PREVALENCE (Number of individuals with defined conditions)

What is the best general-purpose estimate of the number of people who are blind or visually impaired in the United States?

AFB recommends the general-purpose estimate that 10 million people in the United States are blind or visually impaired. This figure reflects a merging and rounding of various estimates from federal surveys of noninstitutional (or community-based) and institutional (mostly nursing home residents) populations studied in the mid- to late 1990s. AFB urges investigators to pay attention to the various other estimates provided in this document, which are appropriate for specific uses. The various estimates differ based on the definitions of visual impairment used, as well as on dates the data was collected, populations surveyed, and other features of the data sources.

Definition and Scope: This estimate applies to people who cannot see at all as well as those who have difficulty seeing with eyeglasses or contact lenses; to those who live in nursing homes and other institutions as well as in the community; and to people of all ages.

Data Source: Merging of various federal surveys. (See the estimates that follow for information about specific data sources.)

How many people in the United States, who are not in institutions, are visually impaired (have a "functional limitation in seeing")?

In 1994-95, 8.1 million people were estimated to have a functional limitation in seeing, including both those with "non-severe limitation" ("difficulty seeing words and letters") and those with "severe limitation" ("unable to see words and letters").

Definition and Scope: This estimate combines individuals ages 16 years and over, who are not in institutions, defined as self-reported or proxy-reported, who have "difficulty seeing words and letters" (a "non-severe limitation") or are "unable to see words and letters" (a "severe limitation").

Data Source: Bureau of the Census, Survey of Income and Program Participation, 1994-95, http://www.census.go v/hhes/www/disable/dissipp.html.

How many legally blind people are there in the United States?

In 1994-95, there were approximately 1.3 million Americans who reported legal blindness (a rate of 5 per 1,000). Of these individuals, 80% (1,040,000) had some "useful vision" (a rate of 40 per 1,000). The other 20% (260,000) had only light perception or less vision (a rate of 1 per 1,000). Half of these individuals were totally blind (130,000), that is, had no light perception (a rate of 0.5 per 10,000).

Definition and Scope: "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data source: Estimate of overall legal blindness is from National Center for Health Statistics, National Health Interview Survey - Disability Supplement, 1994 and 1995, http://www.cdc.gov/nchs/nhis.htm. Breakdown by severity is estimated, with rounding, from National Eye Institute, "Statistics on Blindness in the Model Reporting Area, 1969-70,"(Publication No. [NIH] 73-427), which is conventionally still used as a yardstick.

How many elderly individuals (aged 65 or older) in the United States are visually impaired, including those who are blind?

In 1994-95, approximately 5 million elderly individuals not residing in nursing homes reported a visual impairment. Of these, 1 million reported a severe visual impairment.

Definition and Scope: In this study, visual impairment refers to individuals who report "difficulty seeing words and letters in regular print, even with their eyeglasses on"; those with a severe visual impairment report being "unable" to do so.

Data Source: Bureau of the Census, Survey of Income and Program Participation, 1994-95, http://www.census.gov/hhes/www/disable/dissipp.html.

How many nursing home residents in the United States are visually impaired, including those who are blind?

In 1997, approximately 26% of all nursing home residents (420,300 individuals) had some level of visual impairment. Considering the severity of the vision problem, about 3% were reported to have completely lost their sight; about 6 percent were reported as "severely visually impaired," and over 16% were reported as "partially visually impaired."

Definition and Scope: Visual impairment was reported by nursing staff familiar with the individual residents in the study's sample. Responses classified as "any difficulty in seeing (when wearing eyeglasses)," also indicated whether the resident's sight was partially impaired, severely impaired, or completely lost. Almost all were 65 years or older.

Data Source: National Center for Health Statistics: National Nursing Home Survey, 1997, http://www.cdc.gov/nchs.

How many visually impaired, blind, and deaf-blind students are served in special education in the United States?

It is estimated that in 1998 approximately 93,600 visually impaired or blind students, 10,800 of whom were deaf-blind, were being served in the special education program.

Definition and Scope: Students reported as being served in the special education system as visually impaired, ages 0-21 years.

Data source: Multistate sample survey of state special education representatives, as part of the project, "National Plan for Training Personnel to Serve Children with Blindness and Low Vision." Report available from the American Foundation for the Blind. For further information, see Kirchner, C., & Diament, S. (1999). Usable data report: Estimates of the number of visually impaired students, their teachers, and orientation and mobility specialists: Part I. Journal of Visual Impairment & Blindness, 93 (9), 600-606.

How many legally blind children are there in the United States?

In 1998-99 there were approximately 55,200 legally blind children.

Definition and Scope: "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to a visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less. The children referred to range in age from 0-21 years.

Data Source: American Printing House for the Blind (APH), 1999. APH maintains an annual register of legally blind persons in educational settings below the college level.

