indicate the note's denomination by voice, a pattern of tones, or a pattern of vibrations for privacy or for users who are deaf-blind.

iBill Talking Banknote Identifier

The iBill Talking Identifier in place on a $20 bill.
Source: Currency Reader Program Should Be Evaluated:
Government Accountability Office

The U.S. Currency Reader Program follows the BEP's successful development and launch of two free mobile applications that operate through a mobile device's camera to scan and identify U.S. currency: EyeNote, which operates on the Apple iOS platform and can be downloaded for free from the Apple iTunes Store, and the IDEAL Currency Identifier, which operates on the Android-based platform and is available on Google Play.

The U.S. government will continue to research a raised tactile feature for use on the next redesigned Federal Reserve note and will continue to add large, high-contrast numerals and different colors to each redesigned note denomination that it is permitted by law to alter. The process for redesigning Federal Reserve notes is complex and time-intensive. Notes with any new features are not expected to be in circulation before 2020.

The Currency Problem for People Who Are Blind or Have Low Vision

In the United States, all banknotes (i.e., paper money) are the same size, shape, and weight, regardless of denomination; in other words, it is not possible to differentiate $1, $5, $10, $20, $50, and $100 bills independently by touch alone. Yes, there are many ways to manage money, including folding techniques and specialized apps, but the basic problem remains: U.S. paper currency denominations are indistinguishable by tactile methods.

In many countries, governments have designed currency – or devised methods – to ensure that banknotes are accessible to all blind and visually impaired citizens:

  • Canadian currency now contains a tactile feature.
  • In many countries, each banknote denomination is a distinct width, size, and color.
  • In Australia, where each banknote is a distinct color and length, a banknote identification card (pictured below) enables blind and visually impaired citizens to measure the length of each bill and differentiate banknotes.
Australian cash test device card

An Australian banknote identification card

What follows is a timeline of the twists and turns the U.S. accessible currency project has taken since it was first introduced, via a lawsuit filed by the American Council of the Blind in 2002. Yes, it's longish, but I also believe it provides an excellent example of the multilayered, deliberative processes that inform governmental change.

Background: The "Meaningful Access" Currency Program

May 2002

The American Council of the Blind (ACB) and two visually impaired individuals filed a complaint in the U.S. District Court for the District of Columbia, alleging that the currency of the United States violates the rights of blind and visually persons because they cannot determine denominations of United States paper currency.

ACB stated that the Treasury Department and [then] Treasury Secretary Henry Paulson violated the Rehabilitation Act of 1973, which was enacted to ensure that people with disabilities can live independently and fully participate in society.

May 2008

A federal appeals court ruled that the U.S. Treasury Department discriminates because it has failed to design and issue paper currency "readily distinguishable to people with poor sight." By a 2-1 vote, the court upheld a ruling by U.S. District Judge James Robertson in a lawsuit filed by ACB against the U.S. Treasury Department (American Council of the Blind v. Paulson).

The appeals court rejected the Treasury Department's arguments that accommodating ACB's proposals would impose an undue burden on the government, and returned the case to Judge Robertson to address the group's request for relief. ACB proposed several possible changes to U.S. currency, including different-sized bills for each denomination, embossed dots, and raised printing.

October 2008

The District Court ruled that the Secretary of the Department of the Treasury "violated Section 504 of the Rehabilitation Act," and required the Secretary to "take such steps as may be required to provide meaningful access to United States currency for blind and other visually impaired persons" in the next currency redesign. The Court also directed the Bureau of Engraving and Printing (BEP) to file status reports every six months, describing the steps taken to implement the Order and Judgment.

August 2009

As part of its effort "to create meaningful access to currency for the blind and visually impaired," BEP announced the results of a comprehensive study analyzing options to assist blind and visually impaired persons "in denominating U.S. currency." The study consisted of three phases:

  • Phase One: Conducted data analysis and gathered information regarding the demographics of the blind and visually impaired community.
  • Phase Two: Examined different technologies, features, and methods currently available.
  • Phase Three: Provided an economic cost/benefit analysis of a range of accommodation options.

May 2010

The Department of the Treasury and BEP issued a notice in the Federal Register to inform the public of the features BEP was proposing to the Secretary of the Treasury and to solicit public comment on the proposed accommodations:

  • Raised Tactile Feature: As part of the next currency redesign, BEP will develop and deploy a raised tactile feature. The tactile feature will be unique to each Federal Reserve note denomination and will provide users with a means of identifying each denomination by touch.
  • Large, High-Contrast Numerals: BEP will continue its practice of adding large, high-contrast numerals and different and distinct color schemes to each denomination to assist visually impaired citizens.
  • Supplemental Currency Reader Program: BEP also proposes to recommend a supplemental process to loan and distribute currency readers to blind and visually impaired persons at no cost.
  • In addition, BEP will continue to explore emerging technological solutions to provide access to U.S. currency, such as the development of software to enable blind and visually impaired individuals to fully access U.S. currency.

The public comment period closed on August 18, 2010 and all comments are available online at regulations.gov.

Raised tactile features proposed for currency redesign

Caption: Raised tactile features proposed for the currency redesign.
Source: Currency Reader Program Should Be Evaluated: GAO.
The $5 bill has one oblong tactile marking in the upper left corner.
The $10 bill has two oblong tactile markings in the upper left corner.
The $20 has three oblong tactile markings in the upper left corner.
The $50 bill has four oblong tactile markings in the upper left corner.
The $100 bill has two oblong tactile markings: one in the upper left
corner and one in the center of the upper edge.

