BY
Dr Shahzad Akhtar Aziz
Learning Objectives
Define blindness, Enlist its causes in community *
Discuss epidemiology of blindness
Discuss the role of vitamin A in the prevention of
*blindness
Explain changing concepts in eye care vision 2020
DEFINITIONS
BLINDNESS:VISUAL ACUITY OF LESS THAN 3/60
OR ITS EQUIVALENT.
LOW VISION:VISUAL ACUITY OF LESS THAN 6/ 18
BUT ≥ 3/60 OR CORRESPONDING TO VISUAL
FIELD LOSS TO LESS THAN 20° IN THE BETTER
EYE WITH BEST POSSIBLE CORRECTION.
AVOIDABLE BLINDNESS:BLINDNESS WHICH
COULD BE EITHER TREATED OR PREVENTED BY
KNOWN COST-EFFECTIVE MEANS.
THE PROBLEM:
WORLDWIDE
161 m PEOPLE ARE VISUALLY IMPAIRED-
124m LOW VISION
37m BLIND
ANOTHER 153m SUFFER FROM VISUAL
IMPAIRMENT DUE TO UNCORRECTED
REFRACTIVE ERRORS
>90% OF WORLD’S VISUALLY IMPAIRED LIVE IN
LOW AND MIDDLE INCOME COUNTRIES.
EXCEPT IN MOST DEVELOPED
COUNTRIES,CATARACT REMAINS THE MOST
COMMON CAUSE OF BLINDNESS.
UPTO 75%S OF ALL BLINDNESS IN ADULTS IS
AVOIDABLE THROUGH PREVENTION AND
TREATMENT.
INFECTIOUS CAUSES HAVE DECREASED
GLOBALLY .THE NUMBER OF PEOPLE AFFECTED
BY BLINDING TRACHOMA HAS DECREASED
FROM 360m TO 80m PRESENTLY.
AN ESTIMATED 1.5m CHILDREN 50YRS.
GENDER:HIGHER IN FEMALES
MALNUTRITION:VIT.A DEFICIENCY ,INFECTIOUS
DISEASES OF NEW BORN.
OCCUPATION:
SOCIAL CLASS:HIGHER IN LOW SOCIO-
ECONOMIC STATUS.
GEOGRAPHICAL:>90% IN DEVELOPING
COUNTRIES( SE ASIA:27%)
REASONS FOR HIGH PREVALENCE
IN PAKISTAN:
SIZE OF POPULATION
LIFE EXPECTANCY
RURAL AREAS HAVE POOR ACCESS TO EYE CARE
FACILITIES
INADEQUATE AVAILABILITY OF TRAINED HEALTH
PERSONNELS
POOR NUTRITIONAL STATUS OF MOTHER AND YOUNG
CHILDREN
ADVERSE ENVIRONMENTAL CONDITIONS AND DOMESTIC
UNHYGIENE CONDITIONS.
LACK OF COMMUNITY AWARENESS & POOR HEALTH
SEEKING BEHAVIOUR
PREV. OF MYTHS & MISCONCEPTIONS ABOUT SURGERIES.
PREVENTION OF BLINDNESS
Concept of avoidable blindness
(i.e.,preventable or curable blindness)by
Improving nutrition, treating cases of infectious
diseases or by improving safety conditions.
Components for action in National programmes for
prevention of blindness comprise the following;
CONTD.
1…INITIAL ASSESSMENT
2…METHODS OF INTERVENTION
a)Primary eye care
b)Secondary eye care
c) Tertiary eye care
d)Specific programmes
3…LONG TERM MRASURES
4…EVALUATION
INITIAL ASSESSMENT
First step is to assess magnitude ,geographic
distribution and causes of blindness within the
country or region by prevalence surveys.
This knowledge is essential for setting priorities &
development of appropriate intervention programmes
METHODS OF INTERVENTION
PRIMARY EYE CARE
Primary eye care is based firmly in primary health care
which is…essential health care….made universally
accessible to individuals & families in the community
through their full participation & at a cost that the
community and country can afford.(Alma Ata
declaration 1978).
CONTD…
Primary health workers must be trained for wide range of eye
conditions i.e,acute conjunctivitis, ophthalmic neonatorum,
superficial foreign bodies & Xerophthalmia.
For this purpose they are provide with essential drugs such as
topical tetracycline, vitamin A capsule, eye bendages,sheilds
etc.
They are also trained to refer difficult cases e.g. corneal ulcers,
penetrating foreign body,painfull eye conditions and chronic
infections.
Their activities involve promotion of personal
hygiene,sanitation,good dietary habits % safety in general.
SECONDARY EYE CARE
It involves definitive management of common
blinding conditions such as cataract, trichiasis,
entropion, occular trauma, glaucoma etc.
This care is provide in PHC’s and district
hospitals where eye departments are
established.
TERTIARY CARE
These services are usually established in the regional
capitals or major cities & are often associated with
Medical colleges& Institutes of Medicine.They provide
sophisticated eye care such as retinal detachment
surgery, corneal grafting & other complex forms of
management not available in secondary centres.
SPECIFIC PROGRAMMES
1. Trachoma control
• Early diagnosis & treatment will cure trachoma
• Topical tetracyclines &improved socioeconomic status
1. School eye health services
• Screening of students for refractive errors, squint,
amblyopia, trachoma
• Health Education ,students taught to practice principals
of good posture, proper lighting, avoidance of glare
&proper distance between books& eye.
1. Vitamin A prophylaxis
2. Occupational eye health services
•VISION 2020:
•The Right to Sight
• ADVOCACY in Action
• WORKING TOGETHER TO ELIMINATE AVOIDABLE
BLINDNESS
Working together to eliminate
avoidable blindness
VISION 2020:
The Right to Sight
is the
global initiative for the
elimination of
avoidable blindness,
a joint programme of
the World Health
Organization and the
International Agency
for the Prevention
of Blindness,
together with its
global membership of
NGOs, professional
bodies, institutions &
corporations.
• Launched 1999
• Facilitating development & implementation of national eye care
plans
• Collaboration between private organisations & public
(government) agencies, International Agency for the Prevention
of Blindness (IAPB)Founded 1975
• Umbrella organisation leading global efforts for the prevention of
blindness
• Over100 members:
• 80+ International NGOs,
• Global professional peak bodies – optometry & ophthalmology
• World-leading academic & medical institutions
• Concerned corporations & foundations
• World Blind Union
VISION 2020 Advocacy With
Governments
• VISION 2020 workshops –
reaching 150 countries
• National prevention of
blindness committees
established in 118 countries
• National eye care plans in 104
countries
• Recent examples:
• Indian government commitment of
USD$265m
• Pakistani government committed
$50m