Friday, June 27, 2014

A Glimpse of Low Vision

"Oh, wow!" my brother exclaimed, "look at the castle! Do you see it?" My two brothers stood beside me outside the gift shop of the science centre, the older of the two peering over his sibling's shoulder, squinting at the book held at arms' length.

"I don't see anything ..." my youngest brother said.

"You need to look in opposite directions," the other advised. A few seconds later there were exclaims of amazement from the younger of the two as image the came into view.

"Can I try?" I asked.

"It won't work for you," my brother informed me. "You can't hold it close." But he held out the book for me and stared over my shoulder as I held it at arms' length and tried to make my eyes look in opposite directions at once. (This was exceedingly difficult considering I have both nystagmus and strabismus in addition to my primary eye condition.) I scrunched up my forehead, tilted my head and squinted, then closed each eye in turn, trying to make an image appear. I imagined a castle rising out of the surface of the page, thick guard towers anchored to the ground and triangular flags flying high in the breeze.

But I knew this was just my imagination, not the real thing. I handed the book back to my brother. "It doesn't work," I confirmed.

As a teenager, I often wondered what it was like to be fully sighted. Like my imagined experience of looking at a Magic Eye picture, I imagined what it must be like to look down a street and see objects a block or two away. I would often ask my brothers questions about what they could see. A nearby mountain looked to me like a section of horizon painted matte grey. No depth, no colour, just a bunch of dry, grey paint. I was awed when my brothers told me that they could see trees and patches where trails or ski slopes cut through the woods. I would challenge them to read print from a piece of paper held a metre away and laugh in amazement when they read words that I couldn't read even with the page held a centimetre away from my nose.

In grade five or six I discovered Jean Little, a Canadian children's author who was born legally blind and later in life lost the remainder of her vision. In elementary school I read volume one of her autobiography, Little by Little, which I subsequently read almost yearly throughout my childhood and adolescence. In high school I discovered part two of her life story, Stars Come Out Within, and in the pages of the book she described what she could see as a child:
I had never seen a skyful of stars on even my best nights. But I had always seen a scattered few, perhaps six, sometimes a dozen. I had seen more by looking through a monocular and had put together a mental image of the thronging brightness of the Milky Way.
—pp. 118-119
Reading this, I remembered a camping trip as a child where, having gone to bed before everyone else, I reluctantly crawled out of my sleeping bad when my mom called me to come outside to see something. Shivering, I unzipped the tent door and ducked through the flap. I stepped outside into splendour: more stars than I had ever seen in my life were flung across the night sky overhead. Dozens, maybe even hundreds of stars. It was breathtakingly beautiful and awe-inspiring.

I knew, of course, that my parents and brothers probably saw thousands of stars glowing in that sky. Yet, up until that point the night sky usually looked empty to me. On really dark, clear nights a group of us would sometimes walk up to the high school half a block from my house and lie in the field to look at the stars. During these occasions I might see one or two of the brightest stars. I'd lie with my monocular to my eye, my friends directing me where to look to find a few more that I couldn't see with my naked eye. Our view was always obscured by the city lights, but I knew that while I saw half a dozen stars with my monocular, on those nights my friends could see dozens.

As much as I wondered what good vision was like, the curiosity also went the other way. My family and close friends often had an uncanny sense about what I could and couldn't see, and made accommodations automatically. And yet, occasionally they would question me about what the world looked like from my perspective, and occasionally even after being around me for years they had misconceptions.

Several years ago, while in the car with my parents, I commented about how odd the clouds looked.

"I'm surprised you can see clouds," my mom said from the front seat.

"Of course I can see clouds!" I said indignantly. I couldn't believe that my parents had lived with me for more than a quarter century thinking I couldn't see such a thing.

Communicating what the world looks like from my perspective is difficult, because I have never had good vision with which to make a comparison. In medical terms my visual acuity is 20/600; yet, my vision is not the same as someone who is nearsighted and simply takes off their glasses. For one, the world doesn't look blurry to me much of the time. For another, although I am able to see more detail the closer I get to an object, I am never able to see as much detail as someone with good vision, even when that object is right up to my nose. In theory I see an object at 20 feet with the same clarity as someone with normal vision sees it at 600 feet, but what does this mean in real life?

