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<article xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>The Ontological Treatment of Sight and Blindness</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Patrick L. Ray</string-name>
          <email>plray@buffalo.edu</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Alexander P. Cox</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Mark Jensen</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Travis Allen</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Alexander D. Diehl</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>The State University of New York at Buffalo Buffalo</institution>
          ,
          <addr-line>NY</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
      <pub-date>
        <year>2014</year>
      </pub-date>
      <fpage>39</fpage>
      <lpage>42</lpage>
      <abstract>
        <p>-There have been relatively few attempts to represent sight or blindness ontologically. This is unsurprising as the related phenomena of sight and blindness are surprisingly difficult to represent ontologically for a variety of reasons. This paper discusses those reasons, explores the current attempts to represent sight or blindness, and how these attempts fail at representing certain types of blindness, viz., color blindness and flash blindness. We then explore a possible solution to representing sight and blindness ontologically. The solution capitalizes on the resources afforded to one who adopts the upper-level Basic Formal Ontology. Roughly, we characterize sight as a function and blindness as a reduction in the conditions under which the sight function is realized.</p>
      </abstract>
      <kwd-group>
        <kwd>ontology</kwd>
        <kwd>sight</kwd>
        <kwd>blindness</kwd>
        <kwd>function</kwd>
        <kwd>disposition</kwd>
        <kwd>color blindness</kwd>
        <kwd>flash blindness</kwd>
        <kwd>Basic Formal Ontology</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>I. INTRODUCTION</p>
      <p>
        In its most basic form, blindness is the impairment of visual
function below a certain threshold. Where this threshold lies
varies depending on context. The World Health Organization
characterizes blindness as visual acuity of less than 20/500 or a
visual field of less than 10 degrees [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. In the United Kingdom,
the Certificate of Visual Impairment characterizes blindness as
visual acuity of less than 20/400 [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. In the United States, the
American Medical Association characterizes blindness as
visual acuity of less than 20/200 or a visual field of less than 20
degrees [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. This indicates that the standards of blindness vary
across international borders. Furthermore, there are the recent
calls by the International Council of Ophthalmology to define
blindness and visual impairment according to their own
standards, at least part of which involve visual substitution
skills employed by persons [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. Moreover, visual acuity only
represents one dimension of blindness. There are other types of
visual impairments that fall beyond the scope of visual acuity –
such as the ability or inability to differentiate color. Blindness
then has many types and presents in degrees.
      </p>
      <p>There are two obvious problems with representing and
defining blindness and visual loss. First, different groups use
different standards of measurement. Second, different
standards of classification can be used while adopting a single
standard of measurement. The primary difficulty arising from
these problems is that it is exceedingly difficult to gather and
compare data on blindness and vision related disorders. In
addition, there are more complex problems that arise in
representing blindness in formal ontology. This paper explores
the difficulties that arise in representing blindness ontologically
and proposes a novel solution to these problems.</p>
    </sec>
    <sec id="sec-2">
      <title>II. REPRESENTING BLINDNESS ONTOLOGICALLY</title>
      <p>Seeing is a relational process in Basic Formal Ontology
(BFO). The process is a relation between an agent who detects
and processes stimuli from the environment (external to the
agent herself) and the stimulus itself. The process of seeing is
representational insofar as the agent represents the stimulus in
some manner (we will leave the nature of this representation to
further examination). The diminishment or cessation of this
relational process is often characterized as loss of vision or
blindness. The main subject of this paper will be an
examination of the loss of vision (seeing) in formal ontology.</p>
      <p>
        Currently there are very few ontologies that seek to
represent blindness. The reasons for this are as follows: first, it
is rather difficult to characterize an entity via a lack or absence,
which seems to be the case with blindness (the lack of sight)
[
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. Metaphysically speaking, it is unclear whether a lack is
ontologically significant. Taking the paradigm case of
ontological absence involving material entities, a hole, there
does not even seem to be anything to which one can attribute
characteristics at all. This seems to indicate at least a prima
facie problem with characterizing entities via lacks; if one is
defined by a lack, then there are all sorts of things that seem to
count at least when it is both a necessary and sufficient
condition. Although a strategy for representing a lack of a part
in the context of anatomy has emerged, it is contentious
whether such a strategy will translate well for functions
(dispositions) as the latter are not material entities [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
      </p>
      <p>
        Second, blindness does not seem to yield a precise
definition or even clearly differentiated conditions under which
it is present or absent. Many cases of blindness are progressive
and it will be exceedingly difficult to determine at which point
blindness has come into existence. Many cases present in
degrees, which is common with the degeneration of the eye or
apparatuses associated with vision. In addition to these
complications, there is controversy over the threshold for
blindness. It is common for publications regarding blindness to
specify which definition of ‘blindness’ they employ [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ].
