WORLD SIGHT DAYWORLD SIGHT DAY

Dr. Madhuri. DixitDr. Madhuri. Dixit.. M.S.(Ophth)M.S.(Ophth)

Managing Trustee Managing Trustee Vivekanand Nertalaya . Belgaum.Vivekanand Nertalaya . Belgaum.

W S DW S D

• World Sight Day (WSD) is an annual day of awareness held on the second Thursday of October, to focus global attention on blindness and vision impairment.

The global day for awareness of blindness and vision impairment

W H Y W S DW H Y W S D

• Raise public awareness of blindness & vision impairment as major international public health issues

• Influence Governments/Ministers of Health to participate in and designate funds for national blindness prevention programmes

• Educate target audiences about blindness prevention, about VISION 2020 and its activities, and to generate support for VISION 2020 programme activities

What is VISION 2020What is VISION 2020

VISION 2020 : the Right to Sight

VISION 2020 Working together to eliminate avoidable blindness

VISION 2020 PartnershipsVISION 2020 Partnerships

W H O

Technical Assistance

CapacityBuilding

National Partners - National Vision 2020 PlansSustainable program delivery

What is Avoidable BlindnessWhat is Avoidable Blindness

• Avoidable blindness is defined as blindness which could be either treated or prevented by known, cost-effective means.

Global Avoidable Blindness Global Avoidable Blindness

37 million

INDIAN SENARIOINDIAN SENARIO

India has HIGHEST number of blind globaly-12 MILLION

Every year 2 MILLIONS are added

62% are from CATARACTNPCB from 1976 supported by

World bank

• Very Rich

• Levels of rising “overnutrition”

• World class academies and institutes.

• World class health care facilities and booming health tourism

• Women with education, power and influence

• A third of the world’s poor, nearly 400million living on less than $1/day

• 46% of children malnourished

• Highest number of illiterate people in the world

• The infant mortality rate of 57/1000 live births.

• Sex ratio of 933 females/1000 males

Source: 1) Sample Registration System 2003- Annual Report, Office of the Registrar General, India 2) census of India 2001 3) Department of International Development (DFID)

India: a land of contrasts

•Gender disparity are high in almost in every sector of health sector

Prevalence of cataract more in females than males

• In addition, there exists spatial disparities between urban and rural areas, and across Sates

Gender DisparityGender Disparity

• RAAB 2007: prevalence of blindness 9.2% in women and 6.6% in men (over 50)5% lower rate of IOL implantation

• State to State Cataract Surgical Rate (CSR) varies from 500 to 6,000

INNOVATIVE INITIATIONSINNOVATIVE INITIATIONS

• Vivekanand Netralaya.Belgaum.(Priyadarshini Eye Health Care

&Reseach Foundation)

• Clear Mission for VISION-”Comprehensive qwality eye care for poor & underpriviledged blind people , free of cost & training medical & paramedical peressonel for this noble cause .”

INNOVATIVE INITIATIONSINNOVATIVE INITIATIONS Vivekanand Netralaya How we work?

• Focus is only on underpriveledged• Reaching out to them in remote places • Identifying cataract patients• Trasporting them to base hospital• Catract removal with IOL Implantation• Transporting back to their villages • Follow up

Vivekanand Netralaya Vivekanand Netralaya BelgaumBelgaum

• Total No. of Cataract operations 5070

• 99.99% with IOL

• More females than males

35%

11%

41%

13%

Pvt. Hosp.

NGO Hosp

Govt. Hosp.

Eye Camp

Causes of Blindness in India

62.2%19.7%

5.8%

0.9%

11.4%

CataractUncorrected Refractive Errors GlaucomaDiseases of CorneaOthers including Leprosy, diabetic retinopathy etc

Blindness Scenario in IndiaBlindness Scenario in India

Emerging priorities and patterns of eye diseases

• Cataract remains the leading cause of blindness despite impressive advancements in surgical services.

• Uncorrected Refractive Errors is now recognised as the second leading cause, followed by Glaucoma, cornea.

• Childhood Blindness is now gaining attention.

• Diabetic Retinopathy is now becoming a major problem.

