Vision Rehabilitation Services at a Crossroads

Following World War II, troops who were blinded in combat returned home. At that time, the Veterans Administration (now the Department of Veterans Affairs) lacked specialized services to provide rehabilitation for these veterans. Although these services existed through the army and civilian agencies, this was a time of change, and a controversy developed over who would provide services to those who were blinded in the war (Bledsoe, 1997). Civilian agencies, the military, and the Veterans Administration all wanted to serve these blind veterans. Even the American Association of Workers for the Blind appointed a committee to advise the government about the care and training of "the war blind," as they were known at the time. Although much of the controversy was fueled by a genuine desire to provide services to newly blinded veterans, the issues of funding, prestige, and rivalry undoubtedly played a role. In the end, as Bledsoe so aptly chronicled, the existence of blind troops returning from the war became the catalyst for the dramatic change in services to all individuals who are visually impaired, in professional training and in society's view of people with visual impairments. These changes were accompanied by heated discussions, and Bledsoe (1997, p. 587) noted that "Part of the heat undoubtedly was generated by the fact that it was an impassioned time. The program began in a war and because of a war." Yet from this "heat" evolved the first university-based training programs for orientation and mobility (U.S. Department of Veterans Affairs, 2010), and although the impetus focused on blind veterans, the impact spread throughout the profession to include not just adults, but children who were blind. The result was a fundamental restatement of the goals and methods of blind rehabilitation. As Zambone and Suarez (2000, p. 1155) noted, "What emerged, too, was a new perspective on the capacity and role of persons with vision impairments in their homes and communities." The changes included the dramatic expansion of services to include not just individuals who were blind, but individuals with low vision and those with multiple impairments. As the controversy over who would provide services to the veterans who were blinded in the war unfolded, a major medical calamity changed the face of services for blind children in the United States. From the early 1940s to the early 1950s, the number of premature infants who had visual impairments that were due to retrolental fibroplasia (now called retinopathy of prematurity, or ROP) increased in epidemic proportions (Silverman, 2000). According to Silverman (2000), ROP was induced when preterm infants who were placed in incubators were exposed to increased levels of concentration of oxygen because this practice was thought to promote regular breathing patterns. Unfortunately, this procedure also affected the eyes and led to visual impairments in some infants. Once this practice was identified as a cause of the ROP epidemic, it was modified, but the estimated 10,000 children who were already affected needed educational services. ROP remains a concern, and the debate surrounding one of the causes of ROP, the saturation of oxygen necessary to prevent or minimize its occurrence in relation to the saturation necessary to preserve life, continues (Study Group of the Eunice Shriver NICHD Neonatal Research Network, 2010). When it came time to educate the children with ROP, families did not want to send their children to residential schools away from home. It was then that the initial push for the civil rights of children with visual impairments began as parents called for services for their children alongside typically sighted peers. A subsequent shift ensued that resulted in an increase in local school programs for students with visual impairments and a change in the population of children who were served in residential schools for students with visual impairments (Hatlen, 2000). …