WORLD🌏 SIGHT DAY 2020
#HopeInSight
What is World sight day?
World sight day(WSD) is an international day of awareness, held annually on the second Thursday of October to focus attention on the global issue of eye health.
#HopeInSight
What is World sight day?
World sight day(WSD) is an international day of awareness, held annually on the second Thursday of October to focus attention on the global issue of eye health.
There are three commonly employed surgical techniques for cataract removal:
Extracapsular cataract extraction
Phacoemulsification and
Small incision cataract surgery.
Extracapsular cataract extraction
Phacoemulsification and
Small incision cataract surgery.
2. Age-related macular degeneration
Age-related macular degeneration (AMD) is a disease affecting the central area of the retina (macula) at the back of the eye.
Age-related macular degeneration (AMD) is a disease affecting the central area of the retina (macula) at the back of the eye.
Pathophysiology.
Dry AMD
Dry AMD causes a gradual deterioration of the macula, usually over many years, as the retinal cells die off and are not regenerated. There is no current treatment for dry AMD. Around 10% to 15% of people with dry AMD go on to develop wet AMD.
Dry AMD
Dry AMD causes a gradual deterioration of the macula, usually over many years, as the retinal cells die off and are not regenerated. There is no current treatment for dry AMD. Around 10% to 15% of people with dry AMD go on to develop wet AMD.
In wet AMD, abnormal blood vessels grow into the macula and leak blood or fluid which leads to scarring of the macula and rapid loss of central vision.
In the early stages of the disease lipid material accumulates in deposits underneath the retinal pigment epithelium. These deposits are known as drusen, and can be seen as pale yellow spots on the retina.
The pigment of the retinal pigment epithelium may become disturbed, with areas of hyperpigmentation and hypopigmentation. In the later stages of the disease, the retinal pigment epithelium may atrophy completely.
This loss can occur in small focal areas or can be widespread (geographic atrophy).
Wet AMD,
In some cases, new blood vessels grow under the retinal pigment epithelium and occasionally into the subretinal space (exudative or neovascular AMD, or “wet AMD”). Haemorrhage can occur which often results in increased scarring of the retina.
In some cases, new blood vessels grow under the retinal pigment epithelium and occasionally into the subretinal space (exudative or neovascular AMD, or “wet AMD”). Haemorrhage can occur which often results in increased scarring of the retina.
The early stages of the disease are in general asymptomatic. In the later stages there may be considerable distortion within the central visual field leading to a complete loss of central visual function.
Some people with dry AMD go on to develop wet AMD. In wet AMD, abnormal blood vessels grow into the macula and leak blood or fluid which leads to scarring of the macula and rapid loss of central vision
Risk factors,
The major risk factors for AMD are age, genetic factors and tobacco smoking. AMD usually affects people over 60, but can occur earlier.
The major risk factors for AMD are age, genetic factors and tobacco smoking. AMD usually affects people over 60, but can occur earlier.
Considerable research has focussed on the role of diet, light exposure and association with cardiovascular disease and its risk factors, however, the effects of these risk factors are less certain.
Impact
AMD is the third most common cause of blindness in the world and the leading cause of blindness in higher income countries with ageing populations.
AMD is the third most common cause of blindness in the world and the leading cause of blindness in higher income countries with ageing populations.
Approximately 5% of blindness globally is due to AMD. It is estimated that globally 196 million people have AMD in 2020, increasing to 288 million in 2040.
Treatment and Successes
Currently there is no effective treatment for dry AMD. There is some evidence that antioxidant vitamin supplements may slow down the progression of AMD to late stage disease and visual loss.
Currently there is no effective treatment for dry AMD. There is some evidence that antioxidant vitamin supplements may slow down the progression of AMD to late stage disease and visual loss.
Treatment of AMD has been revolutionised by the use of anti-vascular endothelial growth factor agents that bind to vascular endothelial growth factor or their receptors and slow down the growth of new blood vessels.
These interventions are delivered by injection into the eye. However, they are expensive and are only applicable for the neovascular form of the disease.
3. Glaucoma
The term ‘glaucoma’ relates to a group of conditions that can be classified in a variety of ways, but all of which are characterised by optic nerve damage (often referred to as cupping) and visual field loss (often with an arcuate pattern of mid-peripheral loss),
The term ‘glaucoma’ relates to a group of conditions that can be classified in a variety of ways, but all of which are characterised by optic nerve damage (often referred to as cupping) and visual field loss (often with an arcuate pattern of mid-peripheral loss),
secondary to retinal ganglion cell damage and death. The most common types of glaucoma are primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). There are also other, less-common, forms of glaucoma broadly referred to as secondary glaucomas.
