The World Health Organization (W.H.O) in partnership with various Governmental and non -Governmental organizations (NGOs) celebrated the World Sight Day (WSD) on the 9th of October 2014. Traditionally, second Thursdays of October is observed yearly as WSD to create awareness on the plight of about 300 million persons globally suffering from either blindness or visual impairment. This year’s theme focuses on control of avoidable causes of blindness, eye diseases that are either treatable or preventable. More than a decade ago, the same international partnership lunched Vision 2020 ‘The Right to Sight’ with the broad objective of reducing the burden of avoidable causes of blindness through human capital development, disease control and provision of infrastructure and appropriate technology. The major avoidable causes of blindness targeted, especially in the resource poor nations are; cataract, glaucoma, trachoma, onchocerciasis, childhood blindness (numerous causes) and diabetic retinopathy.
Cataract is a condition in which the lens in the human eye becomes cloudy, usually as part of normal aging process, thereby compromising the quality of image we see depending on the location and size of the opacity. It is the commonest cause of blindness world-wide. Fortunately, cataract surgery has been rated as one the most cost effective medical intervention by the World Bank. Sightsavers, an international organization has supported a number of States in Nigeria, Zamfara inclusive, in provision of high output cataract surgical services without compromise to quality. Politicians in Nigeria have made sponsorship of free cataract surgery part of their campaign strategy which to me is a very welcome idea so long as quality is ensured. AMA Foundation, o local Abuja based NGO has sponsored more than 500 free cataract surgeries in both southern and northern parts of the country and hope to maintain the tempo. Despite all these individual and collective efforts, there are hundreds of thousands of Nigerians needlessly blind from cataract. Mal distribution of cataract surgical services, cost of surgery, socio-cultural issues are some of the barriers identified and need to be overcome to reduce the burden of blindness from cataract.
Glaucoma, is a disease that silently and irreversibly, steal our sight unknowingly. It is the commonest cause of irreversible blindness globally. A National blindness survey conducted in Nigeria showed that up to 16% of persons 40 years of age and older are glaucomatous. Research is still ongoing to decipher the mystery behind these group of diseases whose end result is death of the optic nerve that connects our eye to the brain. Persons with family history of glaucoma, high eye pressure, black race, 40 years and older, are at risk of developing the disease. Most persons with glaucoma are symptom free because it affects the peripheral vision at the early stage, the central vision being affected at advanced stage. Every adult that has attain the age of 40 should visit an eye Doctor for glaucoma screening as waiting for symptom of poor vision is synonymous to securing a palace in the blind world. As medical team go out to conduct cataract surgery outreaches, they should screen their clients for glaucoma too and refer as appropriate.
Trachoma is a disease associated with poor personal and environmental hygiene especially in dry, dusty areas. It is caused by bacterium that mainly infects children one to nine years with dirty faces, nasal and eye secretions. Blinding stage occur after 15 years of age as a result of in turning of eye lashes leading to opacity of the cornea (the outermost black part of the eye). Vision 2020 initiatives have reduced significantly the prevalence of trachoma though still endemic in some selected communities of Northern Nigeria. Provisions of adequate water, improvement of personal and environmental hygiene, are key to preventing the onset of trachoma.
Onchocerciasis is on the decline thanks to control programme like ‘African Programme for Onchocerciasis Control (APOC), lunched in 1995. Is an infestation that commonly affects people living in riverine areas. Of the 125 million people at risk world-wide, 96% being Africans, 10 to 20million are infected, about a million blind. The disease mainly affects the skin (swellings, rashes) and the eye, where blinding complication can result.
Childhood blindness is of concern to all because of the number of ‘blind years’ affected children will have to live relative to adult. Every minute 500 children become blind world-wide. One can imagine the negative physical, social and psychological impact of blindness on affected children, parents and the society in general. Most of the causes such as measles, eye injuries and vitamin A deficiency, are preventable. Health promotion by way of adequate nutrition/breast feeding and immunization are some of the control measures. Studies have shown that countries with high under 5 mortality rate are more likely to have high incidence of childhood blindness.
Diabetes mellitus as most of us are familiar is a chronic, multi systemic disease that is associated with complications due to sustained high blood sugar. Recall that the retina is that part of the eye on which the image of objects we view are formed and thereafter transmitted to the brain for interpretation. The most common complication of diabetes is retinopathy, referring to barrage of conditions affecting the retina as a result of uncontrolled diabetes. Diabetic retinopathy has taken the lead as the most common cause of blindness in the industrialize countries and exponentially rising in the developing nations. The emphasis should be on adequate blood sugar control. Diabetics should visit Eye specialist for clinical evaluation as soon as the diagnosis is established and thereafter as indicated.
All hands should be on deck to reduce the barest minimum, blindness from avoidable causes to break the vicious cycle of poverty, dependency and socio-economic handicap among several other ills. This column prays that come 8th October 2015 when we shall be marking the next WSD, If God spares our life, the present alarming indices of blindness would be in the decline.
Dr. Murtala Muhammad Umar
Zamfara State Eye Care Programme
King Fahad Ibn Abdul-Azeez Women and Children Hospital
Gusau, Zamfara State.