BlindnessBlindnessDr. Gopalrao Jogdand, M.D. Ph.D.Dr. Gopalrao Jogdand, M.D. Ph.D.

Professor & Head,Professor & Head,Department of Community Department of Community

MedicineMedicine

DefinitionDefinition Visual acuity less than 3/60 by Visual acuity less than 3/60 by

Snellen’s chart.Snellen’s chart. Economic blindness: Such level of Economic blindness: Such level of

visual acuity, where an individual is visual acuity, where an individual is not able to earn the livelihood.not able to earn the livelihood.

Categories of visual Categories of visual impairmentimpairment

Level of visual Level of visual impairmentimpairment

Maximum or less Maximum or less thanthan

Minimum Minimum equal to or equal to or better thanbetter than

Low visionLow vision 1. 6/181. 6/182.6/602.6/603. 3/603. 3/60

1. 6/601. 6/602. 3/602. 3/603. 1/60 3. 1/60

BlindnessBlindness 1/601/60No light No light

perception.perception.

Light Light Perception.Perception.

Magnitude of the problemMagnitude of the problem Global: It is estimated that 180 Global: It is estimated that 180

million people are visually impaired million people are visually impaired of them 45 million people are blind.of them 45 million people are blind.

India: The prevalence of blindness is India: The prevalence of blindness is 77% and 68 lakh people are blind as 77% and 68 lakh people are blind as per W.H.O. statistics.per W.H.O. statistics.

Major causes of blindnessMajor causes of blindness Global: cataract 19 million people are Global: cataract 19 million people are

affected globally.affected globally. Glaucoma: 6.4 million.Glaucoma: 6.4 million. Trachoma: 5.7 million.Trachoma: 5.7 million. Childhood blindness: More than 1.5 Childhood blindness: More than 1.5

million.million. Onchocerciasis: 0.29 million.Onchocerciasis: 0.29 million. Other causes: 10 million.Other causes: 10 million.

Causes of blindness in IndiaCauses of blindness in India Cataract: 62.6%.Cataract: 62.6%. Refractive errors: 19.7%.Refractive errors: 19.7%. Glaucoma: 5.8%.Glaucoma: 5.8%. Posterior segment Pathology: 4.7%.Posterior segment Pathology: 4.7%. Corneal opacity: 0.9%Corneal opacity: 0.9% Other causes: 6.2%Other causes: 6.2%

Epidemiological factorsEpidemiological factors Age: 30% of the blind loose their Age: 30% of the blind loose their

eyesight before the age of 20 years eyesight before the age of 20 years and many in this category loose eye and many in this category loose eye sight before the age of 5 years.sight before the age of 5 years.

Many loose their eye sight at 20-40 Many loose their eye sight at 20-40 years of age due to various reasons.years of age due to various reasons.

62.6% people loose their eye sight 62.6% people loose their eye sight due to Cataract.due to Cataract.

Continued….Continued…. Nutritional blindness: Vitamin a Nutritional blindness: Vitamin a

deficiency leads to childhood blindness, deficiency leads to childhood blindness, major manifestation of low vitamin A major manifestation of low vitamin A intake from dietary sources.intake from dietary sources.

Occupation: Occupational injuries are Occupation: Occupational injuries are the most common cause of blindness in the most common cause of blindness in working population.working population.

Social class: Twice more common in Social class: Twice more common in poor population as compared to the poor population as compared to the rich.rich.

Changing concepts in Changing concepts in ophthalmic careophthalmic care

Primary eye care: Inclusion of eye care in Primary eye care: Inclusion of eye care in primary health care delivery system and primary health care delivery system and delivered through it, objective is to delivered through it, objective is to improve the quality and coverage of eye improve the quality and coverage of eye care.care.

Epidemiologic approach: Used as a tool to Epidemiologic approach: Used as a tool to find out the prevalence/incidence of find out the prevalence/incidence of diseases causing blindness. Finding out diseases causing blindness. Finding out risk factors for the same and determine risk factors for the same and determine the action needed.the action needed.

Continued….Continued…. Team approach: As the availability of Team approach: As the availability of

ophthalmic surgeon is scarce, govt. ophthalmic surgeon is scarce, govt. has inducted ophthalmic assistants, has inducted ophthalmic assistants, multipurpose workers, village health multipurpose workers, village health guides and the services of voluntary guides and the services of voluntary health agencies for providing eye health agencies for providing eye care to rural/tribal population.care to rural/tribal population.

Continued….Continued…. Commissioning of the National Commissioning of the National

Program: Increasing recognition of Program: Increasing recognition of application of primary health care application of primary health care approach to blindness control has approach to blindness control has resulted in development of a resulted in development of a comprehensive blindness control comprehensive blindness control program at the national level. The goal program at the national level. The goal of this program was to reduce blindness of this program was to reduce blindness to 0.3% by the year 2000 A.D.to 0.3% by the year 2000 A.D.