Within arms reach, I actually see fairly well, at least from my perspective. Looking at a copy of Harry Potter and the Philosopher's Stone sitting on the desk directly in front of me, I can see the red at the top of the page and the red and green of the Hogwart's Express in the middle of the page, though I cannot read the writing on the green plaque. I can make out the vague semblance of a person in the bottom right-hand corner but cannot tell what they are doing. I can't make out any details of the background. I can't see the author's name. I can see the yellow of HARRY POTTER but not the rest of the title underneath.

But can I really see all this? I have, after all, seen this book a million times at much closer range (up to my nose) and under high magnification. In fact, I just looked at it under magnification before placing it in front of me to describe what I could and couldn't see. Would I be able to make out the semblance of a figure in the bottom right corner or the yellow of HARRY POTTER if I hadn't already known it was there?

The fact that I remember so much of what I see up close visually, and use it again when I encounter things in the future, leads a lot of people to think I have much more vision than I actually do. I will remember people in the office by the colour of their clothes and the shape of their body and the manner in which they move. Unless I am within arms reach of someone or slightly beyond, I can't make out any details of their face except maybe the colour of their hair and, possibly, if they're wearing glasses. I can't see facial expressions, or see see most nods or shakes of the head. I have no understanding of what eye contact feels like.

Once, when I was young I was sitting on the couch with my mom, leaning very close to her, when I suddenly burst out laughing. She was perplexed. Nothing funny had happened. When she asked, it turned out that I had been close enough that I had seen her blink. It was the first time in my life I'd seen someone blink, and the fluttering eyelid seemed hilarious to me.

As a kid I was a budding artist who loved drawing, writing, and crafts. I spent hours with pencils, markers, scissors, and paper creating pictures, stories, and all kinds of other creative projects. I'd work holding material so close that it often touched my nose. I cut with scissors a centimetre from my better eye. I usually worked so close that there was no room for my hand between my face and the page I was working on, and the frames of the glasses I used at the time for magnification became permanently deformed due to my forcing my hand into the space and making the necessary room.

I didn't usually think of how close I had to hold objects to see them until someone mentioned it. Standing behind me talking to a friend as I worked, I once heard my mom say that she often forgot I couldn't see until she saw me working on art projects at such close range. I went through a period where I was teased at school by kids who thought I was "kissing" objects when holding them up to my face. To this day, I sometimes get complete strangers in grocery stores ask if I'm smelling products, which has caused me to consciously try to avoid holding things close in this setting. For me, having a working distance of four or six centimetres is natural, but for most around me it's not.

At a distance my vision is much less distinct, even from my perspective. I have enough vision to orient myself to a small room I walk into for the first time, such as a doctor's office. Walking down the sidewalk I can see someone approaching me from a couple of metres away. Looking at a car parked across the street I can see its colour, its type, and (depending on the colour) where its wheels and windows are. I can't see door handles, stickers in the windows, the style of the car, or whether it has a flat tire. A person walking on the other side of the street appears as a moving splotch of colour. I can't see traffic lights, usually, or drivers who might be waving at me from within their vehicles. When I swim, I can see the lane markings at the bottom of the pool that indicate when the lane is coming to an end, and the flags strung across the ceiling to indicate the same—though the latter requires more concentration and is easy to accidentally miss, given its much lower contrast and having to spot it through often foggy and water-streaked goggles.

I found a piece of paper years ago while sorting through old files which documented my participation in adapted downhill skiing as a child. On it, someone had written that I could see as far as four feet in front of me. And, in a sense this was true, since I always got uncomfortable if my guide moved much beyond this distance—but the reason for this was not that I couldn't see them as much as the fact that I have no depth perception and therefore found it difficult to determine when they stopped or made subtle adjustments to their course (although they always communicated these changes verbally to me). My vision, like anyone's vision, does not simply stop at a certain distance. It gets less detailed and distinct, but I am able to see trees, buildings, mountains, clouds, and the sun and stars.

