The International Classification of Diseases 11 (2018) classifies vision impairment into two groups, distance and near presenting vision impairment. Distance vision impairment: Mild – visual acuity worse than 6/12 to 6/18 Moderate – visual acuity worse than 6/18 to 6/60 Severe – visual acuity worse than 6/60 to 3/60 Blindness – visual acuity worse than 3/60

1. BLINDNESS
BY
DR.N.JAYANTHI MS
Asst Professor
REH , KNL

2. DEFINITION
■ WHO defined blindness as visual acuity of less
than 3/60 or its equivalent

3. Categories of visual impairment
■ Mild - visual acuity worse than 6/12.
■ Moderate – visual acuity worse than 6/18.
■ Severe – visual acuity worse than 6/60.
■ Blindness – visual acuity worse than 3/60.

6. CAUSES OF BLINDNESS

8. What can we do to control blindness?
■ Blindness control can be planned at various levels.
■ The approach to planning and implementation of
blindness control measures should be based on the
following:
I. Strategy
II. Disease
III. Services
IV. Community

9. STRATEGIES
■ PRIMARY PREVENTION: prevention of the disease
occurring in the first place.
■ SECONDARY PREVENTION: prevention of visual loss
from the disease once it has occurred.
■ TERTIARY PREVENTION: restoration of sight to a blind
person.

10. DISEASE ORIENTED APPROACH
■ Provision of services for cataract surgery
■ Provision of vit A supplementation
■ Control of trachoma
■ Screening of school children for refractive errors
■ Distribution of ivermectin for onchocerciasis

11. SERVICES ORIENTED APPROACH
■ Primary Care Services :- Community level
■ Secondary Care Services :- Eye Clinic level
- Services are provided by general medical doctors and
non
ophthalmologists.
■ Tertiary Care Services :- Training or Referral centre
level
- Includes eye specialists.

13. COMMUNITY APPROACH
■ To restore and maintain good health in the community:
■ Good quality of food, water and a clean environment
■ Control and prevention of epidemics
■ Control of endemic diseases
■ Education
■ Improved level of maternal and child health

14. NATIONAL PROGRAMME FOR
CONTROL OF BLINDNESS
■ was launched in 1976.
■ Sponsored by central government
■ GOALS:
1. To provide comprehensive eye care facilities at all
levels.
2. To reduce prevalence of blindness from 1.38% to 0.31%
by 2000AD.

15. MAJOR FLIPS IN NPCB
■ Inclusion in Prime Minister’s 20 point programme in
1982.
■ Adoption of vision 2020: right to sight in 2001.

16. OBJECTIVES
■ Reduction in backlog of blindness through identification
and treatment of blinds.
■ Development and strengthening of comprehensive eye
care facilities in every district.
■ Development of human resources for providing eye care
services.
■ Improvement in quality of service delivery.

17. ■ Securing participation of voluntary organizations and
private practitioners in eye care.
■ Enhancement in community awareness on eye care.
■ Setting up mechanism for referral , coordination and
feedback between organizations dedicated to
prevention , treatment and rehabilitation.

18. PROGRAMME ORGANIZATION AND
IMPLEMENTATION
■ Various programme activities are implemented.
■ Central level
■ State level
■ District level.

19. CENTRAL LEVEL
■ In this programme three national bodies have been
constituted as below:
■ National Blindness Control Board, chaired by Secretary
Health to GOI.
■ National Programme Co-ordination Committee, chaired
by Additional Secretary to GOI.
■ National Technical Advisor Committee, headed by
Director General Health Services, GOI

20. ■ Central level activities include:
■ l. Procurement of goods (major equipments, bulk
consumables, vehicles, etc.)
■ 2. Non-recurring grant-in-aid to NGOs.
■ 3. Organizing central level training courses.
■ 4. Information, education and communication (IEC)
activities (prototype development and mass media).
■ 5. Development of MIS, monitoring and evaluation.
■ 6. Procurement of services and consultancy.
■ 7. Salaries of additional staff at the central level

21. STATE LEVEL
■ State-level activities include:
■ l. Execution of civil works for new units.
■ 2. Repairs and renovation of existing units/
equipments.
■ 3. State level training and IEC activities.
■ 4. Management of State Project Cell.
■ 5. Salaries for additional staff.

22. DISTRICT LEVEL
■ To organize the programme at district level, ‘District
Blindness Control Societies’ have been established.
■ District blindness control society The concept of ‘District
Blindness Control Society (DBCS)’ has been introduced, with
the primary purpose to plan, implement and monitor the
blindness control activities comprehensively at the district
level under overall control and guidance of the ‘National
Programme for Control of Blindness’.
■ This concept has been implemented after pioneering work
by DANIDA in five pilot districts in India. Objective of DBCS
establishment is to achieve the maximum reduction in
avoidable blindness in the district through optimal
utilisation of available resources in the district

23. ■ Need for establishment of DBCS was considered because
of the following factors:
1. To make control of blindness a part of the
Government’s policy of designating the district as the unit
for implementing various development programmes.
2. To simplify administrative and financial procedures.
3. To enhance participation of the community and the
private sector