      </p>
      <p>Even with these complications regarding blindness, we feel
it is useful to give a univocal account of the phenomenon for
purposes of ontological development. Such an account should
capture all or a vast majority of the cases of blindness and the
various classifications of blindness found in the literature.
Thus, it should remain general and flexible enough to capture a
wide range of characterizations yet it should also be rigid
enough as to remain informative and insightful.</p>
      <p>There are many types of blindness. It is also the case that
blindness can be defined relative to a context. For example,
there is color blindness and change blindness, which both seem
to be types of blindness themselves. An individual might be
legally blind but still be able to detect some light stimulus – or
one might be blind enough to be prohibited from flying a jet
aircraft but not blind enough to be prohibited from driving. In
this way, we might say that someone is ‘blind according to [x]’
where [x] is some standard of evaluation for sightedness. In
this sense it can be said that blindness comes in degrees. The
extent to which someone has a lack of sight or cannot see will
be graded. If we think of seeing or sight as a relational process
between an agent who is representing and the thing represented
and the accuracy of such representations ranging from 1
(complete representational veracity) and 0 (no representational
veracity), blindness will be somewhere on the continuum from
0 to 1 – the closer to 0 one's representation of stimulus, the
more blind that individual is. Given the above considerations,
one might draw the conclusion that there does not seem to be
an ontological category that corresponds to what blindness is as
an entity – blindness could be an amalgam of loosely related
entities or something that is not itself ontologically well
formed. While this conclusion is tempting, we do not find it to
be satisfactory.</p>
      <p>
        Lending to the confusion surrounding the status of
blindness (and sight) is the method used for assessing visual
acuity. Typically, visual acuity is expressed as a relationship
between two values – the distance a subject stands from an
optical chart, and distance at which a normal subject would
stand from the chart to discern the same visual detail. Putting
aside the problems associated with this particular type of visual
acuity assessment, we have discussed above how this can lead
to confusion regarding what conditions are indicative of
blindness [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ].
      </p>
      <p>It is useful for clinicians and researchers to have a coherent
theory of blindness that encompasses the range of conditions
commonly understood to be forms of blindness. We
simultaneously realize that blindness seems to be characterized
as relative or context-sensitive (the term itself might be
context-sensitive or the phenomenon might be
contextOntology</p>
      <p>Definition</p>
      <p>Term
Gene Ontology (GO)</p>
      <p>Visual perception
sensitive or both). We favor the view that the term ‘blindness’
denotes a single phenomenon reflecting severe visual
impairment relative to a particular context of evaluation. Thus,
‘blindness’ denotes an ontologically well-formed category.</p>
      <p>Attempts to characterize blindness using current ontologies
yields the results listed in table 1.</p>
      <sec id="sec-2-1">
        <title>B. Some Preliminary Distinctions</title>
        <p>
          According to the framework we have adopted, functions
are a type of disposition. Functions are realizable entities that
are realized in processes (what are sometimes called
‘functionings’). Because functions are non-accidental, all of the
functions a given entity possesses are intimately tied to the type
of entity under examination, whether the entity is biological or
artifactual. Functions are internally-grounded realizable entities
so changing the physical structure of its bearer may alter the
realization of the function in question; and if the function
ceases to exist, the bearer must be changed physically [
          <xref ref-type="bibr" rid="ref5">5</xref>
          ].
