Blindness

Blindness : Common conditions leading to blindness in India

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However well prepared one is to face adversity, getting blind is a tragedy which devastates not just the individual but the  whole family. People go blind in their primes, often by the mistakes which could have been avoided by simple precautions. Some useful tips which can make people are extra cautious so as to keep their eye safe.

A usual story in a hospital emergency:

A school teacher brought his six years old son with penetrating injury in the eye by needle of a discarded syringe .  The boy was playing with other children and got hold of a discarded syringe with sharp needle from somewhere. It’s no surprise to see people casually discarding the used syringes in household waste. While playing with it, he got himself injured .

The child presented in emergency with infection in the eyeball (endophthalmitis) resulting from the penetration of that contaminated needle. With everything said and done, child went blind in that eye, for rest of his life. And it was irreversible.

Why did it happen?

Out of 1.4 million blind children in the world, two thirds are living in the developing countries. Unfortunately 50% of the blindness is due to causes that are currently not treatable or preventable. But rest half is due to reasons which are absolutely preventable. What is more surprising is the fact the precautionary measures do not cost anything significant.

One sixth of the childhood blindness is due to eye injuries. Injury to eye affects one in 25 people in urban population in India, and one in 167 people in this population are estimated to be blind in at least one eye due to injuries. The majority of the injuries resulting in blindness occurs during childhood and young adulthood, and slightly more than half occurs while playing.

Injuries in children occur either because of unsafe domestic environment or employment of children in agriculture and other industries. Unattended access of children to sharp objects like knives, needles, bow and arrows , pointed stationary items etc. are the reason for that. Mothers are often busy in domestic chorus to attend children.

Fire cracker injuries

In spite of clear government regulations prohibiting the access of the fire crackers to children less than 18 years of age, the most common age group of receive fire cracker injury in eyes , are children between 10-15 yrs. Age. This is because parents can spare money to purchase firecrackers but not the time to attend to children when they are playing with it.

One third of the children go blind due to lack of  spectacles for refractive errors which is  easily avoidable. All that parents have to do is to be cautious of any problem child has in seeing while playing with toys or reading, or if eyes are not straight. If they find anything suspicious, consult a eye doctor. A pair of spectacle cost around 400-500 INR.

One in every sixth children going blind is due to vitamin A deficiency. If you are reading this post, it’s unlikely you have any children in your family who is at risk of vitamin A Deficiency. But it is very much likely that that your servant or driver has a child who is at risk. Vitamin A deficiency is sign of malnutrition which is in turn common in people living in poverty. Ask them to ensure that child has received vitamin A supplementation offered free in government hospital to all children.

What should be done?

  1. Always keeps sharp and pointed items away from children.
  2. Keep an eye on children when they are playing.
  3. No fire crackers.
  4. Observe the children eyes and his/her ability to see the common things around.
  5. Educate poor and underprivileged around you, regarding protection and vitamin A supplementation.

Another usual story

Twenty years old young guy working as laborer in a sugar mill presented in emergency with one of eye injured with an iron rod. He was bleeding profusely and his father was in tears. Father was cursing the sugar mill administrators for spoiling his son’s life. When asked whether he was wearing any protective glasses while working, he said, he has no idea about any such glasses. These are available at hardware stores for 90 rupees.

The damaged eye has to be removed to prevent infection and bleeding. He was left permanently blind with one eye and a disfigured face with an empty eye socket .

Why did it happen?

Unsafe work environments

Eye Injury while working in unsafe working environment is another major cause of blindness acquired in youth. Usual story is some sharp object or a splinter penetrates in the unprotected eye, as the person is not wearing  protective glasses.

Why do they don’t wear it? Of course there are government regulations, but who has time to enforce them. Most of the people engaged in these jobs are poor and less educated, are in informal sectors. Employers have no interest in their protection. Victims are often young and stupid

Road traffic accidents:

Use of a two wheeler is very common, but not so the use of hamlets. The road traffic accidents are commonly associated with head injury, and injuries to the eyes are associated with it.

Sport related injuries.

Injury with the fast moving balls in sports like cricket and lawn tennis is another reason young adults present with injuries in eyes. Absence of protective eye gears is the main reason.

What can we do?