It is not true that those of us with little or no vision develop superior senses to those who are fully sighted. What is true is that we pay much more attention to our other senses, so much so that we often notice things that others don't. This is true for me and, as my mom relates, caused some consternation when I was younger and used to reach out and touch anything and everything, whether it was a toy or wet paint.

Many times, to those observing, I appear to have more vision than I do not because I can see something but because I am relying on subtle clues from other senses to supplement what I see. Whenever I reach for an object I'm using my vision to aim my hand, but I'm using my fingers to determine when I've reached the object and should stop moving my hand forward. When I turn on my computer the hum of its hard drive gives me as much information as the blue indicator light that blinks on. When I'm crossing a road I'm listening to the flow of traffic just as much as I'm watching it. When walking through a grocery store I pay attention to the smells coming at me from various aisles in addition to the colours.

I rely on visual cues a lot, too, but different cues than most sighted people. I can tell when I'm approaching many bus stops by the way the colour and lighting changes outside the bus window, even though I often can't identify landmarks from within a moving bus. The way the light speckles through the trees on the sidewalk lets me know that I'm getting close to the entrance of my apartment building more than the numbers bolted above its door. The shifting movement of colours on a TV screen give me clues about what's happening, even if I couldn't describe the visual scene to the person sitting next to me on the couch.

Memory, senses, and visual information all come together and play into what I can and can't see living with low vision, much more so than a single letter on an eye chart.

There are times, when I am highly familiar with what an object looks like, that I can "see" things that I shouldn't be able to. I can take a letter, for example, and hold it as close as possible to my eye, and if I squint and the print isn't microscopic, I can figure out if the letter is addressed to me. I can walk into a mall I have been to many times before and make a beeline for a particular store. I can scan a shelf for a well-known product and spot it from half a metre away without any assistance. But when I do these things I don't really see these objects. More often than not I see a fuzzy shape or some mashup of colours that I happen to know, form much past experience, represents a certain word or logo.

Yet ... what I've spent the last few paragraphs describing don't really describe what I see. They describe what I see when my full attention is on something, and when lighting conditions are near ideal. Throw me onto a congested downtown sidewalk and I may only discover a bike rack when my cane clangs off its surface. Put me facing the sun without the aid of sunglasses and the resulting glare can all but obliterate nearby people, cars, buildings, and landmarks. Put me on an unfamiliar footpath as dusk falls and I may rely completely on the tactile feedback of my cane to keep me from straying off into the grass.

Occasionally I'll have a friend or extended family member ask me if I'm ever sad about what I can't see. When I was a teenager I read Sight Unseen by Georgina Kleege. In the introduction, she describes how writing the book made her aware of how little she saw, and also aware of how much information sighted people take in visually:
[...] I knew I could see something—light, form, color, movement—and assumed that this was close enough to what other people saw. As I wrote this book and forced myself to compare my view of the world with what I imagine a normal eye sees, what I learned astounded me. [...] It might seem that this discovery would lead to sadness—what else have I been missing all these years? In fact, it has inspired a kind of perplexed wonder—what do sighted people do with all this visual detail?
—pp. 2
Like Jean Little, I instantly felt a connection with Georgina Kleege. Here, again, was someone who understood what I experienced. And not only what I experienced, but how I felt about it. I have never been sad about what I might be missing. Frustrated sometimes, perhaps, when I can't see something that would otherwise be useful to see. But never sad. Like Kleege, I merely feel a fascination about how much information someone with 20/20 vision must be taking in, and how they can possibly process it all. But then, they probably wonder the same thing about me, sometimes, processing multiple incoming streams of sensory information and integrating it into an understandable whole.


  1. This is all so fascinating. I've often heard how, when sight is diminished, other senses tend to pick up the slack. I accepted it, but never really understood how until you explained it - so thanks for that. (Also, when I saw 20/600, I thought to myself that it's not too much worse than my own vision, but now I understand how little that number really tells!)

  2. I hadn't been here (your blog) before. I'll be back.
    And yup, I agree with Scott. Thank you for taking the time to explain and teach. It's appreciated.

  3. Wow, I wonder how having a 20/20 vision feels like once again. I think I've already forgotten!