24. Composition of DBCS
 Chairman: Deputy Commissioner/District Magistrate.
 Vice-Chairman: Civil Surgeon/District Health Officer.
 Member Secretary:
 Advisor of the society is the State
Programme Manager.
 Technical guidance is provided by the Chief
Ophthalmic Surgeon/Head of the
Ophthalmo-logy Department of Medical
College

25. ■ Revised strategies adopted for implementation of
programme at district level are:
1. Annual district action plan is to be submitted by DBCS.
Funding will be in two instalments through GOI/SBCS.
2. NGO participation made accountable; allotted area of
operation.
3. Revised guidelines for DBCS — capping of expenditure;
phasing out contract managers

26. 4. Emphasis on utilization of existing government
facilities.
5. Gradual shift from camp surgery to institutional
surgery.
6. Development of infrastructure and manpower for IOL
surgery

27. PLAN OF ACTION AND ACTIVITIES
■ The plan of action and activities of ‘National
Programme for Control of Blindness (NPCB) in India can
be described under three headings:
1. Extension of eye care services,
2. Establishment of permanent infrastructure
3. Intensification of eye health education

28. STRATEGIC PLAN FOR VISION 2020:
THE RIGHT TO SIGHT IN INDIA
■ The draft plan of action submitted by the ‘Working
Group’ to the Ministry of Health and Family Welfare
Govt. of India in August, 2002 includes following
strategies:
A. Strengthening advocacy
B. Reduction of disease burden
C. Human resource development, and
D. Eye care infrastructure development

29. STRENTHENING ADVOCACY
■ The essence of these activities is:
■ Public awareness and information about eye care and
prevention of blindness.
■ Introduction of topics on eye care in school curricula.
■ Involvement of professional organizations such as All
India Ophthalmological Society (AIOS), Eye Bank
Association of India (EBAI) and Indian Medical
Association (IMA) in the National Programme for Control
of Blindness

30. ■ To strengthen the functioning of District Blindness
Control Society (DBCS).
■ To enhance involvement of NGOs, local community
societies and community leaders.
■ To strengthen hospital retrieval programmes for eye
donation through effective grief counselling by involving
volunteers, Forensic Deptt., Police etc

31. Reduction of disease burden
(disease-specific approach)
■ Target diseases identified for intervention under ‘Vision
2020’ initiative in India include:
■ Cataract,
■ Childhood blindness,
■ Refractive errors and low vision,
■ Corneal blindness,
■ Diabetic retinopathy,
■ Glaucoma, and Trachoma (focal)

32. CATARACT
■ Cataract continues to be the single largest cause of
blindness.
■ According to latest National Survey in India (1999-
2001), 62.6% of blindness in 50 + population of India was
found to be cataract related.
■ Objective: To improve the quantity and quality of
cataract surgery

33. TARGETS
■ To increase the cataract surgery rate to 4500 per million per
year by 2005, 5000 by 2010, 5500 by 2015 and 6000 by 2020.
■ To improve the visual outcome of surgery to conform to
standards set by WHO (i.e., 80% to have visual outcome
6/18 or >6/18 after surgery).
■ IOL surgery for >80% by the year 2005 and for all by the year
2010.
■ YAG capsulotomy services at all district hospitals by 2010.

34. STRATEGIC ACTIVITIES
■ Primary screening by community health worker.
■ Case selection by eye surgeon at screening camps
■ Cataract extraction with IOL implantation to be done
free of cost for bilateral cases and under served poor
people
■ Reduction in disparities

35. CHILDHOOD BLINDNESS
■ Childhood blindness is an important public health
problem in developing countries due to its social and
economic implications.
■ Prevalence: 0.8/1000
■ Currently there are about 270000 blind children in india

36. ■ Common causes of childhood blindness are vitamin A
deficiency, measles, conjunctivitis, ophthalmia
neonatorum, injuries, congenital cataract, retinopathy
of prematurity (ROP), and childhood glaucoma.
■ Refractive errors are the commonest cause of visual
impairment in children

37. ■ AIM: to eliminate avoidable causes of childhood
blindness by the year 2020
■ STRATEGIES AND ACTIVITIES:
 Detection of eye disorders
 Preventable childhood blindness to be taken care of
through cost effective measures
 Curable childhood blindness to be taken care by experts
at secondary and tertiary level

38. ■ Targets include:
■ Establishment of Paediatric Ophthalmology units. In
India, 50 Pediatric Ophthalmology units are to be
established by 2010 for effective management of
childhood diseases
■ Establishment of refraction services and low vision
centers

39. REFRACTIVE ERRORS AND LOW VISION
■ Targets. To combat refractive error and low vision following
targets have been set in India:
■ Refraction services to be available in all primary health
centres by 2010. Availability of low-cost, good quality
spectacles for children to be insured.
■ Low vision service centres are to be established at 150
tertiary level eye care institutions. 50 such centres are to
be developed by 2010, another 50 by 2015 and the final 50
by 2020.

