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Indian Journal of Community Medicine

Prevention of Blindness and Mobility of A Blind

Author(s): S. Sood, M. Nada, R. C. Nagpal

Vol. 29, No. 2 (2004-04 - 2004-06)

As the age-old saying goes "Prevention is better than cure", it stands true. Visual impairment can be decreased if the prenatal, natal and early infant care is improved. Blindness in general is preventable if proper measures and interventions are taken in time, apart from the hereditary, genetic and development anomalies. The goal of NPCB is to reduce blindness to 0.3% by 2000 AD.1

Methods of Intervention

(a) Primary eye care - Conditions of eye like Acute conjunctivitis, Ophthalmic-neonatorum, Trachoma. Xerophthalmia, Superficial foreign bodies, can be treated by multipurpose health workers at grass-root level. Ophthalmic-assistant can also participate. MPW is trained to refer difficult cases to district hospital, Sub division hospital or equipped PHCs.2 They can promote personal hygiene, sanitation, good dietary habits and safety in general.

b) Secondary eye care - Definitive management of common blinding conditions in district/sub divisional hospitals such as Cataract, Glaucoma surgery, Ocular trauma, Treatment of other acute ailments, Refractive errors, Trichiasis/Entropion and Strengthening of eye mobile units for imparting all above services at the door step of patients.

c) Tertiary care - In medical college and institutes and central mobile units provide sophisticated eye care services like retinal detachment surgery, corneal grafting and other complex forms of managements not available in district hospitals.

d) Specific programmes - Trachoma control programme-merged with NPCB­76, School Health Services: Refractive errors, squint amblyopia, trachoma and malnutrition can be screened. Visually impaired can be spotted out. These should be carried out every year. Vitamin A prophylaxis3,4 occupational eye health services for adults - Hazards of industry. Proper illumination, safety measures, Protective devices-spectacles, face shield welding helmets etc. These all are carried out under NPCB by the development of infrastructure for eye care like, strengthening of PHCs, central mobile units, strengthening of district hospitals, upgrading of department of eye in medical college, establishment of regional eye institute, ophthalmic assistant training centres, district mobile units, establishment of DBCs, eye bank services.

Last but not the least, by involvement of NGOs, voluntary and social agency particularly at eye camp approach. Intensification of eye health education through. Mass media, school teacher, by incorporating it in school syllabus, social workers and community leaders.

Salient points in prevention of childhood blindness

Balanced diet to mothers during pregnancy and lactation. impart health education and eradicate superstition and ignorance, improvement in prenatal, natal and early infant care. Consanguinity to be avoided, toys with sharp edges to be avoided, children should avoid bow-arrow, gulli danda, air guns. Basic facial/ocular hygiene should be maintained. Modification and improvement in dietary intake. Good posture while studying, proper lighting, avoidance of glare, proper book-eye distance. Protective glasses should be worn. Above all avail regular school health services.

Early identification of visually impaired children - RCI (1995) reports that not even 5% of visually impaired population is currently enjoying educational facility5. Early identification and intervention can solve many of the potential problems of the child later in life. Early detection through a) ophthalmologists, b) Eye camps, c) door to door surveys, d) Voluntary organisation, e) School teachers, f) School children, and g) functionaries of village-sarpunch, LHV, ANM, ICDS can be adopted.

Spotting visual impairment - One can use following clues to identify children with some sort of visual impairment: Rubs eyes excessively, holds book/objects close to his eyes, difficulty in taking notes from black board, blinks more frequently, watering of eyes, presence of a squint, presence of a white pupil (Leuco coria), complaint of headache following close work.

Visual impairment leads to information deficit and damage to eye can result in serious limitation in one's ability to see and process information through visual channels. Infants with visual impairment need more stimulation than their nondisabled peers so that whatever residual vision is there can be utilised to the full extent. For example development of sense of touch and hearing usually begins in early weeks of life and continues throughout childhood. These babies devoid of visual impression should touch their toys and objects with purpose and they need to learn to feel for shape, size and other dimensions. Once a child has been identified as possibly having an eye problem - he should be referred to an appropriate ophthalmologist for the possible treatment of condition. Once diagnosed as untreatable visual impairment he has to be referred to an appropriate education system.

