Overview On Blindness: University of Gondar College of Medicine and Health Science Department of Optometry

UNIVERSITY OF GONDAR
COLLEGE OF MEDICINE AND HEALTH

SCIENCE
DEPARTMENT OF OPTOMETRY
Overview on Blindness
By :Mohammed S. (BSc, MSc)

Outline
 Terminology
 Definitions and categorization of VI
 Epidemiology of Visual impairment
 Impact of Visual impairment
 References
Set by Mohammed S.(BSc,MSc) 2

Terms
 According to ICIDH
 A disease is an illness or medical condition,

irrespective of origin or source, that represents
or could represent significant harm to humans.
 An impairment is any loss or abnormality in an

anatomical structure or a physiological or
psychological function.
Cont…
 A disability is any restriction or lack
(resulting from an impairment) of ability to
perform an activity in the manner or within
the range considered normal for a human
being.
 A handicap indicates a person’s

disadvantaged position in society, resulting
from impairment and/or disabilities.
Cont…
 The term "visual impairment" refers to a functional limitation

of the eye(s) or visual system due to a disorder or disease that
can result in a visual disability or a visual handicap.
 Visual disability is a limitation of the ability(ies) of the

individual to do visually guided daily tasks
 Visualhandicap refers to a limitation of personal and

socioeconomic independence resulting from of visual
impairment and disability

The definition and categorization of VI
 Non revised ICD 10th definition of VI
 Low vision: best corrected visual acuity of less than 6/18 to

3/60 or contracture of peripheral visual field which is
between 30 &10 degree in the better eye.
 Blindness: best corrected visual acuity of less than 3/60 or

visual field loss less than 10 degree in the better eye
 VI= low vision + blindness

Cont….
 WHO definitions of VI:
 Low vision : "best corrected visual acuity of less than

6/18 to light perception, or a visual field of less than 10°
from the point of fixation“(service provision
perspective)
 VA less than 6/18 to 3/60 in better eye with best

correction or visual field less than 20º in Diameter
(Epidemiological)

Cont…

Cont…
 The revised ICD 10th definition of VI
 The existing definitions of visual impairment in the

ICD 10th are revised based on recommendations made
by ICO (2002) and WHO (Sept 2003).

Cont…
 The major addressed issues are :
 The definition of visual impairment
 The nomenclature
 The categorization of blindness

The definition of visual impairment
 The existing definitions are based on best

corrected visual acuity, which exclude uncorrected
refractive error as a cause of visual impairment
 It results in substantial underestimation of the

total visual impairment burden.
 Therefore ,the words “best corrected” be

replaced by “presenting” in a revised definition

Nomenclature
 The ICD 10th uses the term 'low vision' for visual impairment
level less than blindness
 Itcauses confusion with the common use of this term for

uncorrectable vision requiring aids or rehabilitation.
 This has led to miscalculations in the estimation of persons

requiring low vision care
 Therefore the term low vision from the current ICD 10

definition is deleted and replaced by moderate and severe VI

The categorization of Blindness
 The existing definition does not make a

distinction between those who have NLP & LP
 The management of these two categories is

different and categorization based on this
would be useful

Proposed revision of categories of visual impairment

Other blindness definitions
 Legal blindness : best-corrected Snellen visual acuity of

6/60 or worse in the better eye or a visual field of 20° or
worse in the better eye.
 Social blindness: Vision 3/60-1/60 or diminution of field of

vision to 10°.
 Absolute blindness: No perception of light
 Economic blindness: Inability of a person to count fingers

from a distance of 6m(technical definition)

Cont…
 Curable blindness: That stage of blindness where the
damage is reversible by prompt management e.g. cataract
 Preventable blindness: The loss of blindness that could

have been completely prevented by institution of effective
preventive or prophylactic measures. E.g: Trachoma,
onchocerciasis,
 Avoidable blindness: The sum total of preventable or

curable blindness is often referred to as avoidable
blindness.

Epidemiology of visual impairment
 Based on the revised definitions

 It is estimated that there are 285 million visually
impaired people Worldwide
▪ 39 millions are blind
▪ 246 million have low vision(moderate + severe VI)

Where?
▪ More than 90% of the world’s visually impaired

people live in developing countries.

Distribution of VI by age
 Around 1.4 million children under age 15 are

blind.
 63% of those with low vision and 82% of blind

people are over 50 years of age.
Corneal scarring is the single most important cause
of avoidable blindness in childhood, followed by
cataract and ROP.

Top causes of visual impairment
 Refractive errors =121 million (43%)

 Cataracts (33%)
 Glaucoma (2%)
 CO, trachoma, DR, AMD, CHB (1%)
 Other (18%)

Top causes of blindness
 Cataracts(51%)
 Glaucoma(8%)
 Age-related macular degeneration (AMD) (5%).
 Corneal opacity (4%)
 Child hood blindness(4%)
 Refractive error (3%)
 Trachoma (3%)
 Other (21%)

Major risk factors for VI
 Age
 Gender
 Socioeconomics status
 Other risk factors
 Tobacco use
 Exposure to ultraviolet radiation
 Vitamin A deficiency
 High body mass index and metabolic disorders.

