copar written report

8/7/2019 copar written report

http://slidepdf.com/reader/full/copar-written-report 1/16

The eye

The eyes are undoubtedly the most sensitive and delicate organs we possess, and perhaps the

most amazing. They present us with the window through which we view the world, and are

responsible for four fifths of all the information our brain receives which is probably why we

rely on our eyesight more than any other sense.



How we see

The images we see are made up of light reflected from the objects we look at. This light enters

the eye through the cornea. Because this part of the eye is curved, it bends the light, creating

an upside-down image on the retina (this is eventually put the right way up by the brain).

Focusing on a nearby object Focusing on a distant object

What happens when light reaches the retina?

The retina is a complex part of the eye, but only the very back of it is light-sensitive. This part of the retina has roughly the area of a 10p coin, and is packed with photosensitive cells called rods

and cones. These allow us to see images in colour and detail, and to see at night.

Cones are the cells responsible for daylight vision. There are three kinds - each responding to a

different wavelength of light: red, green and blue. The cones allow us to see in colour and

detail.

Rods are responsible for night vision. They are sensitive to light but not to colour. In darkness,

the cones do not function at all.

Focusing the image

The lens focuses the image. It can do this because it is adjustable - using muscles to change

shape and help us focus on objects at different distances. The automatic focusing of the lens is

a reflex response and is not controlled by the brain.

Sending the image to the brain

Once the image is clearly focused on the sensitive part of the retina, energy in the light that

makes up that image creates an electrical signal. Nerve impulses can then carry information

about that image to the brain through the optic nerve.



Causes of Blindness

Cataract

What is cataract?

Cataract is a clouding of the eye's lens - the part of the eye responsible for focusing light and

producing clear, sharp images.

The lens is made up mainly of water and protein. Over time, protein can build up, clouding the

light passing through the eye and making sight blurred or fuzzy. For most people, cataracts are

a natural result of aging.

Often cataracts develop in both eyes at the same time. The symptoms vary, but include a

gradual blurring of vision, halos around lights, glare and double vision. The very worst cataracts

- where the iris appears almost entirely clouded over - can cause a total loss of vision.

Causes of cataract

There is no single cause of cataract (the clouding of the eye's lens). A number of risk factors

seem to have an impact. There are some risks that can be reduced by a change in lifestyle, and

some that can't. Sightsavers is raising awareness of the risks, and providing treatment where

possible.

Risks that can be reduced:

y cigarette smokingy drugs: some eye drops used to treat eye problems contain steroids. If unsupervised and

taken over a long time, they can cause cataracts.

y diabetes: proper treatment can reduce the risk of cataract

y dehydration: people who have suffered severe dehydration seem more likely to suffer

from cataract. This can result from severe illness (such as cholera), acute heat stroke or

even from local customs such as withholding water from women during labour and

immediately after giving birth.

Risks that can't be reduced:

y ageing - the single-most important cause of cataract

y genetic predisposition- in 25-50 per cent of cases there is a family history of cataract

y eye conditions such as short sightedness and inflammation in the eye seem to be linked

to cataract. Severe trauma to the eye can also be a cause.

y environmental factors - cataract occurs more often and at an earlier age in developing

countries



y daylight - some controversially believe ultraviolet light worsens cataract. This is

unproven and impossible to combat if true.

Cataracts and poverty

Removing cataract (the clouding of the eye's lens) is a relatively simple surgical procedure. It iscommon and easily accessible in developed countries. But in the countries where Sightsavers

works, many people with cataracts are yet to benefit.

Why is this?

y lack of awareness in some areas about the number of people with cataracts, and how

best to diagnose them

y lack of staff and equipment to significantly reduce the growing backlog of cataract

operations needed.

There are also reasons why prospective patients may be wary of an operation:

y they may not know that the operation is simple and safe

y they may have heard of someone who had a bad experience while having an operation

y they may live far from towns, and getting to hospital may involve a lot of travel and

expense. This is never easy for a blind person.

y as well as the travel costs, people will not be able to work immediately after the

operation and will lose income

y people sometimes expect to go blind as a natural part of ageing and are unaware of how

simple it is to have their sight restored

Sightsavers is raising awareness of the need for cataract treatment and providing it wherever

possible.

Our work with cataract

Our cataract work involves a number of different aspects:

Screening and ref erring those in need

We train local community health workers to identify those in need of cataract treatment,

ensuring that they are referred to an ophthalmic specialist for an operation.

