What can you see?
April 18, 2014 3:44 AM   Subscribe

My boyfriend is legally blind. He was born with cataracts in both eyes and has moderate to severe astigmatism in one of them. I'm struggling to get some idea of what he sees.

Some background:

He had a few cataract surgeries as a child (late 60's and early 70's). He says were ineffective or botched. I'm not sure if the astigmatism was always there or if it was developed later. He walks to work or takes the subway/street car. If we're walking together I'll warn him about dips or elevated bits of sidewalks under my breath (up, pothole at your 2, etc), but otherwise, he's okay on his own. He can read if the font is big enough and the material is close to his face. We've been to a couple different eye doctors and were told that the combination of the cataracts and astigmatism made surgery not an option. If anyone has some insight on that, I'd be interested as well.

Basically, I'd love to have a better idea of what/how he sees. I ask him every now and then, "Can you see that?", which can give me a frame of reference, but it's not the most fun question for him. Since he's had this problem since birth it's hard for him to describe what he's seeing. Everything has always been blurry.

I guess what I'm looking for is some sort of cataract + astigmatism simulator? What might the combination of those two conditions look like?

Thanks in advance and my apologies if this is really disjointed.
posted by heavenstobetsy to Science & Nature (15 answers total) 2 users marked this as a favorite
He can read if the font is big enough and the material is close to his face.

Find, borrow or rent a video camera that you can manually focus. Then focus that camera on a book until it approximates what he sees (checking with him of course). Leave the focus alone at that point and then point the camera all over the place for a rough idea of how he sees the world.
posted by Brandon Blatcher at 4:09 AM on April 18, 2014 [9 favorites]

I can't point you to a simulator but can speak from my personal experience. I was born in the 70s and had a cataract in my left eye that was removed when I was about 1 year old - no further follow-up ops though and no attempt made at putting in a new lens. I have vision in my right eye corrected for shortsightedness.

If I cover my right eye I can make out blurry movement at the periphery of my vision (for instance, I can see me nose...) but there is nothing in the centre - just blank. So, to riff on Brandon's idea - if you have said video camera you might want to try blanking out the centre of the image probably up to about 85-90% of the image. But even the blank would need blurry edges so a ripped tissue might do the job. If your boyfriend had lens replacement, however botched, then there might not be this blank...

In my case I have generally adapted to only having one usable eye and have (I think) reasonable depth perception - just don't expect to me to catch anything thrown directly at me.
posted by IncognitoErgoSum at 4:14 AM on April 18, 2014 [1 favorite]

The minimum definition of legal blindness is 20/200 with correction in the better eye, or severely reduced visual field. So, if he is at that threshold (but it sounds to me like he is beyond that), what someone with 20/20 vision can see at 200 feet, a person with 20/200 vision has to be 20 feet away from it to see it. However, he also probably sees everything through a cloud, almost like when your windshield is fogged over or your shower glass is steamed up. If you ask his what his acuity is in both eyes I can give you a better idea.
posted by Sal and Richard at 5:56 AM on April 18, 2014 [1 favorite]

I've not used it, but WebAIM have a low vision simulator you could try on websites. You can also get simspecs to wear to stimulate different eye conditions. But as I know you're aware, everyone is different, and there's lots of factors that can make a difference, for some people it can vary day to day, or depending on the ambient light, and so on. You possibly know as well as anyone what your boyfriend can and can't see.
posted by Helga-woo at 6:35 AM on April 18, 2014 [1 favorite]

While not legally blind with correction, I am considered low vision and honestly I've never found a way for others to truly understand what I see. Vision is a ohysical thing, and it's also a percepption thing. My issues can largely be seen but their basis is in my brain. For example both my optical nerves are smaller than usual. That's a structural difference but its implcations are in how my brain processes what my eyes see, which can be very variable.

