Blindness and Vision Impairment; NPCBVI.pptx

Blindness and vision impairment are significant global health issues and refer to conditions that affect a person's ability to see clearly or at all. These conditions can range from mild vision loss to complete blindness and can be caused by various factors such as genetics, diseases, injuries, or aging.

1. BLINDNESS & VISION IMPAIRMENT "Blindness is an unfortunate handicap but true vision does not require the eyes.“ -Helen Keller - Puja Kumari (MPH)

2. Contents Introduction History Definition Disease Prevalence Burden Impact of vision impairment Types of blindness Visual impairment levels Risk factors Causes Early signs and symptoms of blindness Signs and symptoms Diagnosis and tests Treatment Treatment advances of blindness Prevention Strategies to address eye conditions to avoid vision impairment Challenges Programme : NPCBVI WHO Response References

3. Introduction: Vision, the most dominant of our senses, plays a critical role in every facet and stage of our lives. We take vision for granted, but without vision, we struggle to learn, to walk, to read, to participate in school and to work. Vision impairment occurs when an eye condition affects the visual system and its vision functions. Everyone, if they live long enough, will experience at least one eye condition in their lifetime that will require appropriate care. Vision impairment has serious consequences for the individual across the life course. Many of these consequences can be mitigated by timely access to quality eye care.

4. History: The blind in the ancient world: It has long been assumed that in the ancient world the blind enjoyed few opportunities and lived out their days in penury as beggars or as wards of their families in the absence of any systematic state or government assistance. Historical knowledge of the lives of blind people in the premodern Western world is extremely limited, and it is strongly influenced by literary or religious texts.  The blind during the  Enlightenment : During the  Enlightenment  of the 17th and 18th centuries in Europe, philosophers introduced new questions about blindness and the nature of the blind, moving the conversation away from strictly spiritual questions toward rational interpretations of understanding and knowledge.

5. Education  and the blind: French philosopher  Denis Diderot  penned one of the first  treatises  to include significant discussion of the blind and education with his “Letter on the Blind for the Use of Those Who Can See” (1749). The essay suggested that the sense of touch could be honed for reading in blind persons, foreshadowing the 19th-century invention of the Braille writing system . The development of Braille: Louis Braille , a student at the Royal Institute for the Blind (National Institute for Blind Children) in Paris in the 1820s, took a raised-dot system of code brought to the school in 1821 and turned it into the most-important advancement in blind education.

6. Definition: World Health Organization Definitions: Blindness is defined as visual acuity of less than 3/60 or corresponding visual field loss in the better eye with best possible correction. Blindness is the inability to see with one’s eye, either partially or totally. Partial blindness is also sometimes referred to as vision impairment.

7. Eye doctors diagnose it when: A person’s best-corrected eyesight (the highest visual acuity they can reach using glasses, medication, or surgery) falls below a certain threshold. A person’s visual field (the area that can be seen when their eyes are fixed on a specific point) is significantly smaller than normal. In the most severe cases, there’s an inability to see even light. It also means that you can’t correct your vision with eyeglasses, contact lenses, eye drops or other medical therapy, or surgery. 

8. Disease Prevalence:

9. BURDEN

10. Global Situation: Globally, at least 2.2 billion people have a near or distance vision impairment. In at least 1 billion of these, vision impairment could have been prevented or is yet to be addressed. Among this 1 billion people, the main conditions causing distance vision impairment or blindness are cataract (94 million), refractive error (88.4 million), age-related macular degeneration (8 million), glaucoma (7.7 million), diabetic retinopathy (3.9 million). The main condition causing near vision impairment is presbyopia (826 million).

11. In terms of regional differences, the prevalence of distance vision impairment in low- and middle-income regions is estimated to be 4 times higher than in high-income regions. With regards to near vision, rates of unaddressed near vision impairment are estimated to be greater than 80% in western, eastern and central sub-Saharan Africa, while comparative rates in high-income regions of North America, Australasia, western Europe, and of Asia-Pacific are reported to be lower than 10%. Vision loss can affect people of all ages; however, most people with vision impairment and blindness are over the age of 50 years.