Risk factors for the development of glaucoma include:
•High intraocular (eye) pressure (IOP)
•Ethnicity
•Increasing age, and
•Positive family history for glaucoma and ethnicity
•High intraocular (eye) pressure (IOP)
•Ethnicity
•Increasing age, and
•Positive family history for glaucoma and ethnicity
IOP
Although elevated IOP is the major risk factor for glaucoma, the condition is not considered to be a direct consequence of the pressure,
Although elevated IOP is the major risk factor for glaucoma, the condition is not considered to be a direct consequence of the pressure,
but to relate to IOP-associated risk factors such as stress susceptibility of the optic nerve supporting structures and optic nerve blood flow, that are affected by IOP
Certain individuals can sustain a degree of IOP elevation without the development of glaucoma and are referred to as having ocular hypertension, although as a group such individuals remain at increased risk of developing glaucoma with time
Ethnicity
POAG is most common in white Caucasians and black individuals of African origin. PACG is most common in South-East Asians and worldwide about 33% of individuals with primary glaucoma have PACG. PACG is associated with a greater risk of blindness in comparison with POAG
POAG is most common in white Caucasians and black individuals of African origin. PACG is most common in South-East Asians and worldwide about 33% of individuals with primary glaucoma have PACG. PACG is associated with a greater risk of blindness in comparison with POAG
Angle closure glaucoma
Small eye size (low axial length, often associated with a hypermetropic refraction)
Small eye size (low axial length, often associated with a hypermetropic refraction)
and other anatomical or pathophysiological ocular features that increase the risk of pupil-block (increased resistance to flow of aqueous from the posterior to anterior chamber), are the major risk factors for PACG.
Impact
Glaucoma is the third leading cause of blindness and a leading cause of irreversible blindness worldwide.
Glaucoma is the third leading cause of blindness and a leading cause of irreversible blindness worldwide.
Most forms of glaucoma do not show symptoms in the early stages and thus patients often present for treatment only after vision loss has occurred.
It has been estimated that by 2020 there were 76 million people with glaucoma, rising to 112 million in 2040. Furthermore, it is thought that at present over 3 million people are blind due to glaucoma,
a figure that is set to rise, unless improved screening and effective treatment strategies are successful.
Treatment and successes
Treatments, which include medication, laser treatment and surgical interventions, cannot restore lost sight but are able to preserve the patient’s remaining visual function.
Treatments, which include medication, laser treatment and surgical interventions, cannot restore lost sight but are able to preserve the patient’s remaining visual function.
Primary open angle glaucoma
The mainstay of treatment for primary open angle glaucoma involves reducing IOP by 20-40%, which can be achieved using medical, laser or surgical strategies.
The mainstay of treatment for primary open angle glaucoma involves reducing IOP by 20-40%, which can be achieved using medical, laser or surgical strategies.
•At present most treated patients are prescribed topical medications. Availability and persistent adherence to topical medications remains a significant problem and side effects both local and systemic can limit their use.
•Laser treatment of the trabecular meshwork (eg selective laser trabeculoplasty) is virtually free of adverse effects, but long-term effectiveness has yet to be determined and lasers are not available throughout all countries.
There are a variety of highly successful surgical procedures to lower IOP, but risks are higher in comparison with non-surgical treatments, so that surgery has not become a popular initial strategy in the management of glaucoma.
At present management choices throughout the world depend on availability of the various therapeutic modalities, this correlating highly with the socioeconomic status of the country.
Primary angle closure glaucoma
The mainstay of treatment for (or prevention of) PACG is the provision of a peripheral laser iridotomy or surgical iridectomy
The mainstay of treatment for (or prevention of) PACG is the provision of a peripheral laser iridotomy or surgical iridectomy
(ie a hole in the iris that connects the posterior and anterior chambers, so bypassing any potential, or established, pupil block to aqueous flow).
4.
Vitamin A deficiency (VAD) remains a significant cause of preventable childhood blindness and increased risk of mortality among children under five years of age, although improvements have been made due to VAD programmes and increase coverage with measles immunization.