As someone who was born this way, a huge thing is that there are things that are so normal to me I don't even realize not everyone's vision is different. Yesterday a question was asked about seeing halos around lights and I was stunned to find out someone with 20/20 wouldn't see that. I wouldn't have even known to describe that.

I don't know if he wears any corrective lenses, but if he does another thing is there are sacrifices in low vision. My astigmatism is not treated for example because I would lose acuity, which is more important in my individual case.

I'm not saying the resources above are bad, but be aware they aren't going to tell you what he sees exactly, and it could be quite different.

Also the can you see this question is truly annoying and something I was asked all the time as a child.
posted by Aranquis at 6:57 AM on April 18, 2014 [4 favorites]

Thanks everyone for your input.

He estimates his vision in his right eye as about 10% and not focused due to the cataracts and his left eye as 40% with some areas of sharper focus, also due to cataracts/astigmatism, if that helps at all.

Aranquis, thanks for your perspective. I try not to ask him "Can you see that?", I can also see how it would be annoying, I suppose I might be too focused on knowing exactly where his limit of sight is, but only because I want to pick up where he leaves off as much as possible. I know though that trying to be TOO helpful can have the opposite effect.
posted by heavenstobetsy at 7:20 AM on April 18, 2014

Also, he does wear glasses (tri focals) which are new. For a lot of years he tried to adapt as much as he could wearing a very old (approx 30 year old, and apparently too strong) prescription, but he does see some improvement with the new glasses.
posted by heavenstobetsy at 7:23 AM on April 18, 2014

I'm assuming he does not currently use a cane since you did not state that he does. If I'm wrong, and he does use a cane, keep in mind that the cane will pick up all the obstacles in his path, so there's no need to constantly narrate his route. I teach the blind how to navigate independently with and without canes, and it gets really annoying to hear feedback from other people. If he's not using a cane, best practice is to assume competence. He's been traveling for years on his own and he's adapted as best as he can. Don't assume that he needs your help to safely go about his business; he's been doing it without your help for a long time.
posted by Sal and Richard at 7:54 AM on April 18, 2014 [2 favorites]

I am not a doctor nor am I legally blind but I do work in ophthalmology.

I'm only familiar with modern cataract surgical procedures but if he had cataract surgery he should no longer have cataracts or his natural lenses; they're removed completely. Do you know if he recieved artificial lenses at any point? I'm not sure what common practice was in the late 60s/early 70s, but his vision might be something like an image captured by a camera with no lens. And then the astigmatism blurs the image even more. I'm not sure how noticeable it would be in an eye without a lens, though. Glasses can correct the astigmatism (and strong enough ones can correct for a missing lens, to a point) but if the astigmatism is bad enough and/or the corneas were damaged during the surgery there are limits to how much the vision can be improved (which is what it sounds like his doctors have told him). So his vision with glasses might be closer to a camera with a badly warped/damaged lens.
posted by AtoBtoA at 8:30 AM on April 18, 2014 [1 favorite]

I was born with cataracts in 1974 and had cataract surgery in 1976, no implants. My surgery was pretty successful, in that I can see about 20/30 corrected in my right eye, good enough to drive. I can't really see much with my left though, it's not worth correcting because the signal from my right eye just overrides any signal from my left. Even corrected, I still couldn't read with my left eye.

So I'm in a pretty unusual situation where I know what good vision looks like, and I also know what bad vision looks like. I guess I would say that the vision in my bad eye, compared to my good eye, is weak and unfocused. Looking through out-of-focus binoculars or a camera would be about as close as someone with good vision could come to seeing like someone with low vision. A lot of what people with normal vision see is really detailed stuff, and that's just not there with low vision. More than just words and faces are gone, all of the transitions between one object and another are gone. I couldn't pick up a pen out of a jumble of other stuff if I had to use my left eye, whereas it would be instantly obvious where it was with my right. I couldn't step off a curb, or see a car coming, with my left eye. There's just not enough information about the world around me getting sent to my brain from my left eye.
posted by rabbitrabbit at 8:35 AM on April 18, 2014 [2 favorites]

I had cataract surgery in both eyes in 2009, and surgical techniques are amazing compared to what (I understand) previous techniques were like. I have (mild) astigmatism and they did not consider that an issue for my surgery. I continue to wear glasses because of the slight correction i needed, and because I still need bifocals. The surgeries themselves were quick and quite painless - i describe it as more uncomfortable than painful. And I did not need to wear an eyepatch at all, except to protect the eye from my fingers and sheets as i slept.