Providing f ree surgery and transport

The only way to treat cataract (the clouding of the eye's lens) is by surgery. This involves

removing the cloudy lens, leaving the capsule that contains it intact. A plastic lens is inserted,

meaning that there is no need to wear special glasses after the operation.



Many people live a long way from hospitals or clinics, so wherever possible we provide

transport so they can get to where their treatment is being carried out.

We also carry out surgical outreach camps in areas that are difficult to access, or there is a poor

or ineffective health system in place.

Training new eye-care personnel

We are tackling the growing number of people needing cataract treatment by training

ophthalmic staff. Experienced ophthalmic nurses are trained to undertake cataract surgery, as

well as to manage eye care services and train and supervise new eye-care workers. Ophthalmic

nurses play a key role in preparing patients for surgery, freeing the surgeon to carry out the eye

operation itself.

Improving the standard of service

Sightsavers believes it is important to ensure that the experience of treatment is positive. If the

experience is good, patients will return to their village and tell people about it, making others

with cataract willing to undergo similar operations.

Trachoma

Trachoma is a potentially blinding eye infection, found worldwide. Though eradicated in most

developed countries, it remains a major health problem in parts of the developing world. It is

closely linked to poverty.

The f acts about trachoma

y It is the world's leading cause of preventable blindness.

y The World Health Organization (WHO) estimates that eight million worldwide are blind

due to trachoma and more than 150 million people are in need of treatment.

y It occurs where people live in overcrowded conditions with limited access to sanitation.

Children and trachoma

Demographically, active trachoma is most prevalent in children, although the scarring doesn't

usually become visible until the early 20s. For those who have suffered since childhood,

trichiasis normally sets in during their 40s - or even earlier in the worst-affected areas.

Women and trachoma

Women are much more susceptible to trachoma than men because they spend far more time in

contact with children, providing childcare.



Causes of trachoma

Trachoma is linked to extreme poverty and poor sanitation. It is triggered by bacteria that cause

repeated conjunctivitis, irritating the eyes and creating a mucous discharge. Although the

conjunctivitis clears up after a month or so, it is easily spread. This is particularly the case in

places where there is little water for people to wash their hands and faces regularly.

How trachoma causes corneal damage:

y reducing the amount of tears produced

y making it difficult to close the eyelids (which lubricate the eye and help flush away dust

and dirt)

y triggering trichiasis, where the eyelid and eyelashes turn in on the eye.

How does it spread?

y The discharge from infected eyes attracts flies that then land on other people's skin.

People in crowded households or neighbourhoods are particularly vulnerable.

Trichiasis

y Each infection of trachoma leads to a small amount of scarring on the cornea and

conjunctiva. This scarring builds up over years of repeated infection until trichiasis sets

in.

Trichiasis is when this scarring causes the eyelid to turn inwards, making eyelashes scratch the

eyeball. Each time the eyelashes are lowered to blink, the cornea - which enables the eye tofocus - is put at risk. Eventually it becomes opaque, causing poor vision and eventual

irreversible blindness.

People often try to pull out the eyelashes themselves, put powder on their eyelids, or use tight

headscarves to pull up the skin around the eye to restrict blinking. None of these provides a

long-term solution.

Tackling trachoma

Sightsavers is part of the Global Elimination of Trachoma by 2020 programme, working

alongside the World Health Organization and other voluntary organisations.

Since its launch in 1998 the programme has treated more than seven million people and

reduced active trachoma in children by 50 per cent.

Sightsavers follows the SAFE strategy for treating trachoma. (Surgery, Antibiotics, Facial

cleanliness and Environmental hygiene).



Surgery

Sightsavers trains nurses to perform surgery for trichiasis in their community. The surgery can

be done at a local health clinic or even in the home, meaning that people do not have to travel

huge distances to seek treatment. The operation involves removing the parts of the eyelid

which are being pulled inwards, causing the lashes to touch the eye, so the eyelids turn backout again. This

y Stops the trichiasis from getting worse

y Improves vision in the short term

y Makes it much more comfortable for people

y Reduces the levels of eye discharge

Antibiotics

Sightsavers provides two types of antibiotic to treat trachoma:

y Tetracycline - ointment applied directly to the eye over a period of six weeks. Done

properly, it has a success rate of 60-80%.

y Oral azithromycin - this is just as medically effective as tetracycline, but because it is

taken orally it is far more successful.

Problemswith antibiotics:

y Antibiotics have side effects

y overuse can make people immune to them. For this reason they should only be part of

trachoma treatment, used with Infection-reduction methods such as facial cleanlinessand good sanitation.

y Treatment takes a long time and is difficult to administer in rural areas.