        </p>
        <p>We think that sight is a BFO function of visual systems (or
at least visual systems of creatures with higher-order cognitive
functions). One of the reasons we have for maintaining this
proposition is that sight appears to be a result of an
evolutionary process and the various mechanisms of sight for
biological organisms straightforwardly seem the product of
evolution. For non-biological entities possessing sight, if any,
the sight that they possess is not accidental, but rather a product
of design or intention on the part of the creator. This is
consistent with with the non-accidental nature of functions.</p>
        <p>Another reason to think that sight is a function is that it is
realized by processes grounded in a material entity. This is a
hallmark of a function as described above. Furthermore,
another reason that sight is a function lies in the fact that if
sight ceases to exist, then the bearer is physically changed.
Although the entities still have the sight function, it is that they
cannot realize that function due to some change in their
physical constitution. Thus, there are many good reasons to
support the assertion that sight is a function.
Decreased visual acuity</p>
        <p>Loss of visual acuity or ability to distinguish small details
The series of events required for an organism to receive a visual stimulus, convert
it to a molecular signal, and recognize and characterize the signal. Visual stimuli
are detected in the form of photons and are processed to form an image.
The series of events in which a visible light stimulus is received by a cell and
converted into a molecular signal. A visible light stimulus is electromagnetic
radiation that can be perceived visually by an organism; for organisms lacking a
visual system, this can be defined as light with a wavelength within the range 380
to 780 nm.</p>
        <p>The series of events involved in visual perception in which a light stimulus is
received and converted into a molecular signal.</p>
        <p>The determination of the type or quality of a sensation. Sensory modalities
include touch, thermal sensation, visual sensation, auditory sensation and pain.
Loss of the sense of sight.</p>
        <p>Inability or decreased ability to see.</p>
        <p>N/A
A blindness that is characterized by the inability or decreased ability to see color,
or perceive color differences, under normal lighting conditions.</p>
        <p>Blindness is the condition of lacking visual perception due to physiological or
neurological factors.
Parent Class
Sensory
perception of
light stimulus
Detection of
light stimulus
Visual
perception
Sensory
processing
Abnormal
vision
Abnormal eye
physiology
Abnormal
visual acuity
Retinal disease
Blindness
Visual
Impairment
GO
GO
GO
MP
MP
DO
Mammalian
Phenotype (MP)
Human Disease
Ontology (DO)</p>
        <p>Proceeding with the proposition that sight is a function, we
can characterize the specific type of function it is by
identifying its defining features. Employing such a strategy, we
characterize sight as the function to receive photons and
interpret them as visual information. Relatedly, we can
characterize seeing as the process by which photons are
interpreted as visual information. Having given an account of
sight as the realization of a function, it is then natural to
identify the process by which the sight function is realized as
vision.</p>
        <p>
          An additional feature of functions (dispositions) and their
functionings (realization processes) is that they are associated
with certain triggering processes under which they are realized.
The nature of this association is currently the subject of
discussion in BFO but this much is clear: the relationship
between the realization of a disposition and the disposition
itself is mediated by the trigger, and the triggering process is
connected to the realization process (perhaps causally) such
that the presence of the trigger and the disposition lead to the
realization of the disposition. For example, a sample of salt has
a disposition to dissolve when placed in water. The realization
process would be the physical mechanism of the dissolving
process while the triggering process (or trigger) is the salt and
water being together such that the process can manifest the
disposition to dissolve. Although there are few attempts to
formalize such entities as triggers, they are a commitment of
BFO [
          <xref ref-type="bibr" rid="ref6">6</xref>
          ].