The experience of cataracts for me was much like a car windshield in winter that has a lot of salt residue on it. I could see reasonably well in indirect light, but when I was in brighter light my vision would wash out into a sea of white. The office I worked in at that time took up an entire floor, with windows all around. My desk was in a spot that was mostly indirect light all the time, so my vision was bad but I was still functional. But when I walked over to the "bright" side that got a lot of sunlight, my vision would get worse and worse with each step. I had to stop driving as well, because headlights would wash out my vision at unfortunate moments.

IANYD, and IANAD, and I know you said that you talked to eye doctors, but I would not expect astigmatism to be an obstacle. Maybe it is an obstacle for more profound cases, but my doctor never flinched about it. He only said I would still see better with glasses because of it. And it could be that his eyes were damaged by his previous surgeries to the extent that current procedures would not be helpful.

I would definately suggest getting several opinions, particularly from doctors who specialize in cataract surgery. (Which you have probably already done, but my case was so successful that I would hate for you to give up too soon.)
posted by Billiken at 10:24 AM on April 18, 2014 [1 favorite]

Echoing Billiken that he needs to go to a specialist (or several) for cataracts, if he has not already done so. My mother-in-law saw significant improvement in her vision by seeing specialists at Wills Eye Hospital and having them do surgery, going there (Pennsylvania) all the way from Vermont for treatment. She had had botched cataract surgery in the 70's and Wills restored some better vision to her (she still needed serious glasses, but things were a lot better post surgery).
posted by gudrun at 11:41 AM on April 18, 2014

In terms of imagining what he sees, I find Oliver Sacks' work on blindness and the experience of it very evocative—he definitely has stuff about cataracts and vision, but I'm not sure if he has anything on cataracts and astigmatism together. One source; another with some similar introductory material.
posted by felix grundy at 12:28 PM on April 18, 2014

My vision is 20/600 in both eyes uncorrected, but I have about 20/30 corrected, so I know what it is like to see and not see. Without my contacts, the world is very confusing. People's faces become a blur the color of their skin and I can no longer recognize them visually. I can read only by putting the book about 4 inches from my face, and even then it's still blurry.

It's not just a matter of seeing things sharply minus sharpness, there are a lot of things I can't perceive at all. I can't see designs or writing on another person's shirt unless its huge (I don't mean I can't read it, I mean my vision is so blurry I can't even see that it's there). I can't see traffic poles or wires so lights are bright green or bright red halos floating in midair. I can't see edges unless the contrast is very strong. So, I can't do things like tell where the sidewalk becomes the dirt, or where the corner in an unfamiliar room is, or see my dog's bones on the carpet. Anything further away than the distance across a room simply doesn't exist, my useful perception is limited to ~10 feet.

I don't think I could survive without a cane if my vision was suddenly uncorrectable tomorrow.
posted by zug at 1:03 PM on April 18, 2014 [1 favorite]

I'm visually impaired, and have often been asked "how much can you see"? In my experience, people seem to find it helpful when I describe what I can and can't see in the immediate environment (including information about the person asking the question). You might ask him to try something like that.

There's more to low vision than can usually be measured by acuity alone. It's not just about what you can see, but what you can extrapolate and interpolate based on the data available to you. This depends a lot on lighting, how familiar you are with the environment, and so on.
posted by Flipping_Hades_Terwilliger at 3:07 PM on April 18, 2014 [1 favorite]

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