Facial cleanliness

Children with dirty faces may be up to two times more likely to contract the trachoma virus

than those without. One of the best ways to prevent the transmission of trachoma is by

encouraging face and hand washing - not easy where water is scarce.

Sightsavers' local partners are encouraging facial cleanliness through:

y Training health workers to conduct health promotion sessions in local communities,

explaining the benefits of face and hand washing

y Promoting the use of the 'leaky tin', a cheap and easy method of face and hand washing

where water is scarce

Improving access to water

y Improving availability of soap



Environmental hygiene

The transmission of trachoma by flies can be tackled by reducing the number of flies people

come into contact with. Sightsavers' local partners helps communities to achieve this by setting

up local sanitation committees to:

y Build covered latrines and encourage facial cleanliness

y Discourage people from sleeping close to their livestock, a common practice in Africa

and Asia.

y Encourage villagers to collect and burn rubbish on a regular basis

Childhood blindness

Of the 45 million people worldwide who are blind, around 1.4 million are children under 16.

The vast majority of childhood blindness happens before the age of five - a period when 75 per

cent of learning is through sight.

What is childhood blindness?

Blindness is more common in poor countries than in rich ones. Children in low-income countries

such as Sierra Leone are four times more likely to be blind than those born in high-income ones

such as the UK. The main cause - corneal scarring - is rooted in poor diet (lack of Vitamin A) and

inadequate sanitation. Sightsavers is working to address both.

Why is childhood blindness a priority?

There are several reasons why Sightsavers believes eliminating childhood blindness is a priority:

y there are an estimated 500,000 new cases each year of childhood blindness - roughly

one per minute

y blindness in children is often preventable if communities and parents become aware of

the causes

y without early intervention for cataract blindness children may go blind permanently

y blinding conditions increase child mortality - up to 50% of children who become blind

die within two years

y 90% of children who are blind don't go to school

y eliminating childhood blindness will lead to a greater reduction in the number of 'blind

years' experienced by adults.

Causes of childhood blindness

Childhood blindness has many causes. In poor countries the main ones are corneal scarring and

cataract. If not treated in childhood, trachoma and river blindness may affect sight in later life.

Some blindness is hereditary.



Global figures show:

y roughly 57 per cent of childhood blindness is unavoidable

y 28 per cent is preventable

y 15 per cent is treatable

The proportion of children suffering non-preventable blindness in wealthy and poor countries is

comparable, but preventable blindness is much more prevalent in the developing world.

The main causes:

y corneal scarring (the drying out and scarring of the outer eye because of vitamin A

deficiency) is the most common cause of childhood blindness. It has caused irreversible

sight loss for around 230,000 children.

y cataract (the clouding of the eye's lens) causes an estimated 39 per cent of all childhood

blindness. It affects around 200,000 children worldwide.

y trachoma is a repeated infection, causing scarring of the upper eyelid, turning it inwards

and making the eyelashes scratch the eye and cause blindness. Although this tends to

blinds adults, after repeated infections, trachoma is often first suffered in childhood.

y river blindness (caused by a parasitic worm and spread by flies) rarely blinds before the

age of 15, but must be prevented by takingMectizan® to avoid blindness in later life.

Vitamin A Def iciency

To celebrate World Sight Day on 12th October, 2006, celebrity chefs such as Gordon Ramsay

helped us to raise awareness of avoidable blindness.

The chefs thought up some unique recipes rich in vitamin A - a vital ingredient for healthy eyes

and a healthy immune system - to raise awareness of the fact that thousands of children in the

poorest countries in the world are going blind due to lack of the vitamin.

Vitamin A can be found in foods such as carrots, sweet potatoes, liver, fish, spinach, butternut

squash and palm oil.

Shocking information

Celebrity chef Gordon Ramsay said: "We take foods high in vitamin A pretty much for granted

here in the UK and I was shocked to learn that huge numbers of children were blinded by a lack

of it around the world.

"Sightsavers is trying to eliminate all types of avoidable blindness, including blindness caused by

vitamin A deficiency, by facilitating the distribution of vitamin A capsules and raising health and

nutrition awareness in affected communities. Around the world today no child should lose their

sight unnecessarily."



Antony Worrall Thompson added: "Over 100 million children are affected by vitamin A

deficiency, it is one of the major causes of childhood blindness in poor communities. Children

who are blind are at a greater risk of social exclusion, missing out on an education and spiraling

further into poverty. However, there is some room for optimism. If the right steps are taken,

vitamin A deficiency can be eliminated by 2010."

