BLINDNESS and VISUAL IMPAIRMENT.ppt

Blindness & Visual Impairment
Dr. Gurmeet Singh
Senior Resident
Department of Community
Medicine
MAMC, New Delhi

NATIONAL BLINDNESS & VISUAL IMPAIRMENT SURVEY INDIA 2015-
2019
Major Causes of Blindness in population aged ≥ 50
Cataract 66.2
Corneal opacity (including trachomatous) 8.2
Cataract surgical complications (including PCO) 7.2
Posterior segment disease (excluding DR & ARMD) 5.9
Glaucoma 5.5
Major Causes of Visual Impairment in population aged ≥ 50
Cataract 71.2
Refractive error 13.4
Cataract surgical complications (including PCO) 5.9

Major Causes of Blindness in population aged 0-49 years
Corneal opacity 37.5
All globe/ CNS abnormality (Amblyopia) 25.0
Phthisis 12.5
Other/undetermined 25.0
Major Causes of Visual Impairment in population aged 0-49 years
Refractive error 29.6
Cataract 25.4
All globe/ CNS abnormality (Amblyopia) 15.5
Corneal opacity 14.1

Categories of Visual impairment (VI)
Presenting distance visual acuity
Classification Category Worse than
Equal to or better
than
Mild or no VI 0 - 6/18
Moderate 1 6/18 6/60
Severe 2 6/60 3/60
Blindness 3 3/60 1/60
Blindness 4 1/60 Light perception
Blindness 5 No light perception
- 9 Undetermined or unspecified

Blindness definitions
 Economic blindness: Inability of a person to count fingers from a
distance of 6 meters or 20 feet technical Definition
 Social blindness: Vision 3/60 or diminution of field of vision to 10°
 Manifest blindness: Vision 1/60 to just perception of light
 Absolute blindness: No perception of light

Blindness definitions......
 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. xerophthalmia, trachoma and glaucoma
 Avoidable blindness: The sum total of preventable or curable
blindness is often referred to as avoidable blindness.

Burden of Blindness
 Prevalence of Blindness - 1.1%. (Blindness Survey 2001-02).
 Prevalence of Blindness – 1.0%. (Blindness Survey 2006-07).
 WHO Goal – reduction of prevalence of avoidable blindness to 0.3%
by 2020.
 NHP target – to reduce the prevalence of blindness to 0.25% by 2025
and disease burden by one third from current levels.

EPIDEMIOLOGICAL DETERMINANTS
1. AGE –
2. SEX – High prevalence of blindness in Females > Males
3. MALNUTRITION – Vitamin A deficiency
4. OCCUPATION – Factories, workshops etc. – exposure to dust, air
borne particles, gases, fumes, radiation etc.
5. SOCIAL CLASS – Blindness twice more prevalent in poorer
classes
6. SOCIAL FACTORS – Quacks, poverty, low standard of personal
and community hygiene, inadequate health services

 National Programme for Control of Blindness (NPCB)
launched in 1976.The Trachoma Control Programme
started in 1963 was merged under NPCB in 1976.
 In the beginning, NPCB was a 100% centrally
sponsored programme (now from 12th FYP it is 60:40
in all States/UTs and 90:10 in hilly states and all NE
States).
 Nomenclature of the programme was changed from
National Programme for Control of Blindness to
National Programme for Control of Blindness & Visual

Goals & Objectives of the Programme
Goal
 To reduce the prevalence of blindness to 0.3% by the year 2020
Objectives
 Reduce the backlog of blindness through identification and treatment of
blind.
 Develop comprehensive eye-care facilities at each level i.e. PHCs, CHCs,
Dist. Hospitals, Medical Colleges and Regional Institutes of Ophthalmology.
 Develop human resources for providing Eye Care Services.
 Improve quality of service delivery.
 Secure participation of Voluntary Organizations/Private Practitioners in eye
care services.

Summary of Programme activities
NHM Component
S. No Activities
1 Free Cataract Surgery at district hospitals and identified NGO eye hospitals/ Pvt.
Practitioners
2 Eye Screening and Distribution of Free spectacles to School children and elderly
3 Collection of Donated Eyes through network of eye banks and eye donation centers
4 Diagnosis and Treatment of other eye diseases (glaucoma, childhood blindness, squint
etc.) at District Hospitals and identified NGO eye hospitals
5 Procurement and maintenance of Ophthalmic equipments at sub-district/district Hospitals
and Vision Centers (in public sector only from FY 2018-19).
6 Training of Para Medical Ophthalmic Assistants posted at PHC/ District Hospitals
7 Strengthening of eye banks (in public sector only from FY 2018-19).
8 IEC activities on promoting eye health, preventing eye diseases and increasing utilization of services.

