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Prevention of blindness

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Prevention of blindness

  1. 1. Community OphthalmologyCommunity Ophthalmology J.B. ChandJ.B. Chand Himalaya Eye HospitalHimalaya Eye Hospital Pokhara, NepalPokhara, Nepal
  2. 2. Community Ophthalmology ? – It represents a conceptual shift from individualized eye care delivery system to community directed approach aimed at the improvement of the ocular health of the entire community – Comprehensive strategy for providing Promotive, Preventive, Curative and Rehabilitative eye care services to the community
  3. 3. Blinding Eye Diseases • Cataract • Glaucoma • Diabetic Retinopathy – Occurs everywhere – Affects Individuals – Affects mainly adults – Requires surgery/Laser – Needs an eye doctor • Hospital Based • Trachoma • Onchocerciasis • Vit A deficiency – Focal disease – Affects Communities – Starts in Children – Require s medicine – No need eye doctor • Community Based Both are Essential
  4. 4. Prevention of Blindness Four important question to be asked when considering prevention of blindness – What is blindness? Definition – How many are blind? Magnitude – Why are people blind? Aetiology – What can we do? Control
  5. 5. Definition of Blindness • WHO has classified visual impairment and blindness into various grade: 6/6-618 Normal vision <6/18-6/60 Visual impairment <6/60-3/60 Severe visual impairment <3/60-NPL Blind (Best available correction in the better eye)
  6. 6. An overview of the Blindness • Many countries in the world have used different definition for designating somebody as blind in view of the prevailing local conditions
  7. 7. Defining Blindness • Economic Blindness: – The level of blindness that prevents an individual from earning his wages. – Vision less then 6/60 with the better eye with best correction • Legal Blindness – The level of blindness that necessitates welfare measures and legal protection – Vision less then 6/60 in better eye with best correction and visual field less then 10 degree.
  8. 8. Defining Blindness.. • Social Blindness – Hampers an individual from socially interacting with the family and peer groups in a satisfactory manner – Vision less then 3/60 with the better eye with best correction • Manifest Blindness – Constraints the accomplishment of tasks for daily living leading to impairment in mobility and corresponding to a vision of 1/60
  9. 9. Defining Blindness.. • Absolute Blindness – Inability to perceive light secondary to irreversible damage to the nerve carrying the visual signals can be classified as absolute blindness (optic atrophy) • Curable Blindness – The stage of blindness where the damage is reversible by prompt management. – Cataract is an example of curable blindness
  10. 10. Defining Blindness.. • Preventable Blindness – The loss of vision that could have been completely prevented by institution of effective preventive and prophylactic measures – Xerophthalmia and trachoma are the example of preventable blindness • Avoidable Blindness – The sum total of preventable and curable blindness is often referred to as avoidable blindness. 90% of blindness in our country is avoidable
  11. 11. Defining Blindness.. • Incurable Blindness – The stage of blindness that can not be treated, prevented and cured and refers to absolute blindness is called incurable blindness. 5-10% of all blindness may fall in this category.
  12. 12. Magnitude • There are 161 million visually impaired people in the world of which 37 million are blind (WHO: 2002) • Prevalence of the blindness is varies in different part of world according to economy and health care
  13. 13. Magnitude Economy and Health Care % Blind Blind Per Million Good 0.25 2500 OK 0.50 5000 Poor 0.75 7500 Very poor 1.00+ 10000+
  14. 14. Global Causes of Blindness 2002 Causes % Cataract 47.8 Glaucoma 12.3 ARMD 8.7 Corneal opacities 5.1 Diabetic retinopathy 4.8 Childhood blindness 3.9 Trachoma 3.6 Onchocerciasis 0.8 Other 13
  15. 15. Nepal: Causes of Blindness 1981 SN Causes % 1 Cataract 72 2 Retinal disease 3.3 3 Glaucoma 3.2 4 Other infection 3.2 5 Trachoma 2.4 6 Smallpox 2.2 7 Trauma 2.2 8 Amblyopia 1.3 9 Nutritional etiology 0.9 10 Miscellaneous 7.5 11 Undetermined 1.8 Total 100
  16. 16. Aetiology • Asia: – Cataract, Trachoma, Corneal disease, Glaucoma and Vitamin A deficiency • Africa: – Cataract, Trachoma, Corneal disease, Glaucoma, Vitamin A deficiency and Onchocerciasis. • Latin America: – Cataract, Glaucoma & Diabetic retinopathy • North America and Europe: – ARMD, Diabetic retinopathy &Glaucoma
  17. 17. Trends in Global Blindness Year Number of Blinds (Millions) 1975 28 1984 31 1990 38 1995 35 2000 50? 2002 37
  18. 18. Causes of Increasing Blindness • Increasing in population • Increasing in life expectancy • Inadequate eye care services • Lack of awareness to seek eye care services • Poverty
  19. 19. Control • Blindness can be control by the different level of prevention – Primary Prevention – Secondary Prevention – Tertiary Prevention
  20. 20. Primary Prevention • To prevent the disease to ever occurring • Example: – VADX Good nutrition – Trachoma Good water & sanitation – Rubella & measles Immunization
  21. 21. Secondary Prevention • To prevent loss of vision from established disease • Example: – Cataract Surgery – Glaucoma Medical & surgical – Diabetic retinopathy Medical & laser T/T – Refractive error Spectacles – Onchocerciasis Medical treatment (Ivermectin)
  22. 22. Tertiary Prevention • Restore vision to a blind person • Example: – Cataract Surgery – Corneal scarring Keratoplasty – Low vision Low vision aids
  23. 23. Where do Most blinds Live? • Most blind people live in developing countries –India 9 million –Africa 7 million –China 6 million
  24. 24. Important Activities for PBL • Every where: – Cataract service delivery – Screening and treatment of refractive error • Focal diseases: – Vitamin A supplementation and dietary counseling – SAFE strategy for trachoma – Ivermectin distribution for ochocerciasis • Specialist service: – Glaucoma – Diabetic retinopathy – Childhood blindness
  25. 25. Thank You

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