Sightsavers works with local organisations in over 30 countries across Africa, Asia and the

Caribbean to prevent and cure blindness and to ensure that people who are blind enjoy equal

rights and opportunities. With local partners, we are work to facilitate the distribution of

vitamin A capsules and provide health and nutrition training.

Our childhood blindness work

Sightsavers is working to reduce the incidence and impact of corneal scarring (the drying and

scarring of the outer eye because of vitamin A deficiency) and cataract (the clouding of the

eye's lens) - the two main causes of childhood blindness. We also work to prevent and treat

trachoma and river blindness - conditions that must be tackled in childhood to prevent

blindness later in life.

We are campaigning internationally to make sure children who are blind or with low vision have

the chance of an education, and are not excluded from society.

Working with local partners Sightsavers is actively taking the following steps to help eradicate

childhood blindness

Cataract

y training primary health-care workers to identify and refer cataract-affected children for

treatment

y training paediatric teams to run specialist eye clinics

y providing follow-up care and glasses for children who have undergone cataract surgery

Corneal scarring

y helping facilitate the distribution of vitamin A capsules to boost deficiency - the main

cause of corneal scarring

y raising health and nutrition awareness

y facilitating immunisation against vitamin A-depleting illnesses such as measles through

logistical support

Exclusion f rom education

y encouraging mainstream schools to include children who are blind



y promoting advocacy to ensure that governments of developing countries do not allow

blind children to be discriminated against, such as by being excluded from education.

Low vision

Low vision is when, even after medical treatment, people have difficulty distinguishing objectsand/or distances. People with low vision can be helped by changes made to their environment,

such as painting the edges of stairs white so they can be seen more easily, or specially made

devices.

Measuring low vision

Eye care specialists measure sight against a standard known as '20/20' vision. This based on

what most people are able to see on a standard eye-test chart at a distance of 20 feet (in

metres this is called 6/6 vision). If you can read the chart at 20 feet you have 20/20 or 'normal'

vision.

The range of low vision:

y in mild cases of low vision, someone looking at a standard eye chart from 6 feet away

will see what somebody with 'normal' or 20/20 vision sees from 18 feet away

y in extreme cases, low vision means that a person standing 3 feet from the eye chart will

see the equivalent of what a person with 'normal' vision will see 60 feet away

y if someone's sight is any worse than this, they are classified as blind.

Low vision is officially defined as 'anybody who has an optimum corrected vision of less than

6/18 to 3/60 in their better eye'.

'Optimum corrected vision' means the 6/18 to 3/60 vision is enabled the aid of standard

corrective visual devices - usually spectacles.

Many diagnosed with low vision can be helped by surgical treatment, and do not need low-

vision aids. Even people with less than 3/60 vision can be helped.

Ref ractive error

Refractive error is an eye disorder meaning the shape of the eye does not bend light correctly,

resulting in a blurred image. The disorder can be simply diagnosed, measured and corrected

with spectacles, yet approximately 8.2 million people remain functionally blind due to

uncorrected refractive error.

Sightsavers works in several ways to improve the vision of people with refractive error:



y screening: we identify individuals with poor vision which can be improved by spectacles

or other optical devices. Last year we screened over 2 million people for refractive error.

y refraction: we evaluate the patient to determine what spectacles or device may be

required.

y manufacture: we manufacture spectacles or an appropriate device and provide to those

in need.

Common ref ractive errors:

y short sight (myopia)

y long sight (hypermetropia)

y Aging of the lens (presbyopia)

y Irregular curvature of the lens (astigmatism)

Low vision aids

Visual aids

Visual aids for improving low vision work for those with visual capability of more than 1/60 (ie

people who can see at a range of one foot what people with 'normal' vision would see at a

range of 60 feet).

There are several types of low-vision device. Each works on particular form of low vision.

Prescription is just the first step - it is also essential to motivate and train people to use the

devices properly.

Visual aids include those that:

y help people seeing things close up. These are particularly useful for reading and to help

children whose education would otherwise suffer. These include hand-held magnifying

glasses and specially made, powerful spectacles.

y help people see things in the distance. These include telescopes.

y Technical enhancements such as closed circuit television, computer scanners and high

tech image magnifiers.