40. GLAUCOMA
■ As per the ‘National Survey on Blindness’ (1999-2001, Govt. of India
Report 2002)9 glaucoma is responsible for 5.8% blindness in 50+
population
■ Following measures are recommended for opportunistic glaucoma
screening (case detection) by tonometry and fundus examination:
■ Opportunisitic screening at eye care institutions should be done in all
persons above the age of 35 years, those with diabetes mellitus, and
those with family history of glaucoma.
■ Community based referral by multi-purpose workers of all persons with
dimunition of vision, coloured haloes, rapid change of glasses, ocular
pain and family history of glaucoma.
■ Opportunistic screening at eye camps in all patients above the age of
35 years.5.8% cases of blindness in 50+ population.

41. DIABETIC RETINOPATHY
■ Emerging as an important cause out of 4.7% cases of
blindness.
■ Following recommendations are made:
■ Awareness generation by health workers.
■ All known diabetics to be examined and referred to Eye
Surgeon by the Ophthalmic Assistant.
■ Confirmation by fundus fluorescein angiography (FFA) and
laser treatment of diabetic retinopathy at tertiary level.
■ The strategy must be to bring down the medical
management of DR at the secondary level.

42. CORNEAL BLINDNESS
■ The major causes of this blindness are corneal ulcers
due to infections, trachoma, ocular injuries and
keratomalacia caused by nutritional deficiencies.
■ OBJECTIVE: to reduce prevalence of preventable and
curable corneal blindness

43. Strategies
■ GENERAL STRATEGIES
■ DISEASE SPECIFIC STRATEGIES
■ KERATOPLASTY AND EYE BANKING

44. General strategies
■ Identification of infants at risk
■ Identification of pre-school children at risk by door to
door survey
■ Identification of schoolchildren through school health
services
■ Identification of senior citizens with post cataract
surgery bullous keratopathy
■ To ensure supply of essential drugs

45. Disease specific strategies
1. Eye infections: Health education and improvement in
personal hygiene will reduce the incidence of
conjunctivitis, corneal ulcer and other eye infections. Early
treatment of eye infections will prevent corneal blindness.
2. Eye injuries: Education of people regarding avoidance of
ocular trauma like cracker blast, industrial accidents, road
accidents and other trauma, thereby reducing irreversible
corneal blindness. Ocular trauma cases should be
immediately referred to specialists for effective
management. Facilities for administrating general
anaesthesia for ocular trauma patients at secondary eye
care level.

46. 3. Trachoma Blindness: In India the corneal blindness due to
trachoma (0.39% WHO-NPCB, 1986-88) is on the decline when
compared with previous figures (20% ICMR 1975).RAAB(2006-
07) reports 0.6% incidence in trachoma blindness. However, In
isolated pockets (focal) blindness related to trachoma
continues to be important.
4. Prevention of Xerophthalmia will make a strong dent in
the number of corneal blinds. The three major known
intervention strategies for the prevention and control of
vitamin A deficiency

47. 5. A total ban should be placed on the ophthalmic practice
by quacks and sale of harmful eye medicines especially
various ‘surmas’.
6. Protective measures: The eyes of industrial workers
and agriculturists should be given protection by goggles
and eye shades

48. Keratoplasty and eye banking
■ There is a need of around 1.4 lakh corneas per year for
transplantation.
■ Currently we are collecting around 25000 eyes/ year.
■ As keratoplasty operation can restore vision in a
significant number of corneal blinds, an intensive
publicity and cooperation of government and non-
government agencies is needed to enhance the
voluntary eye donations

49. ■ Under NPCB, eye donation fortnight is organized from
august 25th to sep 8th every year to promote eye
donation.
■ More eye banks should be established and more
ophthalmic surgeons should be trained for corneal
grafting.
■ Under vision 2020: Indian initiative emphasis is on
hospital retrieval system to get better donor material.
■ Death certificates should bear one line on eye
donations.

50. HUMAN RESOURCE DEVELOPMENT
■ Mid-Level Ophthalmic Personnel (MLOP). The term MLOP has
been introduced to include all categories of paramedics who
work full time in eye care.
■ Broadly two streams of such personnels are envisaged:
1. Hospital-based MLOP. These include ophthalmic nurses,
ophthalmic technicians, optometrists, and orthoptists etc.
2. Community-based MLOP include those with outreach/field
functions such as primary eye care workers and ophthalmic
assistants

52. EYE CARE INFRASTRUCTURE
DEVELOPMENT
■ Based on the recommendations of WHO, there is need
to develop the infrastructure pyramid which includes
■ Primary level Vision Centres: There is a need to
develop 20000 vision centres, each with one Ophthalmic
Assistant or equivalent (Community based MLOP)
covering a population of 50000

53. ■ Service Centres: There is need to develop 2000 service centres
at secondary level — each with two ophthalmologists and 8
paramedics (Hospital based MLOP), covering a population of
500000. One eye care manager will be required at each service
centre
■ Training Centres. There is a need to develop 200 ‘Training
Centres’ for the training of Ophthalmologists. Each tertiary level
training centre will cater to a population of 5 million.
■ Centre of Excellence (COE). There is need to develop 20 COE
with well developed all sub specialities of Ophthalmology. Each
advanced tertiary level center of excellence will cater to a
population of 50 millions.