ORIENTATION AND MOBILITY

How many visually impaired people, including those who are blind, use long canes to get around, that is, for orientation and mobility?

In 1990, approximately 109,000 visually impaired individuals in the United States reported that they used long canes to get around. Nearly two-thirds of these cane users were under 65 years of age, although only about one-third of all people who are "severely visually impaired" are under 65.

Definition and Scope: Data refer to noninstitutionalized individuals.

Data Source: National Center for Health Statistics, National Health Interview Survey, "Supplement on Assistive Technology Devices and Home Accessibility Features," 1992, http://www.cdc.gov/nchs/nhis.htm. For further information, see "Demographics Update: Use of White ("Long") Canes" (1994). Journal of Visual Impairment & Blindness, Part 2, JVIB News Service, 88 (1), 4-5.

How many visually impaired or blind people in the United States use dog guides to get around, that is, for orientation and mobility?

In 1993, just over 7,000 Americans used dog guides. Annually, approximately 1,500 individuals graduate from a user program.

Definition and Scope: Data refer to noninstitutionalized adults.

Data Source: Eames, E., & Eames, T. (1994). A Guide to Guide Dog Schools, (2^nd ed.). For further information, see "Demographics Update: Alternate Estimate of the Number of Guide Dog Users." (1995). Journal of Visual Impairment & Blindness, Part 2, JVIB News Service, 89 (2), 4-6.

CHILDREN'S USE OF BRAILLE

How many legally blind children in the United States use braille as their primary reading medium?

In 1998-99, approximately 5,500 legally blind children used braille as their primary reading medium.

Definition and Scope: "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on the Snellen vision chart, or a visual field of 20 degrees or less. The children referred to range in age from 0-21 years.

Data Source: American Printing House for the Blind (APH), 1999. APH maintains an annual register of legally blind persons in educational settings below the college level.

COMPUTER USE

How many blind or visually impaired adults in the United States use computers?

A minimal estimate is that there are 1.5 million visually impaired computer users, including those who are blind.

Definition and Scope: The total number of people ages 15 and older with any "limitation in seeing", who report they have access to the Internet is just over 1.5 million (1,549,000). The number of people ages 15 and older, with a limitation in seeing, who use a computer regularly is a bit under 1 million (979,000). Of those, about 196,000 people with a "severe" limitation in seeing have access to the Internet, and about 102,000 persons with a severe limitation in seeing use a computer on a regular basis.

Data Source: The U.S. Bureau of the Census (1999) "Survey of Income and Program Participation" (SIPP). For further information, see "Who's Surfing? Internet Access and Computer Use by Visually Impaired Youth and Adults" by Elaine Gerber and Corinne Kirchner. (2001). Journal of Visual Impairment & Blindness, 95 (3), 176-181.

RACE AND ETHNICITY

What is the pattern of racial and ethnic minority groups among individuals in the United States who are visually impaired, including those who are blind?

In 1992, among individuals with visual impairments, approximately 80% were white, 18% were black, and 2% were from other races. Eight percent were of Hispanic origin and may have been of any race. Blacks make up only 12% of the general population of the United States, and thus are overrepresented among individuals with visual impairments.

Definition and Scope: Individuals with "difficulty" in seeing or who are "unable to" see words and letters in regular print, even with their eyeglasses on.

Data Source: Bureau of the Census, Survey of Income and Program Participation, 1992. http://www.census.go v/hhes/www/disable/dissipp.html. For further information, see Kirchner, C., & Schmeidler, E. (1999). "Usable Data Report: Life Chances and Ways of Life: Statistics on Race, Ethnicity, and Visual Impairment." Journal of Visual Impairment & Blindness, 93 (5), 319-324.

EMPLOYMENT

What percentage of working-age adults who are visually impaired (not including those who are legally blind) are employed in the United States?

In 1994-95, approximately 46% of working-age adults (ages 18-69) who were visually impaired but not legally blind were employed.

Definition and Scope: Adults aged 18-69 years, with visual acuity better than 20/200 and a visual field of better than 20 degrees.

Data Source: National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For more information, please see Employment Statistics for People Who Are Blind or Visually Impaired: U.S., 1994-95.

What percentage of working-age adults who are legally blind are employed?

In 1994-95, approximately 32% of working-age adults who were legally blind were employed.

Definition and Scope: Adults were defined as individuals 18-69 years of age. "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data Source: National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For further information, see Kirchner, C., Schmeidler, E., & Todorov, A.(1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. Mississippi State: Mississippi State University, Rehabilitation Research and Training Center on Blindness and Low Vision.

When age is taken into account, what percentage of working-age adults who are visually impaired (not including those who are legally blind) are employed in the United States?

