1) Blindness can be defined and categorized in different ways such as total blindness, functional blindness, and legal blindness which refers to central visual acuity of 20/200 or less. 2) The leading causes of blindness worldwide are cataracts, glaucoma, trachoma, and childhood blindness. In developed countries, common causes include age-related macular degeneration, diabetic retinopathy, accidents, and glaucoma. 3) Management of blindness involves mobility training, use of assistive devices like long canes and guide dogs, reading aids such as magnifiers and braille, and adaptive technology including screen readers and refreshable braille displays.

1. MEDICAL SURGICAL NURSING- II
UNIT – II
NURSING MANAGEMENT OF PATIENTS WITH
DISORDERS OF EYE
TOPIC : BLINDNESS
PRESENTED BY
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)
LECTURER, MSN DEPARTMENT
CON- SRIPMS, COIMBATORE.

2. Helen Keller
Keller went on to become a world-famous speaker and author. She is
remembered as an advocate for people with disabilities, amid numerous other
causes.
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4. BLINDNESS

5. Bats, though not completely blind are said to not have
very good vision. The expression blind as a bat refers to
someone who doesn’t see very well without their glasses.
“Bats catch night flying insects on the
wing by listening to the echoes of their
own rapidly beating cries.”
“A blind man tapping with a cane- and hence
producing a regular sequence of sound pulses
is probably the closest human analog to the
remarkable sonar systems of the porpoise or
the bat.”
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6. In the United States, 6.5 million people over age 65
have severe visual impairment, which is defined as the
inability to read newsprint even with glasses. Of those
individuals, 9% have no useful vision, and the remaining 91%
are considered partially sighted. The partially sighted
individual may still have significant visual abilities.
A patient with visual impairment may be categorized by
the level of visual loss.
Total blindness is defined as no light perception and no
usable vision.
Functional blindness is present when the patient has
some light perception but no usable vision.

7. The patient with either total or functional blindness is
considered legally blind.
Legal blindness refers to central visual acuity of 20/200 or less
in the better eye with correction, or a peripheral visual field of 20
degrees or less. It is estimated that about 1.3 million people in the
United States are legally blind.
Almost all blindness in the United States is the result of
common eye diseases, including cataracts, glaucoma, age-related
macular degeneration, and diabetic retinopathy. Less than 4% of
blindness is the result of injuries.

8. BLINDNESS
• WHO definition of blindness
Visual acuity of less than 3/60 (Snellens) or its
equivalent
• In the absence appropriate vision charts (By
non-specialized personnel), the WHO has now
added the “Inability to count fingers in
daylight at a distance of 3 meters” to indicate
less than 3/60 or its equivalent.

9. The problem
world
• 180 million people worldwide are visually disabled,
of them 45 million are blind
• 80% of blindness is avoidable.
• Major cause of blindness and their estimated
prevalence are
– Cataract 19 million
– Glaucoma 6.4 million
– Trachoma 5.6 million
– Childhood blindness > 1.5 million
– Other 10 million
32% of world’s blind are aged 45-59
years 58% are >60 years old

10. CAUSES OF BLINDNESS
In developed countries
• Accidents, glaucoma, DM, vascular disease,
cataract & degeneration of ocular tissue
Leading causes of childhood blindness
• Xerophthalmia, congenital cataract, congenital
cataract, congenital glaucoma & optic atrophy.

11. EPIDEMIOLOGICAL DETERMINANTS
• Age:
– In children & young: Refractive error, trachoma,
conjunctivitis, malnutrition.
– In adults: cataract, refractive error, glaucoma, DM
• Sex:
– Higher prevalence of trachoma, conjunctivitis and
cataract in women leading to higher prevalence of
blindness in women

12. • Malnutrition:
– Infectious diseases of childhood especially measles &
diarrhoea
– PEM
– Severe blinding corneal destruction due to vit. A
deficiency in first 4 to 6 years of life.
• Occupation:
– People working in factories, workshop, industries are
prone to eye injuries because of exposure to dust,
airborne particles, flying objects, gases, fumes,
radiation.

13. • Social class:
– Surveys indicate that blindness twice more
prevalent in poorer classes than in the well to do.
• Social factors:
– Basic social factors are ignorance, poverty, low
standards of personal and community hygiene and
inadequate health care services.

