Blindness
By Dr. M. Siva Durga Prasad Nayak
Definition
Visual acuity less than 3/60 by Snellen’s
chart.
Economic blindness: Such level of visual
acuity, where an individual is not able to
earn the livelihood.
Categories of visual impairment
Level of visual Maximum or less Minimum equal
impairment than to or better
than
Low vision 1. 6/18 1. 6/60
2.6/60 2. 3/60
3. 3/60 3. 1/60
Blindness 1/60 Light
No light perception. Perception.
Magnitude of the problem
Global: It is estimated that 180 million
people are visually impaired of them 45
million people are blind.
India: The prevalence of blindness is 77%
and 68 lakh people are blind as per
W.H.O. statistics.
Major causes of blindness
Global: cataract 19 million people are
affected globally.
Glaucoma: 6.4 million.
Trachoma: 5.7 million.
Childhood blindness: More than 1.5 million.
Onchocerciasis: 0.29 million.
Other causes: 10 million.
Causes of blindness in India
Cataract: 62.6%.
Refractive errors: 19.7%.
Glaucoma: 5.8%.
Posterior segment Pathology: 4.7%.
Corneal opacity: 0.9%
Other causes: 6.2%
Epidemiological factors
Age: 30% of the blind loose their eyesight
before the age of 20 years and many in
this category loose eye sight before the
age of 5 years.
Many loose their eye sight at 20-40 years
of age due to various reasons.
62.6% people loose their eye sight due to
Cataract.
Continued….
Nutritional blindness: Vitamin a deficiency
leads to childhood blindness, major
manifestation of low vitamin A intake from
dietary sources.
Occupation: Occupational injuries are the
most common cause of blindness in
working population.
Social class: Twice more common in poor
population as compared to the rich.
Changing concepts in ophthalmic
care
Primary eye care: Inclusion of eye care in
primary health care delivery system and
delivered through it, objective is to improve the
quality and coverage of eye care.
Epidemiologic approach: Used as a tool to find
out the prevalence/incidence of diseases causing
blindness. Finding out risk factors for the same
and determine the action needed.
Continued….
Team approach: As the availability of
ophthalmic surgeon is scarce, govt. has
inducted ophthalmic assistants,
multipurpose workers, village health
guides and the services of voluntary
health agencies for providing eye care to
rural/tribal population.
Continued….
Commissioning of the National Program:
Increasing recognition of application of
primary health care approach to blindness
control has resulted in development of a
comprehensive blindness control program
at the national level. The goal of this
program was to reduce blindness to 0.3%
by the year 2000 A.D.
Components of the National
blindness control program
Initial assessment: First step is to find out
the magnitude, geographic distribution
and causes of blindness in the country.
Objective is to set up the priorities and
development of suitable interventions.
Methods of intervention
Primary eye care: Wide range of eye
conditions can be treated at grass root
level by locally trained health workers
Secondary eye care: Involves the
management of diseases like cataract,
glaucoma, trichiasis, entropion etc at the
secondary level i.e. PHC and District
hospitals.
Continued….
Tertiary eye care: Delivered through
medical colleges and super specialty
hospitals they provide sophisticated eye
care like retinal detachment surgery,
corneal grafting and other sophisticated
forms of eye care.
Specific programs
Trachoma control: National Trachoma
Control Program which started in 1963 is
now merged with National program for
control of blindness in 1976.
School eye health services: Screening of
school children for preventable ocular
morbidities, e.g. refractive errors, vit. A
deficiency, squint, trachoma etc.
Continued….
Occupational eye services: Provisions are
made to provide eye care to the workers
on campus through the industrial medical
officer and a occupational nurse. Minor
injuries and ailments are treated on
campus, for serious injuries referral is
given.
Control of Nutritional blindness
Vitamin A prophylaxis: Under this program
200000 I.U. of vitamin A is given to the
children in the age group 1-6 years at the
interval of 6 months. The children are kept
under surveillance for five years to
monitor the signs of Vitamin A deficiency
i.e. Xeropthalmia.
Long term policy
Creating awareness in the population
regarding the importance of consumption
of foods rich in vitamin A, maintenance of
good personal hygiene, control of poor
environmental sanitation, supply of
adequate and safe water. These are long
term interventions to bring out the
improvement in eye care.
Evaluation of the program
Like any other health program evaluation
of the National blindness control program
should be an integral part, to know the
impact of the program. To know to which
extent ophthalmic diseases and blindness
is controlled, assess the manner and
degree to which program activities are
carried out and determine the changes
that may have been produced.
Role of National and International
Agencies
The National Association for the blind
(NAB) is working in this field since 1952 it
is providing welfare services to the blinds.
The Royal Society for the blind is active in
the country since 1950.
International Agency for the prevention of
blindness is a W.H.O. initiative for
preventing blindness globally.
Continued….
Danish International Development Agency
(DANIDA) It is providing support to the
National Blindness control Program in the
form of training of personnel, direct
technical co-operation and funding for the
program. It is the initiative of DANIDA that
doctors in this country are trained in
community ophthalmology.
Vision 2020
The right to sight is a global initiative
started by W.H.O. on 18th February 1999.
The objective of vision 2020 is to assist
member countries in developing a
sustainable system which will enable them
to eliminate avoidable/preventable
blindness by the year 2020.
Thank You