  1. Educate about vitamin A supplementation.  If you are reading this blog, again you neither engage in these sight threatening jobs, nor need eye protection gears. But you must be out sourcing these jobs to people who are too dumb to see that they can injure themselves, or smart enough to use protective eye gears. You can ask them to do so, make it a precondition that they will wear it if they have to work on your contract or premises.

  2. Helmet and other eye protection gears

Still another usual story?

56 yrs old legal practitioner presents with sudden loss of vision in one eye for last one week. He had diabetes for 11 years. He could barely see his way with his better eye. When asked about the treatment, he said he was on and off homeopathy drugs. There was nothing like control of blood sugar, and is usually in range of 300-350 mg%. when asked why was he so casual in his treatment, he said, its because he never had any problem with high blood sugar.

He had a bad form of diabetic eye disease in both the eyes, with one eye totally destroyed. After best treatment he could barely see at one meter from him, with his better eye. Every time he comes, he pleads to do something about his eyes so that he can read. His family is in financial mess as could not practice.

Diabetes

The sedentary lifestyle and changed eating habits have increased the incidence of the diabetes and consequently the cases of people losing their sight due to eye disease due to diabetes. The access to the treatment of diabetes is definitely a challenge in the society. Ignorance of the fact that the long standing uncontrolled disease will cause failure of many organ systems in the body, only adds to this burden. People are not careful as diabetes per say does not cause much physical discomfort.

Glaucoma glaucoma is another silent predator. it is of two types. Painless and painful. One that is painless is often diagnosed late often during the routine examination of eyes by an eye doctor.

What can be done?

  1. If you are not a diabetic, do not be one.
  2. Strict diabetes control. You must realize that drugs only control the sugar levels, if you restrict your sugar intake and exercise regularly. if you think taking pill is all you have to do, than you are seriously mistaken.
  3. Regular eye checkup. If you are above forty, you should see an ophthalmologist once a year. If you have diabetes, and a regular eye examination is even more important, to catch the diabetic eye disease as early as possible.

These are few simple precautions everybody should follow. please comment on the issues which can also be included in the list.

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eye donation

Eye donations in India : Fewer and far apart.

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In spite of the fact that more than a  lac people are blind in our country and need corneal transplants , the cornea (eye) donations are very low in India. why ? 

If the statistics of   National Programme for Control of Blindness (NPCB) are to be believed, currently, India is home to around 120,000 corneal blind persons. It also says that we are adding 25,000-30,000 persons with  corneal blindness cases every year to this list. But that should not be an issue as we can easily help them by donating a cornea to them. After all, we all have a pair of it, which will anyway be useless for us once we are gone.

Now the question is, if it is that simple than why people in India do not donate their corneas.

Lack of awareness 

Large count of those who cannot see is a matter of concern.  So also the fact that rest of us who can actually see, are not aware of this fact. And those of us, who do know, do not how to proceed.

Cultural and spiritual notions 

In certain communities, people have emotional attachment for a body organ, which is why they are reluctant to donate it. The fact that eye is the only external organ that is donated, is also reason people find it hard to decide in favour of its donation.  In Britain, the person registering for the organ donation gives consent for all their organs and tissues for transplantation. Around 50% registered users, withhold their consent for eyes, followed by 40% for heart.

Myths and misconception

Disfigurement of corpse: it stems from the lack of the awareness of the cornea harvesting methods among the people. It is a misconception that whole of the eye will be removed which will leave the corpse disfigured for mourners to witness. Actually the process involves retrieval of the cornea only, and the contour of the lids after closure is very much maintained. Moreover it takes only few minutes so do not delay the funeral as well.

Lack of nationwide donor registration

Donors pledging for donation of the eyes contribute in spreading the concept of eye donation in the community. The conscious and informed decision taken by a living person makes it less difficult for relatives and friend to decide and consent for donating the eyes of the that deceased family member in the moment of immense tragedy, just after his/her death. It is seen that only half of families   approached for donation agree to donate a relative’s organs if they are unaware of their relative’s decision to be a donor.

National Organ & Tissue Transplant Organisation recently constituted to facilitate organ donation and transplantation in India. We are yet to have a centralized organ donor registry which can facilitate this work. The centralized donor registration agency in US is donate life america. It is a non-profit organization, is engaged in awareness and fund raising.  Around 56% of US citizens are registered with it. In India we have few NGO’s which are working in this field but their area of work is still limited.  We need more common organ donation  campaigns which target multiple organs rather than eyes only.