12. In 2020 in India, there were an estimated 270 million people with vision loss. Of these, 9.2 million people were blind. Blindness (crude)- 0.60% All vision loss (crude)- 19.30% Indian Scenario:

13. Personal impact: Young children with early onset irreversible severe vision impairment can experience delayed motor, language, emotional, social and cognitive development, with lifelong consequences. School-age children with vision impairment can also experience lower levels of educational achievement. Vision impairment severely impacts quality of life among adult populations. Adults with vision impairment can experience lower rates of employment and higher rates of depression and anxiety. Impact of vision impairment:

14. In the case of older adults, vision impairment can contribute to social isolation, difficulty walking, a higher risk of falls and fractures, and a greater likelihood of early entry into nursing or care homes. Economic impact: Vision impairment poses an enormous global financial burden with an estimate annual global productivity loss of about US$ 411 billion purchasing power parity (3). This figure far outweighs the estimated cost gap of addressing the unmet need of vision impairment (estimated at about US$ 25 billion).

15. Partial blindness : You still have some vision. People often call this " low vision .“ Complete blindness : You can't see or detect light. This condition is very rare. Congenital blindness : This refers to poor vision that you are born with. The causes include inherited eye and retinal conditions and non-inherited birth defects. Types of blindness:

16. Nutritional blindness : This term describes vision loss from vitamin A deficiency. If the vitamin A deficiency continues, damage to the front surface of the eye ( xerophthalmia ) This type of blindness can also make it more difficult to see at night or in dim light due to retinal cells not functioning as well. Legal blindness : This is when the central vision is 20/200 in your best-seeing eye even when corrected with glass or contact lenses. Having 20/200 vision means that you have to be 10x closer or an object has to be 10x larger in order to see compared to a person with   20/20 vision . In addition, you can be legally blind if your field of vision or peripheral vision is severely reduced (less than 20 degrees).

17. Aside from total and partial blindness, there are three additional types of blindness: color blindness, night blindness and snow blindness.  Color Blindness Color blindness is the inability to distinguish different shades of colors or the inability to see some or all colors. Colorblind people cannot tell the difference between certain colors, especially green and red or blue and yellow. Some cannot see any color at all and view the world in only their shade of gray.

18. Night Blindness: Night blindness refers to difficulty of seeing at night or in poorly lit areas. Night blindness is not in itself a disorder but a symptom of retinal degradation. Many people with night blindness can see well during the day or in well-lit areas. Snow Blindness: Snow blindness refers to a loss of vision because of intensive exposure to ultraviolet light. You can still see shapes and movements if you are snow blind, but your vision is permanently reduced. Wearing sunglasses while outdoors can prevent this condition. 

19. Visual Impairment Levels: The  World Health Organization  categorizes visual impairment into three levels. They are: Moderate visual impairment : someone with a visual acuity of 20/70 to 20/160. Severe visual impairment : someone with visual acuity of 20/200 to 20/400 or visual field of 20 degrees or less. Profound visual impairment : someone with visual acuity of 20/500 to 20/1000 or visual field of 10 degrees or less.

20. Risk Factors: Some major risk factors for blindness include: Aging The existence of certain diseases like diabetes mellitus, cardiovascular disease and hypertension Premature birth The presence of some vision disorders like  strabismus  and  amblyopia Family history of blindness, diabetes or other vision-related illnesses Poor nutrition Failure to wear protective glasses Poor prenatal care (e.g., maternal smoking)

21. Causes: the leading causes of vision impairment and blindness are: refractive errors cataract diabetic retinopathy Glaucoma age-related macular degeneration

22. There are many causes of blindness, including injuries, infections and medical conditions. Eye injuries and blindness: Eye injuries , or ocular trauma, can happen in many ways. It usually affects only one eye. Damage can result from: Chemical burns. Exposure to toxins Fights. Fireworks. Industrial accidents, including falls. Motor vehicle crashes. Sports.

