Prevention of blindness. A presentation on ncds

A brief overview of prevention of blindness

1. Dr. Mahnoor Department of Community Medicine Watim medical college

2. A 6-year-old child presents with night blindness. What could be the cause?

3. Learning Objectives By the end of this session, students should be able to: Define blindness and its global and national burden. Identify risk factors and causes of blindness. Explain prevention strategies based on the epidemiological model. Discuss the role of WHO & national programs in blindness prevention. Apply prevention strategies in community settings

4. What are the main causes of blindness? How does Vitamin A deficiency affect vision? What is the role of public health in preventing blindness?

5. Epidemiology of Blindness WHO defines blindness as visual acuity of 3/60 or its equivalent. In the absence of a vision chart it is the inability to count fingers in daylight at 3 meters distance. Prevalence in Pakistan: 85.4% of blindness is avoidable in Pakistan. Most common causes are untreated cataract and refractive errors.

6. Causes and risk factors In developed countries: Accidents, glaucoma, DM, vascular disease, cataract and ocular degeneration of ocular tissue. Leading causes of childhood blindness. Xerophthalmia, congenital cataract, congenital glaucoma and optic atrophy.

7. Causes of Preventable blindness Uncorrected refractive errors Untreated cataract Glaucoma Xerophthalmia due to (Vit A deficiency): Signs and symptoms on eye examination: Night blindness, dry eyes (xerosis), bitot spot, keratomalacia, corneal ulcers (keratitis). Easily treated with vitamin A supplementation. Trachoma: Caused by chlamydia trachomatis. Trachoma is contagious, spreading through contact with the secretions of eyes, eyelids, and nose/throat secretions of infected people. Spreads in communities due to poor hygiene. Signs and symptoms:Follicular conjunctivitis which scars and tightens eyelids which causes inward-turning of eyelashes (trichiasis) leading to corneal ulcer (keratitis). Treated with antibiotics.

8. Ocular trauma Hereditary conditions such as retinoblstoma Retinopathy of prematurity Congenital cataract Congenital glaucoma Corneal ulcers Diabetic retinopathy Hypertensive retinopathy

9. Bitot spots (xerophthalmia) Corneal ulcer Punctate keratitis seen in measels Hazy cornea seen in xerophthalmia cataract retinoblastoma

10. Trichiasis; a complication of trachoma Trauma leading to exposure keratitis Follicular conjunctivitis

11. Epidemiological determinants Age: In children & young: Refractive errors, trachoma, conjunctivitis, malnutrition. In adults: Cataract, refractive error, glaucoma, DM Sex: Higher prevalence of trachoma, cataract and conjunctivitis in women leading to higher prevalence of blindness in women. Malnutrition: Infectious diseases of childhood especially measles and diarrhea. PEM Corneal destruction due to vitamin A deficiency. Occupation: People working in factories, workshops, industries are prone to eye injuries because of exposure to dust, airborne particles, flying objects, gases, fumes and radiation.

12. PREVENTION PRIMARY EYE CARE : wide range of eye conditions such as xerophthalmia, conjunctivitis, trachoma, foreign bodies, etc can be treated at the grass-root level by locally trained primary health worker who are first to make contact with the community. They are also trained to refer complex cases to nearest PHC or district hospital. SECONDARY CARE : this care is provided in PHCs and district hospitals and involves definitive management of cataracts, glaucoma, ocular trauma, trichiasis etc. Early detection through screening programms for e.g school eye health screening and Mobile eye camps. TERTIARY CARE :services established is national or regional capitals. Specialized tertiary care teaching hospitals/ institutes. They provide sophisticated eye surgery I.e corneal grafting, retinal detachment surgery. Other measures of rehabilitation comprise education of blind in special schools, provision of gainful employment.

13. PREVENTION SPECIFIC PROGRAMMES: Trachoma control school eye health services vitamin A prophylaxis EPI Occupational eye health services LONG TERM MEASURES: these measures are aimed to attack factors responsible for persistence of eye health problems e.g poor sanitation, lack of safe water supplies, little intake of foods rich in vit A, lack of personal hygiene. Health education is important long term measure to create community awareness, motivation and participation.

14. Vision 2020 "Vision 2020: The Right to Sight" was a global initiative launched by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with the goal of eliminating avoidable blindness worldwide by the year 2020, focusing on preventing major causes like cataracts, trachoma, and refractive errors, essentially advocating for everyone's right to sight.

15. National program for prevention and control of blindness The National Program for Prevention and Control of Blindness (NPPCB) is a program in Pakistan that aims to reduce blindness and visual impairment. The program includes activities such as improving eye care services, training eye care personnel, and raising awareness.  Goals  Improve access to eye care Improve the quality of eye care services Develop low-vision services Train eye care personnel Raise awareness about eye health Conduct research Develop community programs

16. Program activities   Upgrading eye departments in hospitals Developing outreach programs Developing new low-vision clinics Training teachers and instructors in orientation and mobility Developing a referral chain from communities to First Level Care Facilities (FLCFs) Integrating eye health indicators into monthly reporting tools Support The NPPCB receives support from international organizations such as Sightsavers . These organizations help with training, capacity building, and developing referral chains. Success Pakistan has eliminated blinding trachoma, which is a significant public health victory. 

17. Case 1: A middle-aged man develops progressive vision loss due to cataracts. What prevention strategies apply? Case 2: A child in a low-income community has night blindness. How can we intervene?

18. Take-Home Message: 80% of blindness is preventable. Prevention starts with awareness. Call to Action: Promote school-based vision screening & eye care awareness.