Avoidable cause of VI
Treatable blindness Preventable blindness

 Cataract  Trachoma
 Refractive error  Vit A deficiency
 Glaucoma  Onchocerciasis
 Corneal opacity  River disease
 Childhood blindness

Global blindness projections

Cont…
 Why the magnitude of VI was forecasted to be

increased?
▪ Increased life expectancy
▪ Increased world population
▪ Increased national censes data (NCD).
▪ Availability of real data on blindness

Cont…
 What kind of measures had been taken?
▪ Global Initiative for the Elimination of

Avoidable Blindness was launched in 1999:
Vision 2020

Global blindness trends and projections

Small group discussion
 Discuss the previous projection of global

blindness and its current estimates

Cont…
 Overall, visual impairment worldwide has decreased

since the early estimates in 1990’s.
 This decrement is principally the result of a reduction

in visual impairment from infectious diseases
through:?
 Overall socioeconomic development;
 Concerted public health action;
 Increased availability of eye care services;
 Awareness of the general population

Assignment
 Visual impairment in Ethiopia
▪ Magnitude
▪ Distribution (sex,geography, cause, race…..)
▪ Cause

Impact of visual impairment
 The impact of visual impairments are multi

directional so that multidisciplinary
interventions is mandatory
 Often leads to functional disabilities to

people’s everyday lives, especially for older
adults.

Impacts
 Functional impact ( on activities of daily living)

 Economic impact
 Social impact
 Psychological impact
 Developmental impact

Con…
 Economic impact
▪ Direct cost
▪ Hospital costs
▪ Prescriptions
▪ General ophthalmic services
▪ Indirect cost
▪ Dead weight welfare loss
▪ Informal care
▪ Loss of productivity
Cont…
 Social impact
 Isolation and loneliness
 higher rates of divorce
 Psychological impact
 Lower life satisfaction
 Anxiety
 Depression and suicide

Cont…
 Developmental impact
 Gross and fine motor skills
▪ The achievements that require self- initiated mobility
are significantly delayed
 Sensory skills
 Cognitive skills

Cont….
 Therefore ,knowing about VI helps us to:

 Anticipate appropriate management/rehabilitation
 Conduct researches
 Allocate rational resources
 Advocate for policy makers
 Address medico legal issues

References
 The economic impact of vision impairment and
blindness in the Republic of Ireland.NCBI (National
Council for the Blind of Ireland), Deloitte Access
Economics, May 2011
 Stickling c. .Impact Of Visual Impairment On
Development. Texas School for the Blind and Visually
Impaired
 National Survey on Blindness, Low Vision and Trachoma
in Ethiopia
 Change the Definition of Blindness
 GLOBAL FACTS (Fact Sheet N°282 Updated August 2014)
 BCSC
Thank you

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UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH

By :Mohammed S. (BSc, MSc)

Set by Mohammed S.(BSc,MSc) 2

 A disease is an illness or medical condition,

 An impairment is any loss or abnormality in an

 A handicap indicates a person’s

 The term "visual impairment" refers to a functional limitation

 Visual disability is a limitation of the ability(ies) of the

 Visualhandicap refers to a limitation of personal and

Set by Mohammed S.(BSc,MSc) 5

 Non revised ICD 10th definition of VI

 Low vision: best corrected visual acuity of less than 6/18 to

 Blindness: best corrected visual acuity of less than 3/60 or

 VI= low vision + blindness

Set by Mohammed S.(BSc,MSc) 7

 Low vision : "best corrected visual acuity of less than

 VA less than 6/18 to 3/60 in better eye with best

Set by Mohammed S.(BSc,MSc) 9

Set by Mohammed S.(BSc,MSc) 10

 The revised ICD 10th definition of VI

 The existing definitions of visual impairment in the

Set by Mohammed S.(BSc,MSc) 11

Set by Mohammed S.(BSc,MSc) 12

 The existing definitions are based on best

 It results in substantial underestimation of the

 Therefore ,the words “best corrected” be

Set by Mohammed S.(BSc,MSc) 13

 Itcauses confusion with the common use of this term for

 This has led to miscalculations in the estimation of persons

 Therefore the term low vision from the current ICD 10

Set by Mohammed S.(BSc,MSc) 14

 The existing definition does not make a

 The management of these two categories is

Set by Mohammed S.(BSc,MSc) 15

Set by Mohammed S.(BSc,MSc) 16

 Legal blindness : best-corrected Snellen visual acuity of

 Social blindness: Vision 3/60-1/60 or diminution of field of

 Absolute blindness: No perception of light

 Economic blindness: Inability of a person to count fingers

Set by Mohammed S.(BSc,MSc) 17

 Preventable blindness: The loss of blindness that could

 Avoidable blindness: The sum total of preventable or

Set by Mohammed S.(BSc,MSc) 18

 Based on the revised definitions

Set by Mohammed S.(BSc,MSc) 19

▪ More than 90% of the world’s visually impaired

Set by Mohammed S.(BSc,MSc) 21

 Around 1.4 million children under age 15 are

 63% of those with low vision and 82% of blind

Set by Mohammed S.(BSc,MSc) 22

 Refractive errors =121 million (43%)

Set by Mohammed S.(BSc,MSc) 23

Set by Mohammed S.(BSc,MSc) 25

Set by Mohammed S.(BSc,MSc) 27

Treatable blindness Preventable blindness

Set by Mohammed S.(BSc,MSc) 28

Set by Mohammed S.(BSc,MSc) 30

 Why the magnitude of VI was forecasted to be

Set by Mohammed S.(BSc,MSc) 31

 What kind of measures had been taken?

▪ Global Initiative for the Elimination of