BY DR.

FAIZ-UR-RAB ASSISTANT PROFESSOR DUHS

LEARNING OBJECTIVES
Definitions of blindness WHO classification of visual impairment Causes of blindness in developing & developed countries Causes of high prevalence in Pakistan Low vision aids

DEFINITIONS
Legal Blindness: Visual acuity of less than 3/60 or its equivalent. Low Vision: Visual acuity of less than 6/ 18 but 3/60 or corresponding to visual field loss to less than 20 in the better eye with best possible correction. Avoidable Blindness: Blindness which could be either treated or prevented by known cost-effective means.

DEFINITIONS
Functional Blindness: Loss of vision sufficient to prevent one from being supporting in an occupation, making the individual dependent on other persons, agencies or devices in order to live. Industrial Blindness: It is present when a worker can no longer pursue an occupation because of poor vision

WHO Classification (Visual Impairment)

Category

Grade

Visual Acuity Best Corrected 6/18 20/60 3/10 (0.3) 6/60 20/200 1/10 (0.1) 3/60 20/400 1/20 (0.05) 1/60 5/300 1/50 (0.02) No light perception

1 Low Vision 2

3 Blindness 4

THE PROBLEM:
Worldwide 161 m people are visually impaired- 124m low vision & 37m blind. >90% of worlds visually impaired live in low and middle income countries. Except in most developed countries, cataract remains the most common cause of blindness.

CAUSES OF BLINDNESS:
IN DEVELOPED COUNTRIES: Accidents ,Glaucoma, Diabetes, Vascular diseases(hypertension), Cataract and Degeneration of Ocular tissues esp. of the Retina and Hereditary conditions. IN DEVELOPING COUNTRIES: Cataract Refractive Errors Glaucoma Post. Segment Disorder Surgical Complication

CAUSES OF CHILDHOOD BLINDNESS: Refractive errors, Trachoma, Conjunctivitis, Xerophthalmia, Congenital Cataract , Retinopathy of Prematurity.

 CAUSES OF AVOIDABLE BLINDNESS:

Cataract, Trachoma, Onchocerciasis, Childhood Blindness, Refractive errors, Glaucoma, Diabetic Retinopathy. EPIDEMIOLOGICAL DETERMINANTS: Age: More than 82% belongs to the group of >50yrs. Gender: Higher in females. Malnutrition: Vitamin A deficiency ,infectious diseases of new born . Social Class: Higher in low socio-economic status. Geographical: >90% in developing countries.

REASONS FOR HIGH PREVALENCE IN PAKISTAN Overall rise in size of population. Major population in rural areas have poor access to eye care facilities. Inadequate availability of trained health personnel & inadequate utilization of available ophthalmic surgeons.

Poor nutritional status of mother and young children Adverse environmental conditions and domestic unhygienic conditions.

 Lack of community awareness & poor health seeking behaviour. Myths & misconceptions about surgeries. LOW VISION AIDS All low vision aids work by presenting the patient with A magnified view of object. Most are optical systems Which act by increasing the angle subtended by the Object at the eye, thus producing an enlarged retinal Image.

GOALS OF LOW VISION

Increase functionality o Make the most of the remaining vision Provide link to community resources and support services Education

FUNCTIONAL EFFECTS OF LOW VISION

Loss of central vision (visual acuity) Loss of peripheral vision (visual field) Glare and contrast

Issues Related to Decreased Acuity

Difficulty reading Problems writing/ completing paperwork Inability to recognize distance objects and faces

Issues Related to Visual Field Loss

Location of scotoma important! Generalized loss of visual field difficult to compensate for Mobility and independent travel Reading may require adaptations

Issues Related to Contrast

Need for additional lighting Problems with glare Increased adjustment to changes in illumination Visual discomfort and fatigue

LIGHTING

GLARE & CONTRAST

Devices To Help Low Vision

STAND MAGNIFIERS

 Video magnifiers are sometimes called closed-circuit television (CCTV) systems and generally use standmounted or hand-held video cameras to project a magnified image onto a video monitor, a television (TV) screen, or a computer monitor.

COMMUNICATION GOALS
Educate patient on eye condition Help them to understand what options are available and how to use/ care for tools Glasses Low vision devices Technology Community resources Educate parents and teachers/ professionals on functional implications

FUNCTIONAL IMPLICATIONS
Print size Visual efficiency and fatigue Mobility issues Positioning/ classroom placement Lighting/ glare reduction needs