Vitamin A deficiency (VAD) remains a significant cause of preventable childhood blindness and increased risk of mortality among children under five years of age, although improvements have been made due to VAD programmes and increase coverage with measles immunization.
Impact
Despite this, VAD is a major public health problem in the developing world affecting 190 million children under five particularly in Africa and South East Asia with India contributing to 85% of cases in South East Asia (WHO, 2009).
Despite this, VAD is a major public health problem in the developing world affecting 190 million children under five particularly in Africa and South East Asia with India contributing to 85% of cases in South East Asia (WHO, 2009).
Biochemical VAD is of public health significance in 122 countries and clinical VAD is of concern in 45 countries (WHO, 2009).
Treatment and successes:
Vitamin A supplementation completely “stops”/prevents childhood blindness from vitamin A deficiency.
Vitamin A supplementation completely “stops”/prevents childhood blindness from vitamin A deficiency.
Just 2 doses of vitamin A given annually to all children 6-59 months of age prevents their developing vitamin A deficiency blindness. Because vitamin A deficiency can have a range of consequences, including an increased risk of child mortality, the term now used is
“vitamin A deficiency disorders” (VADD). The reason why there are global programmes for control of vitamin A deficiency in children is because it also significantly increases under 5 mortality rates in countries where it is a public health problem.
Trends and challenges
Significant progress has been seen globally with an overall rise in VAS coverage among children under 5 years of age with one dose from 50% to 66% (UNICEF, 2012).
Significant progress has been seen globally with an overall rise in VAS coverage among children under 5 years of age with one dose from 50% to 66% (UNICEF, 2012).
The full child survival benefits of VAS need to be realized especially in countries with high under 5 mortality rates (i.e. more than 50 per 1000 live births) U5MR. Adding VAS to child health and immunization days has contributed to increased coverage using a proven,
innovative delivery mechanism. Further effort is necessary to accelerate the gains achieved. Advocacy is required to sustain efforts in VAD prevention and control through poverty reduction strategies.
5. dabetic retinopathy
Diabetes increases the risk of a range of eye diseases, but the main cause of blindness associated with diabetes is diabetic retinopathy (DR).
Diabetes increases the risk of a range of eye diseases, but the main cause of blindness associated with diabetes is diabetic retinopathy (DR).
DR damages blood vessels inside the retina at the back of the eye. It commonly affects both eyes and can lead to vision loss if it is not treated. Poorly controlled blood sugars, high blood pressure and high cholesterol increase the risk of developing DR.
Risk factors
Increased urbanization, the consumption of less-nutritious foods, more sedentary lifestyles and resulting obesity have all contributed to the dramatic rise in the global prevalence of diabetes, particularly in resource-poor countries.
Increased urbanization, the consumption of less-nutritious foods, more sedentary lifestyles and resulting obesity have all contributed to the dramatic rise in the global prevalence of diabetes, particularly in resource-poor countries.
In 2019, approximately 463 million people – or 1 in 11 adults world-wide – were living with diabetes, compared to 108 million in 1980.
Over time, poor glycemic control can result in improper growth or blockage of blood vessels that nourish the retina and lead to leakage of blood, fluids and the formation of lipid deposits in the eye. In more advanced forms of DR,
, new abnormal vessel growth occurs due to reduced oxygen flow caused by damaged or blocked vessels. The resulting retinal scarring, retinal detachment, along with fluid build-up and swelling in the central part of the retina (the macula), lead to impaired vision.
Damage to the retina is often irreversible in the later stages of the disease and results in blindness.
Every person living with diabetes is at risk of developing diabetic retinopathy (DR). Poorly controlled blood sugars, high blood pressure and high cholesterol increase the likelihood of vision loss due to DR,
along with the risk of associated vision disorders such as cataract or glaucoma.
Approximately 1 in 3 people living with diabetes have some degree of diabetic retinopathy and 1 in 10 will develop a vision threatening form of the disease
Approximately 1 in 3 people living with diabetes have some degree of diabetic retinopathy and 1 in 10 will develop a vision threatening form of the disease
Impact
Because diabetic retinopathy is initially asymptomatic many people with diabetes are not aware that their condition, if left unmanaged it may affect their vision and lead to blindness.
Because diabetic retinopathy is initially asymptomatic many people with diabetes are not aware that their condition, if left unmanaged it may affect their vision and lead to blindness.
