Vision impairment: treating the special needs patient with a sensory disability: patients' loss of vision need not impede their dental care

Dental Assistant, The, July-August, 2009 by Janet Jaccarino

There is no doubt that making care available to the patient with disabilities requires extra effort on the part of the entire dental team. Special accommodations that help make your office more accessible, deciding what modifications are needed, and treating the patient, all require a set of special skills. It is important for dental professionals to recognize the mental and physical aspects of having a sensory disability in order to use your resources and imagination to help furnish care.

Sensory disabilities alone do not require changes in treatment methods, just modifications in provisions. Title III of the 1992 Americans with Disabilities Act requires medical and dental offices to be made free of barriers to physical access and effective communication. For example, removing barriers for a blind person may involve adding raised letters or Braille to elevator control buttons. Effective communication may include auxiliary aids such as sign language interpreters, telecommunications devices for deaf persons (TTY and TDD), readers and Braille and large print materials. (1) As with all disabilities preparation, patience, flexibility and consideration are essential and as valuable as technique in providing care.

After reading this article the reader should be able to:

* Define blindness and low vision.

* Describe the incidence of visual impairment in the United States.

* Discuss the statistics and causes of blindness in children and adults.

* Describe oral clinical findings.

* Describe the personal and dental implications for care.

* Explain various methods of communication specific for visual impairment.

* List guidelines for seating and dental management.

* Explain strategies to improve oral self-care.

NUMBERS

More than 20 million Americans report having loss of vision including trouble seeing, even when wearing glasses or contact lenses. Of the 20 million there are those who reported they are blind or unable to see at all. Approximately 6.2 million are seniors age 65 and over. As the baby boom generation ages the number of seniors with vision loss will increase substantially: (2) Legal blindness is defined as a visual acuity of 20/200. A person who is legally blind, even with optical correction, can see at 20 feet what a person with normal vision can see at 200 feet.

Not all visual impairments carry the same degree of blindness. Some individuals who may be considered blind may not be totally without sight. They may be able to distinguish images, light, colors, and may even be able to read large print. Low vision is different than legal blindness and covers a wide range of conditions. (3) Low vision can interfere with a person's ability to perform everyday activities like reading, walking unassisted and cooking. (4)

CAUSES

Blindness in children may result from infection such as rubella or syphilis passed from mother to child during birth, neoplasm and complications of premature birth. Children who are blind often have multiple developmental disabilities such as epilepsy, cerebral palsy or deafness. Two percent of people with severe visual impairments are under 18 years of age. The majority of those who are blind lose vision after age 20. Accidents account for less than 3 percent of blindness. (3,5) The greater part of reported cases maybe related to age such as those described in Table 1 (right). (3-6) Other causes maybe associated with tumors, systemic diseases such as diabetes, hypertension, atherosderosis, leukemia, Sjogren's syndrome, a virus, hereditary degeneration and prolonged use of certain drugs to treat disease. (3,5,7)

ORAL CLINICAL FINDINGS

Vision impairment does not have any direct effect on oral health; however, some may find it difficult to maintain a balanced diet or even visit the dentist. They may not detect dental disease symptoms at an early stage that are typically recognized through vision. Incidents of dental disease may be greater due to poor oral self-care because the patient is not able to see or has not received effective instruction. (6-8) Individuals may have impairment as a result of disease such as diabetes and hypertension that can affect dental treatment more than the impairment. Other oral symptoms that have been noted include lesions due to lip and cheek biting, occlusal wear due to bruxism, trauma due to accidents and increased caries in the patient with Sjogren's syndrome because of lack of saliva. Different types of visual impairments may contraindicate administration of certain dental drugs, for example, dispensation of atropine for patients with glaucoma. (7)

PATIENT FACTORS

Visually-impaired children, especially those who are totally blind, are deprived of the opportunity to learn by imitation. They must adjust to a world they have not seen or experienced because they do not have a workable visual image in their memory. Some parents may be overindulgent and protective that may foster emotional dependence. Blind children may learn to speak later and have an educational level behind that of a sighted child of the same age because they may take longer to cover the same amount of material, or they have started school later. Individuals who are blind from birth or at a very early age quickly adapt to their condition; it becomes part of who they are.