14. CATEGORIES OF VISUAL IMPAIRMENT
CATEGORIES OF VISUAL
IMPAIRMENT
Visual acuity
Maximum less than Minimum equal to or
better than
Low vision 1 6/18 6/60
2 6/60 3/60
Blindness 3 3/60 (finger counting
at Three meters)
1/60 (finger counting at
One meter)
4 1/60 (finger counting
at One meter)
Light perception
5 no light perception

15. ONCHOCERCIASIS
“An estimated 17.7 million persons, most of them in Africa, are
infected with the parasite Onchocerca volvulus. Onchocerciasis has
caused blindness in 270,000 and left another 500,000 with severe
visual impairment. Onchocerciasis also can cause disfiguring skin
changes, musculoskeletal complaints, weight loss, changes in immune
function, epilepsy, and growth arrest. “
XEROPHTHALMIA
Vitamin A deficiency remains a major cause of pediatric ocular
morbidity. Over five million children develop xerophthalmia
annually, a quarter million or more becoming blind.
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16. • History collection
• Physical examination
• Visual acuity testing
• Ophthalmoscopy
Diagnosis

17. PREVENTION OF BLINDNESS
The components for action in national
programmes for the prevention of blindness
comprise the following
• Initial assessment
• Methods of intervention
– primary eye care
– secondary care
– tertiary care
– specific programmes
• Long term measures
• Evaluation

18. • Initial assessment
– Assess the magnitude, geographic distribution,
and causes of blindness within the country by
prevalence survey.

19. METHODS OF INTERVENTION
• Primary eye care
– Wide range of eye conditions can be treated or prevented
at grass root level by locally trained health workers who
are first to make contact with the community.
– They are also trained to refer the difficult cases to the
nearest PHC or district hospital.
– Their activities also involve promotion of personal
hygiene, sanitation, good dietary habits and safety in
general.
– The final objective is to increase the coverage ans quality
of eye health care through Primary health care approach
and thereby improve the utilization of existing resources.

20. • Secondary care:
– Involves definitive management of
common blinding conditions as cataract,
trichiasis, entropion, ocular trauma,
glaucoma.
– It is provided in PHCs and district hospitals where
eye depts are established.
– May involve the use of mobile eye clinics
– The great advantage of this strategy is, it is
problem specific and makes best use of local
resources and provides inexpensive eye care to
the population at the peripheral level.

21. • Tertiary care
– Established in the national or regional capitals and
are often associated with medical colleges and
institutes of medicine.
– Provide sophisticated eye care such as retinal
detachment surgery, corneal grafting which
are not available in the secondary centres.
– Other measures of rehabilitation
comprise education of blind in the special
schools & utilisation of their services in
the gainful employment.

22. • Specific programmes
– Trachoma control
– School eye health services: Screening and
treatment , Health education
– Vit.A prophylaxis
– Occupational eye health services

23. NATIONAL PROGRAMME FOR CONTROL
OF BLINDNESS
• Launched in 1976
• 100 % centrally sponsored programme
• It incorporates the earlier trachoma control
programme started in the year 1968
• Goal: To reduce the prevalence of blindness
from 1.4 to 0.3% by 2000.
• In the year 2006-07: prevalence was 1.0%

24. LONG TERM MEASURES
– Aimed at improving quality of life
– Modifying or attacking the factors responsible for
the persistence of eye health problems.
• Poor sanitation
• Lack of adequate safe water supply
• Poor nutrition
• Lack of personal hyegine

25. MANAGEMENT
Mobility
• Many people with serious visual impairments can travel
independently, using a wide range of tools and techniques.
• Orientation and mobility specialists are professionals who
are specifically trained to teach people with visual
impairments how to travel safely, confidently, and
independently in the home and the community.
• These professionals can also help blind people to practice
travelling on specific routes which they may use often, such
as the route from one's house to a convenience store.
• Becoming familiar with an environment or route can make it
much easier for a blind person to navigate successfully.

26. Folded long cane
A blind man is assisted by a guide dog

27. Reading and magnification
• Most visually impaired people who are not totally blind read
print, either of a regular size or enlarged by magnification
devices.
• Many also read large-print, which is easier for them to read
without such devices.
• A variety of magnifying glasses, some handheld, and some
on desktops, can make reading easier for them.
• Others read braille (or the infrequently used Moon type), or
rely on talking books and readers or reading machines,
which convert printed text to speech or braille.
• They use computers with special hardware such
as scanners and refreshable braille displays as well as
software written specifically for the blind, such as optical
character recognition applications and screen readers.

