Community Optometry

Definition Of Blindness
► WHO has classified visual impairment and blindness
into various grade:

6/6-6/18 Normal vision

<6/18-6/60 visual impairment
<6/60-3/60 Severe visual impairment
<3/60-NPL BLIND
<1/60-PL BLIND
NPL BLIND

(Best available correction in the better eye)

 Defining Blindness
► Economic Blindness:
―The level of blindness that prevents an individual from
earning his wages.
―Vision less than 6/60 with the better eye with best
correction.

► Legal Blindness:
―The level of blindness that necessitates welfare
measures and legal protection

―Vision less than 6/60 in better eye with best correction.

 Defining Blindness
► Social Blindness
― Hampers an individual from socially interacting with
the family and peer groups in a satisfactory manner

― Vision less then 3/60 with the better eye with best
correction.

► Manifest Blindness
― Constraints the accomplishment of tasks for daily living
leading to impairment in mobility and corresponding
to a vision of 1/60.
 Defining Blindness..
► Absolute Blindness
― Inability to perceive light secondary to irreversible damage
to the nerve carrying the visual signals
Eg: Optic atrophy

► Curable Blindness
―The stage of blindness where the damage is
reversible by prompt management.
Eg: Cataract
 Defining Blindness..
► Preventable Blindness
―The loss of vision that could have been completely
prevented by institution of effective preventive and
prophylactic measures.
Eg: Xerophthalmia and trachoma

► Avoidable Blindness
―The sum total of preventable and curable blindness
―90% of blindness in our country is avoidable.
―EG: Cataract ,Refractive error
 Defining Blindness..
► Incurable Blindness
―The stage of blindnes that cannot be
treated, prevented and cured is called
incurable blindness.

―5-10% of all blindness fall in this

category.
Categories of visual impairment used in Nepal surveys and by WHO definition

Distance visual acuity with available correction

Presenting Categories WHO Categories Nepal
Visual Acuity
6/6-6/18 NORMAL VISION NORMAL VISION

<6/18-60 MOD VISUAL IMPAIRMENT MOD VISUAL IMPAIRMENT

<6/60-3/60 SEVERE VISUAL Blindness
IMPAIRMENT (Economic Blindness)

<3/60-NPL BLIND Blindness

(Social Blindness)

<1/60-NPL BLIND Blindness

(Manifest Blindness)

NPL BLIND Blindness

(Absolute Blindness)
 Blinding Eye Diseases
⮚ Cataract

⮚ Glaucoma
⮚ Trachoma
⮚ Diabetic Retinopathy ⮚ Onchocerciasis
⮚ Vit A deficiency
253 million people
are visually impaired
globally 217million have
low vision

36 million are
blind
Fact Sheet N°282 WHO- August 2017
EPIDEMIOLOGY

► About 90% of the world's visually impaired live in low-

income settings.

► 81% of people who are blind or have moderate or severe

vision impairment are aged 50 years and above .
► Un-operated cataract remains the leading cause of blindness
in low- and middle-income countries.

► 80% of all visual impairment can be prevented or cured.

Fact Sheet N°282 WHO- August 2017

► Cataract (51%) is the most common cause of blindness in the
world (Pascolini et al, 2011).

► Moreover, trachoma and childhood blindness are responsible

for 15% and 4% of all blindness respectively.
 Blindness prevalence in Nepal

►Nepal Blindness Survey conducted in 1981 revealed

that 0.84
of the Nepalese populations are blind and
1.7 % has unilateral blindness.

►Prevalence of blindness presenting VA{less

than 3/60}in recent survey was 2.5%
Blindness prevalence in Nepal
cont…

► Nearly 80% of blindness in nepal is avoidable,

either preventable or treatable

► Cataract is the major cause of blindness(66.80%)

Blindness prevalence in Nepal cont..

► Every day 125 Nepalese become blind

( 7 children)

► In Nepal we have 2,10,000 blind people, every year

increases by 24000

► Blind children- 30200, every day 7 become blind.

What is avoidable blindness?
Blindness that can be treated or prevented

► Cataract
► Glaucoma
► Diabetic retinopathy
► Corneal infections
► Ocular trauma
► Refractive error
Cause of Blindness, 1981
 Global Causes of blindness

► Unknown 21%
► ARMD 5%
► Glaucoma 8%
►Diabetic retinopathy 1%
►Childhood blindness 4%
Cataract
► Trachoma 3% 51%
► Corneal opacities 4%
► Refractive errors 3%
Major cause of childhood blindness in
Nepal
► Vitamin A deficiency
► Trachoma
► Trauma
► ROP
► Congenital cataract
► Congenital glaucoma
► Amblyopia
► Refractive errors
Vision 2020 – The Right to Sight
► Launched in Nepal on November 19,1999 AD

