2. INTRODUCTION
There are an estimated 9 million blind in
sub-Saharan Africa and a further 27 million
people are visually impaired.
This represents the highest regional burden
of blindness ratio in the world.
The number of blind in sub-Saharan Africa is
going to increase to 15 million by 2020
unless measures are taken to counter the
problem.
3. Intro ...
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There are about 45 million blind people, and 135
million visually disabled in the world.
About 90% of these live in developing countries.
Zambia has a high incidence and prevalence of
blindness with the Luapula Valley contributing
significantly to the total number of blind persons.
Blindness can occur in combination with such
conditions as mental retardation, autism
spectrum disorders, cerebral palsy, hearing
impairments, and epilepsy.
Blindness in combination with hearing loss is
known as ‘deafblindness’.
4. Definition
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i. Blindness is defined as Best Corrected
visual Acuity (BCVA) of 20/400 to no light
perception.
ii.The clinical definition of blindness is the
absence of light perception; NLP (no light
perception).
iii. Blindness is the condition of lacking
vision perception due to physiological or
neurological factors.
5. WHO Definition ...
iv. Blindness: Vision in a person's best eye of
20/400 or less than 20/500 or a visual field of
less than 10 degrees.
7. Classification/Types
1. Low Vision
This is blindness where the patient has
some light perception but has no usable
vision. It is described as a state of visual
impairment that requires the use of devices
and strategies in addition to corrective
lenses to perform visual tasks. It is defined
as BCVA of 20/70 to 20/200.
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2. Total or Complete Blindness
This is the blindness where the patient
cannot perceive light and has no usable
vision. This can be defined as absolute
blindness with no light perception.
Totally blind people are not able to
differentiate between dark and light.
9. Classification ...
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In practice, the definition depends on
individuals' visual acuity and the extent to
which their field of vision is restricted. The
Department of Health identifies three groups
of people who may be classified as severely
visually impaired.
Those below 3/60 (equivalent to 20/400 in
US notation) Snellen (most people below
3/60 are severely sight impaired),
10. Classification ...
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Those better than 3/60 but below 6/60
Snellen (people who have a very contracted
field of vision only),
Those 6/60 Snellen or above (people in this
group who have a contracted field of vision
especially if the contraction is in the lower
part of the field),
11. CAUSES OF BLINDNESS
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The following are the causes of blindness;
Diseases
Most visual impairments are caused by
diseases and malnutrition.
According to WHO estimates in 2002, the
most common causes of blindness around
the world are:
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Abnormalities and injuries
Eye injuries, most often occurring in
people under 30, are the leading cause of
monocular blindness (visual loss in one
eye).
Abnormalities include entropion and
trichiasis.
People with injuries to the occipital lobe
of the brain can, despite having
undamaged eyes and optic nerves, can
still be legally or totally blind.
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Genetic defects
People with albinism often suffer from visual impairment
to the extent that many are legally blind, though few of
them actually can see.
Childhood blindness can be caused by conditions
related to pregnancy, such as congenital rubella
syndrome and retinopathy of prematurity.
Poisoning
A small portion of all cases of blindness are caused by
the intake of certain chemicals. E.g methanol
breaks down into the substances
formaldehyde and formic acid which in
turn can cause blindness, an array of
other health complications, and death.
15. Causes of blindness ...
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Xerophthalmia: Xerophthalmia is estimated to
affect 5 million children each year; 500,000
develop active corneal involvement, and half of
these go blind.
Cortical blindness: Results from injuries to the
occipital lobe of the brain that prevent the brain
from correctly receiving or interpreting signals
from the optic nerve. Symptoms of cortical
blindness vary greatly across individuals and
may be more severe in periods of exhaustion or
stress. It is common for people with cortical
blindness to have poorer vision later in the day.
16. PREVENTION OF BLINDNESS
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Prevention of blindness is done at three levels;
Primary prevention: this involves preventing
diseases and conditions which may bring about
blindness e.g. vitamin A supplementation to
prevent vitamin A deficiency which may cause
corneal ulceration hence blindness, good
nutrition, immunisation against measles.
17. Prevention ...
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Encourage the vulnerable to have good
nutrition with the necessary nutrients e.g.
eating food rich in vitamin A such as carrots.
Educating the community on the importance
of hand and eye hygiene to prevent
conditions like trachoma.
18. Prevention ...
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Educate the community on the good eye care
measures and seeking medical advise in time
in case of eye infection.
Discourage the use of over the counter drugs
or self prescribed medication as they may
cause more harm and damage to the eye.
Many training schools in the region with
inadequate training programmes and output,
resulting in an insufficient number of
ophthalmic staff trained.
19. Prevention ...
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Educate the community to avoid eye injuries
by wearing protective glasses for high risk
jobs such as welding or metal work.
Educate the community on the importance of
regular eye screening or check up and not
just to wait when there's evidence of
infection.
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Secondary prevention: this involves early
identification and treatment of conditions
and diseases which may predispose an
individual to blindness e.g. trachoma,
diabetes and corneal ulcers.
Tertiary prevention: this involves treating
blinding conditions such as cataract to
restore sight.
21. Rehabilitation
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Rehabilitation is the process of making a blind
person to be as independent as possible.
Training for a blind person focuses on some
major areas:
i. Independent Living Rehabilitation
Services to eligible blind and visually impaired
persons are provided so that they can
function independently in their homes and
communities.
22. Rehabilitation ...
Services include the teaching of alternative
techniques in the activities of daily living,
communication skills in the medium that is
best utilized by the individual, and
homemaking activities.
