There are few human activities we value more, understand less, and perform worse, than person-to-person communication.
(Robert M. Soucie 1979)


SINCE 1981 the Nordic Staff Training Centre for Deafblind Services in Dronninglund, Denmark has arranged courses for all personal categories involved in the care of visually impaired-hearing impaired individuals. In that work we experienced that communication was often the most difficult problem when developing services for this group of people. Although the problem was recognized it was not possible to set aside money and time for studying it until Dr. Arthur Jampolsky suggested that I spend a sabbatical year at Smith-Kettlewell Eye Research Institute, which was made possible by a grant from National Science Foundation through the Academy of Finland.

This text is an updated version of the book "Assessment of Vision and Hearing in Deafblind Persons" that was written at Smith-Kettlewell in 1987-88 and printed by Globe Press Pty Ltd in Brunswick, Australia for the Royal Victorian Institute for the Blind in Melbourne, Australia. It is a result of the clinical examinations of numerous deaf patients with retinitis pigmentosa, macular degeneration or other less common eye diseases. During these examinations Lindsay Gimble was my interpreter, research assistant, social worker and secretary and afterwards analyzed the videotapes with me. Her contribution may not be clearly enough visible in the final product, but without her vast experience in communication and her willingness to try to communicate, even when it seemed to be impossible, this work would never have been completed. The project involved almost everyone at the Institute and was always given enthusiastic and skilled support, for which I would like to express my deep gratitude.

I would like to express my appreciation to the many hearing impaired-visually impaired persons who have taught me about their problems in communication and about deaf culture. It has been one of the most rewarding experiences in my work as an ophthalmologist and vision researcher.

SF …1988


Part I
Communication During Assessment of Vision of Deafblind Person

Deafblind Patients in Departments of Ophthalmology
General Expectations During Communication
Some Facts about Sign Language and Interpreting
Different Types of Communication used by Deafblind Patients
Ethics of Interpreting
Planning for the Examination
Interpreting During a Medical Examination
Relay Interpreting Using an Intermediary Person
Adult Patients with Minimal Language Skills and/or Multiple Impairments
Patients who have forgotten communication
Should the Eye Doctor know Sign Language?

Part II
Interpreter's Role in the Assessment of Vision

Interpreter's Role in the Assessment of Vision
Ophthalmological examinations
Establishing the communication
Demonstration glasses for field defects
Illumination during examination
Relocating in the office
Guiding the patient
Ophthalmological Instruments and Procedures
Ophthalmological Terminology
Devices used by Deafblind Persons
Magnifying systems for screens
Communication devices

Part III
Tests and Techniques

Ocularmotor Functions
Visual Acuity
Optotype tests
Grating acuity
Standardized word lists
Reading of continuous text
Contrast Sensitivity
Contrast sensitivity tests
Grating tests
Commercially available grating tests
Printed optotype tests
Communication during testing of contrast sensitivity
Visual Field
Visual fields and legal blindness
Central scotoma
Assessment of visual field in young and low functioning patients
Colour Vision
Visual Adaption
Absorption glasses
Photochromatic or nonphotochromatic lenses
Examination of Multihandicapped Deafblind Children
Reporting the Findings
How to inform about visual impairment
Parents of deafblind infants
Parents of hearing impaired children 4-9 years of age
Parents and the visually impaired deaf teenager
Breaking the news to an adult hearing impaired patient
The hearing impaired elderly person who is losing vision