► Aim: To eliminate the main causes of avoidable

blindness by the year 2020 AD

► Mainly focused on Cataract, trachoma, Vitamin A

deficiency, Low vision,Glaucoma,Childhood blindness,
Diabetic retinopathy etc.
Commonest cause of blindness in Nepal
is

a) Xerophthalmia
b) Trachoma
c) Cataract
d) Vitamin A deficiency
According to WHO, visual acuity less
than… is termed as legal blind

a) 6/6
b) 2/60
c) 3/60
d) 6/60
Which of the following bone does not involve
in the formation of orbit?

a) Frontal bone
b) Zygomatic bone
c) Lacrimal bone
d) Hyoid bone
Toughest part of eye is

a) Cornea
b) Retina
c) Sclera
d) Iris
Capsule of lens is thinnest at

a) Anterior pole
b) Posterior pole
c) Equator
d) Below equator
Green color blindness is

a) Protanopia
b) Deutanopia
c) Tritanopia
d) Achromatopsia
Hypopyon is

a) PUS in anterior chamber

b) Blood in anterior chamber
c) Cells in Vitreous
d) Blood in Vitreous
Inflammation of whole eyeball
is
a) Endophthalmitis
b) Choroiditis
c) Parsplanitis
d) Panophthalmitis
Distribution of Rods and cones
in retina is
a) Cones
b) Rods
c) Rods> Cones
d) Rods = Cones
Outward turning of lid margin is

a) Trichiasis
b) Entropion
c) Ectropion
d) Trachoma
Use of …. Lens for hypermetropia?

a) Concave
b) Convex
c) Cylindrical
d) Plano- convex
Which separates Anterior segment from
posterior segment

a) Lens
b) Pupil
c) Ciliary body
d) Choroid
Early deficiency of Vit A causes

a) Nyctalopia
b) Cataract
c) Glaucoma
d) Corneal melting
Q) Anterioposteriour diameter of normal
adult eye ball is
a)26mm b) 24mm
c)23mm d) 18mm

Q) Volume of an adult eye ball is

a) 7.5ml b) 6.5ml
c)5.5ml d)8ml
Q)Weight of eye ball is
a) 7g b) 9g
c)11g d)13g

Q)Diameter of optic disc is

a) 1.5mm b) 2.5mm
c) 3.5mm d) 5mm
Q) Optic nerve consists of axons of
a)Ganglion cells b)bipolar cells
c) rods and cones d) all

Q)Which continue to grow in the life time

a) Corona b) iris
c) Lens d) retina
Q)Which of the extraocular muscle has
sympathetic inervation?
a) LPS b) mullers muscles
c) superior rectus d) inferior rectus

Q) Corneal diameter is increased in

a) Megalocornea b) keratoglobus
c) Keratoconus d) all
Q) Kayser Fleisher ring is feature of
a) Keratoconus b) Wilson disease
c) retinopathy d) all

Q)Snellens chart is used to test

a) Vision b) refraction
c) Presbyopia d) colourblindness
Q) Colour blindness is tested in
a) Ischiaria chart b) snellens chart
c) landolts broken chart d)all

Q) Perimetry is test to acess the

a) Visual acquity b) IOP
c) Visual field d) depth of anterior
chamber
Q) SAFE strategy has been developed for
control of
a) conjunctivitis b) trachoma
c) refractive error d) ocular trauma

Q) Which of the following is degenerative

condition?
a)Coloboma b) pterygium
c)Conjunctivitis d)all
Q)Viral infections usually cause
a) conjunctivitis b) keratitis
c) keratoconjuctivitis d)none

Q) In photopthalmia site of lesion is

a) Cornea b)retina
c) Optic nerve d)all
Q)The earliest symptoms to occur in corneal
ulcer is
a)pain b)photophobia
c)loss of sensation d)diminished vision

Q) Sclera is thinnest at
a) Posterior pole b) equator
c) Corneoscleral junction d) points of
muscular attachments
Q)Trabecular pathway of aqueous flow
accounts for
a) 90% b) 80%
c) 60% d)10%

Q)Earliest change in diabetic retinopathy is

a)Hard exudate b) soft exudate
c) harmorrhage
d) microaneurysm
Q) In pupillary reflex nerve tested is
a) Second b) third
c) 4th d) seventh

Q) Dplopia is mainly due to

a) Impaired function of extraocular muscles
b) problems in retina
c) problems in conjunctiva
d) problems in optic nerve
Q)Which of the following is not transparent
layer of retina ?
a)RPE b)ganglion cell
c) outer nuclear layer d)inner nuclear layer

Q) Which of the gland is inflamed in stye ?

a)Gland of zeis
b) Meiobian gland
c) Lacrimal gland
d) Goblet cells
Q) Which of the following is site for aquous
production ?
a) pars plana b) pars plicata
c) epithelium of pars plana d) both a and c .

Q) Blood in anterior chamber is called

a) Hypopyn
b) aquous flare
c) hyphema
d) none
Thank you !!!