This training enables someone who is blind
to orient themselves in their environment
and to travel safely from point to point
without assistance.
23. Rehabilitation ...
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Always inform them when you are leaving the
room.
Orient them where the food is served. E. g
plate with nshima placed at 3 o’clock, relish
at 9 o’clock, a cup of water at 12 o’clock and a
side plate at 6 o’clock.
Orient them on the main corners of the house,
where the toilets, shower facilities are found
and any steps or stairs within the house to
avoid accidental falls.
24. Rehabilitation ...
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A new person entering the room where they
are, should inform them and introduce them
selves.
Orient them on the current currency in
circulation i.e some currencies' banknotes
have a tactile feature to indicate
denomination.
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The primary tool is the white mobility cane.
By making use of other senses, and by
special techniques, the one who is blind
will learn to do almost all of the normal
activities of life without assistance.
Cooking, cleaning, laundry, shopping,
caring for children, etc., can all be easily
mastered with training from rehabilitation
specialists.
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The inability to read or write is one of the
greatest disappointments for those who
become blind.
To make reading possible once again, teach
the braille system.
Created by Louis Braille in 1824, this system
makes use of raised dots which are
recognizable by touch.
The tips of the fingers are moved across the
raised dots from left to right in the same
manner that an eye would scan a printed
page.
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With this system, the blind person can once
again read and write, in either English or any
other language.
Any literature, math, music scores, or even
scientific notation can be made readable in
braille.
Many of the tasks that a blind person might
need to do are made possible by the use of
adapted equipment.
For instance, talking calculators take the
place of normal calculators.
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Talking watches take the place of regular
watches.
Braille typewriters substitute for regular
typewriters.
Much of the specialized equipment and
materials needed by blind people is not
available in Zambia.
To help meet this need, we need to import
and stock many of the items needed by
blind people.
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The items most needed are:
braille writing slates,
white mobility canes,
talking watches,
talking calculators,
talking blood pressure kits,
talking thermometers,
braille typewriters,
and special software and hardware to allow
a blind person to use a computer.
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Occupational Training
The blind should be introduced to
occupational counselors on the need to
change occupation if necessary. They may be
introduced to jobs such as switch board
operation so as to earn a living
Recreation
The blind are entitled to recreation, therefore
they are taught different forms of recreation
such as board games, playing guitars,
keyboards, pianos
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Financial Aid
The blind should be given free education,
sunglasses to cover their damaged eyes as well
as free transport. Financial support and loans
must be accessible.
Community support
The community to be sensitized on the need to
regard the blind as potential contributors to
community and national development, and to
participate in their care e.g. help to cross roads
35. Vision 2020:The Right to Sight
•Vision 2020 is a global initiative that aims to
eliminate avoidable blindness by the year 2020.
It was launched on 18 February 1999 by the
World Health Organisation (WHO) together with
more than 20 international non-governmental
organisations involved in eye care and
prevention and management of blindness.
36. Objectives
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VISION 2020: The right to sight accomplishes its
mission as it attains the three major objectives:
Raise the profile among the key audiences of the
causes of avoidable blindness and the solutions that will
help to eliminate the problem.
Identify and secure the necessary resources around the
world in order to provide an increased level of
prevention and treatment Programmes.
Facilitate the planning, development and
implementation of the three core Vision 2020 strategies
by National Programmes.
37. Core Strategies
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Disease Control
Facilitate the implementation of specific
programmes to control and treat the major
causes of blindness
Human Resource Development
Support training of Ophthalmologists and other
eye care personnel to provide eye care.
Infrastructure and appropriate technology
development
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Infrastructure and appropriate technology
development
Assist to improve infrastructure and technology
to make eye care more available and accessible.
41. Gender and blindness
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Globally about 50 million people are blind,
and of this figure 64% are women.
This figure could increase by 2020 unless
increased efforts are made to prevent
blindness.
It is estimated that 80% of blindness is
preventable.
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Blindness increases with age
As life expectancy increases in the country,
rates of blindness for women, and overall
totals, can be expected to increase as life
expectant rate for women is slightly higher
than men.
Blindness in women is devastating.
This is because women are expected to do
most of the house work therefore it may be
difficult for them to marry sighted men.
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Having this in mind we need to influence
policy-making and the development of
blindness prevention programs.
Peer motivators in prevention should also
be trained as they may be more effective
than health workers in promoting the use
of eye care services.
44. Community Services for the Blind
•Rehabilitation: Certified teachers instruct
program participants in meal preparation,
reading and writing braille, keyboard skills,
labeling and selecting clothes, and using
specially adapted equipment. Specialists
teach safe and effective travel techniques
with the aid of a cane and hand-held
telescopes. Clients learn to orient themselves
to the community and use public
transportation, for increased independence.
45. Community Services for the Blind …
•Computer Technology Center: During one-on-
one training, clients use computers equipped
with speech and screen enlargements
programs. Students learn how to scan
documents, work using word processing and
spreadsheets, database applications, and
access the internet.
46. Community Services for the Blind …
•Specialized services: The Specialized
Services Team offers eighteen support
groups such as Life Skills, Assertiveness
Training, Men’s and Women’s Groups, a Multi-
lingual Support Group, shopping services,
and recreational activities.
47. Community Services for the Blind …
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Radio Information Center for the Blind: RICB
is a 24-hour radio reading service that is
broadcasted throughout.
The center broadcasts on topics ranging
from news, weather, and sports, to problems
and treatments, and much more.
