blindness, children with special need

7/30/2019 Blindness, children with special need

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BLINDNESSPresentation by

DR.VIOLET (de Sa) PINTO

Lecturer, Department of PSM


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Objectives:At the end of the session the student shall have

knowledge of :

Blindness :definition, categories of visual impairment,

its causes and problem statement

Changing concepts in healthcare with regards to eye

care

Prevention of blindness :primary, secondary and

tertiary prevention

Vision 2020


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Visual acuity of less than 3/60 (Snellen) or itsequivalent.

Non specializedpersonnel,

in absence of appropriatevision charts

Inability to count fingers in daylight at a distanceof 3 meters.

Definition


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CATEGORIES OF VISUAL IMPAIRMENT

If it is 6/18 or better = 0 or no visualimpairment

Categories of visual

impairmentVisual acuity

Maximum

< than

Minimum

= or > than

Low vision 1 6/18 6/60

2 6/60 3/60

Blindness 3 3/60 1/60(fingercounting at I

meter)

4 1/60(fingercounting at 1

meter)

Light perception

5 No light

perception


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PROBLEM STATEMENT

Estimated 180 million people are visually disabled,nearly 45 million blind, 4 out of 5 living in developingcountries.

Major causes..cataract, glaucoma, trachoma,childhood blindness, onchoceriasis.

32% are aged 45-59 yrs, large majority 58% are over60 yrs.

SEAR has 1/3rdof the worlds blind,50% of worldsblind children.


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INDIA Causes of blindness Cataract 62.6% more with advancing age

senile cataract- decade

earlier

Uncorrected 19.7%

Refractive error

Glaucoma 5.8%

Posterior 4.7%segment pathology

Corneal Opacity 0.9%

Others 6.2%

Injuries 1.2% cottage industry- carpentry,

blacksmitty, stone crushing,chiseling

Congenital disorder, uveitis, retina detachment,tumours,diabetes,HT,

diseases of nervous system, leprosy.


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CHANGING CONCEPTS IN HEALTH CARE

Primary eye care

Promotional & protection of eye health

On the spot treatment of commonest eye diseases

Improve coverage and quality

Establishment of National Prog.

> Need for PHC approach

Team Concept

Deprofessionalisation

VHG, Ophthalmic assistant,MPW, Voluntary agencies

Epidemiological Approach

Measurement of Incidence, prevalence,

risk factors of disease


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AGENT-Trachoma, Vit A def.

HOST-Age-

About 30% lose eyesight


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ENVIRONMENT-

Malnutrition-

Vit A def.- even due to measles and diarrhoea

PEM related- severe corneal

destruction(keratomalacia)6mth- 3yrs.& 4 -6yrs.

Occupation

Cottage industry, workshops, factories, flying objects, gases.

Doctors- x rays, u.v. rays, premature cataract

Social class twice more prevalent in low social classes

EPIDEMIOLOGICAL

DETERMINANTS


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PREVENTION OF BLINDNESSThe concept ofAvoidable blindness (preventable or curable)

has gained recognition during the recent years.

Initial Assessment

Methods of

Evaluation Intervention

Primary care

Secondary care

Tertiary care

Specific programmes

Long term measures

Components for action in N.H.P.


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1) INITIAL ASSESSMENT

Prevalence surveys magnitude, distribution, causes

Setting priorities and development of appropriate

intervention programmes.


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2) METHODS OF INTERVENTION PRIMARY EYE CARE

Treatment and prevention at grassroot level by

locally trained peripheral health worker. (VHG,MPW)

(acute conjunctivitis, opthalmia neonatrum,

trachoma, superficial foreign body, xeropthalmia)

Provided with essential drugs ; topical tetracycline,

Vit A capsules, eye bandages, shields, etc.


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Trained to refer difficult cases (eg. Corneal ulcer,penetrating foreign bodies, painful eye conditions &infections which do not respond to treatment) to

nearest PHC & district hospital.

Promotion of personal hygiene, sanitation, good diet,safety in general.

Currently 1 VHG / 1000 population, 2 MPW / 5000population.


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SECONDARY CARE

Definitive management of common blinding

conditions such as cataract, trichiasis, entropion,

ocular trauma, glaucoma,etc.

PHCs and district hospitals

where eye departments or eye clinicsare established.


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Mobile clinics-Disadv- lacks permanence,

adv- problem specific best use of local

resource,

provide inexpensive eye care

Eye camp approach-cataract, general eye health, surveys.


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TERTIARY CAREAt National /Regional capitals, often associated

with Medical colleges & institutes of medicine

(National Institute for Blind, Dehradun)

Sophisticated eye care- retinal detachment , corneal

Grafting

Eye banks- Maximum states passed Corneal graftingActs

Education of blind in special schools and utilisation oftheir services (employment)


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SPECIFIC PROGRAMMES1) TRACHOMA CONTROL-

Endemic trachoma and associated infections, major

cause of preventable blindness.

Early diagnosis and treatment

Mass campaigns with topical teracycline

Improvement of SE conditions

TC Programme launched 1963. merged NBCP in 1976.

2) SCHOOL EYE HEALTH SERVICES-

Screened & treated for refractive errors,

squint,ambylopia, trachoma

H.E. good posture, proper lighting, avoidance of glare,

angle between books and eye.


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3) VIT A PROPHYLAXIS

2 lakh IU given 6 monthly 1-6 yrs.,surveillance

4) OCCUPATIONAL EYE HEALTH SERVICES

Education, protective devices, improve safetyof machines, proper illumination, pre

placement examination.


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3) LONG TERM MEASURES1) Improving quality of life, modifying factors responsible

for persistence of eye health problems.Poor sanitation , lack of adequate safe water supplies,

increase intake of food rich in Vit A, lack of personalhygiene.

2) Health Education

Create community awareness of the problem

Motivate community to accept total eye healthprogrammes.

To secure community participation.

4) EVALUATIONEvaluation of objectives.


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VISION 2020

A global initiative to eliminate avoidable

blindness by WHO on 18thfeb.1999.

Objective: Assist member states in developing

sustainable systems, which will enable them to

eliminate avoidable blindness from major causes.


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Plan of Action for country has following features:

Target diseases: Cataract, refractive errors, childhoodblindness, glaucoma, diabetic retinopathy.

H.R.D. as well as infrastructure and technology

developmnt. At various levels of health system.

Proposed 4 tier system


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C.O.E.

20

Training centers

Tertiary care

including retinal

surg.,Corneal

transplant.

200Service Centers 2000

Cataract Surgery

Othr common eye surg.

Facilities for refraction

Referral services

Vision Centers 20,000

Refraction and prescription of glasses

Primary eye care

School eye screening

Screening and referral services

Prof. leadership,

strategy.developmnt,

CME,Standards,quality

assurance, Research.


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Thank You

blindness, children with special need

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