In 1994-95, over three-fifths of visually impaired individuals in the "prime working years" of 22-50 years old were employed. About two-fifths of those 50-59 years old, and one-fifth of those 60 and older, were employed.

Definition and Scope: Adults were defined as individuals 18-69 years of age. "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data Source: National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For further information, see Kirchner, C., Schmeidler, E., & Todorov, A. (1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. Mississippi State: Mississippi State University, Rehabilitation Research and Training Center on Blindness and Low Vision.

When age is taken into account, what percentage of legally blind adults are employed?

In 1995, almost one-half of legally blind individuals in the 22-50-year-old range were employed. By contrast, fewer than one-quarter of legally blind people ages 50-59 years, and one-tenth of those older than 60 years, were employed.

Definition and Scope: Adults were defined as individuals 18-69 years of age. "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data Source: National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For further information, see Kirchner, C., Schmeidler, E., & Todorov, A. (1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. Mississippi State: Mississippi State University, Rehabilitation Research and Training Center on Blindness and Low Vision.

What is the explanation for the discrepancy in the rates of employment between younger (ages 22-50) and older (ages 50-59) visually impaired and legally blind working-age adults?

The lower employment rates for older adults raise the following possibilities:

1. The younger workers have had better access to education.
2. There is age discrimination against older workers.
3. There are more economic disincentives to employment for those closer to retirement age.
4. Adults who have lost their vision late in life have fewer of the skills they would need as employees to cope with their visual impairments.
5. Health problems that might prevent employment increase with age.

Definition and Scope: Adults were defined as individuals 18-69 years of age. "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data Source:National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For further information, see Kirchner, C., Schmeidler, E., & Todorov, A. (1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. Mississippi State: Mississippi State University, Rehabilitation Research and Training Center on Blindness and Low Vision.

When health is taken into account, how does it affect the rates of employment among visually impaired and blind working-age adults?

Health has a major effect on rates of employment. For visually impaired adults under the age of 55, of those who were in "excellent" or "very good" health, 83% were employed, the same as the percentage for sighted adults. If, however, visually impaired adults under age 55 were in "poor" health, only 20% were employed.

The situation is similar for legally blind adults. Of those under 55 years old who reported "excellent" health, 60% were employed, in comparison to a 5% employment rate for those in "poor" health.

Definition and Scope: Adults were defined as individuals 18-69 years of age. "Legal blindness" is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.

Data Source: National Center for Health Statistics (1998), National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm. For further information, see Kirchner, C., Schmeidler, E., & Todorov, A. (1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. Mississippi State: Mississippi State University, Rehabilitation Research and Training Center on Blindness and Low Vision.

What is the explanation for the discrepancy in the rates of employment between individuals who are blind or visually impaired and those who are sighted?

Seventy-four percent of the sighted working-age public are employed, compared to approximately 46% of working-age adults who are blind or visually impaired. However, the sighted public, as a group, is both younger and in better health than are people who are visually impaired or legally blind, and these two factors have major effects on rates of employment.

EDUCATIONAL ATTAINMENT

What educational levels were attained by adults in the United States with severe visual impairment or blindness?

In 1992-93, approximately 55% of individuals with severe visual impairment or blindness did not have a high school diploma, compared to 20% among fully sighted individuals in the same age group. Much smaller differences between these two groups were found in rates of higher education. Among high school graduates, those with severe visual impairment or blindness are about as likely to have attended college without receiving a degree as those who were sighted (24% compared to 27%), but are less likely to have graduated from college (16% compared to 26%).

Definition and Scope: Refers to individuals 18 years and older, not residing in institutions.

Data Source: Bureau of the Census, Survey of Income and Program Participation. 1992-93, http://www.census.go v/hhes/www/disable/dissipp.html.

Does educational attainment differ between men and women with severe visual impairment or blindness?

Yes. In 1994-95, women with severe visual impairments were somewhat more likely to have completed high school (48%) than their male counterparts (26%), but there was virtually no difference between genders with respect to college attendance and graduation. Among those without severe visual impairments, there is no difference between men and women at any of these levels of educational attainment.

Definition and Scope: Refers to individuals 18 years and over, not residing in institutions.

Data Source: Bureau of the Census: Survey of Income and Program Participation, 1994-95, http://www.census.go v/hhes/www/disable/dissipp.html.

Does educational attainment differ among visually impaired or blind individuals of different racial and ethnic categories?

Yes. In 1994-95, approximately 62% of white individuals who were visually impaired had completed high school or higher education, compared to 41% of blacks and 44% of Hispanics with a comparable visual disability.

Definition and Scope: Refers to individuals 18 years and over, not residing in institutions.

Data Source: National Center for Health Statistics: National Health Interview Survey--Disability Supplement, 1994-95, http://www.cdc.gov/nchs/nhis.htm.