Components of the National Components of the National blindness control programblindness control program

Initial assessment: First step is to Initial assessment: First step is to find out the magnitude, geographic find out the magnitude, geographic distribution and causes of blindness distribution and causes of blindness in the country. Objective is to set up in the country. Objective is to set up the priorities and development of the priorities and development of suitable interventions.suitable interventions.

Methods of interventionMethods of intervention Primary eye care: Wide range of eye Primary eye care: Wide range of eye

conditions can be treated at grass conditions can be treated at grass root level by locally trained health root level by locally trained health workersworkers

Secondary eye care: Involves the Secondary eye care: Involves the management of diseases like management of diseases like cataract, glaucoma, trichiasis, cataract, glaucoma, trichiasis, entropion etc at the secondary level entropion etc at the secondary level i.e. PHC and District hospitals.i.e. PHC and District hospitals.

Continued….Continued…. Tertiary eye care: Delivered through Tertiary eye care: Delivered through

medical colleges and super specialty medical colleges and super specialty hospitals they provide sophisticated hospitals they provide sophisticated eye care like retinal detachment eye care like retinal detachment surgery, corneal grafting and other surgery, corneal grafting and other sophisticated forms of eye care.sophisticated forms of eye care.

Specific programsSpecific programs Trachoma control: National Trachoma Trachoma control: National Trachoma

Control Program which started in 1963 Control Program which started in 1963 is now merged with National program is now merged with National program for control of blindness in 1976.for control of blindness in 1976.

School eye health services: Screening of School eye health services: Screening of school children for preventable ocular school children for preventable ocular morbidities, e.g. refractive errors, vit. A morbidities, e.g. refractive errors, vit. A deficiency, squint, trachoma etc.deficiency, squint, trachoma etc.

Continued….Continued…. Occupational eye services: Provisions Occupational eye services: Provisions

are made to provide eye care to the are made to provide eye care to the workers on campus through the workers on campus through the industrial medical officer and a industrial medical officer and a occupational nurse. Minor injuries occupational nurse. Minor injuries and ailments are treated on campus, and ailments are treated on campus, for serious injuries referral is given.for serious injuries referral is given.

Control of Nutritional Control of Nutritional blindnessblindness

Vitamin A prophylaxis: Under this Vitamin A prophylaxis: Under this program 200000 I.U. of vitamin A is program 200000 I.U. of vitamin A is given to the children in the age given to the children in the age group 1-6 years at the interval of 6 group 1-6 years at the interval of 6 months. The children are kept under months. The children are kept under surveillance for five years to monitor surveillance for five years to monitor the signs of Vitamin A deficiency i.e. the signs of Vitamin A deficiency i.e. Xeropthalmia.Xeropthalmia.

Long term policyLong term policy Creating awareness in the population Creating awareness in the population

regarding the importance of regarding the importance of consumption of foods rich in vitamin consumption of foods rich in vitamin A, maintenance of good personal A, maintenance of good personal hygiene, control of poor hygiene, control of poor environmental sanitation, supply of environmental sanitation, supply of adequate and safe water. These are adequate and safe water. These are long term interventions to bring out long term interventions to bring out the improvement in eye care. the improvement in eye care.

Evaluation of the programEvaluation of the program Like any other health program evaluation Like any other health program evaluation

of the National blindness control program of the National blindness control program should be an integral part, to know the should be an integral part, to know the impact of the program. To know to which impact of the program. To know to which extent ophthalmic diseases and blindness extent ophthalmic diseases and blindness is controlled, assess the manner and is controlled, assess the manner and degree to which program activities are degree to which program activities are carried out and determine the changes carried out and determine the changes that may have been produced.that may have been produced.

Role of National and Role of National and International AgenciesInternational Agencies

The National Association for the blind The National Association for the blind (NAB) is working in this field since 1952 (NAB) is working in this field since 1952 it is providing welfare services to the it is providing welfare services to the blinds.blinds.

The Royal Society for the blind is active The Royal Society for the blind is active in the country since 1950.in the country since 1950.

International Agency for the prevention International Agency for the prevention of blindness is a W.H.O. initiative for of blindness is a W.H.O. initiative for preventing blindness globally.preventing blindness globally.

Continued….Continued…. Danish International Development Danish International Development

Agency (DANIDA) It is providing Agency (DANIDA) It is providing support to the National Blindness support to the National Blindness control Program in the form of control Program in the form of training of personnel, direct technical training of personnel, direct technical co-operation and funding for the co-operation and funding for the program. It is the initiative of DANIDA program. It is the initiative of DANIDA that doctors in this country are that doctors in this country are trained in community ophthalmology.trained in community ophthalmology.

Vision 2020Vision 2020 The right to sight is a global initiative The right to sight is a global initiative

started by W.H.O. on 18started by W.H.O. on 18thth February February 1999.1999.

The objective of vision 2020 is to The objective of vision 2020 is to assist member countries in assist member countries in developing a sustainable system developing a sustainable system which will enable them to eliminate which will enable them to eliminate avoidable/preventable blindness by avoidable/preventable blindness by the year 2020.the year 2020.

Thank YouThank You