Rudra Narayan Chowdhury presented a document summarizing blindness and related national programs in India. The document defined blindness according to WHO criteria and discussed the magnitude of visual impairment worldwide and in India. It identified the major causes of blindness as cataract, glaucoma, and uncorrected refractive errors globally and cataract as the leading cause in India. The national program for control of blindness was launched in 1976 with the goal of reducing blindness prevalence, and Vision 2020 is a global initiative to reduce avoidable blindness by 2020.

1. NAME – RUDRA NARAYAN
CHOWDHURY
ROLL NO.– 17101100
SERIAL NO.– 72 MBBS 2017-18

2. BLINDNESS
AND ITS RELATED
NATIONAL PROGRAMME
DATE-12.08.2020

3. CONTENTS
 INTRODUCTION
 THE PROBLEM
 CAUSES OF BLINDNESS
 EPIDEMIOLOGICAL DETERMINANTS
 PREVENTION OF BLINDNESS
 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
 VISION 2020

4. INTRODUCTION
 A compilation published by WHO in 1966 lists 65 definitions of blindness.
 The 25th World Health Assembly in 1972 noted the complexity of the problem
and considered the need for a generally accepted definition of blindness and
visual impairment for national and international comparability.
 Taking into consideration existing definitions, the WHO proposed a uniform
criterion and defined blindness as "visual acuity of less than 3/60 (Snellen) or
its equivalent".
 The term "low vision" included in the previous revision has been replaced by the
categories 1 and 2 to avoid confusion with those requiring low vision care.

5.  The current WHO International Classification of Diseases (ICD-10)
describes the levels of visual impairment as shown in Table below:

6. THE PROBLEM

7. WORLD
 In 2010, an estimated 285 million people worldwide were visually
disabled, of whom nearly 39 million were blind and 246 million were with
low vision, about 90 per cent of them living in developing countries.
About 80 per cent of blindness is avoidable (treatable or potentially
preventable).
 The major causes of blindness and their estimated prevalence are cataract
(33 per cent); glaucoma (2 per cent); and uncorrected refractive errors
(myopia, hyperopia or astigmatism (43 per cent). The number of people
visually impaired from infectious disesases has greatly reduced in the last
20 years.

8.  About 82 per cent of all people who are visually impaired are aged 50
years and older, while this age group comprises about 20 per cent of the
world's population.
 An estimated 19 million children are visually impaired. Of these, 12
million children are visually impaired due to refractory errors, a condition
that could be easily diagnosed and corrected. 1.4 million are irreversibly
blind for the rest of their lives
 Overall, visual impairment worldwide has decreased since the early 1990s.
This decrease is principally the result of a reduction of visual impairment
from infectious diseases through public health action.

9. INDIA
 The estimated prevalence of blindness in India for the year 2004 was
about 11.2 per 1000 population, of this 0.1 per 1000 population was in
age group 0-14 years, 0.6 in age group 15-49 years, and 77.3 in 50+ years
age group. In men the prevalence was 10.2 per 1000 population and in
women 12.2 per 1000 population.
 According to rapid national survey on blindness 2006-07, the prevalence
rate reduced from 1.1 per cent to 1.0 per cent and estimated national
prevalence of childhood blindness/low vision was 0.8 per 1000.

10. CAUSES
OF
BLINDNESS

11. WORLD
 The most frequent causes of blindness in developed countries are
accidents, glaucoma, diabetes, vascular diseases (hypertension), cataract
and degeneration of ocular tissues especially of the retina, and hereditary
conditions.
 In South-East Asia Region, cataract is the single most common cause of
blindness being responsible for 50-80 per cent of all blindness.
 Among the leading causes of childhood blindness in the region are
xerophthalmia, congenital cataract, congenital glaucoma and optic
atrophy due to meningitis, retinopathy of prematurity, and uncorrected
refractive errors.

12. INDIA
 The National Survey on Blindness 2006-07 conducted in the country
recognized the main causes responsible for visual impairment and
blindness.

13. EPIDEMIOLOGICAL
DETERMINANTS

14. AGE & SEX
 About 30 per cent of the blind in India are said to lose their eyesight before they
reach the age of 20 years, and many under the age of 5 years.
 Refractive error, trachoma, conjunctivitis and malnutrition (vitamin A deficiency)
are important causes of blindness among children and the younger age groups;
cataract, refractive error, glaucoma and diabetes are causes of blindness in
middle age; accidents and injuries can occur in all age groups, but more
importantly in the age group 20 to 40 years.
 A higher prevalence of blindness is reported in females than in males in India.
This has been attributed to a higher prevalence of trachoma, conjunctivitis and
cataract among females than in males

15. MALNUTRITION
 Malnutrition as a cause of blindness was hardly recognized a few years
ago. It is closely related not only with low vitamin A intake, but also with
infectious diseases of childhood especially measles and diarrhea (which
precipitate malnutrition).
 In many cases protein energy malnutrition (PEM) is also associated with
blindness. Severe blinding corneal destruction due to vitamin A deficiency
(e.g., keratomalacia) is largely limited to the first 4-6 years of life and is
especially frequent among those 6 months to 3 years of life.

16. OCCUPATION
 It has long been recognized that people working in factories, workshops
and cottage industries are prone to eye injuries because of exposure to
dust, airborne particles, flying objects, gases, fumes, radiation (usually
welding flash), electrical flash, etc.
 Many workers including doctors are known to have developed premature
cataracts while exposed to X-rays, ultraviolet rays or heat waves.

17. SOCIAL CLASS AND SOCIAL FACTORS
 There is a close relationship between the incidence of blindness and
socioeconomic status. Surveys indicate that blindness is twice more
prevalent in the poorer classes than in the well-to-do.
 Many people lose their eyesight because of meddlesome ophthalmology
by quacks. The basic social factors are ignorance, poverty, low standard
of personal and community hygiene, and inadequate health care services.

18. PREVENTION
OF
BLINDNESS

19. COMPONENTS FOR ACTIONS
• Initial assessment
• Methods of intervention
– primary eye care
– secondary care
– tertiary care
– specific programmes
• Long term measures
• Evaluation

20. INITIAL ASSESSMENT
 The first step is to assess the magnitude, geographic distribution and
causes of blindness within the country or region by prevalence surveys.
 This knowledge is essential for setting priorities and development of
appropriate intervention programmes.

21. 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 and quality of eye health care through
Primary health care approach and thereby improve the utilization of existing
resources.

22.  SECONDARY EYE 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.

23.  TERTIARY EYE 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.

24.  SPECIFIC PROGRAMMES
• Trachoma control
• School eye health services: Screening and treatment , Health education
• Vit.A prophylaxis
• Occupational eye health services

25. 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 hygiene

26. EVALUATION
 Evaluation should be an integral part of intervention programmes to
measure the extent to which ocular diseases. and blindness have been
alleviated, assess the manner and degree to which programme activities
have been carried out, and determine the nature of other changes that
may have been produced

27. 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%
 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.

28. 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.

29. PROPOSED STRUCTURE OF VISION 2020

30. THANK YOU