The Massachusetts Commission for the Blind

 

The May CRC Information Session featured guest speaker, Andrea Schein, from the BRIDGE Elder Blind Program through the Massachusetts Commission for the Blind. Ms. Schein gave an informative presentation on the causes of vision loss, definition of legal blindness, mandated reporting, services and programs of the Mass Commission for the Blind, as well as other community resources for those who do not meet the definition for legal blindness.

Vision Loss and Low Vision:

Everyone’s vision changes with age. Around age 40 it is common to need reading glasses. By at 50 vision changes may be more prominent. It takes 4-10 times as much light to see as clearly as one did at age 20. It also takes longer for light adaptation and it may be harder to distinguish colors. Although vision changes may occur, low vision or difficulties performing daily tasks related to vision loss that cannot be corrected with glasses, surgery or medicine is not necessarily a normal part of aging. The four major causes of vision impairment are Macular Degeneration, Glaucoma, Cataracts, and Diabetic Eye Disease.

The following is a brief overview of the four most common types of vision impairments. Click on the disease names (hyperlink) for examples of what an individual who is experiencing this type of vision loss might see.

Macular Degeneration is the leading cause of vision loss in older Americans and is an eye disease that results in a loss of central, “straight-ahead” vision. It has a genetic component and is more common is smokers.

Glaucoma is an eye disease, related to high pressure inside the eye that damages the optic nerve and leads to vision loss affecting peripheral vision initially, but that as it progresses permanently limits the visual field. The loss of vision may not be readily apparent to the one affected, because it happens gradually. Frequent tripping or knocking things over when reaching for a object may be indicators of Glaucoma.

Cataracts are the clouding of the lens leading to hazy vision. Surgery is often a safe and affective treatment, in which the clouded lens is replaced with a plastic lens.

Diabetic Eye Disease symptoms are different for each individual. May include temporary impairments caused by broken capillaries leading to blood in the vitrious gel of the eye, blocking vision. When this happens the blood may settle later in the day, decreasing the vision impairment, but possibly causing confusion in loved-ones who don’t understand the inconsistency of the patient’s complaints.

A warning to all, any sudden vision changes including seeing flashes, lots of floater, a dramatic change in vision should be treated as an emergency situation and should be immediately addressed by a doctor.

Phantom Vision

One phenomenon of vision loss can be especially concerning to elders and their loved-ones who might confuse it with mental illness. “Phantom Vision” occurs in those who had vision in the past, and is similar to the pain and other neurological effects experienced by some who’ve had an amputation. The brain is “expecting” visual signals, and when none are forthcoming creates its own. So people may have what might appear to be visual hallucinations. Ms. Schein recounted one story of a woman “watching” a Broadway musical on her kitchen table. What may help patients/families distinguish Phantom Vision from a visual hallucination, with Phantom Vision:

  1. the individual knows it isn’t really there
  2. the vision has no sound
  3. only occurs in those who previously had vision and
  4. is not frightening

Legal Blindness

Legal Blindness is defined as an individual who has vision with correction (i.e., using glasses or other assistive device) of 20/200 or less in the better eye; or has peripheral field vision of ten degrees or less, regardless of visual acuity. The vision loss must be expected to last at least 6 months. Of those who are considered legally blind, 2/3 are over 65 years old. A common misperception is that those who are legally blind have no vision at all. Most individuals who meet the definition of legal blindness have some limited vision, the amount being dependent upon how and when they lost their vision.

Mandated Reporting

Massachusetts law (C.6,s.136) requires that all eye care professionals who find a person to be legally blind register that person with the Massachusetts Commission for the Blind within 30 days of the date of examination. This applies to any “eye care professional” (i.e., Ophthalmologist or Optometrist). Primary care physicians are not covered by the mandate. Massachusetts is one of two states that legally require physician reporting of legal blindness, statistics are reported to the Federal Government for census purposes and is the basis of much of what we know about prevalence. It also initiates a referral to MCB unless the individual asks not to be contacted. All MCB services are voluntary.

Mandated Reporting is obviously a delicate issue as it triggers the loss of a driver’s license, which many equate with a loss of freedom and independence. The flip side though, is that Mandated Reporting also ensures that legally blind persons get the supportive services and benefits they are entitled to.

Question: What is the process and how is license revocation enforced for those who have been determined to be legally blind?

Individuals who are declared legally blind are required by law to relinquish their driver’s license. After the physician’s mandated report of legal blindness is submitted to the MCB, a letter is sent to the individual explaining that he/she must surrender his/her driver’s license. A list of those who are declared legally blind is then cross-referenced with the RMV’s valid licensed driver list. Anyone who shows up on both lists will be contacted by the RMV and have his/her license revoked.