        </p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>III. TWO INTERESTING CASES</title>
      <p>The reasons for thinking that sight is a function realized by
a vision process in higher-order animals detailed in the last
section provide our initial motivation. This section details two
cases of blindness or types of blindness according to this
account of sight.</p>
      <sec id="sec-3-1">
        <title>A. Color Blindness</title>
        <p>
          Color blindness is a condition wherein an individual has an
inability to distinguish between two or more colors. In some
cases the two wavelengths of light are represented or
interpreted as the same when they are distinct. In other cases,
an individual cannot report a difference between two or more
wavelengths of photons [
          <xref ref-type="bibr" rid="ref7">7</xref>
          ]. The inability to distinguish
between two or more types of light is not limited to just one
cone type [
          <xref ref-type="bibr" rid="ref8">8</xref>
          ]. Complicating this picture somewhat is that there
are many mechanisms identified as causes of color blindness
and that these mechanisms are not localized to one anatomical
region. Some color blindness is due to an individual lacking
cone cells or a certain type of cone cell. Other times the cause
is cortical [
          <xref ref-type="bibr" rid="ref9">9</xref>
          ]. Thus, color blindness is similar to other types of
blindness in that the causes and mechanisms associated with it
are diverse and complex.
        </p>
      </sec>
      <sec id="sec-3-2">
        <title>B. Flash Blindness</title>
        <p>
          Flash blindness is a type of blindness that results from
exposure to sudden-onset bright light. The sudden light will
oversaturate the photopigments of the retina and the individual
will be unable to convert photons to a neural signal due to this
oversaturation [
          <xref ref-type="bibr" rid="ref10">10</xref>
          ]. Flash blindness is commonly temporary
blindness, where the subject regains their full ability to see
within a few minutes. There are some extreme cases, however,
where flash blindness will result in permanent vision loss [
          <xref ref-type="bibr" rid="ref11">11</xref>
          ].
        </p>
      </sec>
      <sec id="sec-3-3">
        <title>C. Current Solutions</title>
        <p>
          Given the above discussion, it seems that there should exist
the resources to represent blindness. One of the most likely
candidate solutions involves using the Human Disease
Ontology (DO). DO currently does not provide a definition of
blindness but one plausible candidate posited on their behalf
would follow their characterization of color blindness as an
inability or decreased ability to detect light stimulus. Color
blindness in DO is defined as: “a blindness that is characterized
by the inability or decreased ability to see color, or perceive
color differences, under normal lighting conditions.” [
          <xref ref-type="bibr" rid="ref12">12</xref>
          ]
Moving from this definition of a specific type of blindness to
blindness generally should produce the result that blindness is
“the inability or decreased ability to see or perceive, under
normal lighting conditions.”
        </p>
        <p>While an attractive view in general and one to which we are
mostly sympathetic, such a definition of blindness will not
stand up to careful examination. In the first place, DO
categorizes blindness as a disease. Blindness is not a disease.
Moreover, it is not a type of retinal disease as DO currently
characterizes it. Blindness may result from many diseases and
many diseases will complicate blindness and the sightedness of
individuals, but is not itself a disease. But it may also be the
case that blindness does not result from a disease but rather a
single event, as is the case with flash blindness. It is also not
the case that blindness is limited to problems in the retina.
Cortical blindness is a type of blindness that does not involve
any malfunction with the retina. Even some specific types of
blindness are not limited to just one mechanism of realization
in one location, as detailed in the last section.</p>
        <p>These rather easily remedied problems notwithstanding, the
more pressing concern is that there does not seem to be any
indication of what an inability or decreased ability would be.
The concern is plain – abilities cannot lack according to BFO.
If abilities are dispositions or functions, then they are realizable
entities. Realizable entities cannot present in degrees, as their
existence is an all-or-nothing affair. If blindness is an inability
to detect light, then all cases of blindness will be a complete
inability to detect light stimulus, which fails to capture the
cases of blindness that are not the complete inability to detect
light stimulus. If blindness is a decreased ability to detect light,
then it cannot be represented as a decreased function or
disposition in BFO. But, since sight is a function, and blindness
is the lack of sight, we are left to wonder whether an account of
blindness can be given as an inability. We believe that this type
of account is confused.</p>
        <p>
          Another route for capturing blindness is to maintain that
blindness is a disorder, where a disorder is “[a] material entity
that is clinically abnormal and part of an extended organism.”