• Despite an over increasing need, low vision services are dramatically lacking

CataractCataract

First cause of blindness (~50%)

– backlog: 20 million un-operated cases

– only 10 million surgeries year

• major constraints :– coverage– access – quality

Cataract operations/million population/year

0

1000

2000

3000

4000

5000

6000

USA EU India Lat.Am Africa China

CSR

Cataract Surgical Rate in India

2001 - 2002 2003 - 2004

WHO 2004

SICS Ray of hope to combat SICS Ray of hope to combat avoidable blindness due to avoidable blindness due to

CataractCataract

• Easy

• Effective

• Economical

Childhood Blindness in IndiaChildhood Blindness in India

• 320,000 children are blind (19% of the world’s blind children) • 50% of these cases are treatable or preventable

• In addition, an estimated 9.2 million children are visually impaired

• Causes: Cataract, Ref Errors, Corneal ulcer/ opacity, ROP, Glaucoma

• Life expectancy of a blind child is assumed to be 48 years, resulting in a loss of 33 working years

• Burden of childhood blindness measured in blind-person years is next only to cataract.

• Loss estimated to India’s GNP is US$11.1 billion

Analysis of blindness profile in Blind SchoolAnalysis of blindness profile in Blind School

Blindness profile in Blind SchoolBlindness profile in Blind School

Congenital Cause25 %

Acquired Cause75 %

TreatableTreatable and Curable62.5 %

Not Treatable37.5 %

37.5 % of 25 % i.e. 9 out of 100 cases untreatable

Corneal Blindness Scenario - IndiaCorneal Blindness Scenario - India

Backlog of corneal blind people : 1.1 million

Added every year : 25,000 - 30,000 

Corneas required / year : 75,000 - 1,00,000

Corneas collected / year : 28,000 - 30,000

Cornea utilized for sight restoration: 12,000 - 15,000

Collection vs. Utilization : 40-55%

Need for Eye BankingNeed for Eye Banking

Non availability of grafts

Lack of quality in preservation & assessment

of cornea tissue

Lack of trained human resources

Lack of standardized protocols, accreditation

& need for appropriate legislation

Lack of awareness of eye donation (gap

between pledge and actual donation)

• Nearly 171 Million Worldwide have Diabetes

• Likely to double to nearly 366 million by 2030.

Diabetes rising worldwideDiabetes rising worldwide

India China US Russia Germany

Pop

ulat

ion

[Mill

ion]

Diabetic Population [Million]

29 31.7

40.9

57

79.4

0

10

20

30

40

50

60

70

80

90

1995 2002 2007 #2025 #2030

• An estimated 200% increase in next two decades

• 5.5 % Diabetic prevalence Rate

• 1/3 to 1/5 of Diabetic patients have DR

• There may be approximately 11-20 million with diabetic retinopathy by 2025

• 75% diabetic for more than 20 years will develop some form of diabetic retinopathy

• If not contained, India may be home for the largest number of diabetic blind

(Source: WHO)

DR Scenario - IndiaDR Scenario - India

Reasons for Rise in DiabetesReasons for Rise in Diabetes

Denial of diabetes and no regular treatment

Limited awareness of diabetes and related eye disease

Asymptomatic nature of DR gives patient no warning

No routine eye examination as a health seeking behavior

Misconceptions:

Controlling blood sugar levels eliminates the risk of visual loss

If I can see well, why seek medical help

Poverty

Eye Care Delivery System

Quality

Equity

Supply and Equipment

National & sub national structures

Urban - rural divide

Life style

Long life expectancy

Human Resources:

Under utilized HR: 12,000 ophthalmologist Of them 50% surgically inactive (Need of 25,000 by 2020)

The ophthalmology population ratio Urban1:25,000 Rural 1:250,000

Lack of mid level personnel Current :24,000; need 75,000

Remoteness and lack of awareness & health promotion

Gaps in Eye Care Program

Eye Health Promotion is the “key” to early detection.

&Early Detection is the “key” to

early intervention. &

Early Intervention is the “key” to controlling avoidable blindness.

LET US ACT NOWLET US ACT NOW

• One person goes blind every 5 seconds and One child goes blind every minute

• Without proper interventions 76 million people could be blind by year 2020

Through collaboration let us commit to bring light & smile to as many as blind fellow human beings

Together we can make a difference. Thank you for your

kind attention