Alternate IDs

Legal Benefits of legal blindness include State and Federal tax exemptions/deductions, real estate tax exemption, auto excise tax exemption, disabled parking/permit rights (legally blind persons may keep a car registered in their name and the permit may be used when they are in the car), Supplemental Security Income (SSI) for eligible persons with limited income and assets, MassHealth services for those who are financially and medically eligible. Other benefits include free use of the MBTA and commuter rail. Note that legal blindness does not by itself qualify one for THE RIDE. THE RIDE eligibility generally requires an additional impairment such as a mobility impairment that prevents one from using public transportation. Click here for a complete list of legal benefits.

Upon request, The MCB will provide a legally blind person with a Certificate of Legal Blindness (up to 3 at a time) that are required to access many of these benefits.

The Massachusetts Commission for the Blind

When a report of legal blindness is received from the eye care professional and legal blindness is established, a staff member of the Massachusetts Commission for the Blind contacts the person to offer a complete explanation of the services and benefits available. Individuals who do not wish to be contacted by the MCB should request that his/her eye care provider include this request on the mandated report form. Individuals may refer themselves to MCB at any time. Typically it takes no more than 2-3 weeks for the MCB to contact the individual.

The MCB also offers extensive supportive services through the Independent Living Social Services Program. With the assistance of a social worker, legally blind people develop individual plans, which may include a wide range of services to meet the special needs of the individual. Examples of services include advocacy, counseling related to blindness, referrals to outside community agencies, rehabilitation teaching, and orientation and mobility training. This includes housing advocacy- something increasingly difficult to come by. Additionally, the MCB offer vocational rehabilitation services to legally blind persons whose disability has become a handicap to employment.

Rehabilitation counselors work with individuals to explore career possibilities. Services of this program include a work assessment, counseling, job training, and assistance with job placement. Often, adaptive equipment is used to make a job accessible to a legally blind person. The MCB often provides adaptive equipment at no cost to the individual depending on means, and there is no means test for the legally blind who are over age 55. Equipment examples include screen magnifiers, computer screen reader software (client must supply the computer), and various “talking” electronics like alarm clocks or calculators. Click here for more detailed information about the programs offered through the MCB.

Other programs are aimed especially at elder populations. Ms. Schein spoke of a federally funded program through MCB that is geared toward the legally blind over 55 population, which provides hearing aides at no cost. The MCB is also able to provide eligible people with individual amplifiers. Also, the MCB can pay for seniors to attend a two week "Essential Skills Program" at the Carroll Center for the Blind in Newton. The program provides intensive training in daily living, travel, and communication skills for adults whose vision loss has affected his/her independence. For more info about the Carroll Center for the Blind please visit their website: www.carroll.org or call 617-969-6200.

Question: Does the MCB periodically reevaluate clients needs in the light of new assistive technology? After the initial assessment is complete and services have been put in place for the legally blind person and the case is closed, MCB does not have adequate staff to check on all past clients. If an individual’s circumstances change and different services or assistance is needed or she/he learns of new technology that might be of use, he/she should contact the MCB to re-open his/her case.

Additional Resources

Many other community agencies and supports exist for individuals who are not considered legally blind. The MCB is a great resource for identifying community agencies and programs (800-392-6450). One example of such an agency is the MAB Community Services organization (www.mabcommunity.org), which provides similar programs to The MCB for individuals with low-vision (i.e., not the legally blind). Another program Ms. Schein highlighted is the Talking Book program. This program offers a free player and books on tape/CD or “described” videos, sent in the mail to the user’s home at no cost (and returned in the mail at no cost), and access to a telephone line that reads the daily newspaper. This program is available to anyone who can’t read comfortably for a significant period of time. So in addition to those with low vision, others who benefit include may include those who have difficulty holding a book, or those who have difficulty reading due to cognitive deficits. Although according to their website, this program, like many, is facing severe cutbacks in state aid. For more information on these or other resources please contact MCB or see the Resource Directory of Massachusetts Agencies and Organizations Serving Individuals Who are Blind or Visually Impaired, which is produced by the Perkins School for the Blind.

The Massachusetts Commission for the Blind
48 Boylston Street Boston , MA 02116
617-727-5550
800-392-6450
www.mass.gov/mcb

-Thanks toAndrea Schein for her interesting and informative presentation and to her and Joe Weisse, MCB Public Information Officer, for their help with this article.

 

 

5/09