Magnif iers

Some magnifiers can be made relatively easily and cheaply in optical workshops. Sometimes

people in poorer countries use 'modified' plastic drainpipes fitted with a lens which acts as an

effective reading aid. Some studies show that over a third of children with low vision who

cannot read would be able to with a simple magnifier.

Non-visual aids



Non-visual aids are often modifications to homes and everyday tools and equipment that make

them low-vision friendly. These modifications are often quite cheap and easy to make.

Non-visual aids include:

y tilted desks for children, meaning they don't have to bend over flat desks to read textclose-up.

y contrasting colours. A meal of rice and boiled fish can be difficult to distinguish for a

low-vision person if served on a white plate. Certain colours and backgrounds can be

combined to make text easier to read.

y size. Providing large felt tip pens or charcoal for children to write with, or using a

photocopier to enlarge printed materials.

y lighting. Low-vision people needing more light can sit closer to windows or have better-

positioned artificial light. People needing less light can benefit from dark glasses or

large-brimmed hats.

y lines. A good way to aid mobility is through well-defined, contrasting-coloured lines to

mark the edge of paths or steps.

Our low vision work

Many people with low vision are often treated as blind, due to lack of proper diagnosis.

However, with assistance, they would be able to carry out many visual tasks.

Sightsavers believes that the first step in helping those with low vision is training people to

identify the condition and advise how best to live with it.

y we train eye care workers, rehabilitation workers and special education teachers to beaware that people with a little vision can be helped

y we train people to make lenses (refractionists) to make stronger reading glasses

y we provide affordable glasses

Children and low vision

One of the most important areas of our work is helping children with low vision. Alongside the

day-to-day problems resulting from poor eye sight, their education often suffers.

We train teachers to overcome this by:

y providing 'adapted' print with large text

y altering classroom seating so that children with low vision sit at the front or in a position

with more light

y using low-vision devices, including magnifiers.



NATIONAL PREVENTION OF BLINDNESS PROGRAM

I. Background

Vision 2020: the right to sight, is a global initiative to eliminate Avoidable

blindness by the year 2020. the program is a partnership between the world health

organization (who) and international agency for prevention of blindness (IAPB), which is the

umbrella organization for eye care professional groups and non-governmental organizations

(NGOs) involved in eye care. The long term aim of vision 2020 is to develop a sustainable

comprehensive health care system to ensure the best possible vision for all people and thereby

improve the quality of life.

The priorities worldwide are the 5 preventable/treatable conditions (cataract,

retractive errors and low vision, trachoma, onchocerciasis and childhood blindness). By

improving the eye care services and targeting the 5 diseases globally instead of 75 million blind

people by year 2020. The number is calculated to be less than 25 million.

75% of blindness and visual impairment in the Philippines is a result of 3

preventable or treatable conditions: cataract, refractive errors and low vision and causes of

childhood blindness. If priority is given to these diseases, then in 2020, instead of more than

790,000 blind people, it is calculated that there will be less than 300,000. A successful vision

2020 program will prevent 400,000 Filipinos becoming blind, thereby saving billions of pesos in

productivity loss.



An error of refraction is the leading cause of visual impairment and of bilateral or

monocular low vision. Cataract is still the leading cause of bilateral (62%) and monocular

blindness. However, compared to the first and second national surveys cataract accounted for

87% and 77% of bilateral blindness respectively, the current results show that the prevalence of

cataract blindness is decreasing.

Prevalence of blindness among age group 0-19 (childhood blindness) is 0.06%.

The cause is cataract, error of refraction, phthisis bulbi; amblyopia and optic atrophy.

A. Vision

All Filipinos enjoy the right to sight by year 2020

B. Mission

The DOH, LHU, partners and stake holders commit to:

1. Strengthen partnership among and with stake holder to eliminate avoidable blindness in

the Philippines.

2. Empower communities to take proactive roles in the promotion of eye health and

prevention of blindness.

3. Provide access to quality eye care services for all.



4. Work towards poverty alleviation through preservation and restoration of sight to indigent

Filipinos.

C. Goal

Reduce the prevalence of avoidable blindness in the Philippines through the provision of

quality eye care.

B. Mission

Gen. Objective 1: increase cataract surgical rate 730 to 2, 500 by the year 2020.

Gen. Objective 2: Reduce visual impairment due to refractive errors by 10% by the year 2020.

Gen. Objective 3: Reduce the prevalence of visual disability in children from 0.43% to 0.20%

by the year 2020.

Date post:	08-Apr-2018
Category:	Documents
Upload:	cheriraytos
View:	238 times
Download:	0 times

copar written report

Documents