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Anne Corn
Professor of Special Education
Vanderbilt University

The use of blindfolds in the teaching and training of all legally blind students has become a topic of discussion in the past few years. At a recent conference, Anne Corn and Phil Hatlen were invited to present their positions and opinions on education of legally blind students with remaining vision. They were members of a panel that took the position that many legally blind students will benefit most by utilizing remaining vision as their primary avenue of learning. Another panel took the position that every legally blind person needs to learn the skills of blindness, and should learn them while blindfolded.

When I was 18 a counselor told me I was denying my blindness because I refused to use a white cane. He was adamant that if I was legally blind I should use blindness methods for my academic, daily living, and mobility skills. I remember feeling inadequate at the time – trying to explain to this very nice man who was blind - why I did not need or want to use a cane. I felt comfortable with using combined visual and auditory methods for getting through heavy amounts of reading assignments, but simply put, I was not blind. I had no other way to rationalize my personal decision or convince him of my visual abilities to function in an efficient, safe, and comfortable manner.

More than thirty years later, I find myself, once again, trying to explain why someone who has low vision and who meets the legal criteria for blindness may not need or want to be blindfolded or employ the methods of blindness during the rehabilitative process or in daily life unless they are unequivocally more efficient and comfortable methods. Still, people with low vision, who are legally blind, based on individual needs, benefit from special education and rehabilitative services if they are to become efficient users of their low vision, learn non-visual methods when more efficient or comfortable, and become employed with jobs that allow for reasonable accommodations.

Let me begin with five premises that are at the heart of my personal convictions about blindfolding. First, a person who has low vision is not a blind person with just a little bit of vision. Second, a person with low vision is not a person trying to deny his or her blindness. Third, a large segment of the population includes persons who have stable conditions or will not lose all of their vision. Fourth, non-visual approaches may be taught with or without a blindfold in circumstances where vision is not an efficient modality. And fifth, a person with low vision is a person with low vision; they are neither blind nor are they fully sighted and should not be coerced into functioning in one way or another. I will speak to these premises and then raise questions about the scientific merits of using a blindfold during the rehabilitative processes.

I find that people who are functionally or totally blind, and those who have not developed visual efficiency for reading or for orienting and way-finding, often think that if people with low vision would only function more as people who are blind, their problems would go away. In effect, they are saying “you are blind” and your little bit of vision is just getting in the way. I believe they find it difficult to understand that people with low vision, especially those who have stable conditions, in the higher levels of legal blindness can and do see a great deal. Vision is, and always will be, the best gatherer of information beyond arm’s reach. Once a blindfold comes off, vision appears to become the dominant sense. To ask people with low vision to function as if they have no vision asks them to not use something that is precious and that will be present and available in their daily lives. I have never seen evidence that having low vision is a detriment in learning about the world by using vision or other senses. I have never seen evidence that people with low vision who have been blindfolded do function differently (better or worse) or have different levels of confidence (higher or lower) than they would if they did not undergo blindfolding for extensive periods of time.

It was in 1934 when the American Medical Association established the visual acuity and visual field criteria for legal blindness. This was before a time when a body of knowledge was developed about the functional use of low vision and before optical devices were available to enhance the use of low vision. At that time, blindness methods were probably appropriate for a vast majority of people who met the criteria for blindness set forth in the 1935 Social Security Act. Today, however, those who receive optical devices, appropriate instruction, and emotional support may obtain competitive levels of print or print and Braille literacy and employment; they function without blindness methods or they know how and when to use non-visual approaches as complementary or secondary methods. The same may be said of those who are functionally or totally blind who receive appropriate devices and technology, appropriate instruction and emotional support – they, too, reach competitive literacy levels and are employed. However, the visually efficient people with low vision are not the ones who are giving testimony about how a lack of Braille skills or blindness skills in their educational programs have held them back academically or emotionally.