Tertiary Eye Care Components
S. No Activities
1 Provision of super specialty and referral eye care services for diabetic retinopathy,
Glaucoma, childhood blindness, retinopathy of prematurity and Keratoplasty (corneal
transplantation) etc. at Regional Institutes of Ophthalmology and Medical Colleges.
2 Construction of modular Eye OTs at RIOs for providing modern and tertiary level eye
care services
3 Training of eye surgeons in various specialties of Ophthalmology for skill development
4 Provision for supply of MK Medium to Govt. Eye Banks through Dr. R.P.Centre, AIIMS,
New Delhi for preservation of donated corneas and improve corneal utility rate.
5 Conducting Surveys (blindness & Visual Impairment Survey, Trachoma Survey etc.)
through identified institutions.

Specific programmes
1) School eye health services
Health education – Posture, proper lighting, avoidance of glare, proper
distance and angle
Screening
2) Vitamin A prophylaxis
3) Occupational eye health services

Corneal scarring from measles infection
and vitamin A deficiency
 Measles can be prevented through immunization.
 It is recommended that children with measles infection should be
treated with high dose vitamin A to reduce the risk of corneal
ulceration
 Food-based interventions such as food fortification

Corneal scarring from conjunctivitis of
the newborn (“ophthalmia neonatorum”)
 Ophthalmia neonatorum can be prevented before birth by treating
the mother’s infection.
 After birth, the infection can be prevented by ocular prophylaxis (i.e.
cleaning the eyelids and instilling an antiseptic or antibiotic shortly
after birth)

Retinopathy of prematurity
 i) Interventions to reduce preterm birth
 ii) A course of antenatal steroids to mothers with threatened
preterm delivery
 iii) High quality neonatal care immediately following birth to address
risk factors (e.g. sepsis, poor oxygen management, failure to gain
weight, fewer blood transfusions)

Congenital and developmental cataract
 Promotion: As early surgery gives better visual outcomes, health
promotion is required for parents and health workers so that
children with signs of cataract (white pupils) are urgently referred.
 Prevention: Rubella immunization

Cataract
 Promotion: Modifiable risk factors for cataract, including UV-B
exposure, cigarette smoking, cortico-steroid use and diabetes, are
also associated with other adverse health outcomes, interventions
aimed at improving their control should be promoted

Age-related macular degeneration
 Prevention: Cigarette smoking is the main modifiable risk factor
 Smoking cessation has been recommended in some clinical
practice guidelines for patients who have, or are at risk of, age-
related macular degeneration

Glaucoma
 Given glaucoma is asymptomatic in the early stages
 Appropriately designed health promotion initiatives targeting early
detection through improved awareness of the importance of
regular eye examinations can be effective in increasing the use of
eye care services among older populations

Diabetic retinopathy
 Health promotion initiatives can be important to raise awareness of
the importance of regular eye examinations among people with
diabetes.
 After diabetes onset, optimal management of key diabetic
retinopathy risk factors (e.g. hyperglycaemia and hypertension) can
prevent or delay the onset and progression of diabetic retinopathy

Pterygium
 Avoidance of proposed environmental risk factors may prevent
development of pterygium. The wearing of sunglasses may protect
against UV radiation, wind and dust

Refractive errors
 Presbyopia, hypermetropia and astigmatism cannot be prevented.
 In the case of myopia, on the other hand, increasing children’s time
spent outdoors and reducing near-work activity might delay the
onset and progression of myopia, which reduces the risk of high
myopia and its complications

Corneal opacity due to injury
 Interventions focused on public and occupational safety through
regulatory and policy measures, such as wearing seat belts and
restricting use of fireworks, can reduce the risk of eye injuries
 Targeted health promotion to improve awareness of trauma
prevention strategies, including wearing of protective eye wear in
high risk activities and industries (e.g. certain sports, agricultural
activities) may also be effective in reducing eye injuries

Trachoma - SAFE
 Surgery
 Antibiotic treatment
 Facial cleanliness
 Environmental improvements

Onchocerciasis
 Onchocerciasis is transmitted by blackflies and can lead to vision
impairment and blindness.
 There is no vaccine or medication to prevent infection.
 Ongoing onchocerciasis control programmes are implemented in
endemic regions and consist of mass drug administration of
Ivermectin using community-directed treatment.
 Vector control has been an additional strategy

Conjunctivitis
 The transmission of viral and bacterial conjunctivitis can be
prevented through hygiene measures (e.g. handwashing)
 The avoidance of allergens can be effective in preventing allergic
conjunctivitis

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