BLINDNESS AND ITS PROBLEMS

by : dr. Nunuk Maria Ulfah Sp M, M.Kes

OBJECTIVES:
To raise the awareness among students about World and Indonesian blindness problems and its prevention strategies

INTRODUCTION
Vision is important: - life survival - correlate to quality of lifes ability, intelegency, productivity, social economic

Blindness problem: patient : time ability chance

work

patients relatives: time to care

cost
goverment : facilities for blinds people

Aspect of vision loss:

1. Organ system: - physical and anatomical changes diseases, disorders 2. Organ system: - visual function changes impairment 3. Whole person: - ability activities of daily living ability / disability 4. Whole person: - social economic consequences handicap quality of life Vision (visus) measured : with Snellen chart

Vision and blindness:

Criteria Corrected Bilateral Vision Minimal Maximal

1 6/60 6/18 2 3/60 6/60 3 1/60 3/60 4 Light perception 1/60 5 No light perception _______________________________________________ Criteria : 3,4,5 : Blindness

THE WORLD BLINDNESS: ( WHO Fact sheet, 2000 )

- 185 million : impaired vision (visus less than 6/18) - 45 million : blind - 95% under developed country - 80% avoidable ( cataract nearly half of the worlds vision loss , and 80% may die before they have a chance for surgery in 1995 low of cataract surgical rate )

WORLD BLINDNESS CAUSES OF BLINDNESS:

Trachoma Xerophthalmia Glaucoma Ocular trauma Cataract Onchocerciasis

INDONESIAN BLINDNESS -- CAUSES OF BLINDNESS

Cataract Glaucoma Refraction anomaly Corneal diseases Retinal Diseases

INDONESIAN BLINDNESS:
Causes of blindness survey 1982 survey 1996

__________________________________________
1. Cataract 2. Glaucoma 3. Retinal diseases 4. Refraction 5. Corneal diseases 0.76 % 0.10 % 0.03 % 0.06 % 0.13 % 1.02 % 0.16 % 0.09 % 0.11 % 0.06 %

1,2,3: aging peoples & life expectancy ( + ) 5: vitamin A deffisiency (- ) ocular infection (-) nutrition (+)

BLINDNESS IN ASIA:
Indonesia ------- 1.5 % Bangladesh --------1 % Myanmar ---------0.9 % Bhutan --------- 0.8 % India ------ 0.6 % Ceylon --- 0.5 % South Korea ------ 0.4 % Thailand --- 0.3 %

BLINDNESS PROBLEMS:
< 0.5% ---0.5 % - 1 % --->1% ---Clinical problems Community health problems Social problems

INDONESIAN BLINDNESS PEOPLES:

Number of blindness 1.5 % .......... 3,000,000 peoples 52 % cataract .........................1,560,000 ,, 9.5 % refraction .......................... 285,000 ,, 13.4 % glaucoma .......................... 402,000 ,, 8.5 % retinal diseases .................... 255,000 ,, 6.4 % corneal diseases ................. 192,000 ,, 10.2 % others .......................... 306,000 ,,

PREVALENCE OF EYE MORBIDITY ( THE BIG TEN ):

Refraction Pterygium Cataract Conjunctivitis Corneal disease Glaucoma Strabismus Hordeolum Blepharitis Papil Atrophy : 22.1 % : 13.9 % : 7.3 % : 1.4 % : 0.4 % : 0.4 % : 0.3 % : 0.3 % : 0.3 % : 0.2 %

INDONESIAN HEALTH CARE:

Indonesia Sehat 2010 ..... Targets: To increase the expectancy of life To increase nutritional status To decrease mother and child mortality To decrease disease morbidity To decrease fisical deformities

VISION 2020 IAPB (International Agency for the prevention of Blindness)

1- The right to sight (every people has right to have optimal vision) global initiative to eliminate avoidable blindness by the year 2020. 2- Target campaign in avoidable blindness: cataract, refractive error and low vision, trachoma, onchocerciasis, glaucoma and diabetic retinopathy

3- Strategies: cost effective close collaboration among partners global awareness community level 4- Program: Disease prevention & control Personel training Strengthening eye infra structure Apropriate and affordable technology Mobilization of resources

VISION IS IMPORTANT EYE HEALTH CARE IS PRIORITY:

1.Epidemiological aspect: - eye diseases: caused blindness a long periode - eye disease: affect all ages, easy to spread, affect in wide area - vision : important in the technological era - blindness prevalence: high 2.Technological aspect: - eye health program can be integrate to other health program

