Blindness Awareness Month - Focus on Dominica

Dr Hazel Shillingford Ricketts - Consultant OpthalmologistDr Hazel Shillingford Ricketts - Consultant OpthalmologistContributed by Dr. Hazel Shillingford Ricketts M.B.B.S. (U.W.I); F.R.C.S. (C)

The month of May has been designated as “Blindness Awareness Month”. This means that during the month of May there will be a number of programmes geared towards informing the general public about blindness.

The Dominica Association of Persons with Disabilities must be congratulated for their efforts in putting together a programmes under the theme: “Preventing blindness and assisting those whose sight cannot be restored”. Their goal is to create a more enabling and accessible environment for persons with impaired vision.

The term blind means the loss of sight. However for the purpose of standardizing the level of loss of vision referred to as blindness, it is defined as the best-corrected visual acuity (that is with corrective lenses) of less than 20/400 or a visual field of less than 10 degrees (The normal being 180 degrees horizontally), in the better eye. Visual Impairment refers to the level of bestcorrected visual acuity of 20/70 to 20/200 or a visual field of less than 20 degrees in the better eye. (WHO classification)

The Snellen Fraction used to designate the level of vision (example 20/400) means that this person can only see letters at 20 feet which a person with normal 20/20 vision can see 400 feet away.

There are about 285 million people around the world who are blind or visually impaired. In Dominica it is estimated that there about 700 persons who are blind and 2100 visually impaired.

There are many causes of blindness. Most of the causes of blindness can be treated to restore vision or prevent loss of vision. However there are some causes of blindness that cannot be treated. About 80% of blindness can be prevented. The majority of people who are blind are older than 50 years. 90% of the those who are blind in the world live in developing countries and most live in poverty.

The number of persons who are blind continues to rise as the world’s population is increasing, people live longer and the prevalence of Diabetes Mellitus is increasing. This is a serious public health issue. It is a serious socioeconomic concern not only for the individual but for their family, their country and the world. Measures must be put in place to address this growing problem.

Vision 2020: ‘The Right to Sight’ is a global initiative of the World Health Organization and The International Agency for the Prevention of Blindness to eliminate preventable causes of blindness by the year 2020.
In 2000, the Caribbean Vision 2020 Programme was launched and the strategy is to eliminate blindness caused by Cataracts, Glaucoma, Diabetic Retinopathy, Childhood Blindness and Refractive Errors (need for glasses). The programme is geared at mobilizing resources to provide more services to reduce this growing public health issue of blindness.There are a number of measures already in place across every sector which helps to prevent blindness in Dominica. Eye care delivered by the Ophthalmological Team is integrated in Primary Health Care throughout the island making eyecare available, affordable and accessible.

Important causes of blindness in children are Measles, Rubella and Vitamin A Deficiency. Immunization and a diet rich in vitamin A has eliminated those causes of childhood blindness. Clean water to bathe and keep the face clean prevents blindness from a bacterial eye infection called trachoma still prevalent in Africa and some other developing countries.

Premature babies are at risk of blindness from Retinopathy of Prematurity. Screening of premature babies to detect and treat this condition to prevent blindness is ongoing.School Health Programme conducted by the Family Nurse Practitioners for 5 and 11 year olds detects children with vision problems. They are referred to the Ophthalmologist for further evaluation and treatment.

In the working age population, Diabetic Retinopathy is the leading cause of blindness. This affects the productive sector of our country. It is important that the risk factors of obesity, lack of exercise and proper nutrition are addressed to reduce the number of people developing diabetes which now affects about 18% of our population.

Those diagnosed with Diabetes have to control their Blood Sugar, Blood Pressure and Cholesterol to reduce the risk of developing Diabetic Retinopathy. In addition,Diabetics must have regular eye examinations to detect the eye complications early. Early detection and treatment can prevent blindness. There is a screening fundus photography programme for Diabetics in the Primary Health Sector. Laser treatment is available for treating Diabetic Retinopathy.

Cataract

Cataract is the leading cause of blindness in the world. It is responsible for over half of the causes of blindness. If everyone live long enough they will develop Cataracts, as aging is the most common risk factor. However blindness from Cataract can be reversed with a day surgery under local anesthetic. It is one of the most cost effective surgical interventions.

Glaucoma

Glaucoma is the most dreaded cause of blindness. It is the leading cause of irreversible blindness. Regular eye examination from the age of 40 is a good practice to detect if one has Glaucoma especially if they have a family member with it. The risk increases as one gets older. It cannot be cured but it can be controlled by lowering the intraocular pressure witheyedrops, laser and surgery. It is a silent thief of sight as it causes no symptoms until it is in the advanced stage. Glaucoma medications are subsidized in the public health sector. Despite treatment, some people still become blind from Glaucoma but most preserve their sight.

Refractive Error

Refractive Errors - the need for glasses, are a significant cause of functional blindness and visual impairment. Some people cannot afford to buy glasses which are medical devices to correct poor vision. The Rotary Club and the VOSH team provide low cost glasses to the public during their Annual Eye Screening Programme The VAT (Value Added Tax) on eyewear increases the cost especially for those with high prescriptions. Consideration should be given to removing VAT on corrective eyewear.

In addition to the Vision 2020 list of eye diseases discussed above, a degenerative retinal condition in older persons on the east coast of Dominica is a significant cause of irreversible blindness. Albinism is an irreversible cause of visual impairment.

People with Down Syndrome have a greater prevalence of high Refractive Errors and Keratoconus making some of them either functionally blind or visually impaired. They should have regular eye examinations and provided with corrective glasses. There are also children who suffered birth asphyxia or who have congenital abnormalities of the optic nerve and brain who are irreversibly blind.

There are many other causes of blindness.

In addition to prevention of blindness, the needs of those whose vision cannot be restored must be addressed. Persons who are blind or visually impaired are entitled to basic services and opportunities wherever they live, and there is a great need to increase understanding of the needs of blind and visually impaired persons.

Blind Awareness Month 2013, provides an opportunity to address the rights and needs of the blind, and so, the agenda for the month’s programme are directed at creating a more enabling and accessible environment for persons with blindness and impaired vision.

The Dominica Association of Persons with Disability has organized workshops, media and video programmes, educational tips, and school presentations. Being blind does not mean one is helpless, can’t learn, can’t work, can’t love and have children, does not have talent or potential. I urge persons who are blind or visually impaired to make use of the opportunities to rehabilitate themselves to continue living fulfilling lives at home, at school, at work and socially.

Being aware of how to assist blind or visually impaired persons will be empower them to become independent. Therefore, the general public especially the cooperate community, service providers, schools, social groups, caregivers and family members of the blind are urged to support and participate in the activities organized for Blindness Awareness Month.

Thanks to the Dominica Association for Persons with disability and others in the community for their ongoing efforts in assisting blind and visually impaired persons.

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