BLINDNESS

Presentation by

DR.VIOLET (de Sa) PINTO

Lecturer, Department of PSM

Objectives:

At the end of the session the student shall have

knowledge of : Blindness :definition, categories of visual impairment, its

causes and problem statement Changing concepts in healthcare with regards to eye

care Prevention of blindness :primary, secondary and tertiary

prevention Vision 2020

“Visual acuity of less than 3/60 (Snellen) or its equivalent.”

Non specialized personnel,

in absence of appropriate vision charts

“Inability to count fingers in daylight at a distance of 3 meters.”

Definition

CATEGORIES OF VISUAL IMPAIRMENT

If it is 6/18 or better = 0 or no visual impairment

Categories of visual impairment

Visual acuity

Maximum

< than

Minimum

= or > than

Low vision 1 6/18 6/60

2 6/60 3/60

Blindness 3 3/60 1/60(fingercounting at I

meter)

4 1/60(finger

counting at 1

meter)

Light perception

5 No light

perception

PROBLEM STATEMENT

Estimated 180 million people are visually disabled, nearly 45 million blind, 4 out of 5 living in developing countries.

Major causes…..cataract, glaucoma, trachoma, childhood blindness, onchoceriasis.

32% are aged 45-59 yrs, large majority 58% are over 60 yrs.

SEAR has 1/3rd of the world’s blind,50% of world’s blind children.

INDIA Causes of blindness Cataract 62.6% more with advancing age senile cataract- decade earlier Uncorrected 19.7% Refractive error Glaucoma 5.8% Posterior 4.7% segment pathology Corneal Opacity 0.9% Others 6.2% Injuries 1.2% cottage industry- carpentry, blacksmitty, stone crushing,

chiseling Congenital disorder, uveitis, retina detachment,tumours,diabetes,HT, diseases of nervous system, leprosy.

CHANGING CONCEPTS IN HEALTH CARE

Primary eye carePromotional & protection of eye health

On the spot treatment of commonest eye diseasesImprove coverage and quality

Establishment of National Prog.> Need for PHC approach

Team ConceptDeprofessionalisation

VHG, Ophthalmic assistant,MPW, Voluntary agencies

Epidemiological ApproachMeasurement of Incidence, prevalence,

risk factors of disease

AGENT-

Trachoma, Vit A def.

HOST-

Age- About 30% lose eyesight <20 yrs. children and young age group- refractive errors, trachoma, conjunctivitis, Vit A def. Middle age- Cataract, glaucoma& diabetes All ages, 20-40- accidents, injuries

Sex- trachoma, conjunctivitis, cataract-More in females, in India

EPIDEMIOLOGICAL DETERMINANTS

ENVIRONMENT-

Malnutrition- Vit A def.- even due to measles and diarrhoea PEM related- severe corneal destruction(keratomalacia)6mth- 3yrs.& 4 -6yrs.

Occupation – Cottage industry, workshops, factories, flying objects, gases.Doctors- x rays, u.v. rays, premature cataract

Social class – twice more prevalent in low social classes

EPIDEMIOLOGICAL DETERMINANTS

PREVENTION OF BLINDNESS

The concept of Avoidable blindness (preventable or curable) has gained recognition during the recent years.

Initial Assessment

Methods of Evaluation Intervention Primary care Secondary care Tertiary care Specific programmes Long term measures

Components for action in N.H.P.

1) INITIAL ASSESSMENT

Prevalence surveys – magnitude, distribution, causes

Setting priorities and development of appropriate intervention programmes.

2) METHODS OF INTERVENTION PRIMARY EYE CARE

Treatment and prevention at grassroot level by locally trained peripheral health worker. (VHG,MPW)

(acute conjunctivitis, opthalmia neonatrum,

trachoma, superficial foreign body, xeropthalmia)

Provided with essential drugs ; topical tetracycline, Vit A capsules, eye bandages, shields, etc.

Trained to refer difficult cases (eg. Corneal ulcer, penetrating foreign bodies, painful eye conditions & infections which do not respond to treatment) to nearest PHC & district hospital.

Promotion of personal hygiene, sanitation, good diet, safety in general.

Currently 1 VHG / 1000 population, 2 MPW / 5000 population.

SECONDARY CARE

Definitive management of common blinding conditions such as cataract, trichiasis, entropion, ocular trauma, glaucoma,etc.

PHC’s and district hospitals

where eye departments or eye clinics

are established.

Mobile clinics- Disadv- lacks permanence, adv- problem specific best use of local resource, provide inexpensive eye care

Eye camp approach- cataract, general eye health, surveys.

TERTIARY CARE

At National /Regional capitals, often associated with Medical colleges & institutes of medicine(National Institute for Blind, Dehradun)

Sophisticated eye care- retinal detachment , cornealGrafting

Eye banks- Maximum states passed Corneal grafting Acts

Education of blind in special schools and utilisation of their services (employment)

SPECIFIC PROGRAMMES

1) TRACHOMA CONTROL-

Endemic trachoma and associated infections, major cause of preventable blindness.

Early diagnosis and treatment Mass campaigns with topical teracycline Improvement of SE conditions TC Programme launched 1963. merged NBCP in 1976.

2) SCHOOL EYE HEALTH SERVICES- Screened & treated for refractive errors,

squint,ambylopia, trachoma H.E. – good posture, proper lighting, avoidance of glare,

angle between books and eye.

3) VIT A PROPHYLAXIS 2 lakh IU given 6 monthly 1-6 yrs.,

surveillance4) OCCUPATIONAL EYE HEALTH SERVICES Education, protective devices, improve safety

of machines, proper illumination, pre placement examination.

3) LONG TERM MEASURES1) Improving quality of life, modifying factors responsible for

persistence of eye health problems. Poor sanitation , lack of adequate safe water supplies,

increase intake of food rich in Vit A, lack of personal hygiene.

2) Health Education Create community awareness of the problem Motivate community to accept total eye health

programmes. To secure community participation.

4) EVALUATION Evaluation of objectives.

VISION 2020

“A global initiative to eliminate avoidable

blindness by WHO on 18th feb.1999.”

Objective: Assist member states in developing sustainable systems, which will enable them to eliminate avoidable blindness from major causes.

Plan of Action for country has following features:

Target diseases: Cataract, refractive errors, childhood blindness, glaucoma, diabetic retinopathy.

H.R.D. as well as infrastructure and technology developmnt. At various levels of health system.

Proposed 4 tier system

C.O.E. 20

Training centersTertiary care including retinal surg.,Corneal transplant. 200

Service Centers 2000Cataract SurgeryOthr common eye surg.Facilities for refractionReferral services

Vision Centers 20,000Refraction and prescription of glassesPrimary eye careSchool eye screening Screening and referral services

Prof. leadership, strategy.developmnt, CME,Standards,quality assurance, Research.

Prof. leadership, strategy.developmnt, CME,Standards,quality assurance, Research.

Thank You