BLINDNESS

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.
 CATEGORIES OF VISUAL IMPAIRMENT

CATEGORIES OF VISUAL Visual acuity

IMPAIRMENT
Maximum less than Minimum equal to or
better than

1 6/18 6/60
Low vision
2 6/60 3/60

3 3/60 (finger counting 1/60 (finger counting at

at Three meters) One meter)
4 1/60 (finger counting
Blindness at One meter)
Light perception
5 no light perception
 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
 India
• Annual incidence of 2 million cataract
induced blindness
• National survey on blindness 2001-02 shows
prevalence of blindness
– >50 yrs : 8.5%
– General population 1.1%
• 6-7% of children aged 10-14 years have
problem with their eyesight
 CAUSES OF BLINDNESS
• World
• 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.
 India

• 2001-02 National survey on blindness

– Cataract 62.6%
– Uncorrected Refractive error 19.7%
– Glaucoma 5.8%
– Posterior segment pathology 4.7%
– Corneal opacity 0.9%
– Other causes 6.2%
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
• 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.
• 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.
 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
• Initial assessment
– Assess the magnitude, geographic distribution,
and causes of blindness within the country by
prevalence survey.
 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.
• 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.
• 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.
• Specific programmes
– Trachoma control
– School eye health services: Screening and
treatment , Health education
– Vit.A prophylaxis
– Occupational eye health services
 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
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.
 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
ORGANIZATIONAL STRUCTURE FOR NPCB
 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.
 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

 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.
PROPOSED STRUCTURE FOR VISION 2020:
THE RIGHT TO SIGHT