[
          <xref ref-type="bibr" rid="ref13">13</xref>
          ] The problem with this approach is that it is unclear that
blindness, as a phenomenon, is a material entity. If one thinks
that blindness is the absence of the sight function, then it does
not seem that blindness is a material entity (material entities are
not absences of functions). Further, one cannot point to a
material entity and identify it as blindness as blindness is not
spatially extended; but spatial extension is a hallmark of
material entities. For these reasons, blindness cannot be a
disorder.
triggers and dispositions in formal ontology. This discussion is
a step toward providing an account of causality in BFO.
        </p>
      </sec>
      <sec id="sec-3-4">
        <title>D. Proposed Solution</title>
        <p>Drawing on the lessons from the previous sections we
propose a solution to the problem that blindness poses for
ontology development. Because sight is a function and
blindness is seemingly the non-realization of the function that
is sight, we set forth an account of blindness where blindness is
a reduction of the conditions under which the disposition that is
the sight function is realized. To put it another way, the range
of the triggering processes is narrowed such that the sight
function is realized under a narrower range of conditions.</p>
        <p>This solution is able to deal with the cases outlined above.
For color blindness, we would say that color blindness is a
reduction in the (color) conditions under which a vision
function is realized. Although different types of color blindness
will involve different types of reduction of conditions, they
will be unified into a single phenomenon by the fact that they
all involve the reduction of the light wavelengths that result in
differentiated visual representation. For flash blindness, we say
that there is a temporary (or possibly permanent) reduction on
the conditions under which the vision function is realized –
whatever the mechanism realizing the function of sightedness
may be. Because the function is realized by a rather
complicated functioning in both cases, the type of blindness
can range over different types of failure in functioning so long
as the reduction of conditions is similar. One could also
classify types of blindness by the types of failure in sight
functionings, if one so chose.</p>
        <p>IV. DISCUSSION</p>
        <p>With the problems associated given the above
classifications of blindness we propose a new definition of
blindness that acknowledges the problems encountered with
previous definitions and seeks to capture the nature of the
phenomenon of blindness identified earlier. If blindness admits
of degrees, then it seems that blindness cannot be a function or
disposition. It also seems that blindness cannot be a lack of a
disposition or function because many things lack the function
yet should not be classified as blind. One of the options
available for defining blindness is to say that sight is the
function to receive photons and interpret them as visual
information and then proceed to define blindness as a reduction
of the conditions under which the disposition is realized
(trigger conditions).</p>
        <p>This view has certain advantages. First, it accounts for the
graded nature of blindness. The slow and sometimes gradual
onset of blindness raises special problems for ontology
construction as it admits of degrees and seemingly vague
boundaries. Second, it classifies sight as an internally-grounded
realizable entity, which makes use of the framework provided
by an upper-level ontology such as BFO. Third, it is
ontologically innocent in that there are no new entities to
countenance in any upper-level ontology. The entities that are
referenced in the theory we advocate are already present in
BFO and so there is no need to introduce new entities. Fourth,
such a treatment of blindness lends credence to discussions of</p>
        <p>The motivation of this project is to provide a simple yet
flexible ontological account of blindness. Since blindness is the
result of many ocular diseases, the construction of ontologies
that incorporate both blindness and the diseases that result in
blindness, either directly or indirectly, is of importance to the
biomedical community. But this is not a purely classificatory
exercise – the employment of the conditions under which a
disposition is realized (in this case a function) is a novel
application of a tool that has been available for ontological
developers for some time. It is the opinion of these authors that
this type of usage could yield further fruitful results.</p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>ACKNOWLEDGMENTS</title>
      <p>The authors would like to thank William Duncan and Isaac
Berger for their insights in commenting on this manuscript. We
would also like to thank three anonymous reviewers for helpful
comments.</p>
    </sec>
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