3. Environmental aspect: - health environment correlate with eye diseases

4. Peoples behaviour aspect: Indonesian survey: 79.1 % eyes patient did not look for a treatment Among them who looked for a treatment: 6.7 % used self treatment, 5.4 % went to the hospital, 2.8 % went to the health centre

VARIOUS INTERVENTIONS FOR BLINDNESS PEOPLES:

The organ
Physical & Anatomical Changes Functional Impairment

The person
Ability to ADL Soc.Ec.Cons equences

Medical, surgical

Visual aid, devices

Education & training

INDONESIAN EYE HEALTH CARE PROGRAM:

1. Aim: Reduce blindness Reduce prevalence of eye diseases Raise peoples awareness Promote eye health program Promote strategic aliances 2. Policy: Dissemination and advocation of eye health program Promote manpowers quality Promote community and NGOs partisipation Develop infra structure

3. Target:
Under five, school ages, productive ages, old peoples Health staffs Professionals NGOs Government

4. Strategies:
Advocation / promotion Eye health care: Primary eye health care ( PEC ) --- health centre Secondary health care ( SEC ) --- district hospital Tertiary health care ( TEC ) ---- province hospital Increase of eye specialist production Education training Research NGOs partnership Develope Information system

PRIMARY EYE CARE: Area : Health centre Services : curative policlinic, admission Refferal TEC & PEC Report & recording Health education Community partisipation SECONDARY EYE CARE: Area : District hospital Service : PEC curative + standard & simple surgery Refferal PEC & TEC Report & recording Health education

TERTIARY EYE CARE: Area : Province hospital Services : SEC curative + hi tech surgery Refferal SEC & PEC Report & recording Health education Research

CATARACT:
Cataract is lens opacity Most common cause of blindness worldwide ( 17 million ) 2020 estimated to be 40 million Surgery: effective & efficient Majority of cases: old age Risk factors: genetic, cigarette smoking,ultra violet exposure,nutrition,diabetic,alcohol use,steroid use

GLAUCOMA
Glaucoma: Primary angle closure Primary open angle common on > 40 years, women > man Risk factors: anatomic predisposition (shallowing anterior chamber, smaller corneal diameter) myop, hypermetrop Prevention: screening

TRACHOMA:
- Infectious eye disease caused by: chlamydia trachomatis - WHO: to cause 15% world blindness - Risk factors : poor community, flies, ethnic, younger age - Trachoma prevention: primary : hygiene secondary : antibiotica tertiary : surgery WHO: strategies of prevention & treatment SAFE : S surgery A antibiotica F face cleanliness E environtment

MICROBIAL KERATITIS (corneal infection)

Risk factors : corneal trauma warm & humid places farmer , stone / brick worker Prevention: - screening - antibiotic & anti fungal for corneal abrasion

REFRACTIVE ERROR:
Large proportion : productive age Most common responsible for visual impairment: myopia Risk factors: genetic, near work,intellegence, premature Prevention: spectacle, contact lens, surgery

VITAMINE A DEFFICIENCY:
* 5 - 10 children develop xerophthalmia / year 500.000 blind * Risk factors: geographic, socio culture, measles * Clinical classification: Night blindness ( XN ) Conjunctival Sign ( XI A & XI B ) Xerosis & Bitots spot Corneal Sign ( X2, X3A, X3B) Corneal Scar (XS) * Prevention: Periodic vit A supplementation Fortification of food stuff Vit A rich food

DIABETIC RETINOPATHY:
- Leading cause of blindness in USA & UK among 2074 years old - Risk factors: older age, family history of diabetes, obesity

INTEGRATIONS PROGRAM:
Programs Eye health programs: Preventive, curative, promotive, refferal

1.Maternal and child health care: * pregnant mother toxoplasmosis, rubela, chlamidia, gonorrhoe, Vit. A deff * baby & children cataract congenital & juvenil, eye infection, leucocoria, strabismus, refraction 2. Nutrition vit. A defficiency 3. Health environment trachoma ( or other contagious eye diseases ) 4. Health Industry industrial accident, industrial health care

INTEGRATIONS PROGRAM:

Programs

Eye health programs: Preventive, curative, promotive, refferal

causes of blindness curative & reffferal of eye dieseases dental infection early detection of refractive errors and eye diseases

5. Health education 6. Policlinic (out patient) 7. Dental health care 8. School health care

Refferences:
1. Van Newkirk M, et al 2003 2004 , Basic and Clinical Science Course, section 13.International Ophthalmology.American Academy of Ophthalmo logy, San Fransisco. 2. Dep. Kes RI: Survei Kesehatan Indera Penglihatan 1993-1996