Understanding visual impairment

Increases in both population size and average age in the United States are contributing to a higher risk of low vision and blindness. This raises concerns, as these conditions negatively impact many aspects of an individual’s health and wellness.¹

The term visual impairment (VI) refers to any individual with any degree of vision loss. This category includes uncorrected refractive error, which occurs when the eye cannot focus light properly on the retina, resulting in blurred vision. Uncorrected refractive error can be corrected using glasses, contacts, or surgery.²

Other, more severe levels of visual impairment include low vision, legal blindness, and total blindness. Normal vision, or 20/20 visual acuity, means that an individual can see at 20 feet what a person with normal vision can see at 20 feet. The World Health Organization defines low vision as best-corrected visual acuity (BCVA) in the better-seeing eye of less than 20/60, legal blindness as BCVA of 20/200, and total blindness as no light perception.³ When an individual has a BCVA of 20/60, they must be 20 feet away to see something that a person with normal vision can see from 60 feet.

The prevalence and incidence rates of these vision impairments are projected to more than double, from 6.45 million to roughly 12.59 million, by 2050.²

Oral health barriers for patients with visual impairment

Visual impairments have been shown to affect an individual’s oral health due to increased exposure to risk factors and, therefore, greater vulnerability.⁴ A recurring theme across the literature is that traditional oral hygiene instruction is often inaccessible to this population, leading to lower oral health literacy and reduced oral hygiene practices.

Systematic reviews by Afsary Jahan Khan et al. and Potes Gallego et al. report that individuals with VI commonly experience barriers including limited access to adapted educational materials, reduced dental service utilization, and a lack of tailored instruction.⁴,⁵ These barriers contribute to an increased prevalence of caries and periodontal disease compared with the sighted population.⁴

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One study from India revealed that 95% of participants were unable to demonstrate adequate oral hygiene practice, reflecting insufficient knowledge and practices and an elevated vulnerability to oral disease risk factors.⁴ Given the evidence supporting these findings, promoting oral health care and education through combined sensory input methods for individuals with VI is necessary to enhance overall oral health outcomes within this population.

Among global health-care systems, Brazil is recognized for its well-organized and specialized centers dedicated to serving this population; however, these services are insufficient to meet demand and are largely concentrated in densely populated urban areas.⁴ Consequently, targeted training of dental hygienists is essential to deliver care that is responsive to the specific needs of individuals with VI.

Why multisensory education matters

A multisensory educational approach for individuals with VI incorporates verbal interaction, tactile experience, and braille. Research reveals this educational approach to be the most effective way to provide improved oral health education to children with VI compared with a unisensory or mixed-method approach.⁶

In dentistry, the tell-show-do (TSD) technique is a behavior guidance approach used to build rapport, provide verbal instruction, demonstrate oral hygiene procedures, and then have the patient perform the task to confirm understanding. A similar technique used in the VI community is referred to as audio-tactile performance technique (ATP). Both methods provide instruction and then confirm understanding through active participation.

If braille educational material is unavailable, ATP is considered the second-best oral hygiene education approach for individuals with VI.⁶ Dental hygienists must understand the importance of incorporating ATP into oral hygiene instruction. While standard TSD can be used for all patients, incorporation of braille in place of clinician demonstration is a more effective reinforcement strategy for visually impaired patients.⁶

The dental hygienist’s role in accessible care

Understanding low vision and its impact on oral health care is essential for clinical dental hygienists who aim to provide equitable, person-centered care. Multisensory tactile instruction such as TSD and ATP are vital for individuals with VI to receive from oral health-care providers.

Oral home care, such as brushing and flossing, can improve with active, hands-on correction from dental hygienists. Verbal encouragement and correction from the dental hygienist can be combined with the ATP method, allowing for active feedback while in the dental chair. Auditory feedback through the use of educational audio videos can solidify the learning that was done, and the patient can listen to these videos at home as well.

Adaptive tools, such as a toothbrush with a tactile buzzer timer for time and pressure or a water flosser with pulsing technology for movement along the gumline, can give real-time feedback to the patient and improve the effectiveness of home care.

Multisensory methods allow hygienists to bridge communication gaps and enhance patient comprehension and independence. These approaches not only improve clinical outcomes for individuals with low vision but also instill trust, empowerment, and inclusivity within the dental setting. By integrating multisensory techniques into practice, dental hygienists play a pivotal role in reducing barriers to care and promoting lifelong oral health for patients with VI.

Looking ahead

Children and adults are spending increasing amounts of time engaging with screens for work, education, entertainment, and social interaction. Concern is growing related to digital eye strain, including visual fatigue, dry eyes, and headaches.⁷ As the population ages and spends more time looking at devices, a greater number of patients may present with varying degrees of vision changes or visual difficulty, making multisensory oral health education even more important.

The importance of these multisensory skills will only continue to grow as future populations face an increased risk of vision issues. Clinical dental hygienists can proactively adapt to these emerging trends, ensuring they are educated to meet the evolving needs of future generations and continue delivering accessible, equitable oral health care.

In conclusion, understanding low vision and its impact on oral health care is essential for clinical dental hygienists who aim to provide equitable, evidence-based, person-centered care.

References

1. Varma R, Vajaranant TS, Burkemper B, et al. Visual impairment and blindness in adults in the United States. JAMA Ophthalmol. 2016;134(7):802. doi:10.1001/jamaophthalmol.2016.1284

2. Chan T, Friedman DS, Bradley C, Massof R. Estimates of incidence and prevalence of visual impairment, low vision, and blindness in the United States. JAMA Ophthalmol. 2018;136(1):12. doi:10.1001/jamaophthalmol.2017.4655

3. World Health Organization. Blindness and vision impairment. World Health Organization. Updated August 10, 2023. Accessed April 3, 2026. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment

4. Potes Gallego MP, Ríos Herrera N, Romero López SP, et al. Oral health in the visually impaired population: Literature review [in Spanish]. Rev Fac Cs Méd Univ Nac Córdoba. 2022;79(3):272-276. doi:10.31053/1853.0605.V79.N3.35265

5. Afsary Jahan Khan M, Ahmad MS, Sabri M. The implications of oral health education interventions in providing oral hygiene care for individuals with visual impairment: A systematic review. Spec Care Dent. 2023. doi:10.1111/scd.12940

6. Kumar R, Deshpande A, Ankola A, et al. Unleashing the most effective oral health education intervention technique for improving the oral hygiene status and oral health knowledge in visually impaired young individuals: A systematic review and meta-analysis. J Educ Health Promot. 2023;12:9. doi:10.4103/jehp.jehp_419_22

7. Mihalache A, Rahmdel P, Huang RS, et al. Association between screen time and guardian-reported vision difficulty in children and adolescents: A population-based analysis. AJO Int. 2025;2(4):100177. doi:10.1016/j.ajoint.2025.100177