While a person with 20/200 visual acuity may not be able to see print without a magnifier with or without glasses, he can see at great distances, using central, mid- and far periphery to complete tasks, sometimes using optical devices, and sometimes using special techniques to enhance visual efficiency. If I ask people who are congenitally totally blind and those who are congenitally sighted the distance at which they think those with 20/200 or 20/400 acuity can see objects, they are often surprised to learn that one may not see details but can see snowcaps on distant mountains or detect objects as small as 3/4 inches at 27 feet from the person or identify a coin on the ground at 7 feet. Why then, would they want to rely on auditory cues and a cane touching the ground only a few steps in front of their bodies, even if this may be a safe way to travel for those who do not use vision? Of course environmental conditions, level of vision, and prior experience in learning to use vision may have an impact on what is seen and how it is interpreted but these levels of vision are often far more efficient than non-visual methods. Also, even when there are fluctuations in vision, I believe people with low vision learn when to use and when not to rely on visual methods, and this may be taught without blindfolding. It is not as if the lights go out, new or different methods are employed based on different environmental conditions, and with vision when appropriate.

Young children with low vision often do “test” to see what it means to be “more blind” or “more sighted”. The world may look “normal” to them and they wonder why others speak about their poor vision. Gradually, they piece together what it means to have low vision and they learn that others are reading small print and identifying objects at much farther distances than they can. As they have no comparison, children with congenital low visual acuity do not see the world as “blurry” or “foggy”. Those with other types of low vision e.g., field restrictions, also put the pieces of the puzzle together and begin to understand how they see differently.

It is heart wrenching when we hear from people who, as children, should have learned Braille or other non-visual methods as primary or complementary methods along with their sight. I am pleased that educational services for students with visual impairments has moved forward in its thinking. With functional vision assessments, learning media assessments, and clinical low vision evaluations, Braille, print, or a dual media approach are appropriately available. Today, the challenge may not be so much as whether a child should learn Braille, print, or a combined approach but how many hours of instruction are delivered by a qualified teacher. Braille can be taught without blindfolding the person learning to read by touch.

Professionals sometimes marvel at the tasks people with low vision can accomplish and then say but the people coming to me have such poor vision that blindfolding is the only approach that makes sense. I wonder, if people weren’t blindfolded whether these same people might reach higher levels of visual efficiency, if this is their choice. Might the opposite approach, teaching enhancement of low vision throughout the day, show significant results.

Only after a functional vision assessment, a clinical low vision assessment, and an orientation and mobility assessment, can projections be made as to the extent to which a child or adult can learn to use their vision for literacy and for orientation and mobility, the extent to which they may become efficient, safe, comfortable, and confident. Without these assessments it is inappropriate to say that everyone needs any specific treatment to become rehabilitated. Blindfolding shouldn’t be the response when people receive no or poor quality low vision services.

Can we draw upon the experiences of people from other disability areas? We don’t place earmuffs on children who are hard of hearing to ask them to learn to sign and read lips. Although some people who are deaf may suggest holding back amplification, this is more of a cultural issue than one of teaching children with hearing impairments to improve their communication skills with the population that hears. The vast majority of professionals in hearing impairments, I believe consider the use of hearing aids and cochlear implants a positive approach rather than one that robs a child of his deafness.

I cannot fully understand the experience of blindness just as I do not believe someone who is blind and who has never seen or who has not become visually efficient can fully understand what the experience of low vision is all about. I would not presume to be the spokesperson to tell what is “best” for people who are blind and I hope that those who are functionally or totally blind would not assume they fully understand what is “best” for children or adults who have the potential to use their vision well. Fully sighted people also cannot fully understand people with low vision just as they cannot fully understand those who are blind. However, there are fully sighted people and blind people who through their professional and personal experiences with those with low vision who are highly respected and who bring much wisdom to this discussion.

Blindness methods work well and can surely be trusted by those who are functionally or totally blind. Educators have for many years believed that multi-sensory approaches work best in teaching skills such as reading. Why then should we assume that removing a sense results in better functioning with that sense?

Some people may say that results are sufficient. Anecdotal responses tell us that people who have been blindfolded are pleased and feel they have benefited from the experience. We know that a portion of people taking placebo drugs also believe they have benefited from taking them. We also have a self-selected sample of the visually impaired population, those who are willing to be blindfolded. This sample may not be able to speak to the benefits or adverse effects that may be derived from blindfolding. We also know that people respond positively to caring treatment. Can you imagine being thrust into blackness (not blindness since they see the inside of their sleep shades) and then have caring people give positive strokes because you have learned skills? I think satisfaction here would be high – but are the results effective?