June 2010

As part of the public comment process, the BEP hosted two open public forums simultaneously at its Washington, DC and Fort Worth, Texas facilities.

April 2011

EyeNote logo

BEP developed an app, called EyeNote, to assist blind and visually impaired persons in identifying U.S. currency. EyeNote, designed for the Apple iOS, scans a bank note and communicates its value back to the user, via image recognition technology. The app is available as a free download on the Apple iTunes Store and a data connection is not required.

May 2011

[Then] Secretary of the Treasury Timothy F. Geithner approved the methods that the Department of the Treasury will use to provide blind and visually impaired individuals with meaningful access to U.S. currency. The Secretary approved the following accommodations, which are based on feedback from the study and the public:

  • Raised Tactile Feature: Adding a raised tactile feature to U.S. currency unique to each Federal Reserve note that it may lawfully change. Currently, U.S. law prohibits any changes to the $1 Federal Reserve note.
  • Large High-Contrast Numerals: Continuing the program of adding large high contrast numerals and different colors to each denomination.
  • Supplemental Currency Reader Program: Implementing a supplemental currency reader distribution program for blind and visually impaired U.S. citizens and those legally residing in the U.S.

June 2012

The Senate Committee on Appropriations issued Senate Report 112-177, which directed BEP to provide a detailed plan, including a timeline, to develop, design, test, and print currency with accessibility features.

August 2012

The U.S. Court of Appeals denied ACB's motion to amend the court's 2008 judgment. ACB had requested that the court direct the Secretary of the Treasury to furnish specific dates by which the currency will be redesigned. ACB had also requested that the Secretary submit a detailed implementation plan describing specific steps to implement three accommodations to provide meaningful access to U.S. currency.

The court ordered the Secretary of the Treasury to continue to file semi-annual reports and to continue to work "diligently and expeditiously" to fulfill its obligations to provide meaningful access to U.S. currency for blind and other visually impaired persons.

The court also ordered the Secretary to inform the court promptly of any additional delays in implementing the next major currency redesign and to be as precise as possible in its semi-annual reports about the timeline for fulfilling its obligations.

July 2013

In place of Senate Report 112-177, which was not enacted, BEP submitted the plan for Meaningful Access to U.S. Currency for Blind and Visually Impaired Individuals to the Treasury Department and the Senate Committee on Appropriations. The Meaningful Access Plan explains BEP's progress and path forward in detail.

July 2014

The BEP outlined its plans to launch the currency reader program at three conferences: the National Federation of the Blind Annual Conference in Orlando, Florida; the American Council of the Blind Annual Conference in Las Vegas, Nevada; and the Blinded Veterans Association Annual Conference in Reno, Nevada.

September 2014

The Government Accountability Office (GAO) released a report, entitled Currency Reader Program Should Be Evaluated While Other Accessibility Features for Visually Impaired Persons Are Developed, stating that BEP had fallen behind schedule in its plans to produce U.S. currency with raised tactile markings. Concerns included cost, durability of tactile features, and the ability to process tactile bills through currency-counting equipment. BEP estimated that currency with tactile features could be delayed until 2020.

Due to the delay, GAO encouraged the government to focus on distributing currency readers while the plan for a tactile feature was developed. BEP expects to spend $35 million over the next several years distributing currency readers free of charge to visually impaired persons.

September 2014

From September 2, 2014 to December 31, 2014, in partnership with the Library of Congress National Library Service for the Blind and Physically Handicapped (NLS), the BEP conducted a four-month pilot program, in which NLS patrons could pre-order a currency reader. The Treasury Department selected the iBill Talking Banknote Identifier, also called the iBill Currency Identifier, from Orbit Research.

iBill and large print numeral on bill

A large, high-contrast numeral on a $5 bill and
the iBill Talking Identifier in place on a $20 bill.
Source: Currency Reader Program Should Be Evaluated:
Government Accountability Office

The pilot program allowed the government to test its ordering and distribution processes and gauge demand for currency readers. Approximately 12,000 NLS patrons pre-ordered a currency reader during the pilot phase.

November 2014

BEP posted the U.S. Currency Reader application to allow the general population of individuals who are blind or visually impaired to apply for an iBill Currency Identifier. The national rollout of the program will begin on January 2, 2015. Through December 31, 2014, NLS patrons are able to pre-order a currency reader through NLS regional libraries.

January 2015

The BEP begins to process all applications from eligible blind and visually impaired individuals who are requesting a free iBill Currency Identifier. Individuals interested in receiving a currency reader must submit an application, signed by a competent authority who can certify eligibility. Applications are available in English and Spanish.

The BEP encourages organizations that support the blind and visually impaired community to distribute these materials, incorporate the information into individualized communications, or link to the U.S. Currency Reader Program website.

More Information

For additional questions or comments about the U.S. Currency Reader Program, you can call 844-815-9388 toll-free or email meaningful.access@bep.gov.

Readers: What is your opinion? Would you like to have accessible U.S. banknotes, or is the banknote reader distribution program sufficient to ensure accessibility for all citizens? We'd like to hear from you.


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