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
 Definition

“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.”
 CATEGORIES OF VISUAL IMPAIRMENT

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

Categories of visual Visual acuity

impairment
Maximum Minimum
< than = 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 Light perception
counting at 1
meter)
1 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
Establishment of National Prog.
> Need for PHC approach

Team Concept
Deprofessionalisation
VHG, Ophthalmic assistant,
MPW, Voluntary agencies

Epidemiological Approach
Measurement of Incidence, prevalence,
risk factors of disease

Primary eye care

Promotional & protection of eye health
On the spot treatment of commonest eye diseases
Improve coverage and quality
AGENT-
Trachoma, Vit A def.

EPIDEMIOLOGICAL
HOST- DETERMINANTS

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
ENVIRONMENT- DETERMINANTS

 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

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

Initial Assessment

Methods of
Evaluation Intervention
Components for action in N.H.P.
Primary care
Secondary care
Tertiary care
Specific programmes

Long term measures

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 , corneal

Grafting

 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.
7) 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.
1) VIT A PROPHYLAXIS
 2 lakh IU given 6 monthly 1-6 yrs.,
surveillance
3) OCCUPATIONAL EYE HEALTH SERVICES
 Education, protective devices, improve safety
of machines, proper illumination, pre
placement examination.
 3)
1)
LONG TERM MEASURES
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.

4) Health Education
 Create community awareness of the problem
 Motivate community to accept total eye health
programmes.
 To secure community participation.

9) 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

Prof. leadership,
strategy.developmnt,
CME,Standards,quality
assurance, Research. C.O.E.
20
Training centers
Tertiary care
including retinal
surg.,Corneal
transplant.
200
Service Centers 2000
Cataract Surgery
Othr common eye surg.
Facilities for refraction
Referral services

Vision Centers 20,000

Refraction and prescription of glasses
Primary eye care
School eye screening
Screening and referral services
Thank You