2008 World Sight Day

I still remember the first time I wore a pair of spectacles in Bawku. The world looked so beautiful and I wondered why I had “cheated” myself for so long!

The fact is that since my secondary school days I had always sat in the front row, because anytime I sat anywhere else I could not see what was written on the blackboard.

Even in the medical school, thanks to Dr Maria Hagan and co. who taught us ophthalmology during our clerkship and made me understand what spectacles were meant for, I could still not imagine myself wearing spectacles and had to struggle through copying notes from other colleague since in the Medical School, there was no permanent seat and anytime I was late I had to sit at the back.

It was when I started working in Bawku Hospital as Medical Officer in 1984 and knew that the hospital had one of the best eye clinics in the country that I decided to check my eyes and discovered how I had missed so many beautiful things in the world!

In a sense, I had been lucky because being short-sighted, I could read my books.

There are probably a lot more schoolchildren who unlike me could hardly see anything or read any book and thus had to drop out of school, their parents and teachers thinking they were not intelligent and thus not much should be wasted on them.

But then how can a child learn anything in school when he/she cannot see what the teachers write on the board or can hardly read their books.

Unfortunately the situation has not changed much since my school days.

There are still many people who need just a simple pair of glasses to go to school or become productive and yet either have no access to health care or cannot afford the pair of glasses.

Worldwide, it is estimated by the World Health Organisation that 124 million are severely visually impaired and 37 million people are blind.

There are also 154 million people who have refractive error, which means they are visually impaired simply because they cannot get an eye test and spectacles.

The major causes of blindness worldwide include cataract, trachoma, glaucoma, onchocerciasis, diabetic retinopathy, refractive errors and low vision and age-related macular degeneration (AMD).

Blindness is both the cause and effect of poverty. It is no wonder therefore that most of the blind people live in the poorer countries of the world.

It is estimated that nine out of 10 blind persons live in the poorer countries of the world and globally it is estimated that productivity is lost annually as a result of visual impairment, which is close to US$42 billion.

Reducing blindness is linked to improving access to educational and employment opportunities, and thus it alleviates household, community and national poverty.

 It is no wonder that the 59th World Health Assembly passed the resolution 59.25 on Blindness Prevention on May 27 2006, which among other things request the Director-General of WHO to ensure that prevention of blindness and visual impairment is included in the implementation and monitoring of WHO's Eleventh General Programme of Work and provide necessary technical support to member states and strengthen global, regional and national activities for prevention of blindness.

The resolution recognises the urgent need to support blindness prevention efforts in countries, especially the developing countries.

It also urges Member States to strengthen eye care services, integrate them into existing health systems, train key categories of personnel, re-train health workers in visual health care and mobilise domestic financial resources for eye care.

Africa has the highest rate of blindness and sub-Saharan Africa has 20 per cent of the global blindness.

In Ghana, the prevalence of blindness is estimated at one per cent of the population. Thus there about 220,000 blind persons in the country with about 50 per cent of these due to cataract.

It is a response to the increasing burden of blindness in the world that Vision 2020: The Right to Sight was conceived.

It is a global initiative of the International Agency for the Prevention of Blindness (IAPB) and the World Health Organisation (WHO), with an international coalition of NGOs, institutions and corporations, which was launched in 1999.

 It aims to eliminate avoidable blindness worldwide by the year 2020 in order to give all people, particularly the millions in the poor countries, The Right to Sight.

The Global Vision 2020 aims to increase awareness of blindness as major public health issue, control the major causes of blindness, train eye care personnel to provide appropriate eye care and create the infrastructure to manage the problems.

Ghana signed the global declaration of support for Vision 2020: The Right to Sight on October 31, 2000, by the then Minister of Health.

World Sight Day is one of the annual activities under the Vision 2020: The Right to Sight programme.

It was first celebrated in 2000 and has since been marked in different ways in many countries around the world each year since.

It is celebrated in the second Thursday of October.

World Sight Day (WSD) is a global day of awareness, which draws attention to the problem of avoidable blindness: Every five seconds someone in the world goes blind and yet 75 per cent of this blindness is needless!

What this means is that three out of four blindness need not have happened as most causes of blindness are avoidable, as they can either be prevented or cured.