Lack of transplantation facilities.

In year 2011 approximately 150000, corneal transplants were done worldwide, out of which majority were done in US and Europe. Though we have largest number to people in need of this service, we could only do approximately 17,000 corneal transplants. This is primarily attributed to underdeveloped eye banking services. Though we have 700 registered eye banks, only an average of 25 corneas are transplanted by each per year. One of the media report said that out of 100 corneas retrieved from donor, only 50 % could actually be transplanted in a recipients.

Whatever the circumstances, we should all strive to increase the corneal donations in our country. As correctly said by someone,

 “It is easy not to donate; it is hard to be blind.”

Please share your comments, what more can be done about this.

Read also

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Blindness control

Role of NPCB in control of preventable blindness in India

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India is also home to around 9 million blinds out of which one third have preventable blindness. Later means that we can treat it if we have capabilities and intention to treat. NPCB has done a great job in containing the problem of preventable blindness in India.

When comes to delivery of results in any social programs, people have serious doubt about the capabilities and intentions of government agencies. The suspicions are not entirely unfounded as corruption, inefficiency, lack of coordination, poor planning, and political interference are some attributes commonly associated with any government agency.

National Program for Control of Blindness, NPCB.

As a launch of any social benefit program attracts media attention, we often are in a hurry to do that. No surprise that India was the first country in the world to launch a 100% public funded programme for the control of blindness also called the National Program for Control of Blindness, NPCB. National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness in India.

As a launch of any social benefit program attracts media attention, we often are in a hurry to do that. No surprise that India was the first country in the world to launch a 100% public funded programme for the control of blindness also called the National Program for Control of Blindness, NPCB. National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness in India.

Experience of  China

Just to put things into perspective, in China, the estimated numbers of blind people in 1990 were 6.7 million.  The China population of people 50 years of age and older (who are at higher risk of blindness) in 2002 had increased by 27% compared to that in 1990. In 2002 there were an estimated 6.9 million blind people in China. That means that with all the efforts and resources the china invested in blindness control, an increase of 3% in the number of blind people was noticed in China, in the year 2002. The may well be attributed to the errors in estimations and projections to calculate these data.

Our achievements

In comparison with that, In India, the estimated numbers of blind people in 1990 was 8.9 million, which was around 2.2 million more blinds than what China had. Just like China, the Indian population of people 50 years of age and older (who are at higher risk of blindness) in 2002 had increased by around 30 % compared to that in 1990. But what’s most surprising is that in 2002 the total number of blind people estimated in India was 6.7 million. It was not only 0.2 million less than what China had,  but also that India reported a decrease of 25% blind people over the numbers published in 1990.

This achievement is partially attributed to factors like patient awareness, and socioeconomic development but the credit primarily goes to the concerted national efforts to control blindness sphere headed by NPCB. This success is attributed to an emphasis on evidence-based practice for planning and policy formulation besides the implementation and identification of strategies appropriate for local needs.

But the story is not over yet. Cataract surgical rate (CSR) is described as number of cataract surgeries done in a year per one million population. The cataract surgical rate (CSR) is one of the major WHO indicators used to assess overall level of blindness control efforts done in a country. WHO recommends an ideal CSR range of 3000-5000 per year per million population to meet the need. In India, CSR is estimated to be more than 5000. Under 11 five year plan (2008-12) around 3 million (2, 94, 07,355 to be exact) cataract cases were operated. From 2013 onward, with exception of few states like UP and Panjab, most of the states are regularly exceeding the target of cataract surgeries planned every year under NPCB.

But then these are just numbers, and often the actual needy is left behind and government funded benefits are taken by socially and economically strong sections of the society. A study reported from Madhya Pradesh, the female patient’s outnumbered males both is outdoor patients and operated patients in the eye camps organized under NPCB. Though this may be partially attributed to higher incidence of cataract in aged females, but it is no less achievement that government is able to deliver them the services. In one of the series of around 2200 cases, author reported that around 88% of the patients were from socially back ward communities. Author added that “A combination of these three factors – female gender, poverty, and backward class – lays an individual in utmost undesirable position. These camps were an immense aid to them”.

Concluding

So next time when you are making a list of what India does better than the rest of the world, do not just include ISRO and Bollywood . Blindness control program NPCB, certainly deserve a place in that list.