23. Infections and blindness: Many infectious diseases can lead to vision loss and sometimes blindness. These include: Trachoma. This is the leading cause of preventable blindness in the world. Cytomegalovirus Endophthalmitis Histoplasmosis. Keratitis, including  acanthamoeba keratitis Rubella Shingles Syphilis Toxoplasmosis Uveitis

24. Non-infectious diseases and blindness: Many non-infectious diseases can cause blindness, but some in only the most severe stages of the disease. These include: Retinitis pigmentosa ( a group of conditions that affect your  retina , leads first to problems seeing at night and then subsequent loss of your peripheral vision) Age-related macular degeneration  (affects the macula, When substantial central vision loss occurs, tasks like reading or recognizing people’s faces become very difficult, but your peripheral vision often remains intact) Retinopathy of prematurity ( some  premature babies Blood vessels grow into parts of their eye where they don’t belong. Scar tissue forms and can damage their retina, leading to significant vision loss and blindness)

25. Cataracts .  Cataracts cause vision loss by clouding the lenses of your eyes, leading a blurring of the vision and loss of contrast. Without access to surgical care, advanced cataracts can lead to blindness. Diabetes-related retinopathy.  This condition may happen when you have diabetes and the blood vessels in the eye are damaged. The vision loss may be mild at first, but with progression or lack of treatment, blindness can occur. Glaucoma .  With this condition, you have optic nerve damage. The vision loss often starts in the periphery but can lead to blindness in advanced stages of the disease. Leber hereditary optic neuropathy .  This term refers to an inherited type of gradual vision loss. For unknown reasons, it affects males more than females.

26. Anophthalmia.   This disease happens when you’re born without one or both eyes. Microphthalmos.   This disease happens when you’re born with very small eyes. Sometimes these smaller eyes don’t work as well as they should, or at all. Stroke.   You can lose your eyesight from a stroke that occurs in an area of the brain that is involved in seeing, like the occipital lobe or along the visual tract. The stroke reduces or blocks blood flow to your brain. Cancer.  Cancers, like   retinoblastoma  or orbital tumors, can cause eyes to become blind. Nutritional deficiencies.  A poor diet can cause vision loss. Vitamin A deficiency is one cause, but you also need B vitamins and other minerals and vitamins for healthy vision.

27. Early Signs and Symptoms of Blindness: Blindness rarely happens suddenly. Some of the early signs and symptoms of this condition include: Excessive light sensitivity Eye pain Difficulty focusing Itchy eye. Red eyes Abnormal eye alignment Pupils changing color from black to white These signs and symptoms are common to many different eye disorders, and not all of them lead to blindness. Do not panic if you have one or more of the symptoms listed above. Your eye doctor will tell you if there is cause for concern.

28. Signs and Symptoms If you have total blindness, you will not see anything regardless of lighting or location. If you have partial blindness, you may experience: Poor vision in low-light areas Cloudy vision Double vision Decrease in vision Inability to tell what shape objects are

29. Diagnosis and Tests : A provider will test each eye for sight, giving you a thorough   eye exam . It’s possible for blindness to affect only one eye. Tests may include: The Snellen test: A provider asks to read lines of letters that get smaller as they go down the page. This test of visual acuity measures what you can see in front of you (central vision). 2. Visual field testing : The visual field means more than central vision. It’s what you can see to either side or above and below without moving your eye.

30. Treatment: The type of treatment available depends on condition. Treatment exists for some forms of blindness, depending on the cause and how extensive the eye damage is. Medication:  Anti-infective drugs treat some forms of blindness caused by infections. Cataract surgery :  Surgery can treat cataracts successfully in most cases. Corneal transplant:  A provider may be able to replace your scarred cornea. Retinal surgery:  A provider may be able to repair damaged retinal tissue with surgery or a laser. Vitamin supplements:  You may be able to reverse the vision loss of xerophthalmia by taking vitamin A. You may need vitamin B or vitamin D supplements to treat vision loss caused by a poor diet.