The purpose of the annual celebration of World Sight Day is to raise public awareness that blindness is a major international public health issue, influence governments and Ministries of Health to participate and designate funds for the national prevention of blindness programmes and finally educate the target audience about blindness prevention and generate support for the programme activities.

This year's celebration falls on October 9

The focus of the celebration this year is on the elderly, hence the global theme: “Eyes on the future – fighting vision impairment in later life”.

I am certain we all want to live for long to see our grandchildren and probably great grandchildren! Unfortunately the risk of vision-impairing conditions such as cataract and macular degeneration increases exponentially with increasing age.

It is estimated that 80 per cent of the world's 37 million blind people are over 50 years of age.

As a result of increasing life expectancy of mankind, it is also expected that the population of the elderly will increase from the 2000 estimate of 600 million to 1.2 billion in 2025, with more that 75 per cent of them living in the middle and lower income countries, Africa being the biggest beneficiary!

The main causes of visual impairment and blindness in the older people are cataract, refractive error, age-related macular degeneration (AMD) and glaucoma.

Cataract is the leading cause of blindness worldwide, with the major risk factor being ageing.

It is, however, curable by a simple, cost-effective operation.

While cataract occurs all over the world, in the developed countries people do not become blind from it, since over 5000 cataract surgeries per million of their population per year is performed.

In the developing countries fewer operations are done and thus there is a large backlog of people who are blind from cataract.

In Ghana for instance, we need to operate about 45,000 cataract per year to prevent most of the people staying blind but what is currently being done is 10,000 per year, just a quarter of what needs to be done.

Trachoma is one of the tragedies of our time. Trachoma thrives in communities with dry, dirty and dusty environment.

What a great joy it will be for us Ghanaians if every household in the country will have access to clean water.

Apart from wiping out trachoma from the communities, all water-borne-related diseases will be reduced to the barest minimum, and releasing all the funds to control these diseases for national development!

Ghana has targeted the year 2010 to eliminate blindness from trachoma. Presently there are 5000 people in the Northern and Upper West regions who need operation to prevent them from becoming blind from trachoma.

Glaucoma has already blinded about 4.5 million people in the world. It is a condition of the eye linked to a gradual rise in the pressure in the eye.

The main risk factors are high ocular pressure, age (over 40 years), family history and ethnicity, the black race being at a greater risk.

It requires lifelong medication and thus compliance is poor leading to blindness. The unfortunate thing is that over 90 per cent of those who have it in the developing world are not even aware of it!

A report by Dr Michael Gyasi and group from Bawku Presby Hospital Eye Clinic shows that about 34 per cent of the patients reported to the hospital when they were already blind in one eye, and that 20 per cent of the patients were below the age of 40.

Refractive errors and low vision affect a significant proportion of the population. Refractive error is the condition for which people can either not see far objects or things that are closer.

Globally, it is estimated to affect over 145 million people, and yet all that most of them to need is a simple pair of spectacles to enable them to be productive and independent.

Usually most people who are aged 40 and above need a simple pair of glasses to enable them to read their newspapers, Bibles, etc, but major of them do not have these glasses probably due to lack of access to the facility or financial barrier.

It is not only the literate or educated who need the glasses but also the rural uneducated, to enable them to thread needles to sew, pick stones or insects from their rice or millets when cooking, etc.

It is important to remember that good vision can help older people to remain active for a longer time.

The older people with good vision usually remain economically and socially active as they age and contribute significantly to the well-being of their families and to the society at large.

Even though the risk of vision-impairing conditions increases with age, timely intervention can delay the effects of these age-related blinding condition, hence the National sub-theme for the WSD 2008 being:

“Eyes on the future – fighting vision impairment in later life starts now”. It is my hope that the government, NGOs, cooperate bodies and individuals will contribute significantly towards the prevention of blindness in the country.

This year's World Sight Day should mark the beginning of active support of all towards prevention of blindness activities in particular and good eye health promotion activities in general.

• The author is the Head, Eye Care Unit, Ghana Health Service and National Co-ordinator, Prevention of Blindness Programme.

By Dr Oscar Debrah

Originating at dr oscar debrah