Most patients who develop diabetic retinopathy have no symptoms until the very late stages (by which time it may be too late for effective treatment)
The Vision Loss Expert Group estimated that in 2020, 1 million people around the world were blind due to diabetic retinopathy, and over three million had moderate-severe vision impairment.
Low- and middle-income countries account for approximately 80% of the global diabetes burden yet many are ill equipped to properly identify, treat and manage the complex and varied consequences of this disease.
Efforts to reduce the prevalence of diabetes or to manage its health consequences more effectively are further undermined by the fact that approximately 50% of people with diabetes are currently undiagnosed.
Treatment and successes
People with diabetic retinopathy whose sight is at risk can be treated, most commonly with laser, to prevent visual impairment and blindness. However, there is no treatment that can restore vision that has already been lost.
People with diabetic retinopathy whose sight is at risk can be treated, most commonly with laser, to prevent visual impairment and blindness. However, there is no treatment that can restore vision that has already been lost.
Therefore screening and early intervention is critical. Targeting resources to the ‘front end’ of the service delivery system over time will help reduce the burden on tertiary services, which are expensive, resource- intensive and often simply unavailable.
Lifestyle changes
There is good evidence, however, that making appropriate lifestyle changes can contain or even reverse the most common form of the disease (Type 2 diabetes).
There is good evidence, however, that making appropriate lifestyle changes can contain or even reverse the most common form of the disease (Type 2 diabetes).
The relevant lifestyle changes involve a sensible lower carbohydrate diet, increased exercise plus control of blood pressure,
, blood sugar and cholesterol. This is the main primary health care approach that can result in lowering the incidence and ultimately the prevalence of diabetes – but community buy-in is critically important.
Public health approach
Therefore, the most effective diabetic retinopathy programs will take a holistic approach, focusing on patient education, behaviour change, and effective disease management strategies in addition to the provision of annual vision exams and high quality,
Therefore, the most effective diabetic retinopathy programs will take a holistic approach, focusing on patient education, behaviour change, and effective disease management strategies in addition to the provision of annual vision exams and high quality,
affordable treatment, when required. Increased cooperation between the diabetes care and ophthalmic communities is essential to preventing the impending epidemic of vision loss due to diabetic retinopathy.
Ensure healthy lives and promote well being for all at all ages-Sdg 3.
Access to the best possible standard of eye health and eye care should be made available by Governments
Access to the best possible standard of eye health and eye care should be made available by Governments
The challenge
Today, at least 2.2 billion people have a vision impairment or blindness. That is nearly a third of the world's population!
Today, at least 2.2 billion people have a vision impairment or blindness. That is nearly a third of the world's population!
The Need
•Most persons just need glasses.
•Some need low cost surgery.
•While others is to see a doctor regularly.
•Most persons just need glasses.
•Some need low cost surgery.
•While others is to see a doctor regularly.
Most Vulnerable
•Women.
•The elderly.
•People with disabilities.
•Ethnic minorities.
•Indigenous people.
•Women.
•The elderly.
•People with disabilities.
•Ethnic minorities.
•Indigenous people.
What can be done?
Government need to integrate eye care into health services. Including :
Early detection.
Treatment.
Prevention.
Rehabilitation.
Government need to integrate eye care into health services. Including :
Early detection.
Treatment.
Prevention.
Rehabilitation.
CONCLUSION
Globally in 2020:
At least 2.2 billion people have a vision impairment that may or may not be addressed.
Of those, at least 1 billion people have a vision impairment that could have been prevented or are yet to be addressed.
I'm addition,
Globally in 2020:
At least 2.2 billion people have a vision impairment that may or may not be addressed.
Of those, at least 1 billion people have a vision impairment that could have been prevented or are yet to be addressed.
I'm addition,
2.6 billion people have myopia, including 312 million children under 19 hears of age.
Additionally millions of people are living with eye conditions that increase their risk of sight loss.
196 million people living wit age-reated muscular degeneration.
Additionally millions of people are living with eye conditions that increase their risk of sight loss.
196 million people living wit age-reated muscular degeneration.
146 million people living with diabetic retinopathy.
76 million people living with glaucoma.
2.5 million people living with trachomatous trichisis.
277 million people living with myopia.
76 million people living with glaucoma.
2.5 million people living with trachomatous trichisis.
277 million people living with myopia.
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