28. Braille watch

29. • Some people access these materials through agencies for
the blind, such as the National Library Service for the Blind
and Physically Handicapped in the United States,
the National Library for the Blind.
• Closed-circuit televisions, equipment that enlarges and
contrasts textual items, are a more high-tech alternative to
traditional magnification devices.
• There are also over 100 radio reading services throughout
the world that provide people with vision impairments with
readings from periodicals over the radio.
• The International Association of Audio Information
Services provides links to all of these organizations.

30. Computers and mobile technology
• Access technology such as screen readers, screen
magnifiers and refreshable braille displays enable the blind
to use mainstream computer applications and mobile
phones.
• The availability of assistive technology is increasing,
accompanied by concerted efforts to ensure the accessibility
of information technology to all potential users, including the
blind.
• Later versions of Microsoft Windows include an Accessibility
Wizard & Magnifier for those with partial vision, and Microsoft
Narrator, a simple screen reader.

31. • macOS and iOS also come with a built-in
screen reader called VoiceOver, while Google
TalkBack is built in to most Android devices.
• Experimental approaches in sensory
substitution are beginning to provide access to
arbitrary live views from a camera.
• Modified visual output that includes large print
and/or clear simple graphics can be of benefit
to users with some residual vision.

32. Other aids and techniques
Blind people may use talking equipment such
as thermometers, watches, clocks, scales, calculators,
and compasses.
They may also enlarge or mark dials on devices such as
ovens and thermostats to make them usable.
Other techniques used by blind people to assist them in
daily activities include:
•Adaptations of coins and banknotes so that the value
can be determined by touch. For example:
• In some currencies, such as the euro, the pound
sterling and the Indian rupee, the size of a note
increases with its value.

33. A tactile feature on a Canadian banknote

34. Communication
• Communication with the visually impaired can
be more difficult than communicating with
someone who doesn't have vision loss.
• However, many people are uncomfortable
with communicating with the blind, and this
can cause communication barriers.

36. 1. What type of blindness is caused by a
parasite?
2. What is the world’s leading cause of
blindness?
3 Which type of blindness is the second leading
cause of blindness in the world?
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QUIZ

37. 
1. 1. Onchocerciasis
2. 2. Cataracts
3. 3. Glaucoma


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ANSWERS

39. NATIONAL PROGRAMME FOR CONTROL
OF BLINDNESS
• Launched in 1976
• 100 % centrally sponsored programme
• It incorporates the earlier trachoma control
programme started in the year 1968
• Goal: To reduce the prevalence of blindness
from 1.4 to 0.3% by 2000.
• In the year 2006-07: prevalence was 1.0%

40. STRATEGY OF PROGRAMME:
• Strengthening service delivery
• Developing human resource for eye care
• Promoting out-reach activities & public
awareness
• Developing institutional capacity
• To establish eye care facilities for every 5 lac
persons.

41. REVISED STRATEGIES:
• More comprehensive by strengthening services for other
causes of blindness
• To shift from eye camp approach to fixed facility surgical
approach and from conventional surgery to IOL
implantation.
• To expand World bank project like building eye care
infrastructure all over country
• To strengthen the participation of Voluntary organization
in programme and to earmark geographical areas to
NGOs.
• To enhance coverage of eye care services in tribal and
other under served areas

42. ORGANIZATIONAL STRUCTURE FOR NPCB

43. SCHOOL EYE SCREENING PROGRAMME
• 6-7 % children age to 10-14 years – Eye sight
problem
• Children – screened by school teachers.
• Suspected refractive error are seen by
ophthalmic assistants & spectacles are
prescribed free of cost.

44. COLLECTION & UTILIZATION OF DONATED EYE
• 40,000 donated eyes every year
• Hospital retrieval programme- major strategy
for collection of eyes.
• Eye donation fortnight-25th Aug to 8th Sept

45. Vision 2020: The Right to Sight
• Global initiative to reduce avoidable
(Preventable and curable) blindness by the
year 2020.
• Main features:
– Target Diseases
– Human resource development and infrastructure
and technology development.

46. PROPOSED STRUCTURE FOR VISION 2020:
THE RIGHT TO SIGHT