To date, I know of no empirical research that speaks to whether there are benefits in the development of skills or self-confidence with the blindfold experience. Some research questions may include:

  1. Are there significant differences in outcomes for the two treatment options (with and without blindfolds) when people have:
    1. stable vs. progressive conditions?
    2. Higher or lower levels of visual functioning
    3. Low visual acuity and/or significant visual field restrictions
    4. Congenital vs. adventitious low vision
    5. Use blindfolds for different periods of time, e.g., 8 hours/day, 16 hours/day, or specific to task learning
    6. Total immersion or gradually add more time and/or more physical movements under blindfolds?
  2. Do people who have had blindfold experience use their low vision more or less efficiently with their other senses when they remove the blindfold than those who have received quality low vision services?
  3. Are there specific personality characteristics that should contraindicate use of sleep shades for rehabilitative processes?

I consider it irresponsible to blindfold for several hours at a time unless we know that there are no adverse effects, e.g., increased fears, or that the adverse effects are minimal or impact a very low percentage of the population. I also consider it irresponsible to blindfold without evidence that there are advantages to use of the blindfold that significantly outweigh receiving rehabilitative services without the blindfold.

I believe when any controversial methodology is used, as blindfolding is today, that clients must receive information about the best scientific knowledge to date along with professionals’ experience with clients with similar eye conditions. One without the other is not acceptable.? Saying, “I believe it works”, or “I hear from others that it has helped them” is simply not providing responsible information to clients. If I were to look into the effectiveness of blindfolding at my university, I would be required to have my methods undergo a review by our human subjects committee. If I were to use any “innovative treatment” at a Vanderbilt facility to aid a person, I would need an informed consent. This consent would need to include any potential adverse effects that are known. Without a method for documenting adverse effects, one cannot assure people undergoing that treatment that none exist.

Furthermore, adults learn to make good choices and problem solve when given opportunities to do so. To require a blindfold experience in order to receive rehabilitation services is taking away one of the most important decisions a person with low vision can make. It also placed them in a difficult position not faced by those who are blind. To accept the blindfold says I am blind and I should do as I am told – to refuse it makes one feel like an imposter, accepting services from a “commission for the blind” where only truly blind people should be recipients. If I were trying to make such a decision, two questions I might ask are, Will I receive visual efficiency training following the use of the blindfold or are you suggesting I just learn not to use my vision at all? How will I understand when my vision is and is not useful to me if I don’t have a chance to receive such feedback during rehabilitation? With research, it may show that the population of people who currently refuse services because of the practice of blindfolding may re-consider and accept services once there is hard data.

Another argument I’ve heard for blindfolding is that people with low vision have low self-esteem. I can assure you it is not because they have vision that they have low self-esteem. I believe some of the problems may be due to the fact that they are being pushed in two directions, to be more like those who are blind and then they feel like the imposter, or to be more like those who are sighted and then they are less capable. I hope to see the time when professionals consider it acceptable for people to just have low vision.

Are there circumstances under which I could envision blindfolding as an effective method? Yes, but I want to know more about the effects before I recommend this to adults who are undergoing rehabilitation. I could envision several appropriate uses for a blindfold including but not limited to: people for whom vision is so low that it is confusing to them under certain circumstances, people who experience night blindness, people who have low levels of vision with progressive conditions and when under the care of a psychologist or psychiatrist a person has such fears of blindness that under controlled circumstances, periods of blindfolding are recommended. I am not saying that low vision or blindness creates in and of themselves a need for mental health care. Rather, I am saying that there are people for whom the adjusting processes are so stressful that counseling should be a part of their rehabilitative services. When some of these conditions are evident and there is scientific evidence to the benefits, then a recommendation may be made that a client consider blindfolding.?

Finally, while our field has traditionally stayed away from the medical model, I see blindfolding as a treatment that can have benefits as well as detrimental effects when not used responsibly. Are we going to continue to carry these personal convictions without scientific review? Are you ready to take your pill – I hear it is good for you.