31. Treatment Advances for Blindness: There are many different treatments for eye conditions that cause blindness. Refractive errors can be treated using prescription eyeglasses or contact lenses. Glaucoma  can be treated using medications that lower eye pressure. Wet form macular degeneration can be treated with injections and medications. Cataracts can be treated with cataract surgery. Corneal scarring or swelling can be treated with a  corneal transplant. The U.S. Food and Drug Administration (FDA) also recently approved a  gene therapy drug that treats certain forms of inherited vision loss. 

32. Prevention: To help reduce your risk of blindness: Control your blood sugar levels . Diabetes mellitus is a leading cause of blindness. Consult your doctor to help you manage your blood sugar, blood pressure and cholesterol levels.  Eat nutritious food . Research has shown that food items like salmon and tuna, rich in omega-3 fatty acids, are good for your eye health. Protect yourself from eye injuries . Putting on protective gear while working or playing sports helps prevent blindness due to injuries. Do not smoke . Research has shown that  smoking can lead to blindness by increasing your risk of developing cataracts, optic nerve damage and age-related macular degeneration. Visit your eye doctor regularly . If you have any symptoms of early blindness, your eye doctor will notice them and deliver the appropriate treatment.

33. Wear protective gear when you’re working, riding a motorcycle or participating in contact sports. Don’t forget to wear sunglasses. Get enough exercise. Ask your provider about an exercise plan that’s healthy for you. Achieve a healthy weight for you. Know about health issues in your family. Quit smoking, or never start. Avoid infections in your eye by always washing your hands when you put your contacts in and following instructions about how often to change them. Treating eye diseases that lead to blindness can often prevent this outcome. Recognizing early symptoms of a developing eye problem is crucial to receiving treatment in an early enough stage to avoid any vision loss.

34. Strategies to address eye conditions to avoid vision impairment: There are effective interventions covering promotion, prevention, treatment and rehabilitation which address the needs associated with eye conditions and vision impairment. While many vision loss cases can be prevented (such as those due to infections, trauma, unsafe traditional medicines, perinatal diseases, nutrition-related diseases, unsafe use or self-administration of topical treatment), this is not possible for all. Spectacle correction for refractive error and surgery for cataract are among the most cost-effective of all health-care interventions.

35. Yet,  globally only 36% of people  with a distance vision impairment due to refractive error have received access to an appropriate pair of spectacles and only 17% of people with vision impairment or blindness due to cataract have received access to quality surgery. Treatment is also available for many eye conditions that do not typically cause vision impairment, such as dry eye, conjunctivitis and blepharitis, but generate discomfort and pain. Treatment of these conditions is directed at alleviating the symptoms and preventing the evolution towards more severe stages of those diseases. Vision rehabilitation is very effective in improving functioning for people with an irreversible vision loss that can be caused by eye conditions such as diabetic retinopathy, glaucoma, consequences of trauma, and age-related macular degeneration.

36. The services can include: Education. Emotional health. Skills training. Technology training. Recreational options. Living With When should I see a healthcare provider about vision issues? Get immediate medical help if you: Lose vision suddenly. Have pain in your eye. Have some type of accident that affects your vision. Have flashes or new floaters in your vision

37. Challenges: Onchocerciasis (River Blindness):  Onchocerciasis, caused by the parasite  Onchocerca volvulus Corneal Blindness Global Causes of Visual Impairment: Uncorrected Refractive Errors:  These account for 43% of visual impairment cases globally. Cataract:  Responsible for 33% of visual impairment cases. Glaucoma:  Contributes to 2% of visual impairment cases. Prevention and Access:  While many vision loss cases are preventable, not all can be avoided.  Factors like infections, trauma, and unsafe traditional medicines contribute to visual impairment.

38. PROGRAMME

39. National Programme for Control of Blindness & Visual Impairment(NPCBVI) About NPCBVI: National Programme for Control of Blindness & Visual Impairment (NPCBVI) was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%. As per Survey in 2001-02, prevalence of blindness is estimated to be 1.1%. Rapid Survey on Avoidable Blindness conducted under NPCBVI during 2006-07 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07). Various activities/initiatives undertaken during the Five Year Plans under NPCBVI are targeted towards achieving the goal of reducing the prevalence of blindness to 0.3% by the year 2020.

40. Goals & Objectives of NPCBVI in the XII Plan: To reduce the backlog of blindness through identification and treatment of blind at primary, secondary and tertiary levels based on assessment of the overall burden of visual impairment in the country. Develop and strengthen the strategy of NPCBVI for “Eye Health” and prevention of visual impairment; through provision of comprehensive Eye Care services and quality service delivery. Strengthening and upgradation of RIOs to become centre of excellence in various sub- specialities of ophthalmology

41. Strengthening the existing and developing additional human resources and infrastructure facilities for providing high quality comprehensive Eye Care in all Districts of the country To enhance community awareness on eye care and lay stress on preventive measures Increase and expand research for prevention of blindness and visual impairment To secure participation of Voluntary Organizations/Private Practitioners in eye Care

42. Implementation : NPCBVI collaborates with various stakeholders, including NGOs, medical colleges, private practitioners, and eye banks. Screening camps, donation centers, and satellite centers contribute to its outreach efforts. Insurance Aspect: While NPCBVI primarily focuses on prevention and treatment, specific insurance schemes related to blindness may exist at the state level. For comprehensive health insurance, you might want to explore broader health insurance policies that cover eye care.

43. WHO response WHO’s work is guided by the recommendations of the  WHO World report on vision (2019) and the resolution on  "integrated, people- centred eye care, including preventable blindness and vision impairment“ adopted at the Seventy-third World Health Assembly in 2020. The key proposal is to make integrated people- centred eye care (IPEC) the care model of choice and to ensure its widespread implementation. It is expected that by shaping the global agenda on vision and eye care, the report and resolution will assist Member States and their partners in their efforts to reduce the burden of eye conditions and vision.

44. Some of WHO’s key areas of work and activities in the prevention of blindness include: Working with Member States and other partners in the field to monitor the global targets for 2030 on integrated people- centred eye care: Developing  reports of the effective coverage of eye care indicators to monitor progress towards the 2030 global targets Developing  resources and technical tools to support the integration of eye care into health information systems Observing and promoting World Sight Day as an annual advocacy event. Supporting the integration of eye care in health systems through the implementation of a series of technical tools: The  Eye care in health systems: Guide for action The   Package of eye care interventions (PECI) The  Eye care competency framework (ECCF)

45. 4.The development and implementation tools to support countries to assess the provision of eye care services such as: The Eye care situation analysis tool The Tool for the assessment of diabetic retinopathy and diabetes management services. The Tool for the assessment of glaucoma services. The Tool for the assessment of refractive services. The Tool for the assessment of rehabilitation services and systems. 5.The development of materials and resources to raise awareness on eye care: The  MyopiaEd : a mobile health toolkit for myopia to increase health literacy. A population-facing app for near and distance visual acuity testing. Graphics promoting healthy eye habits.  

46. References: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual- impairment NPCBVI (mohfw.gov.in) https://www.iapb.org/learn/vision-atlas/magnitude-and-projections/cou ntries / india https://my.clevelandclinic.org/health/ diseases/blindness Blindness: Types, Causes, Risk Factor and More | MyVision.org Website of National Programme for Control of Blindness & Visual Impairment| National Portal of India pib.gov.in/ PressReleaseIframe