Orientation and Mobility of blind - Blindness imposes the restriction on ability to move about and control self and environment in relation to it. Therefore the significance of mobility and orientation in rehabilitation process of visual impairment individuals is indisputable.6

There are three ways of mobility possibility for a visually impaired person:

a) Unassisted mobility, Mobility with the help of sighted companion, and

b) Mobility by using both manual and electronic devices

Though sophisticated electronic appliances have come up. Long cane in our set up is still believed to be a great companion of visually impaired person.

Long Cane: The cane can help finding surfaces of different textures stairs etc. A person can use certain clues and land marks while using cane for his independent travel. Teaching of long cane technique should be assisted by the efficient use of tactile maps. The long cane technique includes : Walking on shoreline, side path, trailing with cane, touch technique, touch and drag technique, touch and slide technique, three point tap technique for walking, using cane on stair ways, exploring of immediate environment with cane, road crossing; safety crossing, setting into bus, train and cart with cane, rural training; drawing water from well etc, door ways-getting in and out

Electronic Devices Sonic guide, Laser Cane, Path sounder are some electronic aids available for mobility but are not common in India because they are expensive.

c Guide dogs: Though using guide dogs for mobility is popular in Europe and in US, the system could not develop in developing countries due to enormous cost and traffic confusion.

Sensory training and mobility - The visually impaired individual enjoys the experience in independent travel when he has a good and efficient training in the use of remaining senses. The loss of sight is compensated by sense of touch and hearing. Sensory stimuli called as clues enable a visually impaired person to determine his position and direction. Hearing plays a dominant role in mobility. The important areas required for sensory training may be branched off as follows

a) Sense of hearing: We rely on the auditory information of the world consciously or unconsciously. Visually impaired persons depends on this sensory training a lot.

b) Sense of touch: Exploration of an object through touch determine the definiteness of the object and help the individual to form a neat conception of them. Sense of touch has a lot to do with reading of the visually impaired student. However, "wholeness" can be perceived by the child only when the object is within the reach of non seeing child's hand.

c) Sense of smell: A good nose voluntarily offers the information of the objects which can be smelt. These are sensible clues for traveller.

During his travel the smell of a gutter, the smell of smoke in chemical industry smell of flowers or smell of kitchen products are source of information for him to locate where he is. For a child who has acquired the necessary sensory skills, orientation to environment becomes easier and this leads him to a greater level of confidence in mobility.

Daily living skills: Daily living skills for every visually impaired person for his day to day living and independent functioning are necessary. These skills are treated as basic "Survival skills". These instil confidence in the child for his main-streaming with sighted children. Efficient use of daily living skills depends upon the ability in sensory training as well as mobility training of the child e.g., going to market for buying vegetables.

Some common daily living skills are: Eating manners, Using toilet. Dressing. Body hygiene : Cleanliness, Taking bath, Washing cloth, Handling money, Shopping, Proper use of electrical appliances, Shaving, Food preparation, Cleaning a place, Using medicines etc. Learning daily living skills of an visually impaired child are means of his proper social development. These skills are difficult but not impossible to learn.

References

  1. Govt. of India (1986). Health Information of India 1986, Central Bureau of Health Intelligence, DGHS, New Delhi.
  2. WHO (1984). Strategies for the prevention of blindness in national programmes, WHO, Geneva.
  3. WHO (1984) Strategies for the prevention of blindness in national programmes, Geneva, WHO.
  4. WHO (1973), WHO Chr. 27 (1) 28.
  5. Bulletin of Rehabilitation. Council of India (1995).
  6. Manual for training of PHC Doctors. "In the field of visual impairments". Rehabilitation Council of India. Under the National Programme on Orientation of Medical Officers working in Primary Health Centres to Disability